Friday, May 22, 2009

Pictures of Breastfeeding? Gosh, Take Them Away

A local NHS (National Health Servive) trust came under fire this week for featuring, among its breastfeeding awareness material, a picture of a child pretending to nurse. This picture was deemed unacceptable because it might cause offence to mothers who had been unsuccessful at breastfeeding. And Amanda of mmmm mama made a comment recently about how it is slightly taboo for happily breastfeeding mothers to sing the praises of breastfeeding lest they should step on the toes those who have chosen not to. How has the human race, whose females are equipped with mammary glands for the express purpose of feeding its young, possibly got itself into this ridiculous situation? Why would any mother be offended by a picture of a child breastfeeding, or another mother talking about it?

First of all, I must state some caveats. I am a breastfeeding mother. Though I have been extremely lucky to have had no major problems, I know lots of other women who have overcome serious challenges to establish breastfeeding. I know it can be very difficult. I also go to several baby groups and I am friends with mothers who bottle feed. They are good mums who love their babies and try to do the best for them. Although I support breastfeeding, I have nothing against mothers who formula feed. If we were to debate our feeding choices then we might disagree, but I do not seek confrontation like that. I know that breast milk is nutritionally superior to formula milk and provides better immunological protection to babies. For these reasons, I think we have a duty to encourage mums-to-be to breastfeed. I would like to understand how non-breastfeeding mothers feel when they see breastfeeding awareness posters, talk to breastfeeding mothers or read pro-breastfeeding writing. In the article below I have tried to imagine how I would feel if I was put in a variety of situations. Others may have very different feelings - I can only speak for myself.

I'm going to assume that breastfeeding mothers are not offended by the promotion of breastfeeding. That means it is the mums who either choose not to breastfeed, or ran into problems that meant they stopped, or simply could not breastfeed. I will first consider the mothers who are physically incapable of breastfeeding. There are several reasons why a woman might be genuinely unable to feed her child herself including illness, a pre-existing medical condition, previous breast surgery and having a very premature baby. I feel very sorry for any woman who would have liked to breastfeed but could not. It must be hard to come to terms with, and it must be painful to see and hear about breastfeeding when you so desperately wanted to do it yourself. But if I was in this position I cannot believe that I would be offended by discussion of breastfeeding. Of course I would not be so insensitive as to whitter on for hours about nursing with a friend who was unable to breastfeed, in the same way that I would not ramble for hours about pregnancy with a friend who was unable to have children. But we would be doing a huge disservice to the next generation of babies if we were to suppress the pro-breastfeeding message in order to spare the feelings of this very small minority of mothers (and I must not forget the fact that a mother who is unable to breastfeed might still be very pro-breastfeeding).

So I will move on to another group of mothers - those who have encountered problems that forced them to stop nursing before they wanted to, and those who think that their bodies are not capable of feeding their babies, but who are really the victims of a lack of support and information. How many first-time mothers have tried to breastfeed in hospital, found the support woefully lacking and concluded that they are unable to nurse? I imagine that in this position I would feel sadness, anger and bitterness. It is understandable that some people direct this anger towards the people who encouraged them to breastfeed. The tragic case of Katy Isden, who committed suicide four months after giving birth to a baby boy, is one example of how the blame for post-natal depression is sometimes heaped at the door of the pro-breastfeeding authoroties. Katy was known to be experiencing difficulties with breastfeeding but the sensationalist media wasted no time in putting two and two together to make five, reporting that her suicide came about because of the pressure she was under to breastfeed. There was absolutely no evidence to suggest that this was the case. Post-natal depression can strike any new mother, and breastfeeding is widely believed to have a role in preventing its occurrence. Difficulties in breastfeeding may well contribute to post-natal depression but that is no reason to stop encouraging new mothers to breastfeed. Rather, it shows that they need more support to help them succeed.

The lack of support received after birth can have far-reaching consequences in a breastfeeding relationship. There are mothers who manage to breastfeed for several weeks or months despite experiencing sore nipples which could have been prevented if they had been instructed in correct positioning and attachment. There are mothers who struggle to produce enough milk for their babies because they were encouraged to supplement their milk with formula during the crucial first fortnight, when the milk supply is being established. It might appear as if these mothers have nursed successfully, but it is no wonder that they may feel disillusioned and bitter towards the people who encouraged them to breastfeed if their own experiences have been painful and unhappy.

