Breast ‘politics’ and a response to Mia Freedman

Yesterday I returned from a family holiday in Canada and came across a piece titled, ‘Time to get a grasp on reality and stop making colossal boobs of ourselves over breast politics’, by Mia Freedman, published in the Sunday Telegraph. I wrote an email to Mia about the article. She was good enough to post it in the comments section of her blog and I have cut and pasted it below because I feel the issues we are discussing are of some importance. I hope you will add your thoughts in the comments below. This is an emotive issue. Many women have tough breastfeeding stories to tell, and many have beautiful stories, also. All are welcome here.

It is important to note that BFHI accredited hospitals (accreditation is governed by the Australian College of Midwives) provide much needed support for all mothers and babies, regardless of their circumstances, desire or ability to breastfeed. It is a global initiative and BFHI policy is the same in every one of the more than 150 countries where it is implemented. The ABA, on the other hand, is a grassroots volunteer organisation that has no involvement with BFHI hospital policy, as implied in Mia’s article.

*****

Feb 27, 2012

Dear Mia Freedman,

Firstly, congratulations on your ongoing role as one of the leading voices of women in Australia, and on your ability to bring important women’s issues into the public eye. I have read many of your articles published at Mamamia.com.au and in the weekend newspapers, and of course we have met and communicated numerous times over the years. Yesterday I came across your piece titled ‘Time to get a grasp on reality and stop making colossal boobs of ourselves over breast politics’ and I felt I should contact you to address some important issues.

I am unaware of any ‘Breast Feeding Association’ that gives accreditation to hospitals, as mentioned in your article. There is a volunteer group called the Australian Breastfeeding Assoc that provides breastfeeding classes and a 24 hour hotline (1800 mum 2 mum) to help women with breastfeeding problems, with the phone lines manned – ‘womaned’ actually – by volunteers who have earned qualifications to help women struggling with breastfeeding related issues, milk supply, attachment problems, etc. They generously provide a free and helpful service but do not provide accreditation to hospitals. The Baby Friendly Health Initiative, or BFHI (previously named the Baby Friendly Hospital Initiative), developed by the World Health Organisation and UNICEF in 1991 and implemented in over 150 countries worldwide, does provide accreditation for hospitals globally, and is governed locally by the Australian College of Midwives (not the ABA). I think this may be the program you are referring to in your article, and as I am patron for BFHI in Australia I thought I should address some of the issues you raised.

The Baby Friendly Health Initiative, and their ‘10 Steps To Successful Breastfeeding’ have been very successful in raising breastfeeding rates in countries with Baby Friendly accredited hospitals. To give one example, after only two years of BFHI implementation in China exclusive breastfeeding rates in that country doubled in rural areas and increased from 10 per cent to 47 per cent in urban areas. Currently, Australia’s exclusive breastfeeding rate at the medically recommended six month mark is 14% – less than half the world average. Governments around the world, medical professionals and organisations like WHO and UNICEF are actively trying to raise breastfeeding rates and in particular exclusive breastfeeding rates during the crucial first six months because of significant health implications for mothers and babies. The focus on exclusive feeding is due to a wealth of evidence showing health risks associated with formula feeding and mixed feeding. Beyond the long-term outcomes like higher rates of infection, disease and obesity associated with formula feeding, unlike breast milk suckled directly from the breast, formula is not sterile. Equally, bottles and teats are not sterile, and making these items medically sterile can be costly in hospitals, using specialised equipment, and parents can only ever have limited success in making them sterile at home. As human beings we are all imperfect, and as a result, the preparation of formula can be flawed and babies can and do get very sick. The latest research shows that an estimated 53 per cent of diarrhoea hospitalisations could be prevented each month by exclusive breastfeeding, breastfed babies have 15 per cent fewer doctor visits in the first six months, and in developing countries where sterilisation techniques are arguably poorest, use of bottles and formula cause an estimated 1.4 million deaths in children under five. These are some of the reasons why BFHI accredited hospitals aim only to introduce bottles to babies (including expressed breast milk in bottles) when medically necessary.

Until such practices were widely banned, many hospitals gave out free packs of formula to new mothers, and had formula tins and formula advertisements displayed within maternity wards, where new mothers are most vulnerable. Unsurprisingly, this resulted in significantly lower breastfeeding rates and higher rates of formula use. (To give an example of how much sway advertising can have on a culture, formula is reportedly one of the top 3 consumer commodities and one of the top imports in the Philippines, where there is currently no ban on the advertising of formula for babies, and sales amount to nearly half a billion US dollars annually despite much of the country living in poverty.) It is for these reasons that formula is not displayed in BFHI accredited hospitals, however it can be readily accessed for medical reasons or if the mother wishes. The introduction of bottles is not taken lightly because of the increased health risks for babies and the potential hurdles it can create for mothers who wish to breastfeed, including ‘nipple confusion’ and attachment problems in newborns, and lowered milk supply in mothers. Breastfeeding is not always easy in the early days or weeks and the last thing we need is any hospital policy that makes it yet harder to breastfeed. For many of the same reasons, nipple substitutes, such as pacifiers, are not encouraged in BFHI accredited hospitals either. It is important to mention that although BFHI accredited hospitals have policies in place to support breastfeeding, they also have policies in place to support women who chose not to breastfeed or can’t breastfeed for medical reasons. That does not extend to actively promoting or displaying artificial nipples or breast milk substitutes. As you wrote in your article ‘formula was never displayed anywhere – it was hidden – and neither were bottles of ANY KIND EVER’. Indeed. Why should formula be displayed in maternity wards? We see aisles of it in supermarkets.

You mentioned in your article that you have breastfed three children and you wrote your piece from the perspective of someone who has loved and hated breastfeeding. Amen. I am writing this as a mother of one who introduced my daughter to formula at only two days of age, on doctor’s recommendations, and fed her formula ‘top-ups’ for six weeks before breastfeeding exclusively. (After some hurdles at the start, we are still going strong with breastfeeding). I do not view my formula use as a personal failure or a source of guilt, and nor should anyone else.

But more importantly, I am writing this not just as a mum, an individual, but as patron of the BFHI program, and in this volunteer role it is my job to pass on evidence-based information on this topic, quite beyond my very small sample size or personal anecdotes. It is because of decades of exhaustive research conducted around the world by scientists and health professionals that I can confidently say that the perceived injustice of an objectionable facial expression from a midwife, or the need for midwives to sign off on formula to feed a newborn, in the case of your friend’s experience, is a small inconvenience for a policy that provides significant improvement in health outcomes for babies and mums, eases the burden on our health system and in some cases even saves lives.

BFHI hospital accreditation exists only to support the health and wellbeing of women and children, to reduce infections and to save lives. Guilt-trips and ‘breast politics’ have nothing to do with it. I encourage any expecting mother to chose a BFHI accredited hospital. I know I will.

You may find these links of interest:

BFHI Australia

World Health Organisation

Please feel free to contact me any time to discuss any of this.

Best wishes,

Tara Moss

UNICEF Patron for Breastfeeding for BFHI

*****

An addendum: I’ve had it pointed out to me that not everyone who wants to birth in a BFHI accredited hospital can find one. This is an excellent point. There is a comprehensive list of BFHI accredited hospitals here, listed by state:

http://www.babyfriendly.org.au/health-professionals/find-a-bfhi-hospital/

If there are no BFHI accredited hospitals in your area, I recommend writing down and communicating your desire to have ‘skin to skin’ time directly after birth. This has a variety of medically proven health benefits, can assist with breastfeeding and is also a wonderful bonding experience for everyone, including those who will not be breastfeeding for any reason. A version of skin-to-skin can also be achieved with caesarean births, so ask your hospital about it. Also, write down and communicate your desire to breastfeed exclusively and not be offered artificial teats or artificial milk unless medically necessary. (Do not worry, if it is medically necessary for any reason the hospital will organise what your baby needs.) All this can be part of what is commonly called a ‘birth plan’, and communicating these desires to the health professionals in the hospital where you intend to give birth will give you a better chance of the ‘baby friendly’ environment you desire. Most hospitals are very receptive to these requests and everything will be done to support you.

Any questions or comments about BFHI or complaints about problems in BFHI hospitals can be directed here:

http://www.babyfriendly.org.au/contact-us/

Thank you for all your feedback and for sharing your stories.

107 Comments

  1. Lynne

    So well put Tara – I am so glad you are the BFHI patron as you will make a big difference to so many people (mostly the littlest and most precious).

  2. Alicia

    Thanks Tara. I need to share your response with my family & friends.

  3. emilynne capelli

    Good writing Tara. maybe you should be doing feature columns for the tabloids! ; )

  4. Laurel

    Thank you for being so open, honest and factual about the information you have provided. Your support of breastfeeding and being an informed parent is appreciated.

