Breastfeeding promotion – a view from a UK doctor

Welcome to the Milk Mama Diaries Carnival (July).  For this month, we join the National Nutrition Council – Department of Health in celebrating Nutrition Month with the theme "Isulong ang Breastfeeding – Tama, Sapat at EKsklusibo!" [This is Tagalog – apparently, it translates as "Push Breastfeeding Forward – Correct, Sufficient, and Exclusive." Participants will share their experiences in promoting breastfeeding or their tips on how breastfeeding should be promoted.  Please scroll down to the end of this post and check out the other carnival participants.

OK, compulsory intro over.  As you can probably deduce, this blog carnival is based in the Philippines.  Undeterred by the fact that I don't know remotely enough about the Philippines to advise on how breastfeeding promotion should best be done there, I figured, hey, no problem, I'll jump in with a post about how I think the healthcare system in the UK should promote breastfeeding.  Reading more of the ongoing discussion on how dramatically different the situation is in the Philippines has made me question the wisdom of that blithe decision.  While I think at least some of what I say is universally applicable, it's easy for me to talk about breastfeeding as just another of life's choices when I have the luxury of living in a well-off country with a clean safe water supply.  I believe there are multiple advantages to breastfeeding even when living in such a country; but they don't begin to compare to the frightening consequences of formula feeding in undeveloped countries.  I think that treating the two situations as comparable would be a terrible idea.

However.  By the time I'd reached that conclusion the post was practically written, and I do think that the basic principles behind the approach I advocate are universally applicable.  So I'm going to go ahead and post it and let other carnival members make the choice as to whether or not they wish to include it on their lists.  If any think it more appropriate not to, then I will fully understand that.  I also ask anyone from the Carnival who does read this post to bear in mind that it was not written with the Philippines or any other developing country in mind, and that some of what it says will therefore not be applicable.  One specific and important example is my belief that it's quite reasonable and low-risk for a woman to give the occasional bottle of formula – the research on which I base this opinion is based entirely in developed countries, and should not be taken as applicable to the situation in countries where safe water supplies are not universally available.  In those countries, a single bottle of formula or drink of water can indeed be extremely dangerous for a baby.

So.  With all that in mind, this is my vision of how I, as a doctor in the UK, would like to see the healthcare system in the UK go about discussing and promoting breastfeeding.  (It is, sadly, very far from the way that it does so at present…)

At the first prenatal appointment, I think it would just be mentioned as something to be discussed at further appointments.  This is simply because there's so much else to discuss at that point that it just doesn't seem like the best time to get into such a complicated subject.  So I'm picturing it more as something that gets introduced and not gone into – "OK, your next appointment will be in a month's time.  At that point we'll check you're OK, have a further chat about what sort of things to expect from the coming months, and start talking about how you want to feed the baby and the pros and cons of the different ways.  Meanwhile, here's some information for you to look through."   The antenatal pack would contain some leaflets on the subject, introducing the kind of information I'll discuss below.

At the next consultation, the midwife (the prenatal care system in the UK is midwife-led for normal pregnancies) would bring up the topic and ask the woman what thoughts she was currently having on how she wanted to feed her baby.  Obviously, at this stage there would be some women who had made a definite decision (which might be for full breastfeeding, full formula feeding, or mixed feeding), some who were thinking more generally in terms of "I'll give breastfeeding a shot and see how it goes", and some who had no idea at all. 

This would be the starting point for discussion and information-giving that would be gradually developed as indicated over subsequent consultations from then throughout the woman's involvement with the midwifery services – so, throughout her pregnancy, she would be finding out more about the decision and having the chance to continue all options, and, after the birth, the midwives would be ensuring that things were going well and looking at what they could do to provide help and support if not. 

After a woman was discharged from midwifery services, the health visitor would take over the same role – keeping an eye on how things were going, providing support, discussing with women who had difficulties what their options were and what the best way forward would be, and troubleshooting by, for example, warning breastfeeding women about what to expect during growth spurts.  Doctors would do the same thing at the six-week check and opportunistically at other times that they happened to see the mother or baby.

