Articles on the health of people in Scotland do not make happy reading. Heart disease, alcoholism and obesity – cancer and long-term health conditions like diabetes, are big problems. For these reasons it is important that we try to make sure that babies born in Scotland have the best start, and for me, that means breast-feeding. The Scottish Government has been actively promoting breast feeding by funding various initiatives for several years now, but my recent experience leads me to believe that the way this is done is actually adversely affecting women in Scotland today.
I am a mother. I have five children ages 23, 22,17,4 and 2. I am totally committed to doing the best for my children and I want for all children in society, what I want for my own – a happy, healthy, nurturing home. There were lots of differences in having my first baby in 1989 and my last baby in 2009, most of them positive. The antenatal care was better, the facilities were better. Labouring in your own room and not on a labour ward is of course, wonderful. The midwives here in Scotland were fabulous and, despite being both old (I had my last two babies at 43 and 45) and fat, I was supported and not judged the whole way through my pregnancies.
The biggest difference I found as a new mum in the 21st Century was the amount of pressure that is placed on us. One of the areas where this is most apparent is the issue of feeding and weaning. Feeding our babies seems to have become a stick with which to beat new mums. A stick which, when wielded by inflexible and unsympathetic professionals and volunteers, actually disempowers women and diminishes their confidence and affects that new, and most important bonding relationship, between a mother and her new baby.
Unfortunately this begins with Breast feeding. Now, before many of you get your keyboards out and start telling me about the benefits of breast-feeding – I know them. I have breast-fed all my children and I am wholly committed to promoting breast-feeding. I am a trained breast-feeding peer supporter and I believe, absolutely, that breast-feeding is best for both mother and baby. What I take issue with is the manner in which breast-feeding is promoted. The messages seem to be, “You must breast feed, you must absolutely breast feed, you must exclusively breast feed, any woman can breast feed and it is not true that some can’t. You are risking your children’s future health, intellect and achievements if you don’t breast feed and you will be failing to do the best for your child.”
If you want to bottle feed your baby, you are completely ignored in the antenatal feeding discussions. There is no demonstration of how to make a bottle up, no discussion of the different feeds, of what will happen in hospital and of how to sterilise or ensure the cleanliness of the feeding equipment. Now, I – writing this and you – reading this – may very well know how to do all these things but if you are a 17-year-old, just out of care, and on your own with no experience of babies – how do you know? You probably don’t even go to antenatal classes, you probably think breast-feeding is “yukky”, a commonly used word to describe breast feeding amongst young adults. If literacy is not your strong point, if English isn’t your first language or you are not very confident then how would you find these things out. If you are cocky and defensive as many single young mothers are – who would you ask? The needs of bottle feeding mums are ignored in this frenzy to promote breast-feeding to the exclusion of everything else. In 2009 the Medical Research Council said that bottle feeding mums felt “…guilt; worry about the impact on their baby and what healthcare professionals might say; uncertainty about how to proceed; a sense of failure; and anger as a result of feeling under pressure to breastfeed.” (MRC/42/09 14th July). They found evidence to show that mothers were not receiving the advice they need to make decisions about quantity, or frequency of feeds and that this neglect of bottle feeding mums can put the health of the baby at risk.
Mixed feeding is actively discouraged. In my pack issued at the hospital there was a leaflet which was given to all new mums with the message that “just one feed” is sufficient to undo all the benefits that you have bestowed on your child from breast-feeding. Just one feed can increase the risk of diabetes, under achievement, asthma and eczema. Just one feed, apparently is enough to mean that your wee one will likely never want your breast again. And this isn’t just confined to bottles – give your new baby a dummy and the leafelt suggests that they are likely to develop nipple confusion. I have looked at this in some detail and can find no scientific evidence that such a thing exists. I have gone as far as e-mailing an old school friend of mine – now a highly experienced pediatrician in a large teaching hospital and even he was unable to give me directions to any research. Many women occasionally swap from one to the other with little effect either on their milk supply or on the baby’s ability to suck. In fact my last baby was bottle fed completely for the first 36 hours and then I put her to the breast and I never gave her a bottle again. Where you have a healthy, full term baby there is no evidence to suggest that a baby will not be able to return to the breast after one or two bottles. Neither is a soother a problem either – and in fact there is research to suggest that a dummy can help to reduce risk of sudden infant death. The effect of leaflets like “just one feed” can be to increase the feelings of guilt, fear and failure in new mums.
I have also found that even those women who do breast feed, feel these feelings of guilt and failure. A mother I knew who was a successful breast-feeding mum, a confident, professional woman, described still waking up in the night worrying about the fact that she gave her baby formula out of a cup when in hospital. This was despite the fact that the professionals advised this was what both she and her baby needed at the time. Exhausted after the birth, a hungry and crying baby and no milk supply yet, she gave him a formula feed – he slept, she slept and she was in a much better position to breast-feed the following day. And yet this smart and confident woman still felt guilt and pain over “just one feed”.