  5. Naomi

    Thankyou for replying to Mia in such an eloquent manner. Did she respond?

  6. Michelle

    Thank you so much Tara – your letter was beautifully written and accurate!

  7. Lee

    Tara, you are amazing. THANK GOD we have such a wonderful Patron in you. You are right, this is not about ‘breast politics’ but the health of our children. I urge any pregnant woman to read ‘Breastfeeding Matters’ by Maureen Minchin if she doubts the perfection of breastmilk and the dangers of artificial baby milk.

  8. Gent

    Fantastic and balanced response! Eloquent, respectful and factual. A total contrast to the original blog entry that you are responding to. Thank you! (Hear, hear Emilynne Capelli…)

  9. Natasha Whiting

    Tara, that was beautiful! Well put……only a woman like you could say this so perfectly without any cause for offence. Good on you!

  10. Marlee

    Tara – I reiterate what you have said and we are lucky to have such a lovely, committed patron to try and boost breastfeeding exclusively. I am answering calls on the Helpline at the moment and they have been back to back for the last 3 hours, so mums are getting the message and seeking help with breastfeeding, so maybe we will get the numbers exclusively breastfeeding, up a great deal more than they are in Australia at the moment. I hope so.

  11. BrissieMum

    Just beautiful; and so glad that Mia Freedman published it. It would be lovely to see a regular Tara Moss column in our newspapers somewhere, too!

  12. Amy

    What an eloquent and informed response Tara.I’ve recently become so dismayed by articles written in regards to motherhood and breastfeeding in our newspapaers that I try not to read them as there is such little evidence based research presented. Every celebrity mother seems to be an expert with a lot to say, not much of which is factual. Thanks for being such a wonderful advocate fo mothers and babies

  13. Jules

    After having my first baby who was also deemed to need formula (given in a bottle as his 3rd feed), the next afternoon he had nipple confusion, and I had bleeding nipples. One midwife said that the way to fix this was to express and give him a bottle of expressed breast milk after I had fed him. So my nipple could heal and so my son could get enough milk. I had horrendous difficulties arising from these two actions and pieces of advice, after some help and education from the ABA and 6 weeks of pain I improved. However had it been a BFHI (or had I known what one was and chosen it) I believe I would have been saved considerable pain and distress, as would my son.

  14. Jules

    After having my first baby who was also deemed to need formula (given in a bottle as his 3rd feed), the next afternoon he had nipple confusion, and I had bleeding nipples. One midwife said that the way to fix this was to express and give him a bottle of expressed breast milk after I had fed him. So my nipple could heal and so my son could get enough milk. I had horrendous difficulties arising from these two actions and pieces of advice, after some help and education from the ABA and 6 weeks of pain I improved. However had it been a BFHI (or had I known what one was and chosen it) I believe I would have been saved considerable pain and distress, as would my son. Thank you for writing such an educative and empathetic response to the article, and sharing it.

  15. gen

    Thank you for your wonderful response. Balanced and clear. What a relief to read.
    Awesome.

  16. Tanya Gill

    Thank you, Tara, for standing up for the sake of correctly informed opinion in the media. I am personally offended and upset when writers such as Mia Freedman and Frances Whiting feel the need to attack volunteers in the media. These almost defamatory comments show a lack of knowledge and a lack of realization that theirs is a voice that is listened to by many women.

  17. Emily

    Thankyou Tara, very well said. And I love the photo 🙂 Just gorgeous.

  18. Jo- Sydney

    Tara, Thanks for writing yet another clearly defined piece so eloquently written. I cried reading your second last paragraph. You are a fantastic ambassador and the world of mothers and babies are lucky to have you advocating so beautifully for them.

  19. Caradene Hannan

    Thank you for this much needed response to Mia’s article.
    Women and babies are indeed fortunate to have you on side.

  20. Ayesha

    Thanks Tara for sharing your views and providing an accurate and informative response. I breastfed my daughter till the age of three and am now currently breastfeeding my 8 week old son. I found breastfeeding difficult the first time round, but with my son, it has been so easy. I love breastfeeding, its bonding, cheap, and once you get the hang of it, very convenient.

    I think it is vitally important that mothers are given the information and support in their breastfeeding journey. I was shocked recently when a woman in her 30s who is having her first baby said there was no difference between breastmilk and formula.

  21. Jotty

    Thank you for writing such an informative and measured piece. I hope your response is read by many. Thanks for helping to get the facts out there.

  22. Emmaline

    This is the best contribution to a breastfeeding discussion I’ve seen in a long time. Tara, it’s great to see you using your role as patron so judiciously, it’s a great place to speak from, and you have made such a clear and welcome statement!

  23. SL

    While I agree that breast-feeding is the best for baby, I have not been able to have a child. My first child is coming home this week through a 6 year adoption process and my only option will be to give him formula. Do not be too critical of those who have to do things a little bit differently – our journey has already been hard enough.

  24. Erin

    I recently had my baby at Frances Perry House in Melbourne which is a BFHI accredited hospital and I am positive it was the reason why I have had no problems getting my three-week old baby to properly attach and feed. I was able to visit their breastfeeding room staffed by a lactation consultant for the first four feeds that I gave my baby boy. I escaped the dreaded sore and cracked nipples because i was shown and helped with correct attachment and feeding tips from the very beginning. Also, being from a lactation consultant meant that I wasn’t given conflicting advice and felt confident in what I was doing. I also had the privilege of staying 4 nights in the private system which meant that I still had the on-hand support of the lactation consultant when my milk came in and feeding became difficult again due to engorgement etc. Like Tara, I would definitely recommend that you seek out a BFHI hospital to give birth in if you contemplating giving birth in the hospital system.

  25. Anonymous

    Dear SL, congratulations on the wonderful news of your upcoming adoption. While I have no personal experience with adoption, some of my friends do, and it may interest you to know that women are having success breastfeeding their adopted children, as it is not necessary to have given birth in order to breastfeed. There is some information here: https://www.breastfeeding.a… and here http://fourfriends.com/abrw/ One of my close friends is unable to carry a child due to cancer treatments but is preparing to breastfeed her surrogate baby, which is very exciting. I’m sure this option has its challenges but it is wonderful to know that it is an option for those who chose it. Like many people I was unaware that it was possible before my friend informed me.
    Best wishes and good luck on your journey,
    Tara

  26. Devashrii Dobe`

    Thankyou for being factual & unemotive. I have breastfed 5 children – my last was born at 27 weeks & I expressed second hourly around the clock to ensure that she received what I know is the best source of nutrition for all babies. My breastfeeding experiences have been superbly beautiful & supremely difficult. But isn’t that what life is like? The most important factor in breastfeeding is education closely followed by support. Let’s educate women & support them so that breastfeeding in this affluent country is "normal". Thankyou Tara again for addressing this article that I will confess, curdled my milk! x

  27. Alison Sneddon

    A beautifully constructed and factual response from Tara to Mia. Such a shame Mia didn’t do some research as a journalist and instead wrote an ill-informed opinion piece. Many thanks Tara for taking the time and effort to respond and to say what many of us would have liked to say

  28. Heidi heywood

    Well written tara! Unfortunately a big problem I find with continuing breastfeeding for more than a few weeks for some mums is that we really don’t have a BF supportive community! I had to BF my 3 week old in the car on a shopping trip recently due simply to a lack of places to sit & feed on a very hot day. Worse still my partner frowned on my suggestion of doing so in a cafe as we would then be forced to buy coffee we neither needed or wanted (and according to him he felt that because of the number of male patrons in the cafe it would be uncomfortable!!)
    Lucky this I’d my 4th and I’m not so easily deterred but seriously… We need somewhere air-conditioned to sit & feed our babies in Mildura!!!

  29. Tasha

    Thanks Tara – interesting stuff. I am a new mum to a now 5 week old. We had a rocky start with heart surgery at day 3, so I was in hospital with him for the first 2 weeks. I can’t tell you how many times a doctor or nurse tried to encourage me to use formula because they were worried about him gaining weight. That is, I felt the opposite pressure to what Mia described – I was in tears a few times insisting on 100% breastfeeding. I managed to tough it out, and he is now thriving. Of course I wouldn’t have let it get dangerous, but I really had the sense we could make it together, which we did. I find it interesting that it seems there is a thought that there is pressure on the opposite side. I was at one of the major children’s hospitals in Sydney.

  30. Karleen

    SL I’ve breastfed two adopted children and have helped many others to do the same. If this is something that you are interested in I’m more than happy to give you more info. Just email me karleeng@uws.edu.au and CONGRATULATIONS on your soon to be son!!!! I hope that the placement goes smoothly and you find much joy in him

  31. Monica

    Tara you wrote a great and well researched response to a not very well researched and rather sensationalist piece.

