Why the hell are 50% of parents made to feel guilty about how they feed their child?
“50% of mother’s who were unable to breastfeed their baby felt guilty”
PHOTO CREDIT: MILES LAMB
This blog aims to make parents feel good about the choices they make for their baby. A move toward guilt free-parenting.
So you can imagine how devastated I was to hear the results of BBC Woman’s Hour’s recent UK poll of over 1,600 mothers, which revealed 50% of mother’s who were unable to breastfeed their baby felt guilty – that they were letting their little one down.
A sure hang over from the Breast is best mantra that has been shoved down the throats of hundreds of thousands of unsuspecting new parents who haven’t been prepared for the actual day-to-day realities of breastfeeding, and are then left to feel the burden of guilt if it doesn’t quite work out as planned.
During World Breast Feeding Week The Huffington Post asked Mums what they wished they’d known about breastfeeding before they’d had their baby. Most wished they’d known about the physical discomfort in the early days, such as painful, cracked nipples, milk blisters and even mastitis (an infection which can be fatal). They also hadn’t realised how tricky the whole thing could be. Getting baby to latch on for a start. Then there’s the awkwardness of feeding in public - fumbling with feeding bras while keeping your tummy and other post-baby wobbly bits hidden. And of course, for many of us, the dreaded drip, drip, drip of the constantly leaky boobs. (I couldn’t go anywhere without breast pads for the first 10 months of my baby’s life, and frequently woke up in the morning in a pool of milky sheets).
The World Health Organisation recommends parents exclusively breastfeed their baby for the first 6 months, and continue breastfeeding alongside other foods until 2 years of age. And while 80% of new mothers start off breastfeeding, by 6 months of age only 1% of babies in the UK are exclusively breastfed. That’s one of the lowest rates in the world.
Those breast-feeding rates really speak for something.
Clearly, in real life, breast isn’t best for the majority of families. The majority of us either choose not to, or can’t, breastfeed in the way the health experts recommend. And with half (HALF!) of us feeling guilty about this, I wanted to dig deeper into whether the evidence behind the Breast is Best mantra really holds up and what the benefits of alternative approaches to feeding might be. Ultimately, I hope this article will help you feel good about however you end up feeding your baby – whether you get a choice or not.
The benefits of breast feeding
What the evidence says
There’s a large body of evidence which suggests breastfeeding your baby has long lasting benefits for mama, baby, and even the economy. If you want to dig deeper, the World Health Organisation published a review of the evidence on the long term effects of breastfeeding. Unicef also does a good job of summarising the evidence from two main scientific peer-reviewed publications; a special issue on the health effects of breastfeeding from Acta Peadiatrica (2015) and one of the largest reviews of evidence on the overall effects of breastfeeding on health and the economy from The Lancet (2016).
These reports provide a persuasive read indeed. In the early months of life breast feeding positively reduces inpatient admission rates for respiratory and gastric conditions, and reduces the risk of Sudden Infant Death Syndrome. In the longer term, it’s associated with lower blood pressure and lower cholesterol, higher performance on intelligence tests, and lower prevalence of obesity and type-2 diabetes. There are a host of benefits for Mama’s health to, including reductions in the prevalence of breast and ovarian cancers, and heart disease. What’s more, according to unicef, increasing breastfeeding rates in the UK could save the NHS up to 50 million whoppers every year. Ca-ching.
“The evidence around breastfeeding is presented as so totally black and white. Is that really the case?”
PHOTO CREDIT: JESSICA LUTZ
What the evidence doesn’t say
I find it really annoying that the evidence around breastfeeding is presented as so totally black and white. Breast = best. Is that really the case?
A few people are starting to question if the findings are really that solid.
One main limitation of the studies available is that, with breastfeeding, it’s not possible to conduct randomised control trials – the ‘gold standard’ method to determine causation. In this type of experiment mothers and their baby would be randomly allocated to a breastfeeding or formula feeding group. However, thanks to some (welcomed) ethical restrictions this isn’t possible. So we can only conduct observational studies; allowing mothers to choose their preferred feeding method, and watching what happens. These studies are correlational in nature - breastfeeding goes up as obesity goes down. The problem here is that other ‘third’ factors can affect the results. For example, people who are healthy often wear trainers, but it doesn’t mean that trainers make you healthier. It’s a third factor – running – that has the real effect. While researchers can try to control for these ‘other’ influences statistically, it’s very hard to do so completely. As a result, we really can’t say with 100% confidence that breastfeeding causes reduced obesity etc. There may be other factors that influence this apparent relationship.