During these chats, there would be a lot of points to cover:

• The pros and cons of different feeding choices – discussed as clearly and honestly as possible.  This would include both evidence-based information of breastfeeding benefits, and practical considerations.
• The practical information needed to implement whatever choice the woman made – whether this be information on how to get breastfeeding to work out well and where to seek help if needed, or on how to mix formula and sterilise bottles safely, or both.
• For women who wanted to try breastfeeding/mixed feeding, a troubleshooting discussion of the problems and booby traps that might arise, and ways of dealing with them.
• For women who wanted to try formula-feeding, a sensitive discussion of the reasons why, and of whether any kind of compromise was possible.  If she was put off by a previous bad experience or by seeing a friend's bad experience, did she know that every breastfeeding experience is different and that breastfeeding another child might not come with the same problems as breastfeeding the first one?  If she was put off by the thought of all the initial difficulties to be overcome, did she know that those difficulties don't affect every woman and would she consider it worth at least giving breastfeeding a brief try to see whether it worked out?  If she wanted to be able to hand her baby over to someone else for a bottle once in a while, did she know that this was still an option for most breastfeeding mothers (either the much-maligned occasional bottle of formula, or pumped milk)? (She might, of course, flat-out not wish to discuss it at all, in which case the midwife would respect her wishes, let her know that the subject was up for discussion any time she wished to introduce it herself, and let it drop thereafter.)
• For women who wanted to breastfeed exclusively, a discussion of whether to introduce bottles of pumped milk, and, if so, when and how to go about it.

All of this would be backed up by written information that would be available in the initial booking pack given to women, with lots of discussion on where to go for further help if needed.

Midwives would aim to keep all information both honest and easy to understand.  This means that:

• They would not try to gloss over potential difficulties.  Breastfeeding can be very easy and, when it goes well, is far more convenient than giving formula, but it doesn't always go well and, for some women, can be very difficult indeed.  While there's no need to approach the subject with an attitude of what my mother calls 'Doom, doom, on the doom drums', it also doesn't do women any favours not to at least warn them of the possibility that breastfeeding may be a miserable experience for them, and, if so, that this is not absolutely guaranteed to improve with time.
• They would be honest about both what the science shows and what it doesn't.  There is extremely good evidence that breastfeeding has a number of health advantages over formula feeding; unless there's some reason such as HIV or a non-negotiable medication regime incompatible with breastfeeding why a woman is not even able to give breastfeeding a try, a woman considering formula-feeding should know the information in favour of breastfeeding in order to be able to make a truly informed choice.  On the other side of things, breastfeeding promotion campaigns have had a regrettable tendency to leap on any study that shows any apparent benefit of breastfeeding with little regard to the quality of the research, or to flat-out confuse opinion with fact.  Where we have strong evidence for a particular benefit of breastfeeding, we should tell women this.  Where the evidence is equivocal or there just isn't much of it one way or the other, we should be honest about this too.
• The research would be presented with actual numbers where possible, rather than just a laundry list of diseases for which the risk is reduced by breastfeeding.  However, these numbers would not be presented as "Formula feeding increases your baby's risk of this disease by X per cent", but as the actual likelihood of a baby being affected by a particular disease simply as a result of the formula feeding (or, to flip it the other way, the likelihood of a breastfed baby avoiding a particular disease simply as a result of the breastfeeding).  The reason for this is that, especially for rare diseases, percentage increases/decreases can be a misleading way to present information.  For example, the worrying-sounding figure of a 36% increase in SIDS in formula-fed babies actually equates to, on average, slightly less than a one in seven thousand chance of dying of SIDS as a result of being formula-fed (and, of course, that's before accounting for the fact that you can reduce your baby's risk below average in other ways).

Throughout these discussions, mixed feeding would be on the table (so to speak) as a possible option, rather than the choices being seen as a very black-and-white breast vs. formula.  That way, women who felt overwhelmed at the thought of exclusively breastfeeding would be aware that giving breastmilk was still an option, and might feel more able to try to do so.  Again, women would of course be given honest and accurate information about the various pros and cons, including the fact that we really don't have a huge amount of data on how mixed feeding stacks up against either full breastfeeding or full formula-feeding, simply because most studies don't consider it as a separate option.

But the most important thing about these discussions would be that the ultimate goal they would be based on would not be that of getting as many women as possible to breastfeed, or to breastfeed for X amount of time, or to breastfeed exclusively.  All those goals and targets have fueled the attitude that, at its darkest, has led to health care professionals browbeating women and endangering babies in the name of breastfeeding promotion.  Instead, the main guiding principle would be "How can I best ensure that this woman has all the information and support she needs to make a genuinely informed choice with which she is going to feel comfortable?"  Because, at the end of the day, that – not breastfeeding – is what matters most.

