A broken culture: choice and shame

I read the articles on infant feeding this morning. I read the information from the Royal College of Midwives (RCM) too – and I cried. I’m an “infant feeding practitioner” rather than a breastfeeding supporter, because I support parents to feed their baby, whether with breastmilk or formula, that’s not my business. So I found all of this made me rage, but perhaps, not for the reasons you might think.  

My overriding impression was how very broken our culture must be for me to be seeing these headlines. What kind of culture do we live in where the RCM felt a need to tell midwives not to shame mothers? Where the media can take one sentence from a document and create an assault on midwives and breastfeeding advocates? Where the media’s concern is to create outrage, rather than inform, educate, or accurately report?

If “Breast is best” why the lack of breastfeeding support?

I think we are seeing symptoms of a much bigger problem, but I think there is a solution if we make it happen.

We live in a culture that describes breastfeeding as best. Our culture champions breastfeeding as something women “should” achieve. However, neither the public, professionals nor the government, actually practically supports breastfeeding. This problem leads to a culture where parents, mostly women, feel shamed for their choice to formula feed. And shamed for their choice to breastfeed. Or shamed if they try to breastfeed and “fail”. Oh, and shamed for the act of breastfeeding, both in public and in their own homes. This is clearly a broken culture.

I think we are seeing symptoms of a much bigger problem, but I think there is a solution if we make it happen.

We live in a culture that describes breastfeeding as best. Our culture champions breastfeeding as something women “should” achieve. However, neither the public, professionals nor the government, actually practically supports breastfeeding. This problem leads to a culture where parents, mostly women, feel shamed for their choice to formula feed. And shamed for their choice to breastfeed. Or shamed if they try to breastfeed and “fail”. Oh, and shamed for the act of breastfeeding, both in public and in their own homes. This is clearly a broken culture.

There should be no need whatsoever in any circumstances to tell a clinical professional not to shame their patient. I mean, is that really necessary? I am certain that we can all agree that shaming anyone’s choices is always completely unprofessional. It shows a lack of empathy, and is hugely damaging to the patient carer relationship, not to mention to patients self-esteem.

Informed choice is best

​Now, I think the way that the media has portrayed midwives and breastfeeding supporters today is unfair. I think the media has depicted them as bullies, and largely, they are not. Yes, I think there is a lot of pressure to breastfeed on parents in our society. When midwives are giving information about breastfeeding, which is necessary to make an informed choice, this pressure may feel overwhelming. But is this the fault of midwives? Many midwives are not breastfeeding experts. Often they have not breastfed themselves, living within our culture with low breastfeeding rates. Myths about tongue tie, latching, pain, thrush, mastitis, milk supply, when milk comes in and much more abound.

Why? Because whilst there is a policy of ‘promoting breastfeeding to increase rates, this isn’t supported by retraining and well-resourced specialist support. Instead overstretched midwives are expected to support parents to establish breastfeeding; whilst also caring for pregnant, birthing and post-natal people whilst chronically understaffed. I’m sure there has been occasion when midwives have taken either their passion for breastfeeding, or their commitment to pursuing the ever-changing targets too far. Let’s hope this guidance does indeed remind those few practitioners that women’s choices must always be respected. However, the vast majority are motivated only to inform women in order that they can make their choice powerfully.

The media: reporting the Infant feeding position statement

Back to the media. What happened today was that the RCM published a position statement on infant feeding. One sentence of this stated:

If, after being given appropriate information, advice and support on breastfeeding, a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.

Royal College Midwives Position Statement: Infant feeding

Now, this isn’t really a change in position, and it certainly didn’t require the media headlines we’ve seen today:

“Bottle feeding mothers must now be respected.”
​”Bottle feeding babies is a woman’s right – midwives told.”
“Midwives ordered not to judge new mothers.”
​”Midwives should no longer pressure new mums into breastfeeding.”

These headlines have, and were designed to, create a storm across social media. We are supposed to now argue about women’s rights, as if we don’t all agree. We’re supposed to argue about whether bottle or breast is best, as if there’s one answer for everyone. And we’re supposed to be angry and upset; to feel validated or vindicated; to be divided! Why? Because it makes the media a lot of money through sales and advertising revenue.

Formula feeding is without shame, but formula funding?

Whilst the choice about how to feed an infant is no doubt down to the parents, particularly the parent on whom the responsibility to produce the milk would fall, there’s still an issue here. We are asking medical practitioners to both promote and improve breastfeeding rates, and accept parents’ choices, whilst the governments and organisations, including, amongst other the Royal College of Paediatrics and Child Health receive significant funding from companies that manufacture breastmilk substitutes. Formula companies; for whom every parent that ‘fails’ to breastfeed or chooses to formula feed is a new client; fund the very individuals we want to promote breastfeeding.

Can anyone spell conflict of interest for me? Can you see the cracks in our feeding culture yet? Formula companies profit from the distress of parents who ‘fail’ at breastfeeding, midwives, and doctors profit down the line from funding donations. When the RCM officially states that informed choice should be respected instead of agreeing that parents have a right to choose, and a right to adequate support for their choices, which they aren’t getting, we get a media tirade against midwives. Midwives placed between the guidelines to promote breastfeeding, and the funding received from formula companies. So we have scapegoated the one healthcare profession that really tries to uphold a ‘woman-centred’ approach to care, in the rush to promote women’s choice.

I suspect there’s an agenda behind labelling midwives, who do their best given their training and resources to offer parents the information needed to make informed choices, as bullies.

