As a newborn hospitalist, I often find myself talking about feeding. In fact, this is the issue that takes up by far the greatest amount of my time when speaking with new parents, and the discussion surrounding the seemingly simple concept of feeding a baby is, in unfortunate reality, rendered extremely complex by a number of societal forces. There is a veritable minefield of misinformation and propaganda to navigate each and every time I meet a mother and ask how they are planning to feed their baby.
Mothers are generally bombarded with societal pressure to breastfeed their babies, often at the expense of their physical and mental well-being and in a way that infantilizes them. The only reason a mother would choose to feed their baby formula rather than breast milk, it is assumed, is ignorance and a lack of enough support. This is not to say that there is no benefit from education and lactation support for some women, but a heavy handed approach is less than ideal.
Most mothers who choose to breastfeed make it through the process okay, and this has resulted in a large degree of societal survivorship bias. A lot of mothers don’t do well, however. Many struggle through periods of poor sleep, physical and emotional discomfort, and economic challenges. Being sleep deprived for long periods of time has numerous known health consequences, from car accidents and dropping babies during feeding attempts to post partum depression and even suicide.
I often refer to the 3 Fs of maternal guilt: Friends, Family, and Facebook. The amount of pressure that many mothers face is undeserved, not based on good science, and thoroughly unhelpful. I lost count long ago of how many mothers I’ve met over the years who were experiencing extreme feelings of guilt over their decision to not breastfeed or even to thoughtfully supplement a baby with formula and it breaks my heart.
Not all babies make it through the early days of breastfeeding without problems, some of which are even life threatening. Severe dehydration accompanied by an elevation in serum sodium levels can be dangerous. Readmission to a hospital for treatment of severe jaundice to prevent permanent brain damage is often associated with breastfeeding difficulty as well. And, as I mentioned earlier, some babies are dropped or suffer sudden unexpected postnatal collapse, which can result in neurological injury or death, during prolonged skin-to-skin promoted aggressively by many in the lactivist communities.
Breastfeeding can be, and often is, a wonderful experience. There are some potential benefits demonstrated at the population level, although in my opinion the data mostly reveals that the environment surrounding a breastfed baby is more meaningful than the breastfeeding itself. And when I’m speaking with an individual mother, I can’t in good faith say that her child will be one of the small percentage of infants who will benefit in any specific way if breastfed exclusively. Discussions with individual mothers should be supportive, nuanced, and honest.
Last week I sat down for an interview with Ruth Ann Harpur from the Infant Feeding Alliance, a group of parents and advocates in the United Kingdom that are focused on countering bad information found online or even spread by healthcare professionals, and on broadening the conversation to include voices that are critical of the current mainstream approach to feeding young infants. They have the ultimate goal of ensuring that compassion, autonomy, and safety are emphasized when counseling individuals and when developing policies that effect large numbers of families:
WE WANT COMPASSION
- Ensure antenatal education reflects the full range of families’ experiences and encourages parents to approach infant feeding with self-kindness.
- Make the mental and physical health of all family members a key consideration when providing infant feeding support and information.
- Show respect for all families by having positive representations of all safe feeding methods on public display and offer inclusive and comprehensive support for all families.
WE WANT AUTONOMY
- Empower us to make our own informed decisions by giving a balanced perspective on the health effects of different feeding options. This should use the full range of high-quality scientific evidence and acknowledge uncertainties in the field. We want to see accurate statistics and clear representations about the benefits and risks of each feeding method.
- Give us information about what options are available to help address feeding problems, along with the strength of the evidence behind them. We can then decide whether to accept help, continue with the current feeding method or change course.
- Recognise the ways in which infant feeding decisions interplay with other aspects of family life, such as sharing parenting responsibilities, work, sleep and looking after older children. Our right to make decisions according to our own needs and values must be respected.
WE WANT SAFETY
- Make it the priority to prevent newborn babies suffering unnecessarily from low blood sugar, jaundice, dehydration, excessive weight loss, faltering growth and other feeding complications.
- Ensure that information about sterilising equipment and milk preparation and storage is easily available to parents and included in antenatal education.
- Recognise the risks of maternal sleep deprivation for a woman’s mental health, as well as for the safety of her children. Adequate maternal sleep should be a key consideration in all infant feeding support.
During the interview, we discuss a variety of issues surrounding breastfeeding promotion. In particular, we talk a lot about so-called Baby Friendly Hospital Initiative, which in reality aren’t always very friendly to babies or their families. We also talk about ways to communicate with mothers who are trying to make a personal decision about how to feed their child. Please check it out and let us know what you think.