breastfeeding and guilt

[The Morrigan]

I'm hoping Pinky will let me put this on the website so EVERYONE can read it! I love this article

Not guilty

As a baby magazine writer and editor, I have been told -"do not write about breastfeeding because it makes bottle feeding mothers feel guilty."

Surely there is no other area of health promotion where this happens. We have no hesitation about informing parents about car restraints, sun protection, or reducing the risks of SIDS by putting babies to sleep on their backs. Sadly, at least in Australia, the breastfeeding part of SIDS prevention is tagged on apologetically, with an "if possible" .

The dangers of smoking are well promoted - and health care providers have no hesitation about using guilt to discourage parents from exposing their babies to cigarette smoke. In fact, many health promotion messages are fired out in a blaze of guilt: let’s consider weight loss advertisements - all those mothers in the "before" photos and the implications that they must have been neglecting their children because of all the activities they couldn’t possibly participate in when they were overweight ! And the shame of being an overweight mother - how many of the women in the ‘after’ shots claim "my husband/ kids/ family are so proud of me now! “

In the name of "informed choice" a publication that I used to write for was considering asking a formula company to provide information about artificial feeding - how to do it , which formulas are "best" etc; so their readers could make "informed choices".

In a feature published in The Australian (July 5 2001), entitled "Is Breast Always the best?", which focussed entirely on the difficulties of breastfeeding, there was a break-out box outlining the "pros" and "cons" of breastfeeding. Presumably this was to "balance" the writer's argument. You can make up your own minds whether this information contributed to "informed choice"

The pros:
• Helps protect babies from diseases including gastric, respiratory and ear infections and certain allergies.
• Convenient and cheap
• Allows for intimacy with baby
Cons:
• Can be physically and emotionally demanding of a mothers time and energy .
• Can be uncomfortable, physically and socially, for a mother .
• Baby may have difficulty feeding


When I wrote Parenting By Heart, my editor, who was somewhat concerned about making mothers feel guilty, asked for more information about bottle feeding to match the comprehensive breastfeeding information. Apart from the issue of weaning gradually and changing sides/ offering lots of skin contact, which I had already included, I declined to write any instructional content about artificial feeding.


Although Parenting By Heart is about exploring options and making choices that are right for you and your child, I don’t see artificial feeding as simply an "option" like perhaps, which brand of pram should we choose?

The choice of infant feeding has consequences for the health of the mother and the health of the child. And what informed person would deliberately choose to risk their own or their child's health? Parents are making choices on their child's behalf. The person most affected by the parents' choice of infant feeding is the child. The parent is the child's advocate.


When we pussyfoot around about making women feel guilty, we are patronising them - how can anyone make an informed choice if information is deliberately withheld?
In any other circumstances, if we deliberately withheld information, we would be considered dishonest or even negligent. When we are prescribed any medication or medical treatment, if we are sensible - we will ask, "what are the risks?" / "are there any side effects?" We expect to make informed choices, and give informed consent about health care.

Even when we don’t deliberately with hold information about breastfeeding, we are likely to couch the information we do give parents in language that misleads them about the importance of breastfeeding as a health care choice;

While we talk about "improving intelligence" or "improving health', some experts claim that this too is "pussy footing". Anthropologist, Katherine Dettwyler, for instance, suggests that using artificial baby milk could, and should be considered reckless endangerment because it increases risks to a baby's life and health, just like parental smoking and failure to use a car seat.

The language we use when we talk about the advantages of breastfeeding - the "lower rates of cancer", the "reduced risk of allergies" , the "enhanced bonding" , the "stronger immune system" - reinforces bottle- feeding yet again as the accepted, acceptable norm, not a health risk.

Lactation consultant, Dianne Wiessinger, points outs that health comparisons use a biological , not a cultural norm, whether the information is harmful or helpful. We say smokers have higher rates of illness; increasing prenatal folic acid may reduce fetal defects;

Because breastfeeding is the biological norm:
• breastfed babies are not "healthier" - artificially fed babies are ill more often and more seriously .
• breastfed babies do not "smell better" - artificial feeding results in an abnormal and unpleasant odour that reflects problems in an infant's gut.