Women who have given up breast-feeding are often made to feel like they haven’t tried hard enough. A new mum with a baby who was struggling with feeding mentioned to her health visitor that she was thinking of moving to formula feed to be asked, “What? You are GIVING UP? You know it is best for baby don’t you? You need to try harder”. I have heard stories about a woman sharing a video of her child pouring formula milk samples she had been sent in error – down the toilet. A woman who is also a peer supporter, but emigrated here from another country said in disgust, “Only in such a rich country could people treat food with such disdain.”
Another woman described her anxiety over timing her baby’s feeds; I suggested that she could give her baby a feed two hours after the last one if she wanted. She asked me “Can I? Would that be alright?” I had to point out to her that he was HER baby and she could organise his feeds whichever way suited her and him. She was so relieved that she almost cried. Another woman was so anxious about her breast-fed baby “getting enough” that she put all the information about his feeds into her computer spending ages trying to figure out how much he was getting. Instead of spending time just being with her baby and getting to know him, she was anxious and desperately trying to understand why she was finding it so hard.
I have heard health professionals say in a horrified voice – “They use ground up tuna fish eye sockets for calcium in formula milk” and seen a whole room of women curl their lip in horror. This is just mad. Formula milk may not be breast milk, but it isn’t arsenic in a bottle. I have heard women suggest that other women who bottle feed their babies are less “mothering” than mothers who breastfeed and seen a room of women sneer and denigrate others who use formula milk as though they – breast feeding mothers – are somehow better or superior.
If these messages were successful in increasing breast-feeding across the board, across all different groups of women then it might – just might – have some justification in filling many women with a sense of having failed as a mother before they have actually started . They are however, not successful. Over the last ten years in Scotland the rates of breast-feeding have remained static – there has been slight increases of a percentage point here and there, but no significant increase across the board. Importantly, whilst there has been an increase of a whole 6% in ten years of breast-feeding across the most deprived areas of Scotland – in our poorest communities there are still only around 20% of babies exclusively breast-fed at 6-8 weeks. Even when you add in mixed feeding the figure is still only 22.3%. The Government set a target to increase the proportion of new born children exclusively breastfed at 6-8 weeks in Scotland, from 26.2% in 2006/07 to 32.7% in 2010/11 (an increase of 25%). We are failing to achieve this. In 2010/11 the figure was 26.5%.
When we get to weaning the inflexibility of advice continues. The official advice is that weaning should not take place until the baby is 6 months old. This advice is lifted straight from the World Health Organisation Guidelines. I want to make it clear that I am not talking about other countries here but Scotland. There are countries where formula milk is not high quality and where hygiene is not of a high standard and this makes using formula milk dangerous. I am not talking about countries with low birth weight babies or without clean places to prepare weaning food. I’m talking about Scotland. These guidelines are WORLD guidelines, they offer guidance to countries where infant mortality is high and birth weight low. The average birth weight in Scotland is good at just under 8lbs. Telling mums that breast milk is the best food for children up to 6 months – come what may – takes no account of your child and their own needs. I know women whose babies cried and cried and they slogged it out until 6 months – exhausted, wondering where their happy child went, in order not to give their wee one solid food before six months. Other women had babies who were not the slightest bit interested in food until they were past 6 months. They are all different – they are BABIES not computers. There was recent research to show that weaning at 4 months can be beneficial and yet the official advice is absolutely NOT to wean your baby before 6 months old.
If you have a health visitor with common sense then you maybe told on the quiet, that starting at four months old is ok. But many mothers report being told absolutely, under no circumstances are they to even think about weaning before 6 months. When I was first a mum in 1989 and 1990 I was often told by professionals, “You know your baby, what do you think?” I was able to discuss whether my baby was hungry enough for weaning or not. I was advised – not ordered, supported – not scared into doing what I was told and my children were all weaned at different ages because they were all ready for weaning at different ages. I was given credit for being a mother, a good one. And in many places in Scotland today that doesn’t seem to happen.
So what are we doing? What on earth happened to freedom and support? What happened to the nurturing and help that older women would give to younger women on the birth of their babies? Surely, as women, we have campaigned to have choices, as feminists in the 21st century, we believe in choice for women and the right to live happy, fulfilled lives. How then can we justify pressuring women over this so that they feel the emotions I have mentioned? We have women who are finding they lack confidence in mothering, women who feel that they have no power to make choices which are right for them and their babies for fear of either being labelled a failure, or of damning their children to a life of ill health and intellectual failure because of “just one feed”. In Scotland today, we have a system which does not allow for the needs of individual babies and mums to be taken into account in a positive and empowering way. We have otherwise well-adjusted women so disempowered by the advice, that they feel they have no control over the frequency, type and duration of infant feeding and we also have socially disadvantaged women, completely unreached by the message that breast is best, easy and fun to do. It strikes me that it is the whole approach to promoting breast-feeding which is failing – not the mums who use bottles, dummies or wean at 4 months. If an Independent Scotland wants to make a real difference to breast-feeding rates and the health of its population, then we need to empower women to make informed decisions without the use of a big stick – all women – including those in the poorest areas of our country and if we can do this, then we might just start to change these depressing statistics and improve the health of Scotland in years to come.