    I am BF my 14 week old twins at the moment, and also my 2 and 4 year olds still both get a feed before bed. I am a great advocate for breastfeeding, but completely support a womans right to choose how they feed their child, as long as they are making an informed choice.

    The breastfeeding rate is appalling in Australia, if only women saw others BF in public, maybe more women would see it is the normal way to feed your baby. It would be great if they accessed the amazing support we have available here too (LCs, ABA counsellors etc). Unfortunately we live in a highly sexualised society that values breasts for pleasure above nurturing a child!

    I had a 21 year old say to me recently that she wouldn’t be BF as she found it "disgusting" and that breasts were for fun 🙁 I was absolutely speechless at the attitude or such a young, but otherwise well educated, girl

    I really hope that articulate and well educated women like yourself can help to open peoples eyes to the fact that breastfeeding is not "best" breastfeeding is just normal.

  32. Marisa Vernon

    Both of my sons were premature, my youngest born at 30 weeks in September 2011.
    Mia has overlooked the fact that ANYTHING to be consumed by a hospitalised neonate must be double signed for after id bands are checked.
    This goes for medicine, formula and/or expressed breast milk that is administered by oral or naso-gastric tube, or by bottle or teat if the baby can suck.
    This routine checking/signing practice is much like the process of administering medicine in an adult ward.
    Also, in my experience in a BHFI accredited neonatal intensive care bottles, teats, tubes, syringes, pumps and breasts are all common sights. Even if it exclusively fed breast milk, there is no other way to feed a baby in separation from its mother, than via bottle. To say bottles are hidden or frowned upon is just ridiculous.
    Mia’s article was offensive to me as the mother of two prem sons who has endured the stress of their stays in hospital. She would do well to check her facts.
    Thank YOU Tara for you more informed contribution.

  33. Robyn

    Loved your response Tara, so factual and well presented. I breastfed my daughter till she was 5 years old, that’s right 5 years old, but of course she was feeding spasmodically for a while before the end. It was a beautiful time in our relationship and one that will no doubt provide her with many health benefits. I truly believe the popular use of formula in our society comes from our ever increasing consumption of processed foods. For people who consume plenty of fresh and healthy food then breast is the fresh and healthy choice for their babies.

  34. Jody

    As a member of my local ABA group, I was so proud to read the article in a recent issue of Essence magazine announcing your appointment as a Breastfeeding ambassador. The response you have written to Mia has further cemented my elation at your appointment. You are a wonderful, strong, well educated and informed woman and I believe many out there will listen to what you have to say on this topic. Those 6 months BF rates have no chance of doing anything but rising from here on in! Well done Tara! 🙂

  35. J.

    i was told by hospital staff that it was a waste of time trying to breastfeed my first child as i was planning to go back to work part time in 4 months and it would take that long to establish a good feeding routine.At 3 months we were admitted to hospital with ‘feeding issues’and i was told by the nursing staff before they had even seen him feed that it was due to the type of bottles i was using. After 7 days he was diagnosed as being allergic to milk proteins and having severe silent reflux. Needless to say the attitudes of the staff made me feel like i was doing everything wrong as a mother. In reality there was a medical problem which had been overlooked many times and i was being dismissed as a tired over reacting ‘first time mum’. This kind of treatment should never occur.

  36. Fantastic blog Tara. Thankyou for writing and sharing. All evidence based information but so well written. As a midwife, I am delighted to see what great work you are doing at promoting breastfeeding, and what a brilliant ambassador for breastfeeding you are!

  37. Kay

    Thank you Tara, excellent piece. From reading the comments to Mia’s blog, there are a lot of angry women venting at breastfeeding advocates. If only they could use that anger positively to insist on a better standard of care so that those mothers who wish to breastfeed are more likely to achieve their goal.

  38. Louise Forbes

    Fantastic work Tara! I totally agree but would struggle to express myself so eloquently.

  39. Well written piece. I am so surprised at the number of educated mothers who find the idea of breast feeding disgusting and go straight to the bottle. I had so much trouble with attachment with both my babies (both borderline tongue tie) cracked bleeding nipples…the whole catastrophe. But I was so determined to breast feed and after about 6 weeks it started working and is so worth it! So ladies if you feel like you are getting bitten by a shark every couple of hours, take heart and persist cos it’s just so good for the baby and is a lovely bonding experience for mama too! I had some pressure to switch to formula too which gets progressively harder to ignore in the face of sore breasts and sleep deprivation! But it’s been so worth it!

  40. Emma

    So glad to see that BFHI has such an eloquent, well-researched spokesperson. Thank you for your words!

  41. Bubbamumma

    I am a first time mother to a 17 month old boy who I unfortunately stopped breastfeeding 2 months ago. I was very lucky to meet you while I was working under Carolyn at UNICEF before I had my baby. You are such an amazing woman and a perfect ambassador for UNICEF and breastfeeding. I loved your article and hopefully more mothers will read this who are having problems breastfeeding and contact their local ABA for help.

  42. Sherrie James

    I’m always curious as to where they get their figures from… "Currently, Australia’s exclusive breastfeeding rate at the medically recommended six month mark is 14% – less than half the world average."
    I have breastfeed all my 4 children. The first 3 to 18-20mths and the last child to 22mths. No organisation has ever asked me if I breastfed my babies.
    Sherrie.

  43. Glory

    We were also at one of the two major children’s hospitals in Sydney. Our daughter was hospitalised at birth for three weeks and ended up having surgery at nine days old. Not once were we pushed, or even encouraged, to formula feed her. The wonderful nurse unit manager of our beloved ward, who is a lactation consultant, helped my partner with attachment and positioning. We stuck it out and our daughter was thriving. We made it through two surgeries and six general anaesthetics, then Christmas hit and we were travelling with a 3 month old. Once the holidays had passed and we’d settled into 2012, we discovered that our beautiful five month old was losing weight. Rapidly. Even with all the feeding, the lactation cookies, the expressing in the middle of the night (our daughter has been sleeping through since about 3 months old), my partners supply was dipping. Our daughter cannot lose weight. Losing weight puts her final surgery in doubt and she she needs this surgery to finally be a regular little girl. Under the advice of our wonderful team of doctors and nurses (including that wonderful nurse unit manager and lactation consultant), we’ve been topping her breastfeeds up with formula. The only reason I tell this story is to illustrate that sometimes it’s not as simple as you think. My partner would give anything in the world to have the milk supply to satisfy our daughter. She has cried and agonised, she has felt guilty and bereft, that she’s somehow failed our daughter. We are doing the best we can.

  44. Erika

    I am one of those women who had a lot of trouble breast feeding. I greatly appreciated the encouragement I received from the wonderful women at the breast feeding clinic at the mercy hospital. However I found that the mixed advice I received from various lactation consultants and volunteers at the Australian breastfeeding association left me feeling like I just wasn’t trying hard enough or doing it right. This really dented my confidence as a first time mum. It turns out my supply was low and I had a "sleepy" baby who just didn’t want to feed. I did persist and ended up breast feeding my daughter for 10 months but it nearly cost me my relationship and my sanity. Now pregnant with my second child my preference is to breast feed but if it doesn’t work out I won’t hesitate to supplement with formula. Tara while I agree with your sentiments in principle, it isn’t always back and white as I have found.

  45. Amy Jenkins

    What a classy, eloquent piece of writing. Tara, I heard you speak at the ABA conference in October & couldn’t think of a better advocate for breastfeeding in this country. Keep up the fantastic work!

  46. Annie

    Thank goodness someone more eloquent and less emotional than me had a say. I was most dismayed with the original article.

  47. Ms Nichol

    Tara, I am a midwife and had exactly the same thoughts that you express in your response to Mia. Thank you for your very intelligent and eloquent piece. Many women speak of guilt being imposed on them by bread feeding advocates, especially midwives. Midwives are bound by ethics to promote and support breast feeding. I have lost count of the number of times a woman has subtly tried to get me to endorse her decision to bottle feed, for a variety of reasons. Ethically, all I can do is to promote breast feeding, assist her in whatever way that I can to breast feed, ( and there are many additional fantastic and fully funded services to assist as well), and provide science based information on the benefits of breast milk and the risks of formula. (Which, as Mia pointed out, often cannot be seen obviously. Ie;formula contains iron because it is so foreign to an infant human gut that it causes micro bleeds with every feed, depleting iron.)I CANNOT endorse a woman’s decision to artificially feed, I can accept her right to make an informed choice, having provided her with the relevant information.