Because this language is not our "mother tongue" we may need some practice.

Are you familiar with the research on parental smoking and IQ? And what about the studies about breastfeeding and infant brain development? These are perfect examples: When these studies are quoted in the media - we read or hear - "Children of smoking mothers have LOWER IQs." We also hear "breastfed babies are smarter" - I have yet to see a headline screaming "Artificial feeding lowers infant intelligence"

We cannot expect to create a breastfeeding culture if we do not use a breastfeeding model of health. When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision making information.

If you are a health care provider, you are also the child's advocate. Can you imagine how you would react if parents arrived to take their brand new baby home from hospital in a car without a fitted child restraint?? If giving these parents honest information about the risks they were exposing their baby to meant that they would feel guilty, would you have any qualms about protecting their feelings?

I believe we have been "sold" the concept of guilt - when I interviewed parents for Parenting By Heart, I discovered - perhaps not surprisingly - that mothers feel guilty about anything and everything to do with their children. Many parents view their children's health, brilliance and behaviour as a direct reflection of their own good parenting efforts. Many of us walk a fine line between normal parental pride and seeing our child as product with us, the parent, in solemn charge of every aspect of quality control. Anything less than perfection -either in effort or results- is not good enough.

This is an inevitable spin-off from the burgeoning industry of parenting experts (ourselves included) - and parent blaming - (which I hope doesn’t include us). There are shelves of best selling books that not only give us recipes for the perfect child (pity our kids don’t read these books!) but also blame parents, especially mothers, for things that go wrong.

The truth is, that kids aren't cakes. We can't simply mix up a recipe for the perfect child any more than we can say "oops, I forgot the baking powder," when our "cake" child doesn't "turn out" twenty years later. Just like a cake, it takes a whole bowl full of ingredients to make a child "turn out" -and even though our choices have an important impact, we are just one of a range of influences. The down side to our unrealistic expectations is that if we happen to have a less than perfect child (most of them actually, most of the time), that we cant wear as a badge of our good mothering - we must be bad mothers, mustn't we? And we call this feeling guilt.

Yet, when we really examine mothers' feelings about things gone wrong, it is rarely guilt that they are expressing, especially about not breastfeeding or not breastfeeding as long or as completely as they would have liked to.

• Well informed mothers who reach for the bottle after a struggle with breastfeeding know they have done the best they could with the resources they had at the time - these mothers may feel disappointed but they don’t feel guilty.

• Mothers who later discover that they were "short changed" by receiving inadequate information are likely to feel angry or betrayed. These mothers don’t feel guilty either.

• A mother who gives up on breastfeeding because she allowed herself to be talked into something that was less than perfect for her baby, is likely to find that her self image as a competent mother is compromised. It is perfectly normal for a mother to feel she would die to protect her baby - and most mothers would! So when mothers give in to external pressures to wean their babies, they lose confidence in their ability to protect their young.

And if there are later consequences from a decision not to breastfeed, such as a child who becomes ill with a condition that may have been prevented, the emotion felt is not guilt, but regret. That awful feeling of, ‘if only… If only I had known, if only I had done things differently.’

Guilt is only legitimate if we have let another person down - if we haven't honestly done all that we could have or should have. And nobody can make us feel guilty without our permission. Feelings of guilt may be triggered by external factors -like a health professional telling us about the hazards of artificial feeding, as we are reaching for the bottle - but these are OUR feelings. This is our own internal value system at work. We each need to decide whether this guilt is legitimate or not - or whether it is in fact, guilt , or some other feeling - and how we will act on this feeling.

For the sake of the mother child relationship, we do need to help mothers differentiate between feelings of guilt, and unrealistic expectations of perfection. We can encourage mothers to examine their feelings - to ask them selves -

• "Where is this feeling coming from?"

• "Is this the best I can do for now? Or am I really letting my child down?"
• "What are my responsibilities?"
• "What can I change?"
• "Where can I find support?"