So I can understand why a mother who wanted to breastfeed, but was not adequately supported, might direct her ill-feeling towards the breastfeeding lobby. She may be saddened or angered by another mother talking positively about breastfeeding. But once again I do not feel that this is sufficient reason to suppress the pro-breastfeeding message. Many (possibly most) of the breastfeeding peer supporters at my local Children's Centre had very difficult experences with their first baby, but went on to breastfeed subsequent children successfully and became very vocal advocates of nursing.

The final group of women is those who choose to formula feed. Some people make this decision with full knowledge of the drawbacks of formula feeding compared to breastfeeding. Whilst I might not agree with their choice, I respect their right to make the decision that is most appropriate for their family. I cannot see how a fully informed woman in this situation can object to anybody else promoting breastfeeding. Research has proven the superiority of breastfeeding for babies' health, but presumably a mother who makes an informed decision to formula feed has judged that, on balance, her family will benefit more if she feeds from bottles. She would also have been aware, before making her decision, that she would continue to see posters about breastfeeding and socialise with breastfeeding women. If I had made such a decision, perhaps these constant reminders would make me feel guilty. But the decision would have been my own, and any negative feelings I had would be my own responsibility.

Unfortunately there are many people who make the decision to feed formula milk without being fully informed, or because they are virtually forced to by their close family. Some inherit prejudices against breastfeeding from the people around them. And there are those who do not give much thought to the decision, and feed formula because it is more familiar to them than breastfeeding. These people would certainly benefit from better antenatal education so that their decision could be made with the benefit of greater knowledge. To really make a difference to breastfeeding rates, the information must also be disseminated beyond the pregnant woman, to her partner and family. I do empathise with those who initially choose formula but later wish they had tried breastfeeding; it is a shame that this is an irreversible decision. Feelings of guilt for not breastfeeding must be hard to shake off, especially when the mother is exposed to pro-breastfeeding information. But I would repeat again that it is wrong to avoid promoting breastfeeding just to spare the feelings of mothers who feel guilty for their choices. It would be better to educate pregnant women more comprehensively so that the guilt scenario could be avoided in future mothers.

Normal human sensitivity must be employed whenever we talk about breastfeeding. Though there are hard facts that prove that breast is the ideal food for babies, it is completely wrong to judge or voice disapproval about mothers who formula feed. They may have very good and complex reasons for doing so. But any formula feeding mother who does take offence at the promotion of breastfeeding should also consider why she is offended, and if her offence really justifies the denial of breastfeeding information to mothers-to-be.

The solution to the whole unhappy situation would be to properly educate pregnant women about their feeding choices and provide robust, reliable support for new mothers who want to breastfeed. This is surely the only way to ensure that mothers are confident in the feeding decisions they make, and that women who want to breastfeed are successful. The mummy wars would not even exist if we were all truly happy with our choices.


The Dotterel said...

Agreed - it's an unhappy situation. But I wonder whether those that object or complain are really those involved, or others who think a certain type of mum might be offended? Most mums - whatever decision they've made - seem happy.

Mel said...

I could write volumes on this issue..but I'll try not to :)

Having experienced both sides of the breastfeeding fence - a failed attempt with my first child but a successful and happy experience with my second, I know only too well the emotions that go along with the whole debate. But without going into all of the details it was indeed a support and misinformation issue that contributed to my *giving up* the first time around.

But here's the rub - we are told over and over and over again in our pregnancies that breast is best, but (and this only counts for hospital births, which I avoided with my second child - coincidence? I think not!) the minute our babies are born, unless they magically (and we know this isn't always the case) latch on and nurse there are overworked, harried nurses pushing formula and bottles to 'top-up' our struggling infants simply because they don't have the time to spend with you but don't want the baby dehydrating on their watch. So when you combine the you-MUST-breastfeed-or-you're-a-failure propaganda with the complete and utter lack of support, it is a recipe for a monumental burden of guilt and self-loathing - the absolute last thing a new mother needs.

So while I can certainly support the necessity of advertising/promoting the importance of breastfeeding and agree that the idea that it should be downplayed so as not to *offend* anyone is just plain ridiculous, I think there is much more to be done that just education. If the support systems are not put in place - and by support I mean USEFUL support (home visits etc) - then the job is only half done and there will be more women who begin their Mothering journey feeling like a failure.

And as for the women that choose formula from the beginning - I believe that is a function of the great marketing machine and years of conditioning that have made formula the "norm" and breastfeeding the 'alternative'...sad, very sad.

I would also like to add that with any belief system, there will be zealots that have no compunction with belittling or abusing those who do not side with their beliefs and I met a few pro-nursing folk who fall in that category...those would be the ones making non-nursing mothers feel like criminals....