 

Check out the other Carnival posts:

Three Ways I Promote Breastfeeding by Example – Dainty @ Dainty Mom

A Simple Breastfeeding Campaign – The Lazy Mama

I Am A Breastfeeding Mom – The Painter's Wife

Why I Don't Nurse in Breastfeeding Rooms – Legally Mom

The Low-Milk-Supply Mommy Did It! – The Odyssey of Dinna

Breastfeeding Promotion Tips from a Formula Feeder (Yes, you read that correctly…) – The Fearless Formula Feeder

On Promoting Breastfeeding – ImPerfectly Created

Milk Mama Diaries 3 – MimmaBenz

Breastfeeding Mama – canDIshhh

I *heart* Breastfeeding – The Mum Side

Spreading the Word on Breastfeeding – Mommy Kuwentos

Taking Breastfeeding Further – Mec

A Breastfeeding Formula-Fed Mother – Soprano Mother

Breastfeeding: Promoting It Even If I Didn't Get Lucky The First Time Around – Glamma Momma

I am your breastfeeding friend – Lyndel's Mom

Thoughts of a LactatING Counselor: Breastfeeding is More of Psychology! – Handy Mommy

More on Breastfeeding Promotion plus a Guest Post – Chronicles of a Nursing Mom

Celebrating My Magic Milk – Denise

Breastfeeding Sisters – Isis Evasco

Philosophy Of An Unnatural Parent

Welcome to the July Carnival of Natural Parenting: Parenting Philosophy

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Code Name: Mama and Hobo Mama. This month our participants have shared their parenting practices and how they fit in with their parenting purpose. Please read to the end to find a list of links to the other carnival participants.

(OK, that one needs a moment of explanation both for regular readers of mine who are wondering if they’re on the wrong blog and for Carnival readers who might find other parts of this blog not exactly what they were expecting.  I don’t consider myself to be a Natural Parent – I share their core philosophies, but there are others on which I disagree with them, and the whole thing just doesn’t speak to me personally.  But, as the Carnival topic this month is one that’s also important to us non-natural parents, I figured I’d jump in and give it a shot.)

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The thought-provoking topic for this Carnival is parenting philosophy and how our parenting practices can help further our goals.  I’d never thought before in terms of figuring out how to summarise my Philosophy of Parenting – while I certainly have one, so far I’ve articulated it more in terms of ‘Do what works for you, don’t assume it’s what’ll work for anyone else, and be very suspicious of anyone who tries to claim they have the OneTrueWay to follow, because they’re probably very blinkered’.  Which is great for a philosophy of parenting generally, but this carnival is clearly meant to be more about what philosophy guides me, myself, in my individual parenting decisions.  So, I had to do some thinking about what my underlying philosophy really was, and how I could best put it into words.  And these are the words I came up with:

My job as a parent is to work together with my children to help them grow into the best people they can be.

What do I mean by ‘the best people they can be’?  It means I want to encourage them to think about what they want in life and to reach out and work towards that; and, at the same time, I want to encourage the qualities in them that will help them make their lives both fulfilling for themselves and beneficial to others.  Compassion.  Reason.  Articulacy.  Common sense.  Humour.  The ability to think for themselves and to know when to be sceptical.  The strength and the skills to stand up for what they believe to be right.

What do I mean by working together with my children?  It means that I don’t expect them to pick all these skills and qualities up simply by some sort of process of osmosis in which I spend their childhood telling them what I think they should do and focusing on how best to get them to go along with my plans or my advice, then expect them to have magically figured out how to do it all by themselves by the time they hit eighteen.  Instead, I try to work with them on problem-solving skills, to use day-to-day clashes and problems and dilemmas as teaching opportunities, wherever I can – to guide my children bit by bit to the point where they can make more of these decisions for themselves, and give them the tools they need to do so.

This weekend, the children wanted to build our marble run, and we ran into problems straight away – Jamie automatically took on the job of passing me the blocks that were needed (‘from the shop’, as he puts it), but Katie wanted that job too.  I could have just lectured them on the obvious solution (“Now, children, you need to take turns.  You can go first, and you can wait and go next…”) but instead, I said “OK, wait, wait, wait a minute!  Jamie, you want to mind the shop and give the blocks to me, but Katie, you want that job as well.  Can anyone think of what we could do?”

“I have an idea!” Katie exclaimed.  “We could both do it!”

“Wait, wait!” Jamie waved us into silence, overwhelmed by his inspiration.  “I know!  I could do the odd-numbered instructions, and Katie could do the even-numbered instructions!!”

Katie agreed to this, and a peace was thus agreed that lasted through an entire six instructions, although it was crumbling by the end of instruction 7 and finally crashed, along with the marble run (kicked over by Jamie) in a fight over who got to put the marbles in in which order.  But it was really good while it lasted.  And, while I realise that that probably isn’t sounding like too dramatic a success story to anyone who hasn’t had to take care of two small and strong-willed children, one of them autistic… believe you me, some of history’s international treaties have involved less miraculous feats of interpersonal diplomacy.  For a short but glorious while, it actually worked. 