The positive thing about guilt is that we can act on it: If we feel guilty about the choices we are making, we can use these feelings to motivate us to make better choices. There is a vast difference between guilt and regret. We can act on guilt. The sad thing about regret is that it is too late. We don’t get another chance to go back and do it all differently with each baby.

This is why we, as health professionals, have a responsibility to inform parents about the hazards of artificial feeding. We also have a responsibility to offer accurate information about managing breastfeeding, as well as the practical support necessary to overcome difficulties.

Ideally this information and support will begin long before a baby is screaming to be fed. We will need to shoot another sacred cow in the process, by informing women about the importance of taking responsibility for their birth choices and seeking good childbirth education - that an alert, aware mother and baby have a head start in the breastfeeding stakes, and that if a woman learns to trust that her body can give birth, she can also trust that her body will produce milk to feed her baby.

We need to encourage mothers to connect with their babies and follow their baby's cues. Mothers need to trust their babies and their own body signals, rather than following practices like rigid feeding and sleep schedules that create disharmony between baby and breast. And, don’t be deceived - these practices did not disappear with Truby King - they are alive and well and being promoted with zeal by ‘self acclaimed experts’ and health professionals alike. According to the stack of emails I receive every day, mothers of babies as young as 6 to 8 weeks are being pressured to attend "sleep school", to implement feeding schedules and not to allow babies to fall asleep at the breast under any circumstances. These practices undermine mothers' natural urges to respond to their infants, as well as their confidence.

We also need to emphasise the importance of setting up support networks -long before mothers find themselves crying more than their babies. It is much easier to call a familiar face for information when there are a few niggling doubts, than to expect the proverbial ambulance - or a complete stranger - to rescue mothers when they have landed in a heap at the bottom of the cliff. And if mothers have their own cheering squad - if they are surrounded by positive voices about birth, babies and breastfeeding, and, most importantly of all, have observed other mothers happily breastfeeding, they are more likely to trust their own ability, and their body's, to do what nature intended.

Breastfeeding promotion is not about promoting guilt. It should never involve persecution of mothers who make other choices. If a mother has made an informed choice not to breastfeed, that is her right.

Breastfeeding promotion should be seen like any other aspect of health promotion - for the well being of the baby, the family and the community. There is no excuse for compliance with calculated misinformation packaged and sold to us, along with the myth of guilty mothers, by those with vested interests in promoting artificial infant food.

There is no excuse for using maternal guilt as an argument for with holding information about breastfeeding - the very information that could prevent feelings of guilt, sadness, anger, inadequacy, betrayal and regret. Health professionals who use this argument need to ask them selves, who am I trying to protect? Am I trying to protect myself from guilt , perhaps because I lack the knowledge and competence to help mothers breastfeed? Or will I have to confront more personal feelings of guilt that I may have failed my own child, because my own child wasn't breastfed?


AS well as acknowledging breastfeeding as the perfect infant food, we also must acknowledge that breastfeeding is more than just a method of feeding - breastfeeding is a relationship, an integral part of a woman’s love life and an intrinsic aspect of our biological femininity. When the breastfeeding relationship is ended prematurely, rather than guilt, most mothers also feel a deep sense of loss.

This emotion is grief - not guilt! And while we offer mothers platitudes like "you have given him a good start" in the hope of alleviating guilt, we are not giving them permission to mourn the loss of this intimate relationship. We are dismissing their very real feelings of grief.

Pinky McKay is an International Board Certified Lactation Consultant and the author of Parenting By Heart and 100 Ways to Calm the Crying For information about Pinky’s classes, visit her website www.pinky-mychild.com

[Kali]

I can understand the problems with guilt. I know alot of mothers that drove themselves crazy trying to breastfeed. It got to the point that the frustration and lack of sleep and pain, caused depression. They were so determand to feed, but they found themselves missing out on bonding and enjoyment of being new mums.
Sometimes we need to put things into perspective, which is healthier, a child who isn't being nourshed enough and is being resented by a mother who can't feed, but really wants to, or a child who is being fed formula which is not the best, but atleast they are now growing and their mum can now relax and enjoy parenthood?

