Tamara Ecclestone, breastfeeding, and how it feels to see representations of love that you’re unable to give

Last week I was interested to see a picture of celebrity Tamara Ecclestone pop up on my newsfeed.

 

Source: BBC. http://www.bbc.co.uk/news/amp/38932320

Source: BBC.
http://www.bbc.co.uk/news/amp/38932320

Tamara was shocked. Shocked and saddened that her valiant attempt to normalise breastfeeding through a stunning photoshoot had not been received with the blanket adulation that she had expected. More than that though, for Tamara there is nothing but love in the images and it’s such a shame that it brings out anger in some of you it’s sad for you that that’s how you choose to live.  Personally, I think that love may well have been the order of the day, but there were also probably more scatter cushions than there were in the John Lewis Christmas sale this year.

I don’t know why she would expect blanket adulation because my experience of being a woman and having access to the internet has shown me that I could post an image of a packet of crisps with a vagina and somebody would try to concern troll over what birth control it was using.  Post a picture of breastfeeding and you are guaranteed to uncover that very special type of person who is mortally offended by a nipple.  This is annoying and these people deserve to be treated as the newts that they are and I delight in doing so. However, the four of five newts come with legions of likes, shares and messages of support, as I’m sure Tamara’s PR team know well.

The thing is, we’ve seen these images before, Gisele did it, [here]. Body confidence advocate Tess Holliday used the women’s marches two weeks ago to do it [here] and this week, it’s Tamara’s turn [here].  All of these images have striking similarities.  We see beautiful, wealthy, white and glamorous women gazing off into the distance while effortlessly nurturing wide-eyed babies (scatter cushions optional).  These women are professionals at re-packaging our bodies as an ideal and selling them back to us, they have a team of PR execs and agents to help them in their quest for self-promotion and this is exactly what’s happening here. Usually we are allowed to be angry about the lack of realism and unattainability of things like the thigh gap, but here the product is breastmilk and it’s different rules.

In the UK, 81% or women initiate breastfeeding whilst they are in hospital.  Given that figure, it’s hard to keep a straight face when someone tells you that seeing someone breastfeed is some sort of revelation, but they do.  By the time the baby is six weeks old that figure falls to 55% and by six months, it’s at 1%.  Of those women who stop breastfeeding, 80% of them desperately wanted to but could not. These women have internalised the mantra breast is best and they’ve given it everything they’ve got but come away feeling like abject failures when their breastfeeding dreams didn’t come true.

For them, when they see an image like that with the words powerful demonstration of love and nurturing it feels like a kick in the teeth. As I imagine it does for those among the 20% who don’t attempt to breastfeed because they’re transgender or survivors of sexual violence, on certain medications or adoptive parents, or because it simply isn’t the best choice for their family.  For those parents all they can hear is:

A powerful demonstration of love and nurturing THAT YOU CAN’T GIVE.

That you can’t give, written as if by sparkler; bright, hot, fleeting and gas lit. Or worse, that you are too selfish to give. Of course there is anger.

The late John Berger wrote a lot about advertising and how it works.  To skim it, a good advertising campaign creates a tableau that we all recognise subconsciously to some extent, like the Madonna and Child. You foreground a product of lifestyle that is difficult but perhaps not impossible to imagine yourself attaining, this creates envy.  Then you distribute it far and wide. If it’s something that everybody can have it simply won’t sell as either an image or product.  I mean I love my Henry the Hoover, it never lets me down. I’m never going to make it look like Tamara makes breastmilk look because it is so very mundane and attainable.

If you haven’t yet read Berger’s book Ways of Seeing then you should, because he also makes the point that:

“[P]ublicity turns consumption into a substitute for democracy. The choice of what one eats […] takes the place of significant political choice. Publicity helps to mask and compensate for all that is undemocratic within society. And it also masks what is happening in the rest of the world.” [Berger: Ways of Seeing, p. 149]

 

Tamara and her photographer’s image, and those that came before are the epitome of the genre. Glamorous and unattainable, always just slightly beyond reach.  Why? Because for all of the hashtags and so called ‘normalising’, they do nothing to address the structural inequalities that mean that none of us really gets to choose to live the way we would really like. They are publicity as a mask.

