Wednesday, 10 December 2014

Breastfeeding: Not Glorious, Not Grotesque, Just Ordinary


So, inevitably, as soon as the media have finished telling us all how to give birth it's time to start instructing us on how to feed those born as they should be babies.

There were two main stories in the news this week about breastfeeding and a third which touched on it so, as this is my blog, I'll be starting with the sciency one:


On first look it's tempting to assign this to the yet more breast is best propaganda pile, but the study is actually quite interesting. One thing the headlines don't make clear is that the study doesn't call for more women to breastfeed, but for more support to help those who want to to do it for longer. And while the cost savings headlined are just estimates, what's interesting to me is that they are based on all the factors proven to be effected by breastfeeding in the UK. These are - certain infections in young babies, breast cancer risk for mothers and  - and that's it.

Contrary to all manner of claims, there is no good evidence that breastfeeding increases IQ, reduces obesity or improves social skills*. True, there have been individual studies which suggested all these things and got many column inches in response but they all suffered from one major flaw: Overwhelmingly in the UK women who breastfeed are well educated and well off (hence the recent dubious voucher scheme) so these studies aren't just comparing breast v formula fed babies, they are comparing rich v poor. Was it the breastfeeding that made the difference? It's possible, but it could also be the better diet, reduced smoking, better housing, less stress, etc. etc. etc. Basically, if you are born relatively privileged in this country then you will most likely do better than your poorer peers, however you are fed as an infant.

Before I go on I want to be quite clear - I'm not anti breastfeeding, far from it. I near as damn it exclusively breast fed both my girls for at least 14 months each. At times it was exhausting and excruciating but ultimately I'm very glad I did it. Even if all the health benefits were removed it is still cheaper than formula, less faff than sterilising bottles and you can't forget to take a boob with you when you go out for the day. I absolutely agree that there should be more, better and more consistent support for mothers who want to breastfeed. But I also think that support needs a reality check sometimes. If trying to breastfeed is placing a huge strain on a mothers physical or mental health then there are times when it is better for everyone, especially the baby, to say that bottle would be best.

This last point came to mind last week with the tragic story of a Mother in Bristol who walked out of hospital one night with her newborn baby, both were found dead the following day. The press suggested that she had stopped taking medication for mental health conditions so that she could breastfeed. I have no idea if that is true, whatever happened it's a heartbreaking story and the causes were no doubt complex, I really don't want to speculate further than that. But as the news came out that day a number of people on twitter began to relate their own experiences of being advised or coerced into stopping important medication so they could breastfeed. Sometimes with terrible long lasting effects for their whole families. The self-abnegating mother, sacrificing her own health for that of her child is a nice romantic story, but in reality the health of the mother is utterly interwoven with that of the child and when all we're talking about is the potential for a few less infections for a few months, in a country where we have access to antibiotics and top quality medical care, sometimes, breastfeeding just isn't worth it.

So we have a tricky balance to make. How do we encourage those who want to breastfeed without stigmatising those who don't or can't? Well perhaps we could start by normalising breastfeeding, by just making it completely and utterly ordinary.



And that brings us nicely to the whole  Claridges-Napkin-Farage-#Ostentatiousbreastfeeding media opinion-fest.


For the benefit of my non-UK readers, Claridges is a very swanky hotel. Recently a woman breastfeeding her small baby in the restaurant was told to cover up with a large napkin. She posted photos on twitter, people got cross. Then the ever hideous politician Nigel Farrage, weighed in to criticise "ostentatious breastfeeding" and suggest feeding mothers should sit in the corner because some older people found the sight of them uncomfortable. And lo was born a very amusing #hashtag.

Frankly, in my little corner of South London, you are more likely to get a dirty look if you are caught bottle feeding a baby, and at least one local friend was praised by an elderly woman for public breastfeeding, something the woman wished she could have done when a young mother herself. But I appreciate that the sight of a breastfeeding mum is a bit uncomfortable for some people. But why? 

This uneasiness isn't the result of some natural aversion to an unsanitary act. In an stroke of stunning hypocrisy the Sun newspaper actually likened public breastfeeding to urination on it's front page (UK readers will be well aware of what is on page three**). But the only reason we feel unnerved by breastfeeding is because it's not a common sight. In our culture, breasts are purely sexual objects, and as such decent people shouldn't get involved with them, at least not in public. But this is our own invention. The day after MissE was born I shuffled along to the obligatory breastfeeding workshop, taught by a wonderfully frank, loud and hilarious African midwife who told us all:

 "You women here are all afraid to get your breasts out because you think it's all sexy! But you all walk around in your short short skirts with your asses hanging out! Your breasts are for your babies, not for the men! Put your asses away and get your breasts out!". 

Seriously, she was the only good thing about that hospital stay.

She was also completely right (well maybe not about the skirts). If some people feel uncomfortable at the sight of a woman breastfeeding then I am sorry for that, but the best way to cure that sexy-lady-things-feeding-baby-AHHH cognitive dissonance isn't to hide breastfeeding, it's to normalise it, to make it ordinary. People used to freak out at the sight of woman in trousers or a tiny flash of ankle, even UKIP are probably ok with that now, because we see it every single day, it's not special and it's not shocking.

The bottom line (covered by a nice long skirt for the benefit of that midwife) is that there are benefits to breastfeeding, but in the context of a developed nation they aren't huge. If women want to breastfeed then it's worth the NHS investing in helping them but it's also important that women know it's not that big a deal. It's lovely for the individual mum and baby, for the rest of society - meh. The problem is it will always be a big deal when any hint of a breast being used for something non-sexual is splashed across the press and open season for idiot commentators (I'm aware I'm perhaps putting myself in that category right now). It will also continue to be a big deal if we go on haranguing mothers with piles of unproven claims about the wonders of breastmilk and holding it up as some magical, perfect act of motherhood. If only women could breastfeed in public without comment, and do the same with bottles, if only it was just as ordinary as changing a nappy or giving your toddler a hug when they fall over, then perhaps we could stop damning women whatever they do. Breastfeeding is neither glorious nor grotesque, it's an ordinary everyday thing, or at least it should be.

SBx

*The other often quoted benefit of breastfeeding is that it aids bonding of mother and baby. I've not included this as I've never seen any research either way on it. If anyone has some please let me know. Personally I'm doubtful that the mother-baby relationship really suffers because of bottles. I also have to admit, when breastfeeding I rarely spent all those hours staring in dewy eyed adoration at my babies. With a good arrangement of cushions or a sling, breastfeeding is almost hands free, so I was generally on twitter/facebook and/or watching boxsets of Downton Abbey. Not terribly bondy but it got me through the utter tedium of it all. It was the times I used a bottle that I actually concentrated, that seems to require about 3 hands!

** For the benefit of non-UK readers the Sun is a national newspaper which has a daily, topless," page three girl".

2 comments:

  1. Fantastic blog. I can tell you that having read a lot of the primary evidence re infant feeding and bonding (and reviewed it in our book 'Guilt-Free Bottle Feeding') it is even less robust than that for breast feeding and IQ. @drsashahowad

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  2. I think you're absolutely right about this. Breastfeeding is a perfectly valid way to feed a baby, and might be the best choice for any particular mother/baby/family. But the same could be said for bottle feeding, and maybe it's time we, as a society, all got over it and moved on. It's important, but not special.

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