I'm sure when they read about brestfeeding, they feel guilt and jealousy, but I'm also sure that those mothers still believe that breast is best and would wish that for other babies too.
Trying to deny that breastfeeding is a better choice, is absolutly ridiculous!!!!

[MadreFelice]

I used to think this too - but now I am not so sure........."Sometimes we need to put things into perspective, which is healthier, a child who isn't being nourshed enough and is being resented by a mother who can't feed, but really wants to, or a child who is being fed formula which is not the best, but atleast they are now growing and their mum can now relax and enjoy parenthood? "
Having now sat down and asked many mothers re their breastfeeding, and why it didnt work for them, I have found it a damn shame and really sad that many of them were not demand feeding, but doing it by the clock - and wondered why they sometimes did not have enough milk to feed their babies. Bubbas way back then (and of course in the here and now for those of us who do it!) were feeding when they chose to and when their mothers felt that they needed it LONG before clocks were introduced to the world.

I am just gutted how many MHCN tell women to not feed their babies more than 3-4 hourly, and that they 'must be sleeping through' by a certain age, and not 'needing' night feeds, when this is biologically proven to be a thing that does happen and should naturally. Just another example of how many women are told that 'their milk is not enough'

I understand that women will feel that they are not nourishing their children enough, because some of them are told this and listen to it. I just dont get it :

So many women also feel that they arent getting enough sleep. I wonder why then the children are put to bed up the hall in another room and they have to get up so often in the night to feed them, or listen to them cry if that is their chosen method of parenting. I'd be knackered too! So many problems with feeding are brought on my so called 'professionals' who tell good and caring mummas that they arent doing the 'right thing' . The right thing in whose book I wonder? Women then feel pressured to make changes for the good?? of the child - which often leads to a breakdown in the breastfeeding pattern and relationship. Our babies are perfectly capable (if we keep in good health ourselves) to provide breastmilk just as our babies need it, for colder weather, hotter weather or in times of illness. We just gotta get more women trusting that!! Finn was 8.2 kgs at just under 4 months on boobs alone - and didnt touch food until he was 8 months old - or any water or other drinks for that matter. I grew to trust my body would provide and that it did. When he was ready (and not the book that said 'feed that kid at 6 months' - he ate. And I smiled - and rejoiced that to this day he is an absolute delight with food, and my theory on this is because it wasnt shoved down to make anyone happy.

I had depression too after Finn was born, but it was caused by the grief of his birth, and although I was told that I would probably never breastfeed successfully, I was determined to. Yes - it hurt some days - yes, other days I worried that he may not be getting enough - but when it came down to it - it came back to surrounding myself with women who 'get it' and coming to the realisation that I would succeed - and did. Hard work - but damn worth it. The counselling cost me a fortune - but at least I was not hospitalised for depression as I had been in the past - and those days and memories of breastfeeding Finn and the closeness that gave us can never be erased.
Ok - rant ok. Sorry :

[The Morrigan]

I feel similarly to you, Donna. Women are NOT informed, NOT supported, NOT anything much except told that it doesn't matter how you feed your baby so long as you feed it. Well, I think, in a wider sense it matters very much. Apart from on a personal level, where we've seen the tremendous grief that accompanies the loss of a wanted breastfeeding relationship and the ensuing difficulties with comforting and nurturing a tiny baby, the ramifications for our whole society are deep. Every time a baby loses out on the boob, it's risks of disease are magnified significantly. Hospitalisations and illnesses, which are paid for in many ways including economically, become common as ff babies are sick more often and more sick when they do get sick. That immune protection is vital and comes in several stages over some time; something the "weaned at 6 months" babies are missing. The women who don't bf increase their risks of cancers, risking leaving children and families who need them, and again spending health dollars on something preventable. If we were really serious about public health in this country, bf would be top of the list and promoted like it is in the Scandanavian countries where their rates are up in the 90s. So like Pinky says, how about we provide real information to women? I don't understand why imagined guilt is the reason to close our eyes to reality. Just pretending something ain't so, don't make it so, yk? Breastfeeding should be every baby's right and if we didn't have artificial milk substances being made by multinationals who stand to lose oceans of money, we'd have very different outlooks on the important to public health of the free, simple, NORMAL act of breastfeeding. Our largest maternity hospy in this city boasts (boasts for gods sake!) about it's bf figures! They are roughly - 60% fully bf, 20% comping (or weaning slowly as we all know that really is!) and 20% on the bottle. This is partly due to how crap their birth system is, so drugged up, sliced open women even if they want to bf really struggle and also because in their mad mad mad world where surgeons rule, artificial is ok. It's criminal. Absolutely criminal! But those are perceived to be good figures and they are an accredited BFHI hospy which only further proves what shite that system is! I could get my recycling bin accredited without much trouble!

