If women are not supported, and educated in their choice not to breastfeed, both mother and infant are put at risk. The realization of this risk may result in future hospital admissions. If the correct preparation and storage of infant formula is not followed, infants are compromised from bacterial infections, diarrhoea, hypernatraemia or hyponatraemia or under nutrition. Mothers who do not breastfeed and do not feel they were supported in their choice are also at risk. The potential risks for the mother involve feelings of guilt, anger, worry, uncertainty and a sense of failure.
Within its recently updated statement on breastfeeding, the American Academy of Pediatrics (AAP) issued a plea for universal adoption of the Baby Friendly Hospital Initiative (BFHI). If you’re interested in my thoughts on the BFHI, click here, but here’s the Cliff’s Notes: While I love the idea of better support for breastfeeding in theory, in practice, I do not think these “10 Steps to Successful Breastfeeding” will be all that successful. More urgently, I’m concerned for the parents who have made an informed choice to formula feed, and for the women who go in intending to breastfeed, but who have an unexpected, dramatic, physical or emotional reaction to the act itself (i.e., D-MER, flashbacks of sexual abuse, nerve damage). And I’m concerned for their babies. Because if formula feeding parents are not given proper support and guidance, mistakes can be made, and there can be serious consequences.
That said, I was pleased as punch to stumble across a study entitled “Women’s perceptions of their healthcare experiences when they choose not to breastfeed”, which was published in the March 2011 edition of the journal Women and Birth. “The purpose of this study was to explore the postnatal
experiences of women who do not breastfeed and to gain an understanding of women’s perceptions of their care and support in their choice not to breastfeed their baby. The research focused on a group of women who are representative of those who have made the decision not to breastfeed by the time they are discharged from hospital. This demographic is often excluded by the current health care focus on
breastfeeding,” the study begins. While this qualitative research study only examined a small group of women in one hospital, the authors speak to significant need for further exploration of this topic:
Once I’d pinched myself sufficiently to ensure that this wasn’t just a fantasy – that there was actually a published study which not only acknowledged formula feeding mothers as something other than truants or morons, but also addressed a very real, and very current need for formula education – I contacted the lead author, Lisa Wirihana. She very kindly agreed to answer some questions for us about her study, as well as offering some thoughts on the BFHI and how formula feeding mothers are being approached. I hope Lisa’s work will begin a healthier conversation about how breastfeeding can be encouraged and protected without throwing the formula fed baby out with the bathwater.
FFF: Why did you become interested in this topic?
LW: When I had my children, I breastfed, because that is what my mother and sister did and what I thought I should do. I enjoyed breastfeeding, and I did not experience any problems with it. I had friends who bottle fed their children and I was interested in their stories of how they felt they were treated. Many years later, when I was working nightshift as a midwife on a Maternity ward, one of the other midwives came into the office. This midwife was concerned because she had just spent a lot of time with a bottle feeding mother who had been upset by what she called ‘breastfeeding nazi’s’. At the time I was studying for a Master of Nursing and was searching for a topic for a research project. I was really interested in the topic, because for me, I think it is a matter of equity. All mothers and babies should have their needs met, regardless of their choice of infant feeding.
FFF: How is the system currently affecting women who decide not to breastfeed? What are the possible detrimental effects of the current status quo, both to mothers and babies?
LW: I think it is important not to underestimate a woman’s desire to be seen as a good mother. When women are made to feel that they have made a poor decision regarding infant feeding it puts them at risk psychologically. By not arming a woman with the correct information on how to sterilize feeding equipment and how to make up a formula safely, babies are being put at risk for gastrointestinal illness and other forms of sepsis.
FFF: Did your findings support your initial thesis, or were you surprised by what you discovered?
LW: When I started interviewing women and asking them to describe their experience with bottle feeding in a maternity hospital setting, I was actually surprised by one factor. Almost all of the women really liked the hospital and really liked the care that they had been given. They expressed a great respect for most of the midwives. In the next breath they would say that they got no information about how to make up a bottle and were not permitted to obtain their own bottle from the milk room. They felt that they were not supported in their decision to bottle feed. I am surprised that those two factors can go together.
As far as the need for more teaching and support and the desire not to be pressured into feeling like they should breastfeed, I was expecting those results.
FFF: Did you speak to any healthcare workers while conducting your research? What was their take on the situation?
LW: I had a mixed reaction. There were some midwives who were very in favour of the research and even helpful to find participants and show me posters that they were concerned with. There were a few that were less helpful. I was told subtly that I needed to be careful as midwives who appear to be pro bottle feeding could be at risk of losing their midwifery registration.
FFF: In your opinion, how do you think healthcare providers should approach the infant feeding decision? If a woman has expressed an interest in formula feeding, how should this be handled?
LW: I think when a woman expresses the desire to formula feed a gentle questioning of what her reasons behind that decision should be explored. It may be from lack of information that the decision has been made. If the woman fully understands and can make an informed decision to formula feed, (for reasons that are important to her) all efforts should be made to support her in that decision. This should include documentation that she has made an informed decision, so that she does not need to be questioned again.
FFF: How has the BFHI changed women’s experiences in the hospital?
LW: I believe the introduction of BFHI has had an effect on women’s experience. For breastfeeding mothers, I think that effect is a positive one. Much more support and education has been developed to promote, protect and support breastfeeding. For mothers who are bottle feeding, I believe there has been a less than positive effect. All information regarding formula feeding is seen as a risk to mothers who are breast feeding. The policy is that no breastfeeding mother should be exposed to anything related to bottle feeding. This has had an effect on the treatment of all mothers. I believe that not only is this detrimental to the psyche of bottle feeding mothers, it also contributes to the lack of knowledge that they receive. However, it must be said that BFHI guidelines clearly state that once a woman has made a decision to bottle feed she should be educated and supported in that decision. I think there are variations on how that is interpreted. Also, the promotion, protection and support of breastfeeding is incredibly important. However, that should not be done at the detriment to those who do not breastfeed.
FFF: Has this study been well received?
LW: The study has stimulated a lot of discussion. If it achieves nothing more than making people aware of the needs of bottle feeding mothers, it will have been a success.
I want to thank Lisa once again for participating in this interview. She tells me she is currently looking to enroll in a PhD study to examine the culture of infant feeding within western society, and I seriously hope that she continues down this path. We need more people with this level of sensitivity, nuance and intelligence contributing to the infant feeding discourse.
And what about you, FFFs? How would you envision a truly baby – and mother – friendly hospital operating? How would you have wanted to be approached by healthcare providers when it came to your feeding decisions (or lack thereof)?