And simply telling them they had to take turns would not have worked, or not nearly as well.  But, because I framed the problem for them and then gave them the space to think about the solution for themselves, not only did they come up with a solution that they were happy to work with in a way that they wouldn’t have been with an externally-imposed one, they have also had a chance to see how problems are solved and practice some of the skills for themselves, in a way small enough for them to manage at the stage they’re at. 

Next time they want to get the marble run out, I’ll try to avoid another heat-of-the-moment fight by encouraging them to plan at the start how they’re going to arrange the order in which they put the marbles in; and thus, by having the chance to think that problem through before things become too heated, they’ll (hopefully) learn just a tiny sliver more.  Multiply that by thousands and thousands of events throughout their childhood, thousands of increasingly complex problems and dilemmas that I can guide them through solving themselves, backing off just a bit more and a bit more as time goes by, taking one hand and then both hands off the bike and letting them ride free of me.  We’ll work on figuring these things out together, because that’s how I can help them to practice the skills that they’ll need for the day when they have to face life’s problems and figure them out alone.

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Visit Code Name: Mama and Hobo Mama to find out how you can participate in the next Carnival of Natural Parenting!

Please take time to read the submissions by the other carnival participants:

(THIS LIST IS NOW UPDATED. Sorry for the delay and do check out any links that you couldn’t get to work before!)

