Do we really need to keep talking about breastfeeding? It is understandably a subject fraught with emotion and there are plenty of people who are fed up with hearing about the whole darn thing.
But yes, sadly we do need to keep talking about it.
Around 85% of mothers who stop breastfeeding in the first few weeks, would have liked to have breastfed for longer. And it is these mothers who are being unacceptably let down and at an increased risk of post-natal depression (Borra et al, 2014; Brown et al, 2015).
They can often be left reeling with a deep sense of failure and guilt. But in truth, it is never their personal responsibility. It is the failure of a medical and cultural system, that has not enabled them to reach their goals, or at the very least, given them a knowledgeable and non-judgmental explanation as to what happened.
And this is why we need to do more talking. Only in a different way.
The current dialogue about breastfeeding in the media and across our society is more often than not focused on three things: 1. The "failure of breastfeeding" 2. The "pressure to breastfeed" and 3. The notion of "fed is best".
So forgive me for challenging the narrative but let's break this down:
The "failure of breastfeeding"
Not everybody can fully breastfeed (or breastfeed at all) and it would by lying to suggest that everybody can. However, in the vast majority of cases and crucially, with the right management of breastfeeding, it CAN and it WILL work out, if this is what the mother wants.
Highly questionable research, given kudos in the media, that make sweeping statements to the contrary (such as inflated numbers of women physiologically unable to make enough milk), are suitably flawed to warrant their results being destined for a bin. Unfortunately they simply fly around the internet instead.
Whether it's milk supply issues, severe pain, babies having trouble latching, infections, babies falling asleep at the breast, babies crying and squirming at the breast, slow weight gain.... and countless other scenarios, women deserve to have the necessary support to figure out, WHAT is going on, WHY it's happening and HOW to change things.
When breastfeeding is challenging, it isn't usually breastfeeding per se that fails. It is the failure to work knowledgeably and effectively with the mother and child, to provide solutions for any problems they may encounter. At the end of the day, women deserve to know that most breastfeeding problems do have breastfeeding solutions.
The "pressure to breastfeed"
Granted, there are definitely some professionals who maintain the "just keep at it" attitude, without offering up much (if any!) practical advice to help achieve successful breastfeeding. This undoubtedly leaves women feeling under pressure, at a time when they may already be feeling distraught and frustrated with the whole process. It is this MINORITY of people which lends itself to a bad name.
Anyone worth their salt in this line of work do not work in this way and luckily there are thousands of specifically trained (mainly) women who devote themselves to helping mothers through this precious time in their lives. They will not dictate. They will work with a mother and her family, to find effective strategies to help her meet whatever feeding goals she has, whilst keeping both her and the baby safe - whether this ends up with exclusive breastfeeding, exclusive pumping, mixed feeding or weaning off the breast and introducing bottles altogether. They do, and will, work with it all.
Many also cite that the sharing of information about breastfeeding equates to pressure. Is this honestly true? Sharing evidence-based information, in a sensitive and non-judgmental way, is not pressure. It is necessary.
I believe that enabling parents to make informed decisions about how they feed their baby is surely a parents right. They have the information. They do with it what they want. In my opinion, not to have access to that information in the first place, is wrong on many levels.
Regardless of research or debates, many women simply have an instinctive mothering desire to want to give breastfeeding a go and I steadfastly believe that we all have a responsibility in society, to support them to do so.
The real irony is, the mix of some of our cultural beliefs, social media activity and the genius marketing strategies of the infant feeding industry, is only serving to pressure women into formula feeding. This is why the multi-billion dollar formula companies are laughing all the way to the bank, since the accepted view at large, is that somehow this isn't pressure, only effective marketing and smart business. This isn't about being against the product itself, it is simply about the underhand ways the companies go about chipping away at our confidence and changing our attitudes.
Any breastfeeding mother will say that no sooner than they started to breastfeed, the questions and comments (often meant with love) come pouring in:
"How long are you going to be able to keep that up?"
"You need some rest, let's just give a bottle"
"oooh teeth, I suppose you're stopping now then"
"Why don't you just use a bottle when you're out?"
.....and so it goes on. The list is endless. Unfortunately, this IS pressure to formula feed. I hear it from mothers everyday and yet it isn't talked about in the mainstream for fear of causing offence.
However, this is increasingly a one-sided point. We constantly hear about unacceptable judgment sometimes directed towards formula-feeding mothers. But, what of the judgment placed on breastfeeding mothers and the staff supporting them?
In truth, they are being increasingly marginalised, scoffed at, silenced and sweepingly called highly offensive names such as 'breastapo' and 'breastfeeding nazis'. How is this even acceptable? It takes thought and guts to post a picture or a comment online, that implies you are enjoying breastfeeding and mothering in your chosen way and I believe this all to be so wrong.
"Fed is Best"
This is the most recent part of the dialogue and one which also can't be ignored. Of course babies need feeding. But fed is not best. It is simply necessary.
Nevertheless, the slogan is catchy and appearing to be effective in driving doubt and deflection.
Doubt into the biological competence of all women's bodies to be able to produce milk for their children and deflection from the significant body of evidence, accumulated over many years of research, that is available on how breastfeeding is in fact different to formula, not only in developing countries (as is often argued) but indeed, across the industrialised world as well.
Many headlines in the media that undermine the significance of breastfeeding, are taken from studies peppered with methodological issues. One of the most common of these issues are the diluted definitions of what constitutes their breastfeeding sample groups. This group has been known to include any babies who have ever been breastfed - that is, they are classified as having been breastfed, even if they only ever had, 1 or 2 breastfeeds! In such cases, it is hardly surprising that there are minimal (if any) differences found.
No research claims that breastfeeding eliminates ill-health....what it does do is alter the risk compared with non-breastfeeding. There will always be breastfed babies who are ill and/or grow up to develop disease and breastfeeding women who subsequently develop breast or ovarian cancer. As there will always be formula-fed babies who lead perfectly healthy lives and women who have not breastfed, who remain cancer-free. It is crucial to remember that the differences are significant across populations and not simply when pairing one individual up against another.
We should all have the right to be:
1. Given impartial and rigorous evidence-based information to make our own informed choices.
2. Respected in the individual choices we then make. Whatever they are.
3. Supported by professionals fully equipped to do the job and further supported by society at large.
This isn't happening nearly enough. So in the meantime, it is my hope for all mothers to at least know this:
It is not your fault if things don't go to plan.
Borra C, Iacovou M, Sevilla A. New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women's Intentions. Maternal and Child Health Journal. 2014;19(4):897-907.
Brown A, Rance J, Bennett P. Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing. 2015;72(2):273-282.
Vanessa Christie is one of the UK's leading Lactation Consultants and Early Parenting Experts. She is a speaks at large parenting events and regularly contributes to magazines and blogs. She provides online & phone consultations (and in-home consultations in West Kent/East Sussex) and early parenting workshops. Find out more here.