Last week, the Guardian published an open letter to new mothers from a Health Visitor. In a key paragraph, the Health Visitor says:
"You talk to me about breastfeeding. I want to tell you that, for some women, it just doesn’t happen. I also want to tell you that something so important now won’t feel so important in a few years’ time. Fed is best, regardless of how."
My Twitter Feed soon started buzzing in response.
Roughly half agreed with what the Health Visitor said. They were only frustrated that the Health Visitor doesn't say the things she wants to say.
The other half were deeply angered and saddened.
I can understand both reactions. There are big problems with this letter, but it is also partially right.
What Was Right?
It's right that for some women breastfeeding doesn't happen and that it is okay if you do not breastfeed. (More than that it is okay if you do not breastfeed whether this is because you can't or because infant formula works best for your family.)
Mothers have a right not to breastfeed. A mother should not need 'permission to stop' from her Health Visitor. Unfortunately, many women do end up feeling as if they are required to breastfeed - or try until a medical professional tells them to stop. I've written about why this might be here.
I think we can say that it is okay not to breastfeed - and your child is likely to be absolutely fine if you don't breastfeed - while accepting all the reasons breastfeeding advocates want to increase breastfeeding rates. We need to distinguish between (1) total effects overall a population of trends in behaviour and the risks for an individual; (2) relative risks and absolute risks. Increases in breastfeeding rates make an important difference at the population level, but this doesn't mean it's risky not to breastfeed for most individual babies. In addition, reports about breastfeeding often discuss relative risk, but if the baseline risks are small, this can mean that 'doubling your chances' doesn't lead to a big absolute risk. And of course, 'Is it okay not to breastfeed?' is a very different question than 'Is breastfeeding worth doing?', so there might be lots of reasons that make breastfeeding worth doing while it is still true that it is absolutely fine not to breastfeed.
I also recognise that breastfeeding can be lifesaving in some conditions, for example if there is no access to clean water or so little money that parents end up watering down formula. But if that is the case then it is not the lack of breastfeeding that we should focus on. It is the scandalous situation that the parents don't have access to clean water or enough money to feed their family.
What Was Wrong?
The letter gave a lot of people the impression that the Health Visitor thinks breastfeeding is not important. It's wrong to think that breastfeeding is not important. Breastfeeding is important to a lot of women. If it is important to them, it should be important to us.
Mothers have a right to breastfeed. (Well technically, the mother-baby dyad has a right to breastfeed. You wrong both mother and baby if you violate this right.) This includes a right to support that is needed to overcome difficulties.
It's also wrong that what feels important now won't feel important in a few years' time. When feeding experiences go badly, this can deeply affect mothers' experiences of those first weeks and months with their babies. Women can carry this with them for years. It can continue when their children are thinking about feeding their own babies, and affect their children's experiences. (Heather Trickey uses an extremely vivid example to describe this phenomenon here.) Here it isn't so much how the baby ends up being fed that makes the difference but whether the mother ended up feeling supported, listened to, and at peace with her feeding journey.
One thing that can cause lasting pain is feeling guilty or that others are judging you. (This is the problem the anonymous HV is trying to solve.) However, it can be equally bad to feel as if you were brushed off, told that it didn't matter and that you should 'just give a bottle', when what you wanted was support to continue - or at least all the information to make the decision for yourself.
I think that many people are angered by the HV's letter because it reminds them to those experiences of being brushed off. If breastfeeding is important to you, it is heartbreaking to think that you could have done it, if only you'd had the right advice and support at the right time.
I have something like this regret myself. After my first baby was born, I had to have an epidural and surgical repairs. (That's right folks. I got the pain relief after labour was all finished.) We were separated during this time. After the surgery, it was very late and I was put in a ward with my baby in a cot by my side. I could not walk. I could not reach her. I wanted to try to breastfeed, but everyone was busy and I didn't want to be a bother. By the time I got to try and breastfeed, she was so weak that she could not latch. It took a horrible time of pumping and trying to feed round the clock, a lovely lactation consultation, months of nipple shields, and lakes of tears from both me and the baby before feeding finally clicked. It clouded a lot of the beginning of motherhood for me.
I am convinced that if I had had the confidence to ask for my baby to be brought to me after birth, I would have avoided all that heartbreak. And I will probably always be upset about that. Because it could have been better if I'd had better information.
It's Not Easy To Get it Right
Some mothers need their health visitors to simply tell them it is ok not to breastfeed. Some need to be supported to continue. Some won't end up breastfeeding but need to feel like they have been given all the help and information they need. It's hard for a Health Visitor to tell the difference - especially when they are, like all health professionals, overworked and underpaid. But it is important and it starts with listening to each mother.