Ah, breastfeeding. Few subjects are guaranteed to draw the ire of so many with the utterance of a single word. Most recently, Jamie Oliver managed to call upon himself the wrath of women across the land who felt he was not entitled to an opinion on what they should do with their breasts. I won’t deny, it’s a hugely complicated issue.
It has not been long since some shocking data was published in the Lancet confirming that the UK has the lowest rate of breastfeeding at 1 year in the world.
Now, before I start picking things apart, I’m going to lay down some bedding of basic facts. There are a multitude of studies of varying quality that ascribe various benefits to breastfeeding. I’m not going to go into any of these individually because they muddy the waters terribly and because I’m sure most of you aren’t looking for a critical appraisal of all breastfeeding related papers.
I could bombard you with guidelines, like the World Health Organisation advice that infants are breastfed (alongside a normal diet) for 2 years and beyond. Or the NHS advice that babies are exclusively breastfed for 6 months and that breastmilk forms the mainstay of their diet for the first year. But by the time we’ve got to that stage, the issue is already confused and people are angry and hurt.
Instead, I’m going to try and pare it back to the basics.
1) As far as infant feeding is concerned (and I use the term infant feeding to describe the food ingested by infants and only that), breastmilk is superior to any alternatives. It contains a combination of nutrients and antibodies that are not reproducible in artificial feeding products. Some of these benefits (specific antibodies) are only produced by the suckling of the infant.
2) Can’t and won’t are different when it comes to breastfeeding, but does it matter? The proportion of women who can’t (and by that I mean that their bodies/breasts are physically incapable of feeding) breastfeed is actually very low. There are a limited amount of reasons for which a woman may not be able to breastfeed: drug therapy with incompatible medication (rare), previous breast surgery (may reduce milk production but unlikely to halt it completely), HIV infection, certain conditions of breast tissue growth (breast hypoplasia – rare). In the vast majority of cases, milk production is governed by a simple endocrine feedback mechanism that links suckling to production and it can/will be sufficient.
3) It takes two to tango. Breastfeeding support powerhouse La Leche League use the term “the breastfeeding dyad”, which I find to be a useful and apt description. This means that there are two people participating in the breastfeeding relationship and that their rights should be respected and their “voices” heard.
4)A mother’s decision not to breastfeed is hers to make. As mothers we are asked to make so many decisions about our parenting (increasingly so and increasingly publicly). This decision does not define us completely, just like the others don’t either.
5) Breastfeeding can be hard. And I don’t mean in a “ugh I’m watching TV and I’m hungry but I can’t be bothered to go to the fridge” way. It is a skill that has to be learned in the middle of a war zone of sleep deprivation, hormones and loneliness. No one’s breasts are available but your own. It can hurt. It can bleed. It can be hell (yes, it can be wonderful too). Babies are born into all sorts of circumstances, to all sorts of mothers. The love they receive is not defined by a single act. Breastfeeding and breastmilk may be the best thing for a baby in a world where babies existed in limbo, with no other factors or extenuating circumstances. But the moment the baby is born we can’t suddenly focus all our attention on its cute little scrunched- raisin face and forget all about the woman whose world this baby now is. Is this the best thing for the dyad?
I hear the word ‘guilt’ thrown around like a sharpened dagger of accusation. Women made to feel guilty by the pressure to breastfeed. Women made to feel guilty about breastfeeding too often, too ‘ostentatiously’ (thanks Nigel Farage) in public, or for too long.
In which other sphere of parenting, apart from those reportable to social services, do we employ guilt? Here we have a situation where women who have scars borne of the same battles are going to war with eachother, backing up their arguments with the full force of the pain and frustration that the challenge of motherhood has given them.
I’ve been wading through this topic for long enough to take a step to the side and disclose a few further facts. I’m a doctor. I’m a mother to a 2-year-old, who I still breastfeed (increasingly infrequently, but weaning is a post for another day!). I have responsibilities in both of those roles, but they are hugely different.
As a mother, I am responsible for my child and for myself, and for ensuring that we are both happy and healthy. If I’m asked by another mum, I’ll happily give advice.
As a doctor, I am responsible for providing patients with all the evidence-based information I have available, for knowing the limitations of my knowledge and when to seek help or advice to enhance it (this one’s actually in the GMC guidelines for good practice!) and for allowing them to then make their own decision based on that information. I can’t deny that it is my responsibility as a doctor to inform patients that breastfeeding is the gold standard and that breastmilk is irreplicable. Once I have done that, my duty is to support them in achieving this, but not against their wishes. I can address issues as they arise. I can seek support from other, specialist professionals. But if a mother makes a decision after being in full possession of the facts, undermining that decision insults her intelligence and competence as a parent.
To bring this opus to a close, I don’t have an answer.
It is hugely disappointing that the breastfeeding rates in this country are so low. I inhabit the real world (most of the time) and I understand that breastfeeding isn’t possible or appropriate for some women. It can’t be that the facts aren’t out there, because whilst some feel unsupported, others feel pummelled by information about how breastfeeding is superior to formula feeding. So I can only assume that whatever support we’re giving isn’t the right support and as a result we have women feeling bullied, marginalised, humiliated and despondent, whether they choose to breastfeed or not. We are branded ‘failures’ if we don’t, ‘breastapo’, ‘boob nazis’, ‘weirdos’ or ‘sickos’ if we do. So wrong have we got it that instead of focusing our energy on improving, we are raging against eachother in a vicious cycle that leaves the most important people, you and your baby, on the sidelines.