Breastfeeding is NOT a War
My daughter is rapidly approaching 3 years old. I am over the moon that we are still sharing our breastfeeding journey. I made an informed choice to breastfeed my daughter and had unending support from my family (lets face it, they didn’t have a choice!).
A position statement released by the Royal College of Midwives earlier this year (RCM, 2018) prompted some strong sensational headlines in the media…
”Spilt milk: are the breastfeeding wars finally over” (The Guardian)
“Bottle feeding is a woman’s right, midwives told” (BBC)
“New mothers should not be shamed into breastfeeding” (The Telegraph)
The statement, effectively, supports World Health Organisation and UK Department of Health strategies to promote and support breastfeeding for the first two years of a child's life. But crucially reflects UNICEF's rationale for midwives to explore women's thoughts and feelings about feeding choices through meaningful conversations (UNICEF, 2013). This approach is not new.
Now imagine this headline, a scenario i have seen on several occasions, “Woman forced to give her baby formula milk”. Technically not forced, but definitely coerced.
Perhaps some midwives do regimentally promote breastfeeding, and for women on the receiving end of this it can be a soul destroying journey. There are definitely midwives who do not fully explore a woman’s choice to either breast or formula feed and this can be equally as destructive. However, from listening to colleagues around me and women’s stories it is often the other way round: women are too quickly encouraged to give their baby formula milk.
What is a meaningful conversation?
A person’s choices are influenced by so many things; experience, friends and family, media, health professionals. Midwives are there to facilitate; to give information, to share positive and negative sides of both breast and formula feeding. During pregnancy is the best time to explore thoughts, feelings, experiences and influences; before women are faced with a hungry baby and sleep deprivation. We must always try to include her partner or closest family member as their influence and actions will be the most powerful. But it shouldn't stop there, or be an isolated conversation. Women should have the opportunity to discuss feeding choices throughout pregnancy and once their baby is born. Choice, just like experience, is changeable.
Always a different midwife
The reality in the current NHS maternity system is that many women do not see the same midwife throughout their journey (NHS England, 2016). This in itself makes meaningful conversations difficult. Women may not feel comfortable (or even see the point) discussing whether their mum and sister breast of formula fed, the ‘horror’ story they heard from one friend but how everyone else finds the same thing really easy, the latest news headlines, social expectations. Throw into the mix that each time they see a different midwife who is pressured for time, perhaps in a clinic she's never been to, and is busy completing a set of prescribed tasks. Naturally, that midwife might leave the meaningful conversation to another midwife and so no one ever takes responsibility. In this situation it would be very easy to give the impression of only promoting breastfeeding, because after all that is on the list of things to discuss.
Breastfeeding is a tough journey for many women, myself included (see my blog on breastfeeding with a posterior tongue tie). But the stories of mothers who persevere with breastfeeding, or simply make an informed choice to formula feed from the offset do not make for exciting reading because no one can be blamed. Sadly the media do not see that their sensational headlines and portrayal of motherhood are a catalyst to women feeling as though they have made the wrong choice. It appears to me that social pressures, personal experience and support from friends and family are ultimately more powerful than any influence a midwife has.
There is never a single answer about how to feed a baby; the answer is unique to the family. If NHS midwives were gifted with more time then perhaps women’s poor or incomplete care would not lead to a perception of a war being waged over breastfeeding. Choice is personal and changeable. As midwives we must respect and explore that in whatever way we can; because time is not a gift we will be given. As a mother I would have been mortified if a midwife had suggested I offer formula milk to my baby.
It's about human rights: the right to have all the information, the right to choose.
NHS England (2016) Better Births: Improving outcomes of maternity services in England. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
Royal College of Midwives (2018) Position Statement: Infant Feeding. Available at: https://www.rcm.org.uk/sites/default/files/Infant%20Feeding.pdf
UNICEF (20113) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. Available at: https://www.unicef.org.uk/wp-content/uploads/sites/2/2013/09/baby_friendly_evidence_rationale.pdf