My plea for a better quality discussion on breastfeeding

Every time I see an apparently well-intentioned opinion piece on breastfeeding or other health matters filled with statements that any doctor could tell you are false or misleading, I feel saddened. Every time I see an article that creates false divides between breastfeeding and non-breastfeeding mothers, I feel saddened. There are a lot of blogs out there and a lot of opinion pieces. A parent or parent-to-be searching for answers online is going to come across a lot of good information, and a lot of potentially damaging misinformation as well.

With this in mind, I have a plea. My plea is this:

As writers, can we please treat health matters with care?

Can we please insert facts and references into opinion pieces on health matters, and not only expressions of our own naturally limited personal experiences?

The great thing about research is that it encompasses experiences outside our own. It provides perspective. It provides, well, science. And on matters of health, though the science may sometimes seem confusing or contradictory, on many matters, the science is well and truly in. On breastfeeding, for example, the science is in, yet every opinion piece that begins with ‘I support breastfeeding but’, and then goes on to list reasons why women shouldn’t breastfeed, or why breastfeeding doesn’t have any ‘real’ benefits, or why breastfeeding will be an awful experience for you (because it was for the writer), undermines decades of research, important health messages and hard facts.

Every article that perpetuates the myth that there are no benefits after six months and breastfeeding mothers are ‘only doing it for themselves’ is false and unhelpful. Every article that uses terms like ‘breastfeeding nazi’ or is called ‘F*ck You Breastfeeding’ (Yes, the real title of a piece I won’t link to here), labels mothers who breastfeed past infancy as ‘sick’, or mothers who formula feed as ‘selfish’, spreads misinformation, lowers the quality of an important, complex discussion and encourages a false divide between parents.

Further, we risk fuelling misinformation and unlawful harassment of parents every time we get caught in a broad public debate about the personal opinions of a TV host regarding the need for mothers to be ‘discreet’ and refrain from breastfeeding in certain public areas, without staying focussed on the fact that breastfeeding mothers have the legal right to breastfeed whenever, wherever and however they need to (without covers or under covers, directly from the breast or expressing into bottles, etc) in any public space, regardless of their attire, the age of their child, or what you think about it.

Every parent must make decisions for themselves and their children. Some decisions are tough. Will every parent form their own opinions along the way? Naturally. Should we share our opinions? Some of the time, yes. It is human to do so. But beware. Just because someone has an opinion does not make it correct – even if it is printed in a well-read publication.

Let’s be careful not to perpetuate the so-called ‘mummy wars’. Let’s take aim, not at other women, but at the systems that let women down with inadequate medical, social, financial and workplace support. According to Australian Institute of Health and Welfare over 90% of mothers in Australia will breastfeed, but the majority will quit before they choose to, largely due to external pressures and lack of support. Let’s be careful not to create false divides between mothers who breastfeed and mothers who don’t, or parents who work and parents who do not.

Oversimplification is not the answer, either. The popular mantra I see in many opinion pieces at the moment is ‘happy mother equals healthy baby’, and unfortunately, though I would like that to be true, strictly speaking it is not. The happiness – and sanity and ability to cope – of a parent is hugely important and has a strong bearing on the wellbeing and health of his or her children, but it simply does not follow that being a happy parent can save your child from health problems. Happy mother quickly becomes unhappy mother when baby is not well – I know this from personal experience and experience in the area of maternal health. The idea is to be informed so you can reduce the chances of ill health or be aware of what may be happening if something does go wrong. In my view ‘Happy mother, healthy baby’ is unfortunately an overly simplistic idea when applied to health choices, even if at its essence it is a statement that I want to support because it attempts to tackle a very serious problem – the harassment of parents (particularly mothers) for making perfectly valid and legal choices that others disagree with.

We all deserve to live our lives by our own choices, free of harassment, and we deserve real information on matters that count so we can make choices based on the best information available. This applies to all health matters, of course, but breastfeeding is the topic I am best placed to comment on at this time because my honorary role as UNICEF Australia’s Patron for Breastfeeding for the Baby Friendly Health Initiative requires regular fact-checking on my part, discussions with experts and attendance at maternal health conferences. This does not make me an expert, only someone who is very familiar with this topic.

In my experience, the quality of the popular discussion around breastfeeding in Australia is very poor and divisive, and in no way reflects the professional discussions in this area. We can and should rectify this.

So, why listen to me? This is after all, just another blog. You should not rely on a blog or an opinion piece for important health information.

I don’t want you to believe me. 

I want you to believe The World Health OrganizationThe Australian Department of HealthThe US Department of HealthUNICEF, the Australian College of Midwives and the Baby Friendly Health Initiative, all of whom are creating better breastfeeding education and support services, and systems that provide more support for all parents regardless of how they feed their children. If you are expecting I hope will not rely on opinion pieces, but will speak to a reliable and qualified doctor, midwife or health professional, and take a look at the hard data at the links above so that you can make informed decisions and put in place support systems to better achieve your breastfeeding goals, if that is what you choose, or know what you can do to help boost your child’s health and reduce existing risks if you are not able to breastfeed. (Do compare the information at the links above with any advice you receive, even from your health professional, and never feel afraid to ask questions or seek help with services like the free National Breastfeeding Helpline 1800 mum 2 mum.)

With good information we can make healthier decisions for ourselves, or at least know what ideals to aim for. With good information we can better adapt to the realities and challenges ahead, whatever that means for us as individuals.

As a writer I pledge to always try my very best to fill my writings with research, hard data and a sense of balance.

And if I am reading an article on health matters that includes no references to credible health professionals or organisations, I will stop reading. 

We could all use a little less misinformation. I’ll leave you with this quote, most often attributed to Daniel Patrick Moynihan -

You are entitled to your opinion. But you are not entitled to your own facts.

Indeed.

* Image above: With UNICEF representatives and representatives of the Australian College of Midwives at the 2011 International Breastfeeding Conference in Canberra.

* Find Baby Friendly BFHI accredited hospitals in Australia

20 Comments

  1. Cassandra

    Excellent points raised Tara. You have said much of what I usually say if drawn into a “mummy debate”. I really hate the perceived divide that has occurred between mothers. No matter what choices you make (Breastfeeding or not is not the only one) you should be doing what is right for you and your family and not attacking or judging others who do it differently. As someone who couldn’t breastfeed I found it hardest when I was judged as selfish and making excuses. But I always stand up for Breastfeeding and like to direct people to research or societies that can help them make an informed decision. I just wish there were more people who could calmly discuss matters of parenthood instead of flying off the handle and providing heavy handed radical veiws without giving any proper information. Keep up the good work.

  2. Great article, with just one little correction. Unfortunately the number of doctors who are misinformed about breastfeeding is a large one, and this is one influence on women giving up breastfeeding before they choose to. I had a doctor who told me I would be giving my four month old baby vitamin c deficiency if I didn’t give him orange juice. I was fortunate enough to know better, but I do wonder how many more women would be supported in their choice if doctors were better informed.

  3. I agree with Mel. I had a doctor tell me when my firstborn was 3 months that I should be drinking cow’s milk (in order to make human milk, apparently), and that I should not feed her overnight, but rather, give her water. I knew better thankfully but like others I wonder how many mothers are given false or poor information by GPs who are largely uneducated about breastfeeding. Other than that, great article!

  4. Tara Moss

    Thank you Cassandra, Stacey and Mel. You are right that some doctors unfortunately spread misinformation and outdated advice regarding breastfeeding, and in fact I did have that experience myself at one point and it has been a focus of discussion at some health conferences I have attended. I have added a small reference in brackets, so I hope that helps. I always recommend reading the hard data on breastfeeding at credible sources, like those I link to in the article (UNICEF, WHO, BFHI, government websites, etc), and comparing that against any advice.
    Best wishes and many thanks for reading,
    Tara

  5. Jane

    Great piece Tara, however I think “perceived divide” isn’t just perceived when you look through parenting forums. I recently had to make the choice whether to do controlled crying with my 7 month old and most of the “information” I found on the matter, when performing a google search, was baby website forums. The vitriolic responses provided to mothers seeking information when making a very difficult choice is shocking. Unfortunately competitive parenting has become the new sport of choice for many insecure mothers. And really it’s people’s own insecurities at the heart of their judgement. For some reason many parents view the parenting choices of others as a judgement on their own methods in raising their own children.

  6. This is a really great post, thank you Tara. I think our breastfeeding rates are testament to the fact that we need to discuss breastfeeding and talk about how we can better support women who wish to breastfeed but are being let down. And as the AIHW study shows, most women wean before they are ready—it’s these women for whom we need to have this discourse. But breastfeeding discussions are so often fraught with understandably triggered emotions, accusations and misinformation. For these reasons, I think our media revel in flinging the word ‘breastfeeding’ into a headline with little more intention than to satisfy a need for hits.

    As a breastfeeding advocate and opinion writer myself, your post is a timely reminder for me to take care with the words and information I use. I think that presenting facts and scientific evidence is imperative, however, I think we also need to remember that breastfeeding is a skill we learn from each other: it’s an art passed from woman to woman. Sometimes, no science in the world can teach us that. Sometimes, only women can share the skills and knowledge and reassurances of breastfeeding with each other. And as others have said, well-meaning health professionals don’t always have the right information. That is where opinion writing—careful, kind, accurate, well-referenced opinion writing—is an important part of breastfeeding information and support.

    I think that sometimes we over-intellectualise breastfeeding. After all, breastfeeding is nothing more than the biological norm. Sleep-deprived new mothers, riding tumultuous hormones, need simple and empathic advice and information. Mothers shouldn’t have to have degrees in research or statistical data analysis to breastfeed. But mothers DO have a right to correct, up-to-date, truly supportive information. And our breastfeeding rates demonstrate that most mothers aren’t getting that. As Mary Paton, founding mother of the ABA said, “every new mother needs the shoulder of a more experienced mother to lean on.” I think that is what women really need.

    Thank you again for a great post. Have shared.
    Kim xo

  7. Anne Weeks

    Tara, here’s some Australian research by medical doctors about doctors and their knowledge about breastfeeding: http://jhl.sagepub.com/content/24/4/422.short
    Breastfeeding and Australian GP Registrars—Their Knowledge and Attitudes
    “However, 40% of the knowledge items were answered incorrectly by the majority of participants.”
    By W Brodribb, A Fallon, C Jackson, & D Hegney

    Abstract
    The aim of this study was to identify the breastfeeding attitudes and knowledge of a sample of Australian general practice (GP) registrars and investigate how confident and effective they thought their interactions with breastfeeding women were. Between February and May 2007, a 90-item questionnaire containing demographic, attitude, and knowledge items was distributed to final-year Australian GP registrars. The mean attitude score (5 = maximum score) was 3.99. The mean knowledge score (5 = maximum score) was 3.40, indicating some degree of breastfeeding knowledge. However, 40% of the knowledge items were answered incorrectly by the majority of participants. Approximately 40% of the cohort were confident and thought they were effective assisting breastfeeding women. Having more than 26 weeks personal experience with breastfeeding (self or partner) increased breastfeeding knowledge, attitudes, confidence, and effectiveness. Further targeted training is needed to improve Australian GP registrars’ breastfeeding knowledge, attitudes, confidence, and effectiveness. J Hum Lact. 24(4):422-430.

  8. Fantastic article, Tara. Thank you.

    This resonates with me today:
    “According to Australian Institute of Health and Welfare over 90% of mothers in Australia will breastfeed, but the majority will quit before they choose to, largely due to external pressures and lack of support.”

    I attended a client today who gave birth to a 6lb baby less than 12 hours ago. Baby was term, healthy, and the labour and birth normal. Nonetheless, by the time I got to see her early this morning (baby was born last night) the hospital had advised her to give the baby formula within a few hours of birth. His blood sugar is fine, he is alert and active and healthy, and doing all the right things. But the hospital is telling her she needs to give him formula because he’s “small”. His mother is quite petite, and clearly this baby’s size is his genetic inheritance, yet her attempts to breastfeed have been sabotaged from the get go for no reason whatsoever.

    It’s beyond frustrating.

  9. Aveline Clarke

    Thank you so much for opening up this discussion, Tara. To be able to have a community and society that has quality, trusted, researched and reliable support for new and expecting mothers is not just an ideal: it’s a future goal that we need.
    I feel that we have gone so far away from understanding the truth of breastfeeding, to create a space where the mummy bloggers and opinion-based articles have filled that space, and further supported by medical professionals whose own education is below-par. Now is the time to bring back common sense, the knowledge that exists, an embracing of our human mothering instincts, and acknowledgement of other societies around the world that are doing better than us.
    I gave birth to twin boys over 2 years ago at a leading hospital specialising in multiples. My birth was uncomplicated, the twins were full term, and totalled 6.2kg in combined weight. However I was told by the paediatrician that I would struggle to breastfeed and might as well just give them formula straight up. I was fortunate to have a breastfeeding consultant visit me straight after and advised me otherwise, saying her own sister breastfeed her twins to 16 months. She told me to keep her advice quiet as it was contrary to the paediatrician’s!
    That the two health professionals were at odds in their advice to such a natural and normal function of mothering – was disturbing. And that, Tara, is one of the things I hope and pray that will be resolved as more conversations are had that are based on research and not opinion. Women need the best support systems possible, and in our western world we have all the information and education available – so lets put it to good use.

    And for the record – I breastfed my twins until the day they turned 2. I followed my mother intuition and was glad I did.

    I applaud the work you’re doing, thank you. And I look forward to seeing more quality articles on this topic in the future.

