Infant Feeding

Georgia Culley Watkins

April 16, 2019

Growing up in the UK, breastfeeding was something that I almost never saw, and yet I somehow managed to have a lot of misconceptions about. I unconsciously picked up snippets of opinions from those around me. The message was confused;

  • “breast is best”,
  • boobs are funny/sexy,
  • fluids that come out of bodies are gross/dirty/obscene,
  • bottle feeding is selfish,
  • public breastfeeding is showing off…

How to reconcile these conflicting ideas? When I was pregnant I did a lot of reading. Some great books and websites gave me great, solid information but what really stood out were the click-bait articles, spewing out anger and intolerance on both sides of the debate.  The message was still confused;

  • the breastfeeding rates in this country are way too low,
  • not every woman is able to produce enough milk,
  • militant nipple Nazis are shaming bottle feeders all around the country,
  • breast milk is a miracle food,
  • breastfeeding is horribly painful,
  • mothers must breastfeed for at least 2 years,
  • breast feeding toddlers will give them psychological scars…

The society we live in makes how you feed your babies a political stance, a defining trait of your parenting identity, and pits women opposite each other at a time when we are vulnerable.

Raising my babies in Sweden has given me a new perspective.  The breastfeeding rates are much higher than in much of Europe, meaning that mothers to be will almost certainly have been around other breastfeeding women and it is very much a normalised part of parenting culture.  Whether a mother breastfeeds “modestly” or more openly seems to depend on the weather more than the social setting. The assumption throughout maternity care is that the mother wants to breastfeed and there is a good amount of support available to facilitate this.  Informational videos about positions and latching are routinely shown at midwife appointments, midwives and nurses in the post-birth recovery wards are trained to support breastfeeding and all new mothers are given the phone number for specialist lactation nurses where they can usually get an appointment within a few days. (It is worth noting that this is the information I have for people living in or near cities, whereas the situation may be very different in rural communities within the Arctic Circle where hospitals may be hundreds of miles away). There doesn’t seem to be any public debate on this; on the surface, infant feeding appears to be a non-issue.

The flip-side of this is that those who choose not to or are unable to breastfeed have considerably less support.  Anecdotally, I have heard accounts from friends who have experienced very negative attitudes and outright judgement from peers, strangers and medical professionals when bottle feeding their babies.  One woman was told by her baby nurse “It is your choice but your baby will get sick”. Another was told by a doula that it was her fault she couldn’t breastfeed.  One friend believes that repeatedly being asked why she wasn’t breastfeeding played a major role in her developing postpartum depression.  She found that she could not buy bottles suitable for younger babies in the usual baby shops and had to go to UK websites to get any information about safely sterilising and preparing bottles. Another friend whose baby was born a few weeks early felt like her concerns weren’t being taken serious by health professionals when her baby wasn’t putting on weight with breastmilk alone. She wasn’t referred to a lactation nurse despite repeatedly asking for help and when she chose to supplement with formula, she couldn’t access any information about it from Swedish sources. Clearly, the celebrated breastfeeding statistics do not show the full picture, and policies put in place to raise breastfeeding rates risk leaving many vulnerable women behind.

However, while statistics miss out an important part of the story, they do hint at where a large problem may lie. In the UK, the proportion of women who initiate breastfeeding in the first few days is relatively high, then the rate drops off very quickly. This goes against the theory that women either don’t want to breastfeed or don’t know the benefits of breastmilk.  When people stop breastfeeding on day 5, day 14, week 8 or month 6, it probably isn’t because they have somehow forgotten the many scientifically proven benefits of breastfeeding, so throwing more information at them about reduced risk of type II diabetes is unlikely to be either helpful or well received. Much more likely is that they are experiencing pain, social obstacles, worrying about sufficiency or finding that it is taking a much bigger toll than they were expecting. Therefore it would likely be much more beneficial to provide information on where to get help with a painful latch, with medical issues such as thrush, and where to find supportive environments such as local mums groups, la leche league etc.

Importantly, I think a lot of women are lacking an idea of what to expect when breastfeeding, e.g. the timescales involved; how much time per day they might be breastfeeding for, how much variation there is between babies, how much weight the baby might initially lose, how long it might take to gain back. The information out there can be extremely polarised. At one end of the scale; feed for 15 minutes on each side, every 3 hours, baby must adhere closely to their line on the growth chart. On the other end; feed for as long as the baby wants, as often as they want, weight charts are irrelevant. I think women need to know how many shades of grey are in between these two models and that it is ok to be somewhere in the middle.

Looking at the statistics alone also leads us to the simplistic view that the higher the breastfeeding rate, the better. Looking at the science, there is no denying that breastmilk is better than formula milk. Assuming that the mother doesn’t have health issues such as HIV or nutritional deficiencies.  Assuming that the mother doesn’t have mental health issues that are exacerbated by breastfeeding. Assuming that there is an adequate supply. Assuming that the baby can access sufficient quantities of it. These assumptions cannot be ignored when evaluating the most basic premise of whether breast is in fact always best. Aside from this, the woman’s personal situation should be factored in. Does she have adequate help for looking after older siblings while she is breastfeeding? Can she afford formula? Is she likely to face criticism from those whose opinions mean the most to her for her choice?

Personally, I think the best way to stay impartial and to move away from our own biases is to listen to women, lots of different women who have had totally different experiences from our own (and sometimes men may have something worthwhile to say on the subject too).  I have heard the stories of;

  • friends who happily and easily breastfed their children up to the age of five,
  • friends who decided long before pregnancy that breastfeeding wasn’t for them,
  • friends with severe social and body anxiety who found the idea of public breastfeeding horribly stressful,
  • friends who were raised in a family where bottle feeding is the norm and feels comfortable for them,
  • friends who were desperate to breastfeed but found many obstacles in the way,
  • friends who regret switching to bottles before trying to get more help,
  • friends who regret having persevered and suffered for so long that their mental health suffered.

The fact that these women are my friends obviously makes it easier for me to empathise with them and respect their feelings and choices but opens the doors towards respecting all women as individuals and extending that to those outside of my culture and social circle.  Looking solely at statistics can allow us to ignore the individual and human aspects of people’s experience. When you can accept people as individuals with their own stories, backgrounds and motivations, the statistics and polarised opinions become irrelevant.

Support can come in many styles, and the best approach to support someone is going to depend on their personality.  Do they want information on how to safely sterilise bottles or do they want someone to listen to them.  Do they want pragmatic advise, handy prepared phrases to say to interfering relatives, or do they just want someone to have their back.

Ultimately, I think the most important thing as a doula is to set one’s agenda aside and face the individual needs of the women we support with an open mind and heart, and start with the basic premise that women can be trusted to make the decisions about their own bodies and their own babies.

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