  48. Rose

    Yeeeha! Great response… I am always curious about cash for comment (however insidious)for public figures Even more so since the exposure of a resources conglomerate secretly providing millions and millions of dollars to various global mouthpieces claiming climate change doesnt exist. The artificial formula billion dollar industry is not beyond planting their propaganda with public figures and websites (including babble.com) and we have to be on high alert to ultimately protect babies with the truth. Tara you are a calm cool collected smooth operator and I am so proud to have you on the side of good….
    Tara…Bright, Beautiful, Breastfeeder

  49. Belinda

    Thanks for your article. It is so important for this issue to be discussed in a balanced, rational way which helps to empower women in their mothering, without the politics. No one wants to feel that they are not doing everything they can to best nourish their child; no one wants to feel guilty or shamed. In my experience, the strong push towards being politically correct has meant that as a breastfeeding mother I have found myself feeling reluctant to share my story in the presence of mothers who have had troubles with breast feeding and were angry towards pro-breastfeeders; I have felt discriminated against, I have felt like I was not normal. Promoting breast feeding and offering support to women who wish to is not automatically frowning upon women who don’t, for reasons within or outside their control. As a first time mum it’s hard enough to manage the steep learning curve without us turning on each other. If you are doing all you can to give your child the nourishment they need, then you are doing a good job. Us mums have got to stick together!

  50. Robyn

    Eloquently put, Tara. I missed the article by Mia but understand the BFHI now. Unfortunately some of us don’t have the option of more than one hospital to choose from.

  51. Dee Fernandez

    Completely agree Tara! You’ve created a stalwart case for those who support BFHI’s. Hope you continue your journey into motherhood with lots and lots of love and support around you – for you, your family and of course, your beautiful baby!

  52. Belynda Smith

    I was dismayed by the original article, and heartened to read your response Tara. Balanced, sensible and open-hearted. Fabulous. Great comments too by Ms Nichol. Interesting that all these ‘radical’ pro-breastfeeders are the ones who provide the sensible, non-sensationalist, evidence-based information!

  53. Maja

    Another thank-you from me. So very well written. Im glad there are strong woman out there (like you Tara) who have taken up this challenge that has been put to us all.

  54. Virginia

    An excellent response to an article that needed to be addressed. Breastfeeding needs protecting despite all the wonderful research re.benefits for both baby and mother. It’s comments such as Mia Freedman’s that show that we still have a long way to go. lets hope that all hospitals in Australia will be BFHI accredited in the very near future and all women will consider breastfeeding as simply normal. Keep up the good work Tara and breast wishes.

  55. Leah

    Everything I wanted to say but couldn’t quite! Thank you for correcting the facts, this was much needed. As an ABA volunteer I am proud to uphold a code of ethics which requires a non judgmental approach, without dogma. Articles such as Mia’s do get me a little down sometimes. Choice is only true choice if a woman is well informed and well supported in her parenting journey. The BFHI is working to provide true choice to mothers. Thanks Tara for all you do. X

  56. Leonie

    Well done, Tara. As a mother of two exclusively breastfed babies (one born in a BFH, one at home) and advocate of support, not commercialism, I appreciate your work to encourage the best food for babies.

  57. Sa

    While I applaud and support you for writing this article Tara, the reality is that not all of us mums, no matter how hard we try or how much support (or, in my case, criticism) we receive, are going to be physically ABLE to breastfeed.

    And before anyone leaps to any conclusions: I spent 2 months trying to feed, taking fenugreek supplements, domperidone, attaching my sore nipples to an evil squeaking machine (pump) for hours a day all to get a total of 45ml of milk. I developed PND, was a miserable nervous wreck, felt like a failure, and instead of helping me find an alternative or supporting me in bottle feeding, I was told by pretty much any health professional I asked that I wasn’t trying hard enough.

    Finally, after months of failure and misery, supplementing and weighing, I was diagnosed by one lovely community nurse as having hypoplastic tubular breasts. Basically my breasts never fully developed, especially the milk glands, and no amount of pressure or practice would change that. It was a relief to finally have an answer…

    If only the judgement had stopped then too. I basically ended up lying and saying I was breastfeeding to stop the constant criticism from so called well-meaning health professionals (like the paediatric nurse who told me, " You’re just lazy, my boobs are smaller than yours and I could breastfeed fine.")

    Now, I was lucky enough to receive donations from family who were feeding, but regardless my now 3 year old son was primarily formula fed. He is smart, healthy and happy. As am I. In the end isn’t that the most important thing?!

    Let’s stop all the judgement and guilt us mums put on ourselves and each other, and instead work towards making everyone, mums and kids, happier and healthier, however we can.

  58. Linda

    What I like most, as a Breastfeeding counsellor with the Australian Breastfeeding Association, is that I am not an ambulance chaser. The mostly mothers (but also grandmas, dads, sisters and friends) 48 last month, who ring me want information about and support with breastfeeding. If someone is telling mums who don’t want to breastfeed they must, it isn’t me!

  59. Anonymous

    Hi Sa,
    I am so sorry you experienced so much difficulty, but also proud of you for all your efforts. Unfortunately, there are always going to be individuals who make inappropriate comments, offer poor or even damaging advice, or make things unpleasant when they don’t need to be. I have experienced this myself, and been brought to tears in the early weeks, and it is an awful thing. (Thankfully the midwives and community nurse who helped me were excellent, and real life savers frankly…but some other people were very disappointing.) Bullying and judgement are not appropriate in any context. Support and evidence-based advice is key. Be assured that BFHI hospitals do have policies in place for supporting women who cannot breastfeed for any reason, and bullying is not permitted.
    Congratulations on your beautiful son.
    Best wishes,
    Tara

  60. Monique

    Tara, thank you for your informative and insightful article. I love the photo of you and your baby, although it did make me cry as I still feel the pain of not being able to breastfeed my baby. I was determined to breastfeed exclusively, but when my baby was born five weeks’ early and lost more than 10% of her body weight post natally, I was told I had to give her formula supplements. I resisted, but then she became jaundiced so I relented. I was in hospital a week, and my milk never came in. I went home determined to do away with the supplements. I offered her the breast every feed, took Motillium nine times a day as well as Fenugreek, I expressed after every feed, used the supply line, had several attempts at non-stop ‘at the breast’ to stimulate the production, co-slept with my baby and also engaged a lactation consultation. No matter what I did, my milk never came in. I had milk, but not enough. I kept offering the breast until she was 15 weeks’ old but by then, she preferred the bottle. The grief and the guilt I feel is terrible. Every time I see a mother breastfeeding I feel that loss. I’ve tried to get someone (obstetrician, paediatrician, lactation consultant, ABA counsellor) to give me some insight into why this has happened. I was 41 when Alice was born and she was conceived via IVF. Many have suggested age and the method of her conception may have contributed. Still, this is only anecdotal evidence and no scientifically valid studies appear to have been done to look at these issues. I’d love it if this area was researched more fully so women such as myself could have some answers and perhaps even take steps to mitigate the risk of this happening with subsequent children. Thanks again Tara.

  61. Ros

    Thanks Tara – so eloquently expressed. I liked the way you highlighted the dangers of not breastfeeding rather than simply going through the so called "benefits" of something that is biologically normal. Infant feeding is so much more than a nutrition or lifestyle choice. As a lactation consultant and breastfeeding counsellor, I too regret that mothers who really can’t breastfeed are treated disrespectfully – there is no excuse for that. However, there are now so many women who say they were not able to breastfeed that we have to wonder why the human race is suddenly faced with mass lactation failure after thousands of years of breastfeeding (when there was no option). I acknowledge that it’s often not the mother’s fault, even though she is the one who inevitably feels guilty. Practices in some non-BFHI hospitals can doom breastfeeding within days. There is a lack of skilled support services in the community. Often friends and family have too little time to just be with a new mother during those challenging early days and weeks. ALL mothers need support and confidence, not undermining.

  62. Kate Blackwell

    Congratulations Tara on being a patron of this wonderful organisation.

    I have successfully breastfed two children after rocky starts.

    I don’t think that breastfeeding mothers want to make anyone else feel guilty about not being able to breastfeed but there are certain facts about breastfeeding that Tara has described more eloquently than I could.

    Breastfeeding is a skill that babies and mothers learn together and it needs to be supported to be successful.

    Having a baby can be a lonely and isolating experience. Initiatives that give women confidence and support are crucial for healthy, happy families.

  63. Junebug

    Beautiful response; thank you Tara. I only wish MM hadn’t relegated it to be lost among 500+ comments as well as made greater efforts to correct the original piece than a strikethrough at the end.

  64. Margie

    Brilliant. Thanks Tara. I loved breastfeeding. I still get teary talking about when my son weaned. He was 17 months. It is the greatest feeling ever to breastfeed.

  65. Tanya

    Thank you Tara. Such a beautiful, informative and balanced response. We need more pieces like this in the media that support and educate women rather than divide us or make us ‘pick a side.

  66. While I respect every mother’s right to make an informed decision about what is best for her baby, I think people living in developed countries lose sight of the issues that Tara raises about formula and bottle use having the potential to increase infection and disease.

    I live in a country where infants, children and adults contract illness, and can die, due to poor water quality. And where parents will spend hard earned money on formula only to mix it incorrectly and with substandard water to give to their babies because they honestly believe that a store bought "white man" product is best for their child.

    I have seen sick, malnourished infants, and poor formula practices this with my own eyes, and it’s enough to break your heart.

    People in Australia and other developed countries mustn’t lose sight of the fact that the BFHI is a GLOBAL education initiative, and not simply one facility or organisation being paternalistic. It is not about opinions. It is about evidenced based education.

    The World Health Organisation has a global hand hygiene education initiative. It is an evidence based initiative which stems from research and proven theories that hand hygiene reduces the transmission of disease and rates of infection and illness. This initiative has been adopted by institutions and governments world wide, and is viewed to be the basis of good hygiene and disease prevention not just in medical settings but also in the home. Many of us wouldn’t dream of not washing our hands after using the toilet, or before eating, because we have been educated as to the risks associated with poor hand hygiene. We don’t view this as paternalistic, so why should a global initiative to educate about the benefits of breastfeeding and the risks that may be associated with the use of formula and / or bottles as being such?

    Step 6 of the 10 Steps to Successful Breastfeeding, as promoted by the BFHI, states "Give newborn infants no food or drink other than breastmilk, unless medically indicated".

    "unless medically indicated" – Voila! There is the key phrase that people are overlooking in this whole "breast politics" debacle. If a mother is unable to produce enough milk, if cracked and painful nipples are inhibiting ones ability to feed, if a baby is not gaining weight as they should be… All of these are medical indications that complemantary feeds with formula, or exclusive feeding with formula would be appropriate interventions! It is up to medical professionals to get behind the BFHI initiative and identify when there are medical indications that may necessitate something other than breastfeeding.

    It is not about creating a one rule for all scenario. It is about giving people the right information to allow them to make an informed decision about what is right for them.

    What people chose to do with that information is then up to the individual, and that informed choice should be respected, even if it is not the choice that you personally would make.

    Well done Tara for bringing some evidence and information to the table to help balance Mia’s (less informed) opinions.

  67. As a lactation consultant I was thrilled to see you promote skin to skin which of course is one of the ‘Ten Steps to Successful Breastfeeding’. I was also heartened to read that, inspite of some formula in the early days, you went on to exclusively breastfeed. Congratulations for realising a bit of a glitch in the beginning doesn’t mean mum and baby can’t progress and successfully breastfeed. The role of private lactations in the community provide invaluable ongoing support after hospital stays.

  68. Dr Vivienne Miller

    Hi Tara, as a medical practitioner who specialises in this area and also as a mother I would like to say that most of your research about health benefits such as gastro reduction,infections and so apply in places with poor hygiene, notably 3rd world countries. I don’t believe there is any evidence for professional sterilisation of bottles or teats in houses with good hygeine and clean water. Boiled water is quite ok for making up formula. Obviously I agree that we should promote breast feeding but I think it important that we don’t perpetuate information that doesn’t apply widely to Australia as a reason for breast feeding. It is important to have balance in such a promotion and I see a lot of depressed women who for medical reasons cannot breast feed and feel a failure because of articles such as this which usually tell them their child will be sicker, less intelligent and fatter as a result of their inadequacy. This is nonsense, of course. I agree there needs to be more practical support in breastfeeding in hospitals and the community and this is the underlying problem. Those who don’t want to breast feed but who are informed of the benefits are free to choose, but those who can’t breast feed are usually tarred with the same brush. Please don’t forget them. Also don’t forget the damage poor dietary intake from inadequate breast feeding and no complementary feeding can do in the first few months and over the longer term, whatever country you are born in. A healthy bottle fed baby is better than a starved, irritable baby and a depressed mother with poor milk supply and no support. Please don’t foget the ones who can’t breast feed – they can do with some sympathy too. Bottle feeding is not necessarily the enemy!!!

  69. Karleen Gribble

    Vivienne,
    You might like to check out the research in relation to infection rates and formula feeding in developed country contexts. I’ll give you some to get started
    Bachrach VR, Schwarz E, Bachrach LR. Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis. Archives of Pediatrics and Adolescent Medicine. Mar 2003;157(3):237-243.
    Talayero JMP, Lizan-Garcia M, Otero Puime A, et al. Full breastfeeding and hospitalization as a result of infections in the first year of life. Pediatrics. 2006;118(1):e92-99.
    Quigley MA, Kelly YJ, Sacker A. Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics. Apr 2007;119(4):e837-842.
    We don’t have the high mortality rates associated with formula feeding in Australia but if what happens in the UK and Spain is anything to go with infants formula fed from birth are 3-5x more likely to be hospitalised in their first year of life as children who are exclusively breastfed for several months (and exlcusivity is really important when it comes to infection). The reason why we don’t have high mortality rates associated with formula feeding is not because babies don’t get sick it is because we have good treatments for diarrhoea and respiratory tract infections. The reason why health departments promote breastfeeding is not ideological it is because formula feeding costs them a lot of $$ and resources.

    Furthermore there is some decent research on bottle feeding and hygiene from developed country contexts that shows that it is seriously difficult to clean bottles and make up formula in a way that does not cause potential problems for infants. Again, I’ll give you a few to look at

    Redmond EC, Griffith CJ, Riley S, check. Contamination of bottles used for feeding reconstituted powdered infant formula and implications for public health. Perspectives in Public Health. Mar 2009;129(2):85-94.
    Redmond E, Griffith CJ, check. Disinfection methods used in decontamination of bottles used for feeding powdered infant formula. Journal of Family Health Care. 2009;19(1):26-31.
    Renfrew MJ, McLoughlin M, McFadden A. Cleaning and sterilisation of infant feeding equipment: a systematic review. Public Health Nutrition. 2008;Forthcoming(-1):1-12.
    WHO, FAO. Enterobacter sakazakii and other microorganisms in powdered infant formula. Geneva: WHO; 2004.

    Parents who are formula feeding need lots and lots of education and support on how to make up formula and clean and sterilise bottles and other feeding implements.

    There was nothing in what Tara has written that I have seen that is not accurate for Australia.

    I agree with you entirely that mothers need support to be able to breastfeed and that judgement has no place in infant feeding decisions. I’m a firm believer in the "good enough mother" being the goal, not the "perfect mother" for that is an unachievable and unnecessary goal.

  70. Patricia

    Thank you Dr. Miller for putting some perspective on this piece. Tara’s facts and figures and WHO recommendations are based on 3rd world country practices. I myself had a myriad of problems trying to breast feed and would imagine there is a link between failure to breast feed and PND. Interesting to see that study. Also, in my mother’s group (of 15 3-month old babies) one baby has been back to hospital for a few days with gastro and another got a bad cold – Thank God both are exclusively breast fed. Phew for the formula feeding Mums.

  71. Lalage Phillips

    Tara thanks for your article, very factually and informative. But I have to say, I think though you have lost the heart of Mia Freedman’s article beyond the blog-speak….that positively intended initiatives brought into hospitals to the raise breastfeeding rates have resulted, in many cases, in a perceived environment of judgment, secrecy and fear, where new mothers who experience breastfeeding difficulties in those vital early days, are too afraid to ask for a wide range of information from the experts who’ve been entrusted to help them at their most vulnerable.

    And then beyond that, a community environment of division between those-who-do and those-who-don’t. For those who cannot, it’s a confusing politics.

    The ‘small inconvenience for policy’ that you write of was life changing trauma for me and I will never get that opportunity back. Hearing that you went from formula feed at two days to exclusively breastfeed hurts me enormously, as I was told this was impossible. I felt forced to decide, as if it were my ‘choice’. I was never given supportive information to match my circumstance, and made to sign a form which I found humiliating and proved I thus was excommunicated from the breastfeeding world.

    I am still floored by a picture (such as yours) of a happy breastfeeding mum, immobilized with guilt, sadness and jealousy and this ongoing debate continues to cause me and many others, real pain.

    Something went wrong somewhere. Why wasn’t I able to breastfeed? Who can tell me?

    Can we all agree and accept that breastfeeding support should be beyond global policy and focused towards individual need.

    PS note about formula in supermarkets, no one knows its there till they have to buy it.

  72. Dear Lalage Phillips,

    I am very sorry for the life changing trauma you have experienced with breastfeeding problems and bad advice. That sort of suffering should not happen and it is my hope that more women are given the right advice at the right time, so women and their babies benefit. I am also sorry that my response to Mia and my breastfeeding photo caused upset for you or for anyone else.

    My comment about a ‘small inconvenience for policy’ was directed at the part of Mia’s article where she articulated that bottles and formula aren’t displayed and midwives have to sign out on formula (as it happens, they need signatures in hospitals for anything given to a neonate, not only formula) and that someone gave her friend ‘a look’. (How do we perceive a look when we are emotional about something? Can we sometimes imagine judgement in a look? And if someone really gives us an awful, silent look that is wrong, we can’t tar a whole system or policy with that brush.) I did not intend to belittle the suffering of women who don’t get the right support. I was one of them for a while.

    Women need support and evidence-based advice, not judgement. If you would like to contact the wonderful women of the ABA they may be able to answer some of your questions above, and give you support. They volunteer their time only to help women. https://www.breastfeeding.a… In my experience no one is excommunicated from the breastfeeding world. It is an inclusive world where stories should be shared. The recent ABA conference in Canberra was about creating an inclusive breastfeeding culture, and that means being able to breastfeed openly, or bottle feed if that is your choice or situation. All these issues need to be discussed and I appreciate your feedback, though it hurts me to see that my writing may have caused further pain to anyone.

    Best wishes,
    Tara

    *****
    Dear Dr. Vivienne Miller,

    Thank you for your comments also. PND is very serious and anything that I can do to help lessen negativity on this subject is something I take very seriously. If you have any suggestions on how to articulate the facts, and to encourage women to keeping trying even if and when they run into problems in the early days (as I did) without contributing to negative feelings, please let myself and the BFHI team know: http://www.babyfriendly.org

    I am more than happy to send you some of the research my stats are based on (the 53 per cent of diarrhoea hospitalisations stat and 15 per cent fewer doctor visits for breastfed babies stat are strictly first world stats. Similarly, 27% of lower respiratory tract infection hospitalisations could have been prevented each month by exclusive breastfeeding, according to a large study recently done in the UK, and presented in 2011) Or even better, perhaps you would like to be introduced to some of the BFHI team so we can all work towards the common goal of supporting women in the community? All feedback is appreciated.

    Best wishes,
    Tara

  73. Andy

    We all know breast is best, we get it!!
    I have bottle fed (I mean "artificial fed" that is NSW health term now – more guilt- remember breast is best!) 2 children and they are happy healthy little ones! However, there is no information or support or basics of bottle feeding given to anyone, should the mums AND dads need, choose, decide (yep we parents can make our own decisions!), want, intend to bottle feed. But again I know breast is best! I have passed bottle feeding information(tips, hints practicalities) onto mothers and families who want it from own experience. Ignoring that mothers bottle feed/artifical feed is detrimental and risky to the baby and parents, and providing little information does not in turn mean the mothers will just breastfeed (although again I hear you breast is best!) Support ALL parents in their safe choices for their children.

  74. Sa

    I feel forced to respond to the comment made by Ros:
    "However, there are now so many women who say they were not able to breastfeed that we have to wonder why the human race is suddenly faced with mass lactation failure after thousands of years…"

    Sorry Ros, but you are illustrating exactly the sort of attitude we women who are UNABLE to feed are faced with constantly. Suspicion.

    Perhaps the reason is that medical science has progressed more, perhaps women feel less ashamed about admitting they cannot do what is supposed to be ‘natural’, perhaps there are better records kept, perhaps (shock, horror), women are exercising their right to choose what to do with their own bodies…either way, what difference does it make?

    Really, (and I know this will not be a popular opinion, but believe me when I say I, too, used to be ‘hardline’ about the idea of breastfeeding…until I couldn’t) if a woman chooses not to feed, or is unable to – for whatever reason – in the end it is none of your business. Formula is not poison. It is not child-abuse to feed your child from a bottle. And despite the stats, my 3 yr old has never been sick with gastro, or anything worse than the common cold.

    Besides, in the old days there were wet-nurses: helpful friends, family or neighbours, and the concept of accepting milk from a stranger was not seen (as it is now by so many people) as ‘gross’.

    Either that, or the babies died.

    Which is what I thought about every single time I fed my son from a bottle.

    ps. Thanks Dr Vivienne, for pointing out the importance of maternal health and happiness too, which I think often gets lost in discussions like these. Ensuring the health of our babies is important, yes, but not at the expense of their mums’!

  75. Clare Meeker

    Hi Tara

    I have noticed in two articles that you have written recently that you refer to a ‘medically proven six month exclusive breastfeeding’ recommendation.

    Could you please comment on the growing medical evidence that suggests it is actually better to not breastfeed exclusively to six months and to introduce solids between four and six months to help prevent iron deficiencies and food allergies in children? An example of a media article reporting such medical evidence is on The Guardian website: http://www.guardian.co.uk/l… You can also search PubMed to find peer-reviewed scientific articles reporting research into introducing solids earlier than six months and the link with lower allergies.

    I would like to add that I had a negative experience resulting from advice that I received from the Australian Breastfeeding Association. I sought help from the ABA regarding attachment problems when my baby was four weeks old. The ABA advised to use baby-led attachment and ultimately it caused my breastfeeding to get worse with the result that my baby didn’t put on any weight for two weeks. This led me to make the decision to complement breastfeeding with formula. Using formula was the best decision I made for the health of my baby and for my mental health.

    I find the ABA too militant with their anti-formula view. For example this advice regarding breastfeeding and alcohol is ridiculous: "And at the end of the day, remember this: it is generally better to breastfeed with a small amount of alcohol in your system than to feed your baby artificial baby milk. There are risks in feeding your baby artificial baby milk". This is a crazy thing to say and just another way to make mothers feel guilty. Sigh.

    Cheers
    Clare

  76. Anonymous

    Dear Clare,

    Thank you for your comments. I’m sorry you have had bad experiences. This is a tricky topic because it is an emotive one and everyone’s stories count. Respectfully, although I wish I could, I simply can’t control the way medical stats make people feel. Unfortunately there are some risks involved in using artificial milk for babies (and absolutely there can also be benefits when medically indicated) and this is why the risks are explicitly spelled out by formula companies, by doctors and by health organisations, and I am reporting that information as a patron of BFHI and as someone who has myself used formula and acknowledged and seen first hand that it can be necessary. This information is necessary to keep people informed and is not meant to make anyone feel inadequate. It was written in response to Mia’s questioning of hospital policy in maternity wards re: the ‘displaying’ of formula and bottles. As I mentioned, if medically indicated or if the mother chooses, formula is provided and advice and support given for use. That is the way it should be. BFHI hospitals have policies in place to support all mothers and circumstances, which is one of the reasons why I support the program.

    The ‘medically recommended six months’ of exclusive breastfeeding I have mentioned in my articles is a direct reporting of the current recommendations by local government, the Royal Australian College of General Practitioners, the Australian College of Midwives, the World Health Organisation, UNICEF and more. If that recommendation does change I will report it. However, it currently continues to be policy for health practitioners to make a recommendation of exclusive breastfeeding for six months, hence I am reporting that. You can read this official recommendation re: six months of exclusive breastfeeding here:

    http://www.racgp.org.au/pol

    http://www.who.int/topics/b

    http://www.unicef.org/nutri

    BFHI hospital accreditation (which is governed is by the Australian College of Midwives, not ABA), is designed to support mothers in their aim to do their best, whether or not that includes breastfeeding, and they have proven results in achieving better health outcomes for mothers and babies. This is why I support the program.

    Best wishes,
    Tara

  77. Heidi

    Thanks so much Tara, awesome response. I couldn’t find it in the comments sections of Mia’s blog so I googled to find it here.

  78. Catherine

    Tara, I found your response to Mia’s article unfair and doesn’t properly deal with the issue she raised – the bullying of mothers who choose not to or cannot breastfeed.

    Yes, I include “choose”. What I gather from many comments in this thread is that it is okay not to breastfeed if you really really can’t but if you choose not to, that is a completely different matter. Some sympathy is extended to those who give up too soon, though they should have had more ‘support’ apparently.

    You say that bullying is not on in the comments (though I’m unclear if that just extends to those who can’t), it saddens you and that it is against policy. But the fact remains that it happens and it happens frequently. Hence Mia’s article.

    And if she can but chooses not to, then what? Is there free reign to pressure? Yes there is evidence for some improved outcomes for mother and child through breastfeeding but there are significant benefits for a whole range of actions (eg improving diet) that mothers can choose to take that have yet to become the focus of such intense emotional peer pressure. I notice that cherry picking and confirmation bias appears prevalent in this space and that claims of harm, especially for women who have good access to high quality formula are overblown – either through deliberate fear mongering or due to poor scientific literacy or both.

    The breastfeeding recommendations are made on what is the best known findings, research knowledge develops and many of those findings are far from conclusive. Eg the statement you linked to from the RACGP in support of breastfeeding includes reduction of asthma as one of the supposed benefits. For a while women were told to breastfeed for at least a year to reduce the chance of allergies and asthma developing. That advice has since been questioned, with breastfeeding beyond six months now appearing to be harmful for this. See:
    http://www.biomedcentral.co

    You "can’t control the way medical stats make people feel" but you can choose how you frame those statistics. It seems the choice has been made to promote breastfeeding by overstating the possible harms of not doing so (thereby unnecessarily distressing mothers who can’t) and ignoring the evidence that suggests there are harms to extended breastfeeding. Sure don’t lie to a woman to make her feel good but don’t mispresent evidence to her to make her feel bad either. One of my friends, who had a dreadful time in a major hospital when she couldn’t breastfeed her child who was rapidly losing weight, spoke to me of the immense relief when she found out formula wasn’t so bad after all. It’s a pity that didn’t happen before. As another commenter mentioned, she’ll never get back what should have been wonderful first days with her baby. Like it or not, the breast is best message is responsible for that when it doesn’t make any attempt to tell mothers formula CAN be okay. Leaving it to after a woman has had multiple failed attempts is too late and ensures the creation of significant distress.

    I completely support women being fully informed about the evidence based benefits of breastfeeding – for the most part it’s brilliant if you choose to do it. I also completely support a woman’s right to breastfeed comfortably in public. But I also support a woman’s right to choose what to do with her own body. I support a woman being fully informed that it’s not the end of the world if she doesn’t breastfeed – she has a choice.

    I understand that there is still a battle to be fought for acceptance of breastfeeding in some quarters. But it seems that one of the methods of this battle is to make not breastfeeding socially unacceptable – as if the choice not to somehow impacts on those who choose to. Either way, when choice is removed, it is women who are the victims. That’s not a good thing.

    There are a variety of reasons – financial, career based, psychological or personal – why a fully informed woman might choose not to breastfeed. That is her business. We need to afford her the respect to make that choice instead of censuring or labelling her. She understands her circumstances better than others. Doing so will hopefully flow through to improve attitudes towards those who cannot so that those early days are not filled with guilt and emotional pain despite all the wish in the world to breastfeed.

    Quite frankly your response is disappointing. Instead of taking this opportunity to examine how in your position you can work to improving the communication provided to women who do not breastfeed so that bullying is eradicated and distress reduced, you have chosen to see Mia’s concern as an attack on breastfeeding and thus perpetuate the problem.

    Catherine
    NB Your comment system is revealing commenters’ email addresses without any warning. Just mouse over the names of commenters to see.

  79. Madeline Gerry

    I read this article and was saddened by what, once again, seemed like an overinflated attempt to reiterate what we are constantly hearing, the idea that breast is best! Great, thanks we get it!!! We’ve read it, we know it, we are bombarded with the message.
    Where once they were called hippies for wanting to give their child what came most naturally, now it seems that there is a fascist movement committed to waving the ‘better be breast or else’ flag!!! As a mother, I wanted nothing more than to breastfeed my child. Unlike many women, i didn’t experience any nipple pain, my baby latched on immediately, and breastfeeding seemed like the most beautiful and most natural thing in the world. But after 4 weeks of exclusive breastfeeding my baby still hadn’t managed to regain her birth weight. As each day passed, she became more and more upset, it seemed she was forever on my breast and yet never satisfied. My mother had the same issue when she brestfed us, and sadly my sister has had the same situation with her son recently. For some reason, despite my connectedness, my utter content, my desperate desire to breast feed exclusively and continual use of a breast pump after each feed to increase my supply, I simply wasn’t producing enough milk.
    I believe there needs to be a support group for those of us who understand what is best but for whatever reason have not been able to achieve it.
    Thank you Catherine ( comment above) for expressing what the women of my family have experienced.

  80. Monique

    Madeline, I just wanted to say that I understand how you feel as I, too, despite my best efforts, could not produce enough milk for my baby. On top of the guilt and grief I felt, I’ve since been flabbergasted at how little seems to be understood about this in medical terms. I was told to ‘get over it’, ‘move on’, ‘stop making it all about the feeding’, yet, what I wanted was for someone to care enough to look into why this had happened. I still don’t know. It just doesn’t seem to be an area that medical researchers are interested in investigating. Meanwhile I am left wondering if there is something I should have done differently or if I have some undiagnosed physiological problem. I wish I hadn’t spent the first three months of my baby’s life feeling like I was feeding her poison when in fact, I should have been grateful there was an alternative available to me otherwise my baby would have been malnourished. Like you, I would love to have other women to talk to about this.

  81. Karleen Gribble

    Clare and Catherine,
    The research on allergy and asthma and infant feeding is really murky. Unfortunately almost all of the research in this area is plagued by really poor definitions of how babies were fed (meaning that there was not an exclusively breastfed control group and without this no conclusions can be drawn about the impact of breastfeeding vs the impact of formula feeding vs the impact of time of intro to solids). It makes the results of this research difficult or impossible to interpret. Unfortunately, there are also business interests who place a lot of money into pushing views that will improve their bottom line. I think that it will be quite some time before we get a clear picture- and it is likely that the increase in allergy that we are seeing at a population level has nothing to do with infant feeding.
    However, of the research in this area the only big study I am aware of that had very strict definitions of feeding is that of Wendy Oddy of WA. In her research an early introduction to cows milk protein was associated with greater risk of allergy and asthma. Oddy, W. H., P. G. Holt, et al. (1999). "Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study." BMJ 319(7213): 815-819.
    It is a very confusing situation for parents. Made more so by the funding of education of health professionals by the baby food industry who have made a concerted effort to convince doctors and nurses that the recommendations for the recommended duration of breastfeeding has changed from 6 months to 4 months.

  82. Irene

    Well written article, a thoughtful response. As someone that initially struggled with breastfeeding I can say that it isn’t easy but with support it can be achieved for more women than statistics indicate.

  83. Just thank you Tara for being such an amazing advocate for breastfeeding. I feel extremely fortunate to have breastfed all 4 of my kids and long beyond the usual finish date. I was thrilled to see your piece in response to Mia and that it was published beyond the comments sections on her website.
    Michelle

  84. Catherine

    As a mother who has been lucky enough to successfully breastfeed 3 children (2 for 30 plus months and my last for 22 months) and as a woman who often feels she has to watch what she says in conversations about breast v bottle for fear of being labelled a breastfeeding fanatic, and who feels in the minority for something that is so natural and so right – I thank you Tara for your amazing article. I am so proud of what I achieved in feeding my kids and whilst there are some women for whom it is very difficult or medically impossible to breastfeed, I do think a lot of women give up too easily. It is hard, but anything worth doing often is. You are a wonderful woman Tara Moss.

  85. Bethany

    Tara, you have missed Mia’s point completely. You spend half your blog regurgitating ABA facts we can read on their web page. Mia tells it like it is. You tell it like you are preaching to us mums who really find breastfeeding a struggle. I am so please you are so lucky to have your life working out for you. You deserve it I am sure. But I must say I can now see why you don’t write mainstream copy like Mia does.

  86. Anonymous

    Dear Bethany,

    I agree with Mia’s point that we should chill out about breasts. I’m glad she used that headline in the blog version of her article because it is a good sentiment. I have had very aggressive responses to my breastfeeding, and my bottle feeding, as other women have. The aggression is unnecessary. I have also struggled and if my personal story would make a difference here I would tell it, but I felt the facts were what was missing.

    There was some misinformation in Mia’s piece and I have tried to correct those misconceptions. The ABA has nothing to do with BFHI or hospital policy. The facts I am giving are not from the ABA, but from the World Health Organisation and Australian government documents. I know all these facts are not necessarily facts we all want to hear, but those who wish to be informed have the right to know.

    I wish us all peace with this topic and I wish good, evidence-based support for every struggling mother.

    Best wishes,
    Tara

  87. Emily

    Thankyou, Tara 🙂

    Your breastfeeding advocacy, intellect and eloquence are all sincerely appreciated.

  88. Belynda Smith

    Tara your continued grace under pressure is inspiring.

    I’m now at the two year mark for breastfeeding and hitting the next hurdle – social norms dictate that breastfeeding a toddler is not ok. My son seems to think it is fine!

    I bring this up as it is interesting to me that people I know who chose not to breastfeed in the early days, and felt judged, have judged me and others for breastfeeding for ‘too long’. If we all stopped looking askance at one another and instead just focused our energies on our beautiful kids, things would most likely be fine.

    Where comments about breastfeeding must be made, I hope we can all get past the more emotive/negative responses like Mia’s, and instead go for more factual, reasoned comments like yours Tara… around the whole breastfeeding experience. It should be something that brings us all together – we all want the best for our kids and we all make the best choices we can in each moment.

    Once again, thank you Tara for your time and commitment, and your obvious respect for every one of the comments here. You are doing a fantastic job.

  89. Sam

    I have a query for you, Tara. How does the BHFI weigh up the health benefits of breastfeeding against the emotional toll of breastfeeding difficulties?

    You state: They aim only to introduce bottles to babies when medically necessary.