[Kali]

I used to feel exaclty the same as both of you, till I almost stopped trying to feed Aiden at a week old. I just COULDN'T get him to attach. He would get himself in a tizz trying to find it or stay on, that there would be no-way he could feed till he calmed down again, so sometimes it would take 2 hours to fianlly get my starving baby a feed. I had breastfed 3 babies before him, with no problems, so I was an expert, I knew how to do it.
The main problem was at the hospital, the midwoves tried to force me into feeding him when all he wanted to do was sleep a while after the 36 hours of constant contractions squishing him down into a closed cervix. I knew he would wake up for a feed after a good sleep, but NO, the midwives insisted I wake him and try and force my tiny new born to feed. They even tried to hand express MY BREAST : I was in agony. If he was my first child, they would have defianlty turned me off breastfeeding altogether. So because of the stress the midwives put me under, telling me I didn't know what I was doing and I was neglecting him for not waking him to feed him, I came home very tense. My breasts were also so engorged, they were burning red. My milk came in so fast and strong, that when Aiden finally DID attach, he would choke and gag and slide off and we would be back to square one, trying to get him to latch on for another 2 hours.
I finally realised just how hard and stressful it actually is to breastfeed some babies. I was advised to bottle feed by DH who just wanted me to stop stressing out about it, but that just made me snap at him :evil: I thought I would really resent Aiden if he wouldn't take to feeding. On the 3rd night home, I decided, if he wasn't on in the first 10 minutes, then I would put him to bed and walk away.There was no way I was giving him a bottle. I was so stressed out and crazy from the whole saga, I would have rathered let him starve if he wouldn't breasfeed. I know it was totally irrational, but that's just how stressing it is when you can't breastfeed and it means the whole world to you. I couldn't imagin having to miss out on one of the most important and precious parts of motherhood.
I don't know if it was some sort or miracle, or of he knew he was about to be left to scream if he didn't feed, but suddenly he latched on straight away and hasn't stopped feeding since (thank god for that), I'm sure I would have ended up in the looney bin if I had to bottlefeed.

After all of that, if I didn't have it drummed into my head that breastfeeding is the only way, I probably would have quit a day earlier, and flt fine bottlefeeding. i would have figured, well i gave it a good try, but it didn't work out.
If he was my first, it would have been that way for sure.

[Clare]

Great article Janet Just quickly because I am fak (when aren't I? : ) I was privy to an interesting discussion a little while ago that started out as a discussion on advocacy tshirts for cloth nappies. One of the ideas mentioned nappies, as well as breastfeeding and cosleeping and was a beautiful thought. Well, you should have heard the outrage! Don't lump it in with breastfeeding statments coming out the wazoo. Where are the advocacy tshirts for bottle feeding? someone asked. It turned very much into offense being the best form of defence, and I think it's a sad day when I have to justify my decision to breastfeed my child. It was as Pinky's opening statement says:

-"do not write about breastfeeding because it makes bottle feeding mothers feel guilty."

