13 Jun

Mommy Wars Much?

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.

21 Mar

Media manages to shut Jamie Oliver up over breastfeeding. Nice one.

As soon as Jamie Oliver opened his mouth, it was open season for bashing the breastfeeding supporters once again. To be fair, his choice of words was poor. ‘It’s easy, it’s more convenient, it’s more nutritious, it’s better, it’s free,’ he said. Well, it’s certainly free.

Cue a whole cornucopia of articles arguing the rest of those points, largely from journalists who experienced a variety of difficulties in feeding their own babies, most of whom seem to be using this most inappropriate platform to debrief their feelings of guilt and anger and disappointment.

The typical argument goes something like this:

He’s a man. How dare he stand up for women?
It’s not even true. How dare he say that breastfeeding is a good thing? Lots of women can’t do it. I couldn’t do it.
Breastfeeding support is all about pressuring you to continue. All my friends said so too.

This argument is generally concluded with either “I actually fed my baby for 18 months but don’t beat yourself up if you can’t;” or “I gave my baby formula and she’s fine and I’m fine so shut up.”

And this is how journalists manage to perpetuate the social and cultural difficulty of breastfeeding. I have no problem with them reminding us that breastfeeding can be hard; this is supported by experience and by evidence. The sadly now-discontinued Infant Feeding Survey showed in 2010 the drop-off rate from around 80% to around 55% of mothers breastfeeding their babies by six weeks, and 34% at six months (none of this is exclusive breastfeeding, just a baby getting any breastmilk at all). The 2005 survey showed that 90% of the mothers who stopped by six weeks, had planned to breastfeed for longer. This is the statistic that we should be shouting about, because this represents all that guilt and anger and disappointment.

We need to stop setting up straw man arguments like the Smug Self-Righteous Lactivist, and ask why councils are closing down breastfeeding support services run by highly-trained breastfeeding counsellors and attended by huge numbers of mothers. To take one example, 17% of all new mothers attended the Hampshire drop-ins, and 98% of them would recommend the service to others. This doesn’t speak of pushy, pressurising, “well-meaning” (translation: “ineffectual”) supporters who spout about “breast is best” and insist you carry on no matter what.

Generally speaking, breastfeeding counsellors are trained to listen and support women (and sometimes men); to give them a safe space to figure out what they want to do and how they want to do it; and to share information to help with that decision making. Breastfeeding counsellors don’t use words like “easy” and “convenient,” mainly because their experience is of working every single day with women who are not finding it easy or convenient. Nor do they use such phrases as “breast is best,” since they are well aware that parents tend not to make feeding decisions on the basis of evidence about nutrition. No, parents make decisions on the basis of what’s happening to them at the time. Telling a struggling mother to continue doing something that is making her miserable, because it is best for her child, is contrary to the philosophies and the training of all the UK breastfeeding support organisations.

Yes, Jamie oversimplified breastfeeding in his statement on the radio, but that was a droplet compared with the oversimplification of the state of breastfeeding that followed, media-wide. Well done for enabling a backlash that prevented someone speaking out for supporting women.

11 Feb

My complaint to the BBC

Dear BBC

I wish to raise a complaint with regard to the choice of Clare Byam-Cook, who was represented as a “breastfeeding expert,” a “breastfeeding counsellor,” and a “lactation consultant” on Woman’s Hour on Monday morning. With respect, she is none of these things, and I am deeply unimpressed that BBC researchers were unaware of this, despite complaints every single time she appears.

The information given out by Byam-Cook about tongue tie, milk supply, and the baby’s latch at the breast were fundamentally incorrect. Since the purpose of this piece was to explore the reasons why women feel unsupported and do not breastfeed for long in the UK, I am surprised that this misinformation was perpetuated without comment. This is negligent of the BBC.

Byam-Cook was also allowed to talk about her video and book, and mention that she is available for private consultations. I understood that the BBC was required to adhere to certain standards about allowing advertising. If this had been advertised on ITV I would be making a complaint to the ASA, since her book contains many factual errors that would undermine the breastfeeding experience of most women.

Please do not bother to send me your standard response, as I have read it. I take issue with the statement that ” Unlike other breast feeding counsellors, she doesn’t believe that breastfeeding is the be all and end all.” As a Breastfeeding Counsellor, I am very well aware that breastfeeding is one part of the complex experience of becoming a parent, and I have supported parents in many different situations, making many different decisions. The word “counsellor” should convey to you that we listen and support individual mothers, without an agenda. Nonetheless, breastfeeding is an important public health issue, as shown in last week’s article in the Lancet; and the BBC has a responsibility to give out correct factual information, as well as the helpline numbers from the four reputable organisations whose counsellors are trained to support women in an evidence-based, parent-centred way.

Kind regards
Karen Hall

06 Jun

Precious Vessel

The media week started well, with the heartwarming story about Finnish baby boxes, which I’ll write about later. And then it all went downhill with the release of an amazing report from The Royal College of Obstetricians and Gynaecologists on Chemical exposures during pregnancy.

The RCOG “encourages the study and advancement of the science and practice of obstetrics and gynaecology.” On this occasion, they have taken this to an extreme, by advising women to avoid any possible exposure to chemicals, which may or may not have a harmful effect on their developing baby. While they do explicitly state that none of these harmful effects are proven, this is not how it comes across in the media. Dr Michelle Bellingham, co-author of the report, goes a step further on Radio 4 by asking what harm it does to follow this advice, to err on the side of caution.

So what harm does it do, to tell women not to use cleaning products, shower gel, or make up; not to buy new furniture (presumably including cots and car seats); not to eat any processed or packaged food? Astonishingly, this is presented as “practical” advice. The message it sends is that women themselves are of little importance compared with the package they are carrying. Our job is to breed, and we had better do it well, and if this means no deodorant for nine months, suck it up. In a world where we are made to feel uncomfortable using our breasts for their original purpose and we are expected to glow throughout pregnancy; we are now expected not to wash.

And as the report itself states, there is little or no evidence that any of these items actually do any harm, so this controlling advice is utterly spurious, and the idea that it is supposed to be in any way helpful to women is disingenuous.

Meanwhile any useful evidence-based guidelines are more likely to be ignored by women overwhelmed with conflicting and impractical instructions. On the one hand: good, we are grown-ups, we can make up our own minds. On the other hand, this is a real fail for those of us trying to provide evidence-based support during pregnancy and early parenthood.

Further Reading
The NHS’ excellent Behind The Headlines series takes the report apart here.
Sense About Science dismisses the usefulness of the report and the media coverage here.
Fran Yeoman responds as a new mother, in The Independent.
Risk Sense asks Is everything a risk when you’re pregnant?