Stop demonising parents: we need cultural change

Problem 1: work, work, work: economics of parenting

In our culture, we are expected to all work, to work hard and to work really soon after we have a baby. Maternity pay stops at nine months and many mothers go back to work much sooner than this. My maternity leave over 4 children ranged from 2 weeks to 9 months. If our babies are attached to us almost constantly in the first 4 months gradually moving away over years, how are we supposed to “have it all”? Separate from your babies as soon as possible. Get them into a routine. Make them self-soothe. Rather than meet their needs instead act against evidence that independence is forged through attachment. Live the life expected of us. The life we’re socialised to want.

​We’re also pretty disconnected from each other. Learning about infant feeding or parenting in general is trickier than it used to be when we had extended community support from people who’d been there and done it. Managing it without a village or group of friends for support is near impossible,

Problem 2: government sanctioned economics

Guess what. The government flipping love this culture. They created it. The idea that parents should get out to work to pay taxes, whilst spending a fortune on childcare for the privilege. Therefore helping childcare worker to ‘contribute to the economy’ too. Sounds great to us. We aren’t suggesting that working parents are a problem, but that raising children does have a value, and an economic value as well as a humanitarian one.

Problem 3: breastfeeding support requires long-term thinking

Now government policy only really cares about re-election. This means that looking beyond 4 or 5 year timescales is potentially funding a win that will fall in their adversary’s reign. Therefore, when we tell the government that REAL action to improve breastfeeding success rates, not just pressuring and shaming women and parents through ‘breast is best slogans’, will save the NHS millions over the next 30 years, they genuinely don’t care. However, economically speaking, the best approach to improving would be to spend money to promote real support and cultural change. The reason it doesn’t happen is because it requires governments to plan past their life span.

Problem 4: The media wants your money

See above, a furore caused by drawing a good old ‘us and them’ line benefits the media. They live and breathe by our arguments, our distress and no matter how biased or untruthful their coverage, we buy into it.

Problem 5: Formula companies want your money

I know people don’t love when I rant about formula companies but I don’t care. I love formula; it saves babies. I respect parents who make an informed choice to feed their babies formula; they know their situation and how to balance it. However, I hate formula companies because they exploit parents and purposefully use practices that endanger babies’ lives. They are unethical and they only care about profit margins. They will do or say anything to get you to buy their product.  

Read more about how formula companies created the Mummy Wars for their own benefit.

How can we change a culture?

1. Respect and value parents and babies equally

How about we live in a culture where women’s rights go without saying? A society in which we don’t need to be reminded that women have rights over their bodies.

How about we live in a culture that values the role of partners and fathers in ensuring a healthy family and that the rights of that family and its members are respected and protected. Where society supports partners to be present in the home for a longer period of time, taking pressure off new mothers and advocating for their family. Simple: provide much longer paid paternity leave.

How about we live in a culture that sees babies and children as human beings, who also have rights. Equal rights. A society that inherently considers what is best for the baby in the short and long term in equal proportion to considering the rights of parents.

​*Unfortunately it isn’t that simple to solve the problem in our society that prevents women and children having all the rights they deserve, but change is happening and we keep working.

2. Refuse funding that compromises integrity of health professionals

How about we live in a culture in which it is not acceptable for health professionals to be inherently biased against what is healthy due to the nature of their funding. Seriously. I cannot stress this enough. Simple: let’s make it illegal.

3. Educated health professionals

How about we live in a culture in which health professionals are fully educated in supporting the mode of infant feeding that has the most health benefits overall in each given situation. A society in which any minor problem with breastfeeding is not automatically determined a failure of the woman or of breastfeeding as an activity.  Where formula feeding is understood as a necessary alternative for some parents. Simple: Make lactation training and education mandatory for all Paediatricians, GPs, midwives and health visitors, and provide a team of infant feeding experts into every community to support parents with their choices.

4. Educated parents

How about we live in a society where, when we are becoming parents, we already have lots of knowledge about birth, parenting, infant feeding, and how to understand research and evidence. A society in which we, as parents, are less likely to have our power taken away from us when we are vulnerable, and are more capable of making our own choices without other’s influence as a factor. Simple: Teach teenagers about all aspects of becoming a parent, properly, in schools.

5. No advertising or promotion

How about we live in a culture where we make uninfluenced by corporations? A society that deems it unacceptable that vulnerable parents who need to use formula pay a higher prices for the products with different logos on it. We need a culture where it’s unacceptable for companies to subtly undermine a person’s belief in their body. The solution is simple, ban all advertising of infant formula. This has improved outcomes for mothers and babies in other countries.

“Why does it matter how people feed their babies?” I hear you cry

It matters because it save lives. I will say it again:

Breastfeeding saves hundreds of thousands of lives, for mothers, and babies now and in the future.
Formula saves hundreds of lives when it is needed. SO IT REALLY MATTERS!

To ensure our babies (and mothers) get the best possible lives (which is clearly what we all want) we need a culture that puts the needs of the mother and baby on equal footing to each other, and ahead of the needs of the government, the workplace or profits. If the mother cannot, or does not want to breastfeed, for medical reasons or emotional reasons, then that is balanced against the need of the baby to be fed, and to be fed the most suitable “food”.

Sometimes breast isn’t the right choice for some people, and it must absolutely go without saying that a woman has the right to choose what she does with her body. BUT if we openly and knowingly choose to sustain a culture in which women choose not to breastfeed because it isn’t the done thing, where women feel ashamed no matter how they feed their baby, we need to think about the fact that we have a broken culture.

By Emily Fackrell – Managing Director of CalmFamily