The NHS is struggling and with maternity services, according to the National Health Executive report of January 2017, disturbingly high numbers of women are experiencing so-called ‘red-flag’ events.  What are ‘red-flag events’? They’re events that happen because we simply do not have enough care for women, even to the point that of women not receiving one-to-one care during established labour. If we can’t even ensure that women have that level of care when they’re giving birth can we hope for better during the post natal period and with breastfeeding support? No prizes here for guessing that no, we can’t:

During the post natal period, women were most likely to express disappointment with their experience in the postnatal wards and breastfeeding support. (Source:  National Health Executive report of January 2017)

On occasions where we have actually spoken to women who found themselves unable to breastfeed over dismissing them as bitter and hateful trolls, we find that something like 80% cite pain as a key reason that they were unable to continue. If a mother simply cannot get the help that she needs from a dedicated professional then she cannot continue.

Since 2010 the UK has faced austerity and whether or not you agree with the necessity, in March 2016 the Women’s Budget Group found that women are hit harder than men and households headed by women such as lone parents […] are hit harder. What does this mean for mothers? It means cash in hand, manual labour jobs where you can’t have your children with you. It means no maternity leave because you’re restricted to short-term, temporary contracts. It means not being able to afford the bus fare to get to the doctors when you have mastitis or to pay for the prescription for medicines you might need to treat it. It means choosing between heating and eating. It means that having the time, energy or will to go through the pain of establishing breastfeeding may well not be at the very top of your agenda.

If you do have a job that you are able to go back to, there is unsurprisingly yet more bad news. The House of Commons committee on Pregnancy and Maternity Discrimination, tells us that not only is there more discrimination reported now than a decade ago, but also there is no legal duty to provide a place to breastfeed or store milk. So even women who are able to afford the highest levels of childcare may not be able to continue to breastfeed their babies until two years of age.

These images are beautiful and modern reinterpretations of the Madonna and child tableau, chic and classic, but they do nothing to address any of the challenges faced by women today. baby-jesusEven if women in their droves started saying that had they just seen one more photo they could have breastfed on, I don’t know if this one would really help. We already know that wealthy, well-educated and thirty something are more likely to breastfeed, it’s already normal. Most of us could only dream of owning that many scatter cushions in a lifetime and one of her shoes could probably cover at least a month’s rent. As a twenty-two year old, pregnant dropout who just couldn’t get her breasts to co-operate, the only thing that image would have done for me is amplify my failure on every single count.  With the benefit of hindsight, and good research, I now know that I’m not alone.

 

Breastfeeding a new baby is already normal, breastfeeding a two year old has yet to become the norm. When every parent has the luxury of choice over how and for how long they feed their babies, it most likely will. Papering over the cracks with a few Instagram snaps and calling your critics angry and bitter isn’t going to cut it.  We need to meet every obstacle head on. We need to treat our fellow parents with empathy.  Above all, we need to support each other.

#ISupportYou.

Stephanie Maia is a UK-based writer for FearlessFormulaFeeder.com and the #ISupportYou movement.

Infant feeding the second, third or nth time around

by Stephanie Maia

 

In the time that I have been lucky enough to be a Mother, nine years to date, I have learnt two important things:

  1. It doesn’t always go to plan
  2. When you think you know what to do, it all changes

The first one of those I learnt bitterly in August 2008 when my nipples turned to meatballs and my baby wasn’t the only one in tears.  Breastfeeding.

Despite going to all the classes, reading all the books and trying my absolute hardest, my nipples almost immediately disintegrated before my eyes and I felt the burning shame of inadequate motherhood.  Or so I believed, given the amount of lactivist (can I swear?) ‘literature’ I had hungrily consumed during the nine month incubation period.  None of the books told me what to do if you accidentally gave birth to a cute, pink, starving but gummy piranha, they only talked about babies who softly do breast crawl until they bring their Cupid’s bow lips bouncing to a perfectly aligned nipple. Le sigh.

As it turned out, despite horrible treatment from cruel midwives who unceremoniously ditched me at the fist whiff of a bottle (it’s a ‘slippery slope so I may as well as not bother’ apparently). Working my own way through agonising thrush (‘If it hurts you’re doing it wrong’, no, if it hurts something IS wrong and you need support and love), I ended up combo feeding for well over a year.  The hurt and shame from those early weeks stayed with me though and over time they turned to anger and the anger to bona fide keyboard warrior status. No woman will be shamed by a lactivist on my watch.  I found my home as a Fearless Formula Feeder.

Roll on 2013 and I was there again with baby number two, still angry, still ready for the fight.  There was absolutely no way on this earth that I was putting myself, or my baby, through that again.  My beautiful little piranha had turned into an incredible four and a half year old and that was in part thanks to amazing science milk.  I had the bottles and I was not afraid to use them.

What happened this time then?  Well, this is where I got to lesson two, when you think you know what to do, it all changes.  This baby arrived and was that baby that I’d read about. She did the breast crawl and then latched with all of the elegance something that’s just emerged from the unmentionables under a spotlight possibly can.  Within five minutes of birth she became the ‘enthusiastic feeder’, clunky nickname but it’s stuck I’m afraid, that we know and love.  I’m not even going to get into the arrival of number three, but you can guess that we get a very different story again.

So, after an emotionally draining first feeding experience, and knowing that babies are more fickle than even politicians, how can you plan for a smoother ride next time?

Tip #1: Find your tribe

If you’re reading this, you’re online and you’re on a parenting-related forum so this definitely relates to you.  Find your tribe.  There are hundreds and hundreds of social media groups, birth boards and twitter feeds that you can follow out there.

Okay, maybe not THIS tribe, but you get the point…

Find one that speaks to you, like-minded people, people who support you and your parenting style.  Don’t waste your emotional energy worrying about that sanctimom who pops up at 2am to remind everyone of how great she is tandem feeding her kids AND her kittens whilst donating to the local goat bank, running a marathon and making banana bread (organic, for-the-win).  Not worth it.  Maybe you don’t need an echo chamber either, what you DO need though is supportive and helpful advice that fits with your parenting style.

Tip #2: Talk it out

Get to grips with what went on last time. Find a doctor, psychiatrist, counselor, therapist, friendly ear, plant or whatever you need.  Just talk out what happened last time.  You went from being responsible for finding at least one Maccy D a day to maintain life yourself (I’m working on minimums here) to being solely responsible for the nutrition of a temperamental and dangerously teeny tiny and beautiful creature, it was always going to be emotional.  You owe it to yourself to go through that and understand what happened. It’s valid and you’re worth it, and you have to do it all over again so get that emotional spring clean.

Tip #3: Make a Plan

Ask yourself what you want to do and put lines in the sand.  If you have absolutely no desire at all to dip your toe into breastfeeding ever again then proudly write that down.  If you don’t know yet, but you’ll see how you feel on the big day, pop it into your notes.  If you decide that you do want to try again, then absolutely try again but absolutely draw some lines in the sand.  Mine were that if I reached for the pump because it was too painful to feed or I found myself dreading her little eyes opening because it would mean the pain of feeding, formula.  If your plan is that you’re not ready to make a plan yet, go to step numbers one and two and wait until you’re ready.  Get your partner on board and prepare those laser eye daggers for any stray lactivists; you are informed and ready and it’s your body.

Tip #4: Remember your body is not a symbol

This is a really tough one because what we do and how we parent is, or becomes, a marker of our identity in many ways, see point one.  However, you need to remember that what you do with your body is not a political statement of any kind, it’s not a symbol or your moral worth, it is your body.

I am a Fearless Formula Feeder even though I haven’t formula fed in eight years and breastfed two subsequent children. What I do with my breasts is nothing to do with how I feel about a woman’s right to choose what she does with her body. You can be an environmentally aware vegan and formula feeder and so on and so forth. The way in which we use our reproductive organs on an individual basis is personal, our bodies are our own, not symbols.

Tip #5: Draw a timeline

Imagine your bump as baby and beyond. Go to thirty two years old if you feel, wild.  Then divide the line into months, then plot on what six months looks like or even four and a half.  Tiny. We don’t sweat the small stuff here at parents HQ, feed the baby with love, that’s it.

Tip #6: Look at what you’ve already achieved

Look at you soon-to-be eldest, look how healthy and happy and loved they are.  Think about all the times you’ve looked down on their sleeping faces and flushed cheeks. You can do this, you don’t need some person on the internet to tell you otherwise.

In case yours aren’t at school age yet, by the way, guess what isn’t number one topic in the playground? Oh yeah, breastfeeding.  Whether you’ve managed to build a nativity themed puppet theatre from a shoebox with ten hours’ notice and made pastéis de nata for thirty-eight plus parents along with Portuguese national dress costume, another matter. 

Tip #7: Repeat the Mantra

My body; my choice.  

My body; my choice.

My body; my choice.

My body; my choice.

Tip #8: Use your experience

You’re about to go from Bambi in the woods to Merida from Brave in the feeding world, very soon you will have aced it with keeping two small and demanding creature nourished. You’re an expert.  Harness the power of the SuperMum by looking out for that first timer struggling on their first outing to a café, a friendly word and knowing look could make the world of difference. There could be some Mum on a forum, somewhere in the world, crying into her dressing gown about something some emotional amoeba has said about infant feeding on the internet.  Be that Mum who says “been there, got that, tear free dressing gown now. You’re a star”.

You might feel like this, but it’s not forever.

Let’s be powerful about this, build each other up and get the message out there.

Tip #9: Enjoy your baby

How not to cliché 101 but….‘it goes quickly/time flies’. There, I did it.  

Whatever happens next, however that baby reaches your arms, savour and treasure those days for yourself. When I look back on those first few confusing days I have one single regret, that’s the names that I called myself and the tears that I cried over feeding.  Don’t go there, especially not twice and especially not over something like feeding.

You’re amazing, you’re informed, you’ve done it before and this is YOUR time, enjoy it.

 

When hospitals are overly aggressive about breastfeeding promotion (Guest Post)

A guest post by Yunyan Jennifer Wang, doctor cheap Ph.D.

We’re reminded constantly that ‘breast is best’. The ads plaster the Metro, viagra 100mg hospital walls and my Facebook feed. Breast milk is touted everywhere these days as liquid gold, the ambrosia of life granting a sacred bond between mother and child. So of course when I was pregnant with my first child in 2015, I planned to nurse my baby. I took the classes, bought milk freezer trays, researched gear in preparation to milk myself at work for the next two years, per WHO recommendations. However, six days after the birth of my child – I changed my mind.

Baby Aria was born via emergency C-section after 22 hours of labor at Johns Hopkins Hospital with a mild case of jaundice – a condition that commonly affects babies of Asian and African descent. As a rookie mom, so I consulted every nurse and lactation consultant who came through the door. I gathered lots of advice, even though some even seemed to conflict with one another. With each new nurse shift, my list of instructions grew longer until I was nursing for 40min, followed by pumping for 30min, repeated every 2.5 hr. Exhausted, I asked a nurse when I was supposed to sleep during all of this, she replied something all new mothers have heard and loathed – sleep when the baby sleeps (but you just told me to pump after nursing?). During the next four days, baby Aria had alarmingly few wet diapers and alternated between being with me and going back to the nursery for 24-hr light therapy sessions to treat jaundice. Throughout this time I was reassured that I was “doing a great job”, that nature had taken its course and my bleeding nipples were ‘normal’ according to one inexperienced nurse.

