When I was pregnant, I knew for sure that I was going to breastfeed. The heavy-handedness of the public health messaging didn’t really bother me: of course I would breastfeed, why would anyone not? It did all seem a bit odd though, evangelical, perhaps slightly misdirected, or just a bit dated. We went to the breastfeeding classes at the hospital, and I was surprised that the whole first session was on the reasons to breastfed (yes, we know, that’s why we’re here – can we move on to the “how to” part?). The hospital is bedecked with soft-focus breastfeeding posters. Breastfeeding DVDs are distributed at the antenatal classes. Clearly, the idea is to make sure every pregnant woman knows that breastfeeding is the bee’s knees.
None of this even remotely prepared me for the reality of breastfeeding.
My nipples were blistered at the second feed. The hospital lactation consultant reiterated the points from the DVD, gave me a sample pack of lanolin nipple cream, and sent me on my merry way. Ten days later, we hit breastfeeding rock bottom. I’d watched the latching demo dozens of times, I was trying to do it exactly as told, but this frantic little beast just wouldn’t bloody well open his mouth wide enough. Every feed took at least an hour. He fussed, he slipped off, he thrashed about. And then one day he gummed down on my already savaged nipple and I howled with pain. I couldn’t put him back on, I just couldn’t. I shoved him at his dad, and cried as I stood in another room using the breast pump. Once bub was finally asleep, having received my precious expressed milk from Mr Daddy, I wrote a detailed and desperate email to a private lactation consultant (subject line: Earliest available appointment).
If you start off intending to breastfeed, and within two weeks are suffering from blistered nipples, blocked ducts, excruciating let down reflex, bruised areolas, and nipple thrush, you’re going to be feeling totally desperate. If you’re committed to breastfeeding, you might really hate the idea of transitioning to formula – but without good support, what else can you do? The baby has to eat. And this is where the “most women can breastfeed successfully” part of the public health message will feel like a kick in the teeth.
Fortunately, I got excellent support, and I got it early. The lactation consultant diagnosed tongue and lip tie before my milk supply was too badly affected; the following week bubs had laser surgery, and by the week after that he was feeding like a champ and gaining weight prodigiously. But that horrible morning, I could absolutely see how some might think “this isn’t working, I must be one of those women who can’t breastfeed” and go buy some formula. Fair enough.
At this point, nine weeks in, breastfeeding is second nature and a cure-all parenting technique. I feel awful for women whose available support wasn’t as good as mine, and who introduced formula despite wanting to breastfeed. Those whose midwives didn’t tell them about good secondary services. Those who can’t afford lactation consultants, or whose partners are less accommodating of breastfeeding “challenges” (read: horrendous ordeals). Those whose own mothers aren’t on hand to provide reassurance and frank advice based on breastfeeding experience.
The breastfeeding promotion is everywhere, unavoidable. The post-birth support is not too bad if you know where to find it, but it would be quite possible to completely absorb the promotion during pregnancy, without receiving any support in the haze of immediate new motherhood.
This is where the messaging is a bit off. You might mistakenly get the impression that breastfeeding comes naturally. While I was pregnant, my mother warned me that breastfeeding was a learned skill, that it might be a bumpy road at first, that there might be pain, but that the tough bit wouldn’t last long and it was worth it, for sure. This extremely useful advice was not included on the slideshow at the hospital classes. Instead, we were told that it’s not meant to hurt, if it hurts you’re doing something wrong. Frankly, that’s like telling a learner driver that cars aren’t meant to stall. We were told that breastfeeding is instinctual, our babies will know what to do. Yeah, uh, no. We were told that breastfeeding is a pleasant experience for both mothers and babies. What part of pain and mutual frustration is meant to be pleasant? We were told that breastfeeding can be a little bit challenging at first. Challenging is the understatement of the century. Oxfam Trailwalker was challenging. Writing a dissertation while working fulltime was challenging. This was soul destroying.
The upbeat messaging does a major disservice to two groups of mothers – those who want to breastfeed, but struggle; and those who aren’t that keen on breastfeeding to start off with. There is huge pressure to breastfeed. Because I knew I wanted to breastfeed, this was neither here nor there to me. For women who don’t want to breastfeed, or who are a bit ambivalent, this pressure must feel like a vote of no confidence in their ability to be good mothers. Now that I’m a fully-fledged breastfeeding mum, I really can’t imagine the annoyance of faffing about with bottles. That said, some people don’t want to breastfeed, and this should be acknowledged. You might feel daunted by the thought of being your child’s sole form of sustenance. You might feel uncomfortable feeding in public. Breastfeeding might trigger dysmorphia or exacerbate existing body image issues. You might want to share the night feeds with the other parent. You might want to be able to leave your baby in the care of others for more than a couple of hours without pumping beforehand. You might just really want to stop sharing your body with your baby, after nine months of pregnancy. You might come from a family or social circle where breastfeeding is uncommon, and see it as a bit strange.
On the Ministry of Health website, these possibilities are ignored. Prospective parents are told “formula is there for when you can’t or shouldn’t feed baby your own breast milk”. By way of contrast, “it is your choice whether or not to immunise your child”. If there was any health issue that justified firmly directive messaging, surely it’s childhood immunisations. But no, immunisation is my choice. Formula is not my choice, it’s only there if I am unable to breastfeed. Because, in bold for emphasis “babies should be exclusively breastfed until they’re around six months old.”
I have no problem with the Ministry of Health promoting breastfeeding: they promote all sorts of lifestyle choices that cumulatively lead to a healthier population. Breastfeeding is part of this picture. But you can’t normalise something by idealising it or by pretending that other options do not exist. To normalise breastfeeding, the very real difficulties should not be sugar-coated. For starters, the routine check at the hospital should include identifying of tongue and lip tie! Breastfeeding support, such as the volunteer-run clinic in Newtown which saved us in our hour of need, should be available throughout the country and publicly funded. It should also be widely acknowledged that while breastfeeding is being established, new mothers cannot be expected to focus on anything else. This is yet another reason why paid parental leave is important.
And finally, if breastfeeding were normalised, we wouldn’t be debating the extent of the ” benefits”. Breastfeeding ain’t got nothing to prove. It’s not out to demonstrate how much better it is than a highly processed substitute. Improvements in the composition of formula can only be a good thing, and shouldn’t threaten breastfeeding any more than improvements in IVF threaten natural conception. Breastfeeding can be seen as the normal, default way to nourish a baby without stigmatising mothers who use formula.
According to Plunket, over 40% of babies receive formula in their first six weeks. This suggests that the support for newly breastfeeding mums is insufficient. We need a frank discussion about how widespread breastfeeding problems are, and how they can be overcome. At the same time, let’s stop assuming that all women want to breastfeed. If the goal is to improve breastfeeding rates, we need to accurately identify the reasons why some people don’t breastfeed. If the goal is to promote secure attachment and protect maternal mental health, mothers need to feel supported, not patronised.