"Breast is best" message under fire - and I agree, really

[hunkermunker]

Interesting, I think

"Current promotional and educational programs which describe breastfeeding as 'best' are undermining women?s capacity to make informed decisions about infant feeding, according to an article published by a University of Wollongong doctoral student in the latest issue of Maternal and Child Nutrition.

Ms Nina Berry from UOW?s Centre for Health Initiatives was joint author of a report with Karleen Gribble from the University of Western Sydney called ?Breast is no longer best: promoting normal infant feeding?. Breastfeeding is not 'best', say the authors, it is simply the normal way to feed human infants.

The article suggested that breastfeeding promotion and education programs should abandon the ?breast is best? message because it is misleading and fails to communicate the importance of breastfeeding.

?In fact, these messages may have obscured the importance of breastfeeding to infant and maternal health and the well-established risks associated with early weaning from breastfeeding,? Ms Berry said. "To say that 'breast is best' is to suggest that what breastfeeding offers is a handful of optional bonuses and that formula-fed infants are the normal standard for comparison. In fact, human babies were designed to be fed human milk."

?Research has found that while most people accept that breastfed babies are healthier, they do not understand that this means that formula-fed babies are likely to be sicker. Because formula feeding is viewed as harmless, women are not getting the support they need to continue breastfeeding and to make informed choices about infant feeding. This misunderstanding demonstrates the failure of the ?breast is best? message and the need to rethink breastfeeding promotion?, she said.

The paper in Maternal and Child Nutrition also illuminates an important addition to the body of evidence pointing to the significance of using breastfed babies as the control group when conducting research.

The World Health Organisation (WHO)?s Multicenter Growth Reference study found that the growth of formula- fed babies deviated from that of breastfed babies and that using growth charts based on formula-fed babies could be contributing to the current obesity epidemic.

The use of formula-fed babies in control groups makes it difficult for readers to see that formula-fed babies are at increased risk of adverse health outcomes, Ms Berry said.

The WHO recommends that children are breastfed for up to two years or more and that they should not be given any food or drink other than breast milk for the first six months of their lives.

?It takes a great deal of support for mothers to reach these goals. However, mothers are not being provided with adequate support because the risks associated with early introduction of foods other than human milk are not well understood by health professionals. Furthermore, many health professionals are reluctant to talk to mothers about risks because they do not want to make mothers feel guilty. This is not about guilt. It is about a mother?s right to have all the information she needs to make an informed choice about how she should feed her baby ? it is about ensuring that mothers have the support they need,? Ms Berry said.

By Bernie Goldie"

That makes a lot of sense.

Also, I'm suspicious of any catchy slogans around breastfeeding decisions because I think the issues are complex, and the more they get simplified the less helpful they are for real live people.

I knew you'd be the first poster on this thread, Wellie

Agree that slogans for bf aren't helpful. I've been saying for ages that bf should be seen as the baseline and not the bells and whistles optional extras "choice".

I agree with this. But there will be a pain barrier to be broken through if there is to be a paradigm shift towards "breast is normal, formula carries risks"

Very thorny challenge

Aaaagh, I'm so predictable aren't I.

vlc is right though - talking about "the risks of formula feeding" is going to make people very angry, and will be seen as scaremongering.

I can also see that people would feel that if you call breastfeeding normal, you're calling formula feeding abnormal - a word which in theory is just neutral but which I think has nasty connotations for some.

Very, very difficult.

too late and woozy to comment intelligently but getting this on my watch list

tis true but difficult

Surely it would be equally important to ensure that HCPs were better trained to offer effective support to mums who do b/f and encounter problems, this would then reduce the number of people who stop early on.

However the message is phrased, it is important not to villify people who do bottle feed, as for some the choice is not their's to make, for whatever reason, and some simply don't want to.

I agree that it is important that we are given all the facts so we can make an informed choice, but it also society's views that have to change, socially, it is seen as more accaptable to bottle feed when out and about than to breast feed, and as we are now, it can take guts to feed in public, not to mention the limited places where one can sit down to feed, esp in winter.

what a tough tough issue.

Pain barrier is a good way to put it, VLC.

It is undeniable - for any great shift to be made wrt the way infant feeding is seen and supported in this country, there will need to be some sucking up of very difficult, painful feelings.

I appreciate that I write from the "lofty" position of "successful breastfeeder" so can never truly understand the grief many women feel about breastfeeding not working out as they intended.

But I would like very much for the words of one woman I spoke to a while back to be echoed more often - she said that she'd had a shit time of bf, without any decent support, she hadn't known much about bf antenatally and she'd not realised how desperate she'd feel when bf wasn't working out. She was sick of the "don't make women feel guilty" line being trotted out and didn't the women who said that realise they're stifling any conversation about infant feeding - and preventing anyone having a better time of it in the future. I spent the whole time nodding, as you might imagine!

off to bed

I agree with that, as another 'successful breastfeeder', it is difficult to understand the emotions women experience when it isn't going to plan.