"Pregnant Alice down the rabbit hole of motherhood"

“Pregnant Alice down the rabbit hole of motherhood”

It seemed that baby got sick each time she came back to me. On day four, an inquisitive nurse weighed Aria before and after a long nursing session, confirming my nagging suspicion that she wasn’t getting any milk from me (<5g weight difference). I had come face to face with the fact that I had starved my child for three days, exacerbating her condition by dehydration. I thought this information would bring change to our care. But nothing happened. I would have felt better if a doctor came running in shouting – “Breastfeeding hasn’t been working for you!” Instead I was urged to continue as I’ve been told and I was still ‘doing a great job’.

On the eve of day five, we are still at the hospital due to her unrelenting jaundice. Severe sleep deprivation from pumping endlessly, cliff-diving hormones combined with guilt from harming my newborn created the perfect storm leading to a breakdown. I couldn’t understand why no one around me responded to reason, to empirical evidence. I lost faith in my healthcare providers’ judgment and my body’s ability to function like a mother. My head buzzed and my legs shook at the mere mention of breastfeeding. I stopped everything I was doing and asked to see a psychiatrist.

In the last 30 years, US hospitals have heeded the call to arms by the Surgeon General to promote breastfeeding. This includes the Baby-Friendly Hospital Initiative, a campaign launched by UNICEF and the WHO in 1991. This 10-step program includes posting breastfeeding literature in hospital rooms, training staff to support breastfeeding, giving other no food or drink to nursing infants unless medically indicated and giving no pacifier or artificial nipple. While these steps are well-intended, there is very little science behind these guidelines.

 

When anxiety became incapacitating, we decided to go for bottle-feeding. We were given dire warnings about nipple confusion, which could seal an infant’s fate to the bottle. A meta-study from last year[1] examined 14 studies on ‘nipple confusion’. Firstly, this is not a medical term. Secondly, it’s a misnomer since babies are less ‘confused’ than prefer the bottle, which is likely an indicator of difficulty and stress associated with nursing. The authors contended, “despite the limited and inconsistent evidence, nipple confusion is widely believed by practitioners” and concluded that causality is difficult to establish in these studies. JHH includes an Avent pacifier in every welcome packet, technically violating the initiative guidelines. Their argument is that pacifier use may help to prevent SIDS, as suggested by research from the APA [2]. So who is the authority on these topics? UNICEF? The CDC? Individual Hospitals? Medical studies? If some of the guidelines for the Baby-Friendly Initiative are outdated, shouldn’t there be review and revision for such a pandemic program?

 

All controversies aside, in our case the JHH staff continued to encourage nursing – which was in fact not working, while it was clearly medically necessary to feed my child somehow to prevent potential brain damage from jaundice. I agree that breastfeeding is ideal if possible. This is a mother’s choice. However in a hospital setting, if healthcare providers choose to ignore clinical signs to pursue political agendas, there is a conflict of interest. For us, the very thing that was supposed to provide nursing support instead endangered my child’s well-being and contributed to my not being able to nurse at all. I believe this was never the intention [3] of the hospital. Given a choice today, I would have traded my swanky single room for an L&D environment that hosted group nursing activities supported by lactation consultants and local support groups.