Thanks for the interesting discussion...

PS. And I think support should be available at ANY point in the nursing relationship because issues can arise at any point along the way which may lead to premature weaning...

Okay, done now. :)

Amity said...

Great post, I fully agree. Mel has a good point though, about needing more than just education and information. We need support systems put in place that are much more intensive and widespread than they are now.

One of the biggest things I think could be done to improve is giving more women access to lactation consultants who are specially trained in establishing breastfeeding in the immediate postpartum period, and having that LC visit women as soon as possible after the birth, and then as often as needed before leaving hospital. Like the midwife and health visitors, they should also do home visits for the first few weeks. One of the most confusing and frustrating things in those first few weeks is the conflicting advice you're given by all of the different healthcare providers. If the midwives tell you one thing, your HV another, your GP yet another and then each friend and family member providing their own personal experiences, it gets confusing fast, and hard to know what to do. I know that if I hadn't found support online I very well might have given up with my first.

Earthenwitch said...

Particularly agree with the comment about breastfeeding mothers not feeling able to say how good it is, or how important, for fear of treading on toes; in real life, the only people I know with children (of any age, virtually!) either chose to formula feed, or their breastfeeding didn't work out for one reason or another. It's deeply frustrating - they often look at me as if I'm in need of sympathy because I'm 'still' feeding the witchling at nearly a year, and they also express amazement that I can stand it, as if I'm overcoming enormous personal pain to continue - ! This, I think, says a lot about the way most people perceive breastfeeding, and also that more education needs to be done in order to get the message across once and for all that if it hurts, you're doing it wrong!

By the way, on a selfish note, is there any chance you'd consider adding the name/url option for your 'comment as' drop-down? Signing in and out of Google, and remembering to copy/paste the comment I nearly always write before I remember I'll need to sign out and in, demands more than my tiny brain is capable of on most days!

Cave Mother said...

Thanks for these comments. To echo what Mel and Amity have said, I have noticed very strongly with other bfing peer supporters that the immediate postpartum hospital period is THE time that makes or breaks their breastfeeding. Even those that had a bad experience in hospital, but managed to start breastfeeding, ended up giving it up earlier than they had wanted. I had a home birth, so I wasn't exposed to the bad attitudes of nurses, and I wasn't put under any pressure to give a bottle just to help me get some sleep. Now I wonder if that is partly why I had such a straightforward start to bfing.

My area is fairly "disadvantaged" and we have a lot of Children's Centres (formerly Surestart centres). They each run bfing support groups which means every woman has access to one-to-one bfing support, every day of the week. Midwives give out the times of these support groups to new mums. But I still think they need to be promoted better. And if you live in a more affluent area I don't know what support is available.

Earthenwitch said...

I wanted a home birth, but ended up in hospital (unsupportive midwife, largely, who told us I'd got hours to go, when in fact the witchling arrived about forty minutes after we got to hospital), and yes - I think your experience there can be absolutely pivotal. I was lucky: the midwife-led centre to which I transferred shortly after the birth itself was very pro-breastfeeding, and we needed their support, as the witchling was very, very tired after the birth, and a little jaundiced, so it took us a few days to get going. But even there, one midwife suggested a bottle 'to pick her up a bit', as if the bottle would be the perfect solution. I could see she thought I was just being stubborn, too.

Oh, and thanks for the name/url option. :)

Amanda said...

I'm seriously confused as to exactly how that lovely picture of that little girl breastfeeding her doll could manage to offend anyone. On the other hand, my husband was a little uncomfortable when my son started nursing his "baby" (a doll my mother gave him when he was born)!

And I'm still nursing him occasionally at 2-1/2 which I never forsaw when I stared down the mamahood road. I thought for sure we'd be done by the time he was 1-yr-old.

Cave Mother said...

Amanda - I have barely foreseen anything correctly so far :). So who knows what the future holds? I applaud your approach - just being relaxed about things, and letting him bf occasionally if he wants, has to be the best (and most natural) thing to do.

allgrownup said...

Wow, loved reading this. I have a medical condition that prevents me producing the correct calories in my milk,my son was skeletal til I offered formula after seeing a b/f specialist at the hospital. For more:
I must agree, to come to terms with not being able to nourish your child is heartbreaking, and when I had to get a bottle out in public, I felt deep shame. (possibly the opposite of most modern attitudes) I adore seeing b/f posters, I want every mum to try it, I loved it!

Cave Mother said...

allgrownup: I just read your article, before I saw this post! I followed the link from the BMB carnival. Nice post, and a lot like something I wrote recently: