Breastfeeding, Tyranny and the RCM’s new Breastfeeding Statement

“End of breastfeeding tyranny!” scream the headlines. “Midwives instructed to stop shaming mothers!” they tell us, as though this is a new revelation that they’ve discovered, as though anyone, ever, telling women what to do, is something that any reasonable person should support.

Where has all this hyperbole come from?

The RCM has released a new breastfeeding position statement. It says, “Breastfeeding, more than any other health behaviour, has a broad-spectrum and long-lasting impact on public health.” This phrase itself should be repeated (and repeated and repeated) at every opportunity by every person campaigning to improve support for breastfeeding. Why is it that this isn’t the phrase that was picked up by the media and splashed across its headlines? Instead, they decided to focus on the phrase, “[if] a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.” It seems that this message, above all others, has been the one chosen to splash across the front covers. It’s a desperately important message, and one that I wholeheartedly support. It is at the root and centre of the training of breastfeeding counsellors, who are required to offer non-judgemental, woman centred support including to women who don’t want to, or who want to stop, breastfeeding. It breaks my heart to read the awful stories that are abounding today from women who have had midwives who are more worried about their BFI status and breastfeeding stats than the people in front of them and I completely agree that any undue pressure must stop, just as women should not be pressured to NOT breastfeed.

But here’s the problem: The media don’t care about breastfeeding support, nor do they give a hoot about the women and babies who are mixed up in the middle of this. All they want to do is to create enormous straw men. In fact, they aim to create a veritable wicker man, with supportive non-judgemental care, and the consequential negative impacts on women and their babies, being the burning sacrifice, all with the aim of kowtowing to the god of the fruit of newspaper sales.

The RCM’s report is packed with hugely valuable and important statements. Let’s just take a look at a few of them:

  • Clinicians should make every effort to support skin to skin for an hour after birth
  • Maternity units should be appropriately staffed, and sufficient investment made In postnatal care to enable each woman to get the support and advice she needs to make informed choices about feeding her baby.
  • UK-wide Infant Feeding surveys (which were discontinued in 2015) should be reinstated

These are just a few examples of some of the really important details that could have been covered by the media, but which have been ignored in favour of the more colourful, but morally vacuous focus on what they are calling “the breastfeeding tyranny”. A reasonable discussion about the removal of qualified support for women where breastfeeding groups have been decommissioned, or a campaign to upskill midwives who are expected to support women to breastfeed with a few days of training (compared to the two year breastfeeding counsellor course), or perhaps an article on why women are still having their babies taken from their bodies and denied skin to skin – these would all be hugely valuable topics for the media to cover. These would all be game changers for mothers and babies.

Let’s not be under any illusions. The media used the component of the report that it did and ignored the rest because it sells newspapers, and it increases the rhetoric that causes even more stress and distress around infant feeding. This was not intended to support women, nor to help those who have had the horrific experiences that we see in the comments section today, and who we must continue to listen to, hear and demand change for,  but to sell newspapers. Nothing more.

 

 

 

 

Anti D: routine intervention debate

A medicine that offers a life line for a small minority has drifted into being used on a much wider population “just in case”.

If a medicine is good for a minority, then surely it’s even better to use it preventively on others? In this case, it appears that the logic doesn’t hold.

Our blood types are commonly understood – “O” “AB” etc. – and in addition we all have an Rh factor, which is the “positive” or “negative” aspect of our blood type. In the 1960s Anti-D was developed to help combat problems for Rh negative women with Rh positive babies, because an immune reaction to the baby’s blood can cause serious health problems in babies.

The people that this drug potentially benefits are:

  • Rh negative women with an Rh positive father of their child
  • Of these women, those who have experienced a trauma such as a car crash or interventions such as a C section during the birth

Originally, the drug was used in the 72 hours following a trauma or following birth interventions to stop an immune reaction in a future pregnancy. However, because studies found that women weren’t being offered the drug after trauma, in 1997 a consensus conference led to a recommendation to give the drug routinely rather than wait for a trauma to occur.

As with other birth culture issues we’ve covered, this is an area with large gaps in the research and a big lobbying pharmaceutical sector to deal with. National expert Sara Wickham has written about it in detail, well worth reading if you want to know more.

If you’re trying to make an informed choice on this intervention, one of the problems is that most of the literature available is produced or funded by the drug companies, rather than being independent. There is a US blog that offers some thoughts to help you (although from an activist not a medically qualified person).

The NHS page on this topic sadly doesn’t cover all the concerns raised by Sara Wickham. For example, if you are Rh negative but your baby’s father is too, then there’s no benefit from the drug, and it says that “it is likely small amounts of blood from your baby will pass into your blood during this time” which Sara points out is a contested point of view.

Rhesus disease can be serious for babies, and Anti-D may well be the best thing for those situations, but routine use of it on Rh negative women means passing the possible side effects onto mother and child without the benefits of preventing Rhesus disease to justify them. Sara points to some evidence suggesting it may even cause the disease in some babies by introducing the antibodies where they didn’t previously exist.