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Pushing for breastfeeding is deeply ingrained as our healthcare legislation. While I am a strong supporter for Obamacare, subsidizing just breast pumps at the hospital is unfair since it excludes a significant group of parents – such as GLBT, adoptive families, and those unable to breastfeed due to tongue-tie, latch issues, inverted nipples, medication and countless other reasons. A free breast pump isn’t always the answer when alternatives such as subsidized formula and milk banks are not accessible to all families. Ideally, all parents will have reasonable family leave (at least three months or past the ‘fourth trimester’) and there will be no stigma against working mothers taking several hours a day to pump at work. This is not yet the case in America. While we need to make those changes happen, it’s important to keep in mind not every family has a lactating mother overflowing with milk. We need to give help to all parents because all babies need to eat.

 

It’s been nine months and Aria is a spunky little girl who spends most of her mornings chasing after our cat at a steady crawl. I have been off meds for post-partum depression for 3 months and life is finally starting to feel normal again. I have talked to many local moms in Baltimore and discovered more than a handful of us feel bullied at the hospital and ended up feeling inadequate or had failed. On my morning commutes, I talk to Aria’s daycare teachers, Metro train conductors, coffee shop clerks and medical professionals. I realize it’s a huge challenge for moms at these presence-demanding jobs to can step away to pump for 30min every 3 hours in a private room in order to maintain an adequate milk supply. We all want to give our children ‘the best’, but what happens when this is not possible? If we are graced with #2 some day, I will prepare myself to nurse again. But if it doesn’t work out despite my best efforts, taking up the bottle certainly won’t be the end of the world this time around.

 

Jennifer is a neuroscientist at Johns Hopkins School of Medicine.
Sources
1. Zimmerman E, Thompson K. J Perinatol. (2015) Clarifying nipple confusion. Nov;35(11):895-9.

2. American Academy of Pediatrics Task Force on Sudden Infant Death S. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005; 116(5): 1245–1255.

3. Bass JL, Gartley T, Kleinman R. Unintended Consequences of Current Breastfeeding Initiatives. JAMA Pediatr. 2016 Aug 22

 

The Mental Health Benefits of Formula Feeding – a Guest Post by Anna Glezer, MD

I’m so thrilled to be able to bring you the following guest post, from Harvard-trained clinician Anna Glezer, MD.  Dr. Glezer holds joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center, and recently launched a new website, Mind Body Pregnancy.

Enjoy!

-The FFF

The Mental Health Benefits of Formula Feeding

A guest post by Anna Glezer, MD

 

In my clinic, I have spoken with many women who struggled with the decision about how to best provide nutrition for their baby. I remember Cindy, a new mom who had low milk supply postpartum and supplemented her baby’s diet with formula, who expressed feeling inadequate as a mother. I remember Sarah, a second time mom who was taking medications that led to her decision not to breastfeed and the difficult time she had making that decision for herself and her baby. I remember Anne, a woman who felt judged by her peers and even strangers in the street when she would bring a bottle out to nourish her crying child.

As a new mom, you may have heard repeatedly from various clinicians, other parents, and perhaps even random strangers about the benefits and importance of breast feeding. However, not all women are able to breast feed and this article is for you. After reviewing the reasons when formula is the right choice and the negative feelings many women experience when making it, we will discuss all the emotional benefits of choosing to formula feed your baby.

Reasons When Formula is the Right Choice

There could be a wide variety of reasons for choosing formula:

– When taking certain medications that can be harmful through the breast milk. These may include medications for conditions such as multiple sclerosis, certain types of cancer, HIV, or others. Women taking medications for mental health reasons (such as certain mood stabilizers) may choose not to breastfeed because of a lack of data at this time on safety.

– When sleep is a significant issue. For women with bipolar disorder, poor sleep is a common trigger for a mood episode. For women with severe illness, the risks of poor sleep may outweigh the benefits of breastfeeding.

– When breastfeeding causes pain to a degree beyond what is typical. This may be due to medical complications such as recurrent mastitis.

– When breast milk supply is poor (due to a multitude of underlying reasons).

– When breastfeeding is not an option due to a woman’s medical history, such as a history of breast cancer and subsequent surgery.

