Yesterday the Royal College of Midwives released a new position statement on infant feeding. It includes the stunning new idea that ‘the decision of whether or not to breastfeed is a woman’s choice and must be respected.’
Inevitably there is a two-pronged kneejerk reaction to this. The Daily Mail and all radio talk shows trumpet an end to ‘Breastfeeding Tyranny,’ which is that thing where anyone remotely connected with supporting breastfeeding mothers is cast as the tyrant (or other even less savoury words); and parents who have had a difficult experience of breastfeeding complain about a) pressure from midwives, and b) pressure from everyone else.
Meanwhile the above-mentioned tyrants divide themselves into separate camps, those who criticise NCT and those who are NCT (and some have a foot in both camps). In the first camp, we have those who criticise NCT for not covering formula and bottlefeeding in antenatal sessions [Spoiler: we do! Have a look at our Infant Feeding Message Framework, which has been revised this year, but nothing new on formula in there, we’ve been covering it for years]; and those who criticise NCT for not cheerleading about breastfeeding enough (usually members of other breastfeeding charities who exempt the NCT from their non-judgemental approach).
As usual, I’m not here to speak for NCT, despite being proud to have been an NCT breastfeeding counsellor for a decade. However I do want to congratulate everyone responding to this new position statement on perpetuating the divisions in infant feeding. Nice one.
How about instead of the kneejerk reaction, we take some time to reflect on the context in which this statement and the responses to it occur. You really don’t have to look very far for reasons why women feel unsupported, whatever feeding decisions they make. We know very well that the majority of women in the UK see a number of different and busy midwives during pregnancy, and still get asked whether they plan to breastfeed or bottlefeed, without the time it would take to have a nuanced and informative discussion about this. Just asking that question frames it as an either/or choice, never mind the evidence that decision making about infant feeding is so much more intricate than that. The path women take is influenced by their family history and social context, by adverts that tell them their nipples will hurt and news stories that tell them they’ll be thrown out of Sports Direct. By every person who ever tells them not to beat themselves up if they can’t do it.
At birth, pressure does come from midwives who encourage early breastfeeding in the knowledge that the option will disappear for that mother if they don’t try to protect it; what a difficult position for those midwives to be in, within the time constraints of their workload. What would be a better way to address this at such a crucial time? There is no easy answer, because this demands cultural change and an end to society operating on the assumption that breastfeeding is difficult and women will be judged for not doing it. Locally, the well-trained volunteer breastfeeding support has been withdrawn from the wards and now also the children’s centres, because there is no longer funding to run the project, adding to the burden on midwives to handle this with sensitivity, kindness and accurate information. Within the time constraints of their workload.
And then there is the rest of the breastfeeding journey, and I know from encounters with women of all ages who tell me, when they find out what I do for a living, stories that some of them have carried for decades. Women feel guilty when they struggle to breastfeed and when they choose not to continue, and they feel angry when they don’t have the knowledge or the support to make decisions they feel happy with; and these stories matter to them. NCT is the best-known of a number of different charities that support breastfeeding mothers, and so of course it is the one that wears the sash of shame about judging and putting pressure on women. NCT is also the one that does most of the antenatal education, including on breastfeeding and on formula and bottlefeeding, and so of course is perceived as a source of guilt and judgement largely because of the impossibility of adequately preparing parents for the realities of life with a new baby. “All my friends found breastfeeding really hard, I’m not going to beat myself up if I can’t do it,” they tell me before their babies are born. And afterwards? “Why didn’t you tell me it would be so hard?” What words, what activities, what level of reflection will square this impossible circle, without changing the entire context?
And that’s why I’m so frustrated, this morning, with all the news and social media that does nothing but reinforce the assumptions and the cultural context within which breastfeeding can be hard, but breastfeeding support can be harder.