[Picture: just a stock photo of a very sweet looking baby].
I'm supposed to be writing a paper, but I just got an email with a link from the NCT and I liked it so much, I felt compelled to post about it on Twitter, but then I had too much to say for 140 characters, so I decided to write a blog post. Why did I feel so strongly about this email? How we feed our babies is such a tricky issue. There is a lot of guilt, shame and judgement floating about. Since I have started working on the philosophy of infant feeding, I've talked to a lot of women about their feeding journeys. I've heard women talk about feeling like a failure for using formula and of the devastating effects this can have on their wellbeing. I've heard woman feel unable to leave the house because they are too worried to breastfeed in public. I've heard women on both sides feeling unsupported and miserable. How we address this issue is so important for the well-being of women and babies. It made me very happy that the NCT got so much right. I think it is really important to highlight good practice. The email was the monthly NCT Matters. I get this email because like so many other parents, I joined the NCT in order to attend their antenatal courses before the birth of my first child. In the Editor's Welcome, it said: "Earlier this month, it was World Breastfeeding Week (1-7 August). We know everyone's experience of feeding their baby is different but support and reassurance is always important. We share useful tips and information about feeding for all new parents." [Click here to see the page.] Right from the start, they acknowledge that all parents need support. As you will see if you click on it, the link leads to a page called "Feeding: your questions answered." It contains a lot of helpful information about holding your baby when breastfeeding, expressing, but also a section called "Can You Tell Me About Formula?". The section begins by noting the variety of different ways of feeding a baby, exclusive formula, exclusive breastfeeding or combination feeding (both breastfeeding and using formula). This is important because combination feeders can feel invisible - as if they don't fit in either 'group'. They then reiterate their support and lack of judgment about how you feed your baby: "This is a personal decision and will depend on individual circumstances." This is really important. Women often feel as if they have to justify their decisions about how to feed their babies. You might feel as if other people are entitled to blame you for not breastfeeding unless you have a 'good enough' excuse. You might feel like you have to explain why you are 'still' breastfeeding. But you don't have to justify how you feed your baby to anyone. (For more on why there is so much mistaken judgment surrounding infant feeding see here.) Next they include the option of support through their breastfeeding helpline for those thinking of introducing formula because breastfeeding isn't going well. This is crucial because the UK has a massive 'disappointment rate - 8 out of 10 mothers who stop breastfeeding in the early weeks do so before they planned. (For good discussion of this, see here.) We seem to be in a very difficult position where two bad things happen. On the one hand, some mothers feel as if they have no option to use formula when this simply isn't true. In fact, some mothers complain that they are pushed to use formula as soon as they report any difficulty. On the other, many mothers feel as if they are pushed to keep breastfeeding and long for 'permission to stop'. It is crucial to support women so they do not needlessly stop breastfeeding before they want to while ensuring no mother feels that she isn't 'allowed' to stop. The next paragraph offers support to those who are 'thinking of introducing formula for other reasons'. There is a lot I like about this. First, it is wonderful to see acknowledgment that mothers can have other reasons that affect their decisions about how they feed their baby. This fights back against a tendency to assume that it is only okay to use formula if you are physically unable to breastfeed. I also like that there is an offer for practical support about how to use formula or to talk through the best option for your 'individual circumstances'. The implication seems to me to be that help is available if you want to discuss your decision to introduce formula, but, equally, you can just talk about how to do it without needing to justify your decision. There are also links to further pages on introducing formula milk and on combination feeding. The page on introducing formula milk has helpful information about what's in formula milk, whether there are different types and whether the brand makes a difference. This is so important because many parents report feeling uninformed and in the dark about formula. Now after so much fulsome praise, you might be wondering if this page is sponsored by the NCT. It's not. I'm also not on the NCT payroll. As I said above, my first experience of the NCT was as a pregnant woman attending an NCT antenatal class. I've also talked to several people within the organisation about infant feeding shame and guilt and am working with Heather Trickey from the NCT on a project to produce some resources to help people feel good about their infant feeding journeys. So I feel like I have some sense of how hard they are working on getting their infant feeding messages right, but that I'm not linked with them in a way that makes me biased. (Or makes this blog post speak for them.)