Even the World Health Organisation highlights this flaw, and those studies that are the most rigorous in controlling for these ‘other’ factors tend to show the smallest effect sizes. In fact, a 2014 study conducted in America found that most of the reported long-term benefits of breastfeeding actually melted away when comparing siblings who were fed differently within the same family (thereby providing rigorous control over important ‘other’ factors such as wealth and education).
So while breastfeeding clearly has a multitude of health benefits, it’s not completely clear how much of these benefits are related to the differences between the types of people who choose (and are able to continue) to breastfeed, and those who choose alternative approaches.
What are the benefits of formula feeding or combination feeding?
Many of the benefits of replacing (or reducing) boob for bottle include reducing some of the less pleasant physical effects of breast feeding (which no one really tells you about until after birth… thanks for that). These include:
· Engorged breasts
· Blocked milk ducts
· Milk blisters
· Mastitis (experienced by 10-30% of BF mothers, with potentially fatal consequences)
· Cracked/bleeding nipples
· Leaky boobs
· Biting (once little newbie has nashers) – ouch!
Other benefits are more related to mental and emotional wellbeing, as breastfeeding can enhance many of the most challenging aspects of new motherhood; isolation, lack of freedom, boredom even if you have a frequent feeder or a dreaded cluster feeder (my little one was born into a heat wave and cluster fed from 5-10pm for what felt like an eternity). Half of women in the BBC poll said breastfeeding was one of the hardest parts of new parenthood.
It also means you can feed in public without feeling embarrassed (something 1 in 3 breastfeeding mothers sadly still experience according to the BBC poll).
The glorious silicone teat also enables ol’ Daddykins to get in on the feeding action. And that means the opportunity for Mama to get a few more winks at night, which can have a HUGE impact on depression, anxiety and wellbeing.
There are a host of practical benefits too, including making the return to work easier (apparently 1 in 3 women have had to express milk in the toilets at work due to lack of provision of suitable facilities), as well as freeing up the possibility that other care givers can get involved – granny and grandad for example. Allowing you two time to yourself now and again.
The BBC poll suggests parent’s who combination fed were some of the happiest. And yet, very little guidance is given to new parents on how to do this well. In fact, many parents are scared off by fear of the dreaded ‘nipple confusion’. The idea that if you give your baby a bottle they will get lazy and forget – or refuse – to suck on a real nipple. Problem is, there isn’t any real evidence for this. Another ‘risk’ thrown at new parents considering the combination approach is the infamous dwindling milk supply. The idea that if you introduce formula to the mix it will mess up the finely tuned balance between supply and demand that develops between you and baby. However, many are sceptic that just a bottle or two a day would be enough to really throw this off course.
The NHS does give some advice on how to follow a combination feeding approach, but it doesn’t exactly feel like parents are really supported to make this decision and feel good about it. Countless anecdotal stories from new mums talk of judgement and general snubbery at the mere mention of formula from health visitors and GPs.
So for those of you interested in finding out more about formula or combination feeding, I’d like to recommend the excellent Fearless Formula Feeder. I love her approach to welcoming all types of feeders; breast, bottle or both. And if you are breastfeeding and want some support, boober provide tips and advice in their newsletter and on their blog.
“New guidance…represents a shift away from Breast is Best and a move toward the more inclusive Fed is Best”
PHOTO CREDIT: KEZIAH KELSEY
Fed is best
New guidance from the Royal College of Midwives, published in 2018, represents a shift away from Breast is Best and a move toward the more inclusive Fed is Best. They acknowledge that “Breastfeeding mothers and their partners should be given information and support to help manage the physical, mental, emotional and societal challenges of breastfeeding. Similarly, those parents of infants that are formula-fed, whether exclusively or partially, should be provided with the information to enable them to do so safely and be given support to encourage the bonding process”. Unicef have also started to acknowledge that “It is time to stop laying the blame for the UK’s low breastfeeding rates in the laps of individual women and instead acknowledge that this is a public health imperative for which government, policy makers, communities and families all share responsibility.”
I’m all for more of an ‘ecosystem’ approach to this issue, but what both of these statements are still missing is the acknowledgment that parents-to-be need to be included in a broader discussion about the day-to-day realities of what to expect from breast feeding, and to hear from a range of voices with different experiences.
While 66% of women in the BBC poll said breastfeeding was one of the best part of being a parent, some claim choosing to formula feed was one of the best decisions they ever made. It’s important that parents-to-be are exposed to voices on both sides, and understand that either choice can bring benefits. I hope this article has gone some way in providing you with the information you need to feel good about the way you end up feeding that plumptious little one of yours. And feed they will, either way.