• Between Love and Fear: On Raising our Children Sensibly — Mamma Earthly at Give an Earthly discusses the fear factor in parenting and how she overcame it, despite societal pressures.
• really, when do i get my cape? — Sarah at small bird on fire is a working city mama trying to learn how to set aside her expectations of perfection and embrace the reality of modern parenting.
• Baby, Infant, and Toddler Wearing — Child wearing is part of Sarah at Nourished and Nurtured‘s parenting philosophy. In this post, Sarah describes benefits of child-wearing and gives tips for wearing babies, infants, and toddlers (even while pregnant).
• First Year Reflections — As her daughter’s first birthday approaches, Holly at First Year Reflections reflects on how she and her husband settled into attachment parenting after initially doing what they thought everyone else did.
• Making an allowance — Lauren at Hobo Mama welcomes a guest post from Sam about the unexpected lessons giving a four-year-old an allowance teaches the child — and the parent.
• How to be a Lazy Parent and Still Raise Great Kids — Lisa at Granola Catholic talks about how being a Lazy Parent has helped her to raise Great Kids.
• Philosophy in Practice — Laura at A Pug in the Kitchen shares how her heart shaped the parenting philosophy in her home.
• What is Attachment Parenting Anyway? — Gaby at Tmuffin describes the challenges of putting a label on her parenting philosophy.
• Of Parenting Styles — Jenny at Chronicles of a Nursing Mom talks about how she and her husband tailored various parenting styles to fit their own preferred parenting philosophy.
• Moment by Moment Parenting — Amy at Peace 4 Parents encourages those who care for children (including herself) to explore and appreciate parenting moment-by-moment with clarity, intention, trust, and action.
• Maintaining Spirituality in the Midst of Everyday Parenting, Marriage, and Life — Sarah at Nourished and Nurtured shares her perspective on finding opportunities for spiritual growth in every day life.
• Parenting Philosophy — Lily, aka Witch Mom’s parenting philosophy is to raise child(ren) to be compassionate, loving, inquisitive, and questioning adults who can be trusted to make decisions for themselves in a way that avoids harming others.
• Long Term — Rosemary at Rosmarinus Officinalis thinks about who she would like to see her daughter become — and what she can do now to lay a strong foundation for those hopes.
• Connection, Communication, Compassion — She’s come a long way, baby! After dropping her career in favour of motherhood, Patti at Jazzy Mama discovered that building solid relationships was going to be her only parenting priority.
• My Parenting Inspirations – Part 4 — Jennifer at Hybrid Rasta Mama looks at her biggest parenting inspiration and how that translates into her long-term parenting philosophy.
• A Parenting Philosophy in One Word: Respect — Jenn at Monkey Butt Junction summarizes her parenting and relationship philosophy in one word: respect.
• Knowledge and Instinct — Kat at Loving {Almost} Every Moment believes that knowledge and instinct are super important … as are love, encouragement and respect. It’s the ideal combo needed to raise happy and healthy children and in turn create meaningful relationships with them.
• THRIVE! — The Sparkle Mama wants to set a tone of confidence, abundance, and happiness in her home that will be the foundation for the rest of her daughter’s life.
• On Children — “Your children are not your children,” say Kahlil Gibran and Hannah at Wild Parenting.
• This One Life Together — Ariadne aka Mudpiemama shares her philosophy of parenting: living fully in the here and now and building the foundation for a happy and healthy life.
• Enjoying life and planning for a bright future — Olivia at Write About Birth shares her most important parenting dilemmas and pours out her heart about past trauma and how healing made her a better parent.
• My Parenting Philosophy: Unconditional and Natural Love — Charise at I Thought I Knew Mama shares what she has learned about her parenting philosophy from a year of following her instincts as a mama.
• An open letter to my children — Isil at Smiling Like Sunshine writes an open letter to her children.
• My Starter Kit for Unconditional Parenting — Sylvia at MaMammalia discusses her wish to raise a good person and summarizes some of the nontraditional practices she’s using with her toddler son in order to fulfill that wish.
• Responsiveness — Sheila at A Gift Universe has many philosophies and goals, but what it all boils down to is responsiveness: listening to what her son wants and providing what he needs.
• Tools for Creating Your Parenting Philosophy — Have you ever really thought about your parenting purpose? Knowing your long-term goals can help you parent with more intent in your daily interactions. Dionna at Code Name: Mama offers exercises and ideas to help you create your own parenting philosophy.
• Be a Daisy — Becky at Old New Legacy philosophizes about individuality and how she thinks it’s important for her daughter’s growth.
• What’s a Mama to Do? — Amyables at Toddler in Tow hopes that her dedication to compassionate parenting will keep her children from becoming too self-critical as adults.
• grown-up anxieties. — Laura at Our Messy Messy Life explains her lone worry concerning her babies growing up.
• Why I Used Montessori Principles in My Parenting Philosophy — Deb Chitwood at Living Montessori Now tells why she chose Montessori principles to help her now-adult children develop qualities she wanted to see in them as children and adults.
• Parenting Philosophies & Planning for the Future — Momma Jorje considers that the future is maybe just a fringe benefit of doing what feels right now.
• Not Just Getting Through — Rachael at The Variegated Life asks what truths she hopes to express even in the most commonplace interactions with her son.
• Parenting Philosophy? Eh… — Ana at Pandamoly shares the philosophy (or lack thereof) being employed to (hopefully) raise a respectful, loving, and responsible child.
• Parenting Philosophy: Being Present — Shannon at The Artful Mama discusses the changes her family has made to accommodate their parenting philosophy and to reflect their ideals as working parents.
• Who They Will Be — Amanda at Let’s Take the Metro shares a short list of some qualities she hopes she is instilling in her children at this very moment.
• Short Term vs. Long Term — Sheryl at Little Snowflakes recounts how long term parenting goals often get lost in the details of everyday life with two kids.
• Parenting Philosophy: Practicing and Nurturing Peace — Terri at Child of the Nature Isle sets personal goals for developing greater peace.
• Yama Niyama & the Red Pajama Mama — Part 1: The Yamas — In part 1 of a set of posts by Zoie at TouchstoneZ, Zoie guest posts at Natural Parents Network about how the Yoga Sutras provide a framework for her parenting philosophy.
• Yama Niyama & the Red Pajama Mama — Part 2: The Niyamas — In part 2 of a set of posts by Zoie at TouchstoneZ, Zoie explores how the Niyamas (one of the eight limbs in traditional Yoga) help her maintain her parenting and life focus.
• Our Sample Parenting Plan — Chante at My Natural Motherhood Journey shares hopes of who her children will become and parenting strategies she employs to get them there.
• Philosophical Parenting: Letting Go — Jona at Life, Intertwined ponders the notion that there’s no right answer when it comes to parenting.
• Unphilosophizing? — jessica at instead of institutions wonders about the usefulness of navel gazing.
• Parenting Sensitively — Amy at Anktangle uses her sensitivity to mother her child in ways that both nurture and affirm.
• how to nurture your relationships — Mrs Green at Little Green Blog believes that sometimes all kids need is a jolly good listening to …
• Philosophy Of An Unnatural Parent — Dr. Sarah at Good Enough Mum sees parenting as a process of guiding her children to develop the skills they’ll need.
• Life with a Challenging Kid: Hidden Blessings — Wendy at High Needs Attachment shares the challenges and joys of raising a high needs child.
• Flying by the Seat of My Pants — Heather at Very Nearly Hippy has realized that she has no idea what she’s doing.