    How about this scenario?
    Day 4 after birth, mother’s milk has yet to come in, baby has been upset on and off all night, mother has been feeding every one to two hours (at midwives encouragement), had no sleep, has a grazed nipple and is teetering on emotional collapse. However, baby’s weight is fine and formula is not deemed medically necessary.

    The question no one seems to ask is this; can formula sometimes be deemed ‘emotionally’ necessary? When does immediate mental need trump future health risk?

    I know the response of my (very lovely, but constrained) midwives in this exact scenario. The decision to supplement was up to me alone, by policy they could not recommend formula in my circumstance, by policy they had to warn me that formula could interrupt my supply, by policy they had to recommend I just keep trying. By policy, I had to be the one to not only demand the formula, but to acknowledge I understood the risks involved – and then sign a document to that effect. In the midst of extreme vulnerability and emotional turmoil I had to find the strength to counter ‘the policy’ in all its subtle pressure – and demand formula so I could get some sleep and be some kind of functioning mother (not just a breast with legs) to my child.

    The aim may not be to cause stress, anxiety or guilt in mothers – but by valuing ‘breast is best’ over everything else – it happens anyway.

  90. Anonymous

    Hi Sam,

    Your query about emotional stress and ‘mental need’ is very relevant, and it is a constant source of research and discussion in maternity care. The key appears to be in providing evidence-based advice and care, which in the vast majority of cases involves putting irrational fears about under-supply to rest. There is a great deal of documentation showing that a fear of under-supply is one of the leading causes of quitting breastfeeding and using formula as a substitute or ‘top up’ when it is not medically necessary to do so and does not benefit baby.

    As hospitals and individual carers become more consistent in their policies this will happen less often and women will receive better support and more confidence in the process. Those who do require intervention will still get the extra care necessary for their newborn.

    I hope that helps.

    Any specific queries you have for BFHI can be directed here: http://www.babyfriendly.org

    Best wishes,
    Tara

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  92. Elizabeth

    Dear Tara
    I was so pleased to hear of your blog. I gave birth to my third baby boy last March (2012). He is a beautiful baby boy but has certainly challenged me in every single way. My first two boys had their ups and downs but both successfully breast fed. The first for 7 months and the last for 9 months. The reason I stopped in both cases was when they were butting their teeth they used to bite me and (as most mothers know) it was painful. I was also planning on returning to work and wanted to have them established on their bottle feeding before that time.

    However my third little munchkin had much different ideas to me. We obviously didn’t read the same manual…. I had trouble feeding him from the word go. I had him at the same hospital I had my older two boys but found that the support this time around was just not there. Whether it was because I had two other children and they didn’t feel that I needed their help or they just didn’t have the staff I’m not sure. I delivered by caesarean section and ended up leaving hospital totally unrested and struggling with a newborn who was not feeding properly and consistently crying.

    The turning point for me was the first week I was out of hopsital. I had an appointment I had to be at by 11.00. Totally achievable. Started feeding baby about an hour before I was due to be at my appointment and thinking he would feed for about half hour to 40 minutes and would leave me plenty of time to load the car and reach my destination. Only to find that he was still feeding nearly an hour into the process and still crying.

    In the end I was late for my appointment and still had a very unsettled baby. I was given wonderful support by the local hospital breastfeeding midwife who visited me at home but for some reason it just was not working this time. I resolved to try my baby on formula that night. He gobbled it down with barely a breath. He had that beautiful drunk look that babies get when they are full. It was the best. I was so upset though.

    With two other children to care for and a husband and me I decided that it may be the best thing for me to try and keep breastfeeding and just supplementary feeding my baby. In the end he was taking hardly any of my milk and having more of the formula. To the point where eventually he just absolutely “point blank” refused to feed from me and would only take his bottle. Once the feeding thing was sorted out we then had minor reflux issues and constipation issues to sort through which we did. However, this did not fix the problem I had of not being able to breastfeed my baby. I knew that this was my last baby as I had a tubal ligation at the time of my delivery. I am now 37 and I have had all the babies my body is capable of carrying and our family is complete. I was devastated to not be able to breastfeed my baby. I ended up going to see a psychologist to chat about my feelings. I had pretty much resolved them by this time but it was still good to go. I found it quite cathartic. I (fortunately) didn’t have post natal depression. I think that is largely due to the fact that I had a very supportive mother and really good friends who would call around in their lunch hour to spend time with me and support me through this time.

    What I found really hard to deal with the most, throughout this whole time, was the talk of “breast is best” in the media. Most mothers if not all mothers know this because it is drummed into us. I had successfully breastfed both my older two children and the media was making me feel that I had failed. I was not a failure (I know this and always did really) but it was still something I wasn’t able to do.

    I guess the whole reason for me writing on your blog is to say that I think the media and the public at large need to be very mindful of the judgments they make on mothers who are not breastfeeding their babies. For those mothers who make a conscious choice not to breastfeed that is their choice but for those mothers like me who did not make a conscious choice and had to bottlefeed because there was no other option the judgment of others can sometimes be quite harsh. They don’t know that at one point I was feeding and then expressing a bottle to then be able to supp feed at my next breastfeed around the clock might I add. I had one breast that my baby wouldn’t attach to and struggled to get him to feed off of and then ended up with a really badly cracked nipple. Added to the above my baby was failing to put on weight and was jaundice (only mildly).

    To my great delight the midwife that was coming to visit was so incredibly supportive of my decision to bottlefeed my baby. She said I had absolutely done the right thing for my baby. That is what, in the end, I need to remind myself. The breastfeeding in the end was more about me instead of making sure that my baby was well fed and thriving. But by bottlefeeding I was putting him first and then struggling with my own emotion.

    For all those mothers out there who had struggled to breastfeed for whatever reason at the end of the day as long as your baby is fed, well loved and cared for my view is that it really doesn’t matter how they are fed (either breast or formula) as long as they are thriving. For those people out there who still feel they have a right to judge those of us not able to breastfeed our children “pull your heads in” and be mindful of the person’s feelings and think before you speek. This includes the media and health professionals at large.

  93. Cassandra

    Hi Tara,

    First off I think your response to Mia’s article if wonderful. I read through all the comments as well and there are some great points raised on both sides of the fence. But why must the fence be there in the first place?

    When I had my son we both nearly died. I arrived at the hospital with a complete placental abruption at 37 weeks. My c-sec was performed under general anesthetic and I didn’t get to meet my son until I woke up in recovery almost two hours after his birth. Immediately I put him on my chest and started to root around and found the breast. Even through the fog of recovering from general that was the best feeling. There were no problems at that moment, his latch was perfect, I didn’t have any pain. But it didn’t last.
    Day three was a hard day for me, the baby blues hit but so did the post op blues. My nipples had become sore as Seth had upped his feeding and seemed to want to be the breast constantly. Even though I started to doubt myself the midwives were great and the support was free flowing. That night one of them carrier him around the ward with her so I could get some much needed sleep. In the morning they asked me to try and express and I did but I got hardly anything. So I started expressing after each feed as instructed to try and up my supply. They said that because I had the general it could take a bit longer for my milk to come in. So I preserved through the pain and doubt. I really wanted to breastfeed and the support was so great and they told me if I needed it they could give him a little formula as a top up. That night it was a different midwife on and I told her I was just too exhausted and that I thought Seth was hungry so would she mind getting me some formula to give him a feed so I could get some rest. I was still expressing every three hours at this stage. I will never forget the line her mouth formed or the look in her eye. She told me flat out that if I wanted to feed my son formula she would get it for me but she would not support my decision. I cried all night. I didn’t want to formula feed but I didn’t want my son to starve either. I spoke to my doctor the next day and he told me it would be in my best interests to not be so hard on myself about Breastfeeding. He told me if a day or two off feeding dried up my supply I could try relactation. He was very supportive and told me my health was just as important as my son’s.
    It turned out even trying relactation I couldn’t breastfeed, my milk never came in, in a large enough quantity so I would have had to supplement feed anyway.
    The thing that bothered me the most was the lack of support once I made the decision to formula feed.
    Mothers need support no matter what. The worst people I encountered were other mothers. They judge you matter what you do, breastfeed or advocate Breastfeeding and you are an inconsiderate baby feeding fascist; formula feed and you are a monster poisoning her baby.

    I am sorry if this turned into a ramble. But what I want other mothers to realise is that no matter what, we are all trying to do what is right for ourselves and our children. Don’t judge and attack other mothers for the decisions they make. There needs to be more information out there so mothers can make the decisions they need to make in an informed manner. The risks need to be outlined yes, but so do the benefits. There should not be this is against them mentality.

    Thank you again Tara for your wonderful article as someone who wanted to breastfeed but couldn’t I can’t fault the support I received from the ABA especially when I was trying relactation.

    ~ Cassandra

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