Well I've been a bottle feeding mother, reluctantly, but in the end it was my decision to put that bottle in her mouth. Yes I waas advised by a dr and everyone else under the sun to do so, but it was still my decision in the end. I could sit and feel guilty, or I could educate myself so that I am better equipped to deal with it the next time - obviously I chose the second option :wink: I do have moments of sadness, these bittersweet feelings that I am able to do for Cai what I could not for D'Arcy, but I did the best I could with what I had available. There are so many things I did not know that could have saved my first breastfeeding relationship. And we don't learn anything if we make people stay quiet so as not to offend.

That wasn't really quickly was it :

[Kali]

big *hugs* to you Clare.

Before almost giving it up with Aiden, I thought that people who bottlefed, were just lazy, or they didn't know what they were doing. Now I realise that I was lucky to have it so easy with the girls. There are REAL problems with breastfeeding at times and it is really hard.

If a baby is screaming all the time and on the boob all the time and not puting on weight, then the stress and concern on both sides put a strain on things at a time when you should be the happiest person in the world. If bottlefeeding helps to ease a situation which has gotten to breaking point, then so be it. Don't feel guilty for doing the best for your child at the time.

[Clare]

Just adding: I was told by our paed that I was only being selfish wanting to continue bf, and it was inferred that I was doing my baby harm by my wanton selfishness :evil: How's that for tactics? I tells ya, I had to walk past his office once a fortnight on the way to my haematologist when I was pg with Cai, and it took all my self control not to go in and have a go.
Ok, rant over :wink:

[Clare]

Just adding: I was told by our paed that I was only being selfish wanting to continue bf, and it was inferred that I was doing my baby harm by my wanton selfishness :evil: How's that for tactics? I tells ya, I had to walk past his office once a fortnight on the way to my haematologist when I was pg with Cai, and it took all my self control not to go in and have a go.
Ok, rant over :wink:

[Keara]

This article is SOOOO timely!

I had wanted to come in here and let off some steam about 'offending' bottlefeeding mums on a forum I go to.

A woman had posted a question in the BREASTFEEDING section, and a poster made the comment that "it wasn't the be all and end all". Another poster jumped on the bandwagon by saying a truer word had never been uttered on said site and that she was sick of women being made to feel guilty.

I couldn't even reply I was so incensed! Sleeping all night isn't the be all and end all of motherhood but they're sure interested in that! They all have an opinion to offer but if a breastfeeding mother dares to give some honest advice about what the posters options are, look out! I'm tired of the hypocrisy. We are all asked to respect each others opinions, so WHY go into a breastfeeding forum, where questions are asked about breastfeeding, if you are offended? :evil: This womans post was so clearly a projection of her own hurt feelings about her not being able to feed.

I've seen both sides, I've resorted after much pain to ff my son. I've seen breastfeeding take off easily, and I've felt the agony of a dozen different midwives poking and prodding me ( post birth) to get my children to feed. The answer for me was ONE LC, who visited at home, and had a gentle approach. I am a HUGE advocate of mother and baby bathing in peace and letting instinctive behaviours be the guide, after all the trauma of hospital midwives and possibly drugged births etc have interfered. But I digress, sorry!

I think it's up to the individual to understand where that guilt is coming from, and not to project their feelings onto those who are simply providers of information. I had awful guilt with my DS, I felt like a leper buying formula. I recall wanting to scratch an old witches eyes out for smuggly saying ( as I gave a bottle of EBM) "I don't know why women have babies if they can't be bothered feeding." She had no insight to what I went through, or that I was still giving him the best I could at that stage... And it stayed with me. I think it formed the basis of a lot of my guilt when out feeding my son a bottle.
It never changed me though, I never became a staunch defender of formula feeding. I can understand the feelings that these women have- the guilt... but I beleive it's just WRONG the way they seem to advocate formula feeding, as a fine alternative, to women SEEKING advice on breastfeeding!
Formula has a place, but the MCHN and Medical professions need to have a long hard look at the kind of messages they are giving women. Hospitals too for that matter! Only then we will see a change in this very odd practice of walking on tippy toes when it comes to advice about breastfeeding and it's "offensiveness".

Sorry for that rant...