But I do think there is a general lack of information regarding the different ways of help which are out there, I know with my first, my Hv only mentioned the clinic up at our local hospital, which at the time had limited hours, and now is all but stopped due to funding, and although there is a baby cafe locally, for many it is a case of getting there.
It is, as hunkermunker said the desperation felt, and also, as a friend commented, that one feels a bit of a failure if it doesn't come easily, that can make it very hard for a woman to ask for help. This is a difficult area for HV's as it requires a fair bit of time to sit with someone and help them through the problem, and like most HCP's, they don't have enough hours in the day.

tricky...

I agree too.

I think the Breast is Best message undermines breastfeeding really, because subliminally we all know that we can't always achieve "best" but we can achieve "good enough". If BF is in the category of one of those things that we only have to aspire to, rather than actually do, then we don't really need to do it, do we? And the state doesn't really need to fund proper support services so that all the mothers who want to, can.

When I was pregnant with DD "breast is best" was shoved at me so often, I started to feel like I didn't want to just because I had been told to so much.

I don't like 'breast is best', either, or breastfeeding is 'the gold standard' and 'breastmilk is liquid gold' and other sloganising....at least not used generally or in campaigning. It's just the normal, physiological nutrition and relationship setting for the young of our species, and of course anything different from this carries risks to the baby and to the mother.

The idea that using formula carries risks in itself, and additional, measurable risks to do with 'not breastfeeding' is enormously challenging and sometimes uncomfortable, whether mothers have chosen to formula feed or not.

But silence on it, to spare people's feelings, is not an option, really. In personal dealings with individual mothers, we need sensitivity and reticence, I think....but the general message should be clear.

I think they used breast is best just cos it rhymes actually!

The University of Wollongong, eh?

I agree hunker.
the only time I ever hear anyone say "breast is best" is in this context:

"breast is best BUT it isn't realistic, formula is just as good these days, my babies were fine etcetc"

slightly OT but I read two interesting projects for increasing bf rates recently. will try and find and link

Message withdrawn

I agree, absolutely. I also think that ironically, fotrmula companies turn 'breast is best' to their advantage - 'breast is best but we're a damn good second and working on drawing level [and some day surpassing bm with our Scientific Advances] all the time'.

It also, as some of you have said, constructs bf as not-the-norm, because how many of us achieve the 'best' in our lives all the time. In the same way, it implies bf is middle-class, a luxury, I dunno, like a Bugaboo or private school or something - and likely to need all kinds of effort and paraphernalia, because achieving the 'best' is always a slog.

We need this shift to describing bf as the norm. I believe it is the single most important step to boosting bf rates, in fact, as it will normalise bf support and make women demand it. But it is going to hurt and upset a lot of people. And my brush with bf-not-working-out gives me an idea of just how much.

any slogans irritate me. concentrate resources on adequate consistent training for HCPs. I think more people starting bfing and continuing till they want to, will help normalise bfing more than any slogans.

I read an interesting article in the BMJ about bf support in E London. The conclusion was:

Conclusions: The decision to initiate breast feeding is influenced more by embodied knowledge gained from seeing breast feeding than by theoretical knowledge about its benefits. Breast feeding involves performing a practical skill, often with others present. The knowledge, confidence, and commitment necessary to breast feed may be more effectively gained through antenatal apprenticeship to a breastfeeding mother than from advice given in consultations or from books.

I think that is interesting, and I have never seen it put into practice. an antenatal buddying scheme could work quite cheaply and effectively I think?

this is the reference:
BMJ 1999;318:30-34 ( 2 January

I would like to see more on the reasons not to breastfeed, I think that having an honest conversation about this would probably go some way to resolving some issues and to understanding how best to support some women.

reasons like 'I find it disgusting' 'I did not want to be bound to the baby'
all reasons I have heard btw could perhaps be talked through.

on the other hand

It has never occurred to me not to breast feed but when the time came the difficulties and lack of support nearly made me give up, much to my distress. I can't imagine how I would feel if I had actually failed to continue breastfeeding

That is a great idea harpsi. I could see myself helping set a scheme like that up. Will have a look at the article.

the other article I read I can't - frustratingly - find. it was a case study of a Health Authority/PCT (in the north of England I think) where every member of staff (catering/repair men/cleaners. everyone) went on BF awareness training. it was a really positive article. how cool is that!
anyway, I can't find it will look later

Not only is breastfeeding not seen as normal in the UK but I also have concerns that the message seems to be out there that you should stop breastfeeding at 6 months and that it is normal to do so when the norm should be 1 year with more support at work.

What I mean is more should keep going until 1 year not that the norm should be to stop as I think you should keep going as long as you want to.