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The Feelings of Many Women Choosing Formula

Women who initially planned to breastfeed but for whatever reason cannot often go through several stages of feelings:

Guilt – Many women describe feeling like a failure as a mother and guilty for being unable to provide breast milk for their infant. I have had women describe this when they are supplementing with formula and when they are exclusively formula feeding, when they are using formula temporarily and when it is for months.

Anxiety – Moms describe feeling worried about their infants’ future. Am I providing my baby with the best possible start? What about my baby’s health?

Shame – While guilt is the feeling you place on yourself with responsibility, shame is what you feel when the judgement of others falls upon you. Women have told me that their parents, partners, clinicians, friends, and acquaintances have made them feel ashamed of their choosing to formula feed their infants.

Depression – Postpartum depression affects 15% of moms, and difficulty with breastfeeding is a significant risk factor.

Grief – A grieving process is not unusual after a significant loss. In this case, the loss is the expectations a mom may have had about what postpartum will be like and what breastfeeding will be like.

How to Manage These Feelings: Looking at the Emotional Benefits of Formula Feeding

Once the decision to formula feed is made (and this is often not an easy decision to make, requiring careful weighing of choices, hopefully with the support of a partner and nonjudgmental health care professional), the next step is managing all those feelings mentioned above that come with that decision.

Recognizing all the positive mental health benefits of formula feeding can help you achieve this.

  1. First, one of the main reasons breastfeeding is considered so important is that it is an essential time of bonding between mom and baby. This doesn’t change with formula! This benefit remains regardless of what the baby is drinking. The key is in how the baby feeds – in mom’s arms, in a loving, strong embrace, looking into mom’s face and seeing her love. This attachment time between mom and baby leads to healthy bonding and positive well-being for both.
  2. Second, formula feeding can help moms work on their emotional wellness by providing them with flexibility. That might mean that while the partner feeds baby, mom has the opportunity to attend an exercise class, go to a therapy appointment, or call a supportive friend. That might also mean that mom can share night-time duties with her partner or others, allowing for better sleep. Sleep is crucial for good mental health, particularly in vulnerable women.
  3. Third, by formula feeding, you might be avoiding some of the emotional costs of breast feeding. One patient of mine suffered severe mastitis from breastfeeding, complicated by a systemic infection requiring hospitalization, which led to the consequence of post-traumatic stress disorder. Others describe the pressure to breastfeed, coupled with feelings of inadequacy, as the trigger for postpartum depression. Anxiety can rise also after the transition back to work, if you are trying to pump and breastfeed while working full-time. These emotional complications – PTSD, depression, and anxiety can potentially be avoided if a woman is able to move past her and others’ expectations and accept formula feeding as a wonderful way of nourishing a baby.
  4. Fourth, formula feeding helps to promote a loving bond between baby and dad. Some fathers have said they feel left out of the relationship with young infants. This helps to foster that bond, which can also have a positive effect on the partner relationship, alleviating the sense of helplessness and jealousy that can sometimes arise.

In summary, it is essential to recognize that the decision a mother makes about breastfeeding or formula feeding is very individual and depends on her unique set of life circumstances, including physical and mental health issues. Having the support of a partner, family, other moms, or a provider will help when making this choice. Being aware of the positive mental health benefits of formula feeding might help you if you are struggling with this decision and experiencing some of those common negative feelings like guilt or anxiety.

 

About Dr. Glezer:

Dr. Anna Glezer is a Harvard-trained clinician with current joint appointments in the reproductive psychiatry and OB/GYN departments at UCSF Medical Center. She is the founder of Mind Body Pregnancy, a new online educational resource that helps women with their emotional well-being and mental health during pregnancy, delivery, and postpartum

A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.

The FFF

***

A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters

 

by Hillary Kuzdeba, MPH

 

In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.

 

Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.

 

The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.

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Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.

 

How does this strategy really play out?

 

  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”

 

  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.

 

  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.

 

Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

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