Can we have better conversations about feeding?

Heather Trickey

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To mark England’s Breastfeeding Celebration Week 2017, Research Associate at DECIPHer, Cardiff University and Research Manager for NCT Heather Trickey considers how we can change the conversation around feeding in the UK. She highlights the need to shift the responsibility for the UK’s low breastfeeding rates away from parents, and instead recognise how we can all have more open, honest and compassionate conversations about feeding journeys. Find out more in the Baby Friendly Initiative’s Call to Action campaign.

This National Breastfeeding Celebration Week, let’s consider how we can change the conversation around breastfeeding and culture. The UK has one of the lowest breastfeeding rates in the world. Many mothers stop before they want to, often after running into problems early on. Extensive research shows that things are unlikely to improve unless we change our services, society and culture. There is a growing consensus that it is time to move away from a focus on persuading mothers to breastfeed towards protecting a context that better supports healthy decisions.

What’s wrong?

At the centre of a highly polarised debate, parents are battered by two unhelpful ideas that are endlessly rehearsed across mainstream and social media. First, that mothers ‘should’ behave in certain ways. Second, that parents who want to breastfeed need only make a ‘choice’ to do so. In fact, too many UK mothers feel pressured and judged, however they feed their babies, and decisions to breastfeed can sometimes be difficult to sustain.

Can we make a difference?

Feeling listened to improves our experiences of feeding. But the language of ‘should’ and ‘choice’ infects our conversations and undermines help from family and friends. How can we avoid conversational traps? No easy answers, but a few ideas here from a series of articles by Dawn Leeming, Fiona Woollard and myself.

Think landscape as well as portrait

When we tell our feeding stories we position ourselves as central characters, focusing on what we experienced and how we decided to respond. So, for example, if breastfeeding doesn’t work out, we explain, ‘I tried everything, but she wouldn’t latch’ or, ‘My nipples were sore and cracked, I had to stop’. But when we look at our feeding stories as a whole, we become more aware of a backdrop. Why is it that Norwegian, Danish, Hungarian, Canadian, German and Australian mothers have less trouble breastfeeding than us? Why am I more likely to breastfeed, and for longer, if I live in a smarter part of town? Yes, my actions matter – but so, it seems, does the wider environment and culture within which I act.

This story, which I gathered from a grandmother whose first baby was born in the 1970s, illustrates the point. In line with the maternity regime of the time, her baby was taken away for several hours after the birth and given a bottle … then,

“Well, you were just sitting on the ward and you were expecting the baby just to latch on … there was no sort of forehand … no instructions, no classes. I had no knowledge, they were all bottle feeding … I think I was the only one probably opted for breastfeeding … and just a lot of, you know, crying babies, so I thought, oh well … feeling, almost inadequate really.”

She sounds resigned. More than 40 years on the feelings were very raw. She could not encourage her daughter to try breastfeeding because she didn’t want her to go through the emotional pain. She’d had no information, had never seen anyone breastfeed, had not learned about it in school, there was no professional help, maternity ward practices had set her up to fail – nonetheless she felt inadequate.

Could we be more alert to the factors that impede, facilitate and shape our unique feeding journeys? Thinking about constraints may motivate us to campaign together for change.

No duty to breastfeed

Parents set out to do the best for their children, often in difficult circumstances, making decisions that they feel will work best for themselves and their families. The health benefits of breastfeeding give mothers additional reasons to breastfeed. But as Fiona Woollard points out in her article, having a ‘reason’ is not the same as being duty bound. Decisions depend on a complex interaction of internal psychological processes and external constraints. It should be possible for me to applaud and celebrate your determination to meet your feeding goals without feeling guilty that my goals are not the same.

More in common

The underlying impulses and mechanisms are the same whether we are formula feeding or breastfeeding. Until recently, there was a tendency to make breastfed babies fit in with outdated formula feeding regimes. In fact, babies do well when they are formula fed in ways that are consistent with the biological norm of breastfeeding. Sharing information, for example on recognising feeding cues and about what’s within the range of usual when it comes to sleep, enables us to focus on what we have in common.

Keeping it real

The last Infant Feeding Survey suggested that just under a third of UK mothers who were exclusively breastfeeding, and two in five who were mixed feeding, had experienced some difficulty in the early weeks. Mothers who use formula milk also ran into problems, being more likely to report colic, vomiting and reflux and that their baby had been unwell. If we don’t expect to struggle we can be left feeling unsure of how to make sense of challenges without blaming ourselves. Dawn Leeming thinks our language may make this worse; for example, describing breastfeeding as ‘natural’ might make us think it should be easy. If we feel the problem is us, if we feel confused or ashamed, we may not talk about our problems or seek help. And so, common adjustment difficulties become a feeding crisis. Can we make it safe to say when the rosy ideal of new parenthood isn’t stacking up?

Airtime for upsides

Perhaps it’s not just talking about the tougher aspects of feeding that we find difficult. Does a focus on health benefits for the baby mean that we downplay other kinds of benefits for ourselves? Breastfeeding a baby is about more than food and protection from disease. But if I say, ‘It’s so lovely, the way she strokes my breast, the way she looks at me’ you may think I’ve found another way to tell you that ‘breast is best’, particularly if I start to translate the word ‘lovely’ into the language of ‘bonding’ or ‘brain development’. Is it unacceptable to say we sometimes feed for our own comfort and enjoyment? This point is not just about breastfeeding. We also feel upsides – closeness, joy, satisfaction, pride, a sense of freedom – when we feed our babies with a bottle. Could we allow each other a little more space to talk, without judgement, about what makes us feel good?

Find out more about The Baby Friendly Initiative’s work to change the conversation on infant feeding in the UK.