  10. Eliza

    Any mothers of prems have major issues with breast feeding – when baby is born too early, and is too small to suck, it can be hard to establish breast feeding. In my own case, very very I’ll with pre-eclampsia and on masses of meds, with a teeny baby lying in an isolette being fed formula through a tube, my milk just never came in. At all.

    My body seemed to go into a kind of shock, I think. Lots of nurses pumping at my breasts with various types of pumps – but nothing.

    This sort of thing has happened forever. Many mothers cant feed. In earlier times, there were always wet nurses in the village
    etc, on hand to help.

    In the modern era, though, we are made to feel like we failed, and are looked down upon by the breastfeeding mafia, who make us feel like we should have tried harder, or should have done more, or read more, or been helped more.

  11. Tara Moss

    Hi Eliza, I’m sorry you had a difficult time. I can relate to the pumps and the formula and bottles and special care in hospital. It was challenging at times, particularly when my girl became sick. I do hope, though, that you aren’t comparing me, or the health professionals who tried to help you, to this so-called ‘breast feeding mafia’ you encountered?

  12. Eliza

    Thanks Tara – not you or the wonderful midwives and feeding professionals at all – loved all of them.
    Am just still a bit peeved by the mothers with raised eyebrows who intimated that I should have tried harder. I couldn’t have tried any harder – nothing ever came out!
    Or the ones who, when I tried to get information on formula (I wanted to find out all I could about it, as I had no choice but to use it!) told me I should just contact the Breastfeeding Association, and Why was I even asking about formula anyway, when I should be breastfeeding?

  13. Tara Moss

    Thank you, Eliza. I am sorry you had so much trouble with unhelpful people. My experience was quite ‘varied’ as well, to put it diplomatically. Thankfully I was able to read a lot online at the credible health organisations I listed above so I had a good understanding of what questions to ask, at least, and I could identify some of the advice I was getting which was just plain outdated and incorrect. I had some trouble in hospital too, as it was a non-BFHI hospital and one doctor in particular made breastfeeding quite difficult by prescribing formula before my milk came in. I look forward to a time when more mothers in Australia get the support they need in hospital, in the community and at work, whatever that involves for individual parents. x

  14. Cath

    Thanks for the article Tara. I was devastated to be unable to breastfeed my first baby. My second baby was the complete opposite. I then discovered how limiting breastfeeding is for someone who isn’t comfortable breastfeeding in public. I was largely trapped at home untlil my daughter could take solids. I know I wass entitled to breastfeed in public and I did when I really had to, but it would have been so much easier for me if public places had to provide a pleasant room for women to breasfeed in and I exclude grotty baby changing rooms from meeting that requirement. I support breastfeeding in public and all power to the women who don’t mind it but I still think that some provision should be made for those of us that are a little shy.

  15. Karen

    Brilliant post Tara! It can be confusing when there are so many people out there with only an opinion to offer and they do so loudly.
    I always find myself quoting the facts and research that I am aware of when asked ‘what I think about… (insert breastfeeding/parenting related topic here)’. I can’t help it because I can’t see how anyone who has been a parent can miss the understanding that we are all doing our best, in the situation that is at hand, for the little person (and personality) that is born to us. I would never assume that my experience, as individual as it is, could be the same as anyone else’s. In the same way that my littles are unlike anyone elses!
    I try to be positive and offer suggestions but I would never dream of asserting that my way is the only way or the right way. Compassion and tolerance – something that we could use a little more of on this topic and quite a few others.
    Thank you for your wisdom.

  16. Cat

    Fantastic article.

    I also am concerned that when expectant or new mums are instructed to seek advice from a doctor, midwives or community health nurse, that the quality of information and support is not what it should be. If I had relied on midwives, CHNs, or hospital and community health LCs, or my regular GPs for breastfeeding support I would not have made it through our breastfeeding struggles. The standard health professionals I encountered just didn’t seem to be able to cope with anything that wasn’t a stock standard new mum with an attachment problem. Thankfully I found my local ABA group, trusted my gut, threw financial caution to the wind and engaged a private LC, and a GP with special interest in breastfeeding. 3 tongue-tie procedures and tons of chiro appointments, and finally at age 9 months we had our first pain-free feeds. I truly believe that our health professionals either need to learn more about breastfeeding, or be upfront and state that it is not an area they are well-versed in.

  17. Hi Tara
    Have you read Monica Dux’s new book “Things I Didn’t Expect (When I Was Expecting)” I thought her chapter on breastfeeding was really, really interesting on so many levels.
    Best
    Lily Mae

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