11 Comments
Melanie F
8/21/2017 11:17:14 am
Women have most choices when they've established breastfeeding. Feeling as though you've not got any choices is a big risk factor for feeling angry and disappointed in your experiences of feeding your baby. So we need to encourage both the NHS and all women to invest in exclusive breastfeeding for the first six weeks of a baby's life. After that, mothers will have overcome most hurdles and have a full milk supply - and that's a powerful position for them to make choices about what they want to do in relation to infant feeding.
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Fiona Woollard
8/21/2017 12:14:53 pm
Thanks for your comment. It looks like we have a lot of common ground but some disagreement. I absolutely agree that we need to support mums as they establish breastfeeding - and we need much more investment in this. But I don't think exclusive breastfeeding for 6 weeks is the best decision for all mums. Some mums may have other reasons, which they already know about, which mean they cannot or do not want to breastfeed. I do not think we empower these women if we insist that they breastfeed exclusively for 6 weeks before recognising their legal and moral right to use formula. I also think it is extremely important that we provide resources to support women who are formula feeding or combination feeding before six weeks. (You probably did not mean this, but 'concentrating on exclusive breastfeeding during the first six weeks' could suggest that we concentrate on exclusive breastfeed in the sense of not using resources to support other feeding methods.) Finally, from a very personal point of view, in my own case, giving my baby formula initially and a LOT of pumping and trying to feed, plus a wonderful NHS lactation consultant, was the route that helped me to move to months of only breastfeeding - and to years of some breastfeeding. I worry about the focus on exclusive breastfeeding - although I do recognise the dangers of the supplementation vicious feedback loop.
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8/21/2017 09:15:49 pm
I completely agree that it's wonderful that the NCT have written an inclusive feeding questions and answers page. It is a rarity to read, particularly from such a recognised charity and well known support network for new parents. I particularly love this article Fiona, as I feel you have used your valuable research to explain just how important it is to support all parents, no matter their feeding choice.
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Fiona Woollard
8/22/2017 09:14:21 am
Thanks for that very thoughtful comment, Holly. I agree that there is a danger that the comment about continuing to breastfeed could be hurtful for some mothers. However, I don't think it was quite as unnecessary as you suggest. I think it is aimed at combatting the attitude that breastfeeding has to be all or nothing and that once you've given a drop of formula, there is no point in doing anything else. One thing I liked about this page was that there was a section on formula within feeding generally, so it wasn't some completely separate issue addressed to a totally different set of mothers. So some mothers exclusively breastfeed, some mostly breastfeed with the odd bottle of formula, some mostly feed pumped breastmilk, some use mostly formula with a bit of breastfeeding, and some use just formula.
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Heather Welford
8/29/2017 05:22:18 pm
Thanks for these comments Fiona. The page you are complimenting (change your link, btw - it doesn't work from a non academic email) is I think my own writing - until last year I worked for NCT putting policy into written practice on the website and we totally overhauled the feeding info, in line with the new framework developed by the charity and overseen by among others Heather Trickey. NCT was well aware that our website was in need of careful updating especially on feeding, and it needed to reflect and respond to the needs of all parents. Alongside this we needed to correct myths, and to acknowledge the value of breastmilk/breastfeeding and the health effects of infant feeding decisions. You are quite right to say it's important to include info for mothers using formula alongside breastfeeding. They need to know their BF is worthwhile, too - the research is clear on this. Thanks for highlighting this work.
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Fiona Woollard
9/4/2017 03:23:24 pm
Hi Heather. Nice to meet you. As you can see, I really like your work. These are some very difficult challenges that you (and the NCT in general) are taking on: being inclusive and non-judgmental while recognising the value of breastfeeding; help fight the many myths which can lead to women giving up breastfeeding before they want to without making women feel they have to justify their decisions to stop. I thought that this was a really good example of how to combine those aims.
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Sarah McMullen
9/4/2017 09:42:16 pm
Hi Fiona,
Fiona Woollard
9/5/2017 02:03:21 pm
That's great. Thanks Sarah!
Sarah McMullen
8/30/2017 09:18:55 pm
Hi Fiona,
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Fiona Woollard
9/5/2017 02:05:00 pm
Hmmm. I did reply to you at the same time I replied to Heather, but it seems to have disappeared. Anyway, thank you, Sarah. I'm really glad you liked the blog. It's fantastic to see the NCT putting so much effort into this really important issue.
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