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.





Breastfeeding community building

A guest blog today from Lucy Sangster, who’s been reading up on the latest breastfeeding research for us.

New research shows how peer support for breastfeeding helps strengthen local communities. While existing research on breastfeeding support shows that it is effective and valued, work on how it fits into social cohesion has been missing, according to the authors of a new study: Gill Thomson, Marie-Clare Balaam and Kirsty Hymers.

Reading their work on Blackpool’s breastfeeding peer support, the value of the research is that, at a time when provision is at risk, proving wider benefits for breastfeeding support may well help groups argue for funding and gather more allies for breastfeeding support in their own areas.

The full report is packed with stories, quotes and evidence of what is working in Blackpool, here’s a summary of some of their findings.

There are really determined efforts to remove barriers to breastfeeding in Blackpool:

  • A crèche is provided at meetings
  • A peer will meet someone new before a meeting so there is a familiar face for them
  • They get to know women before the birth
  • They involve peers from some of their minority communities
  • They go out to people who are less likely to get in contact: at young parent groups and at a supported accommodation centre for homeless families
  • They involve partners, families and grandparents, so that they understand and can support breastfeeding
  • They raise the profile of breastfeeding in Blackpool with events, local media, work in schools, and wearing their ‘uniform’ t-shirts around town
  • They’ve made breastfeeding feel more normal through local businesses displaying a sticker ‘breastfeeding friendly business’ so a less confident woman doesn’t need to worry about whether it’s ok to breastfeed.
  • They work hard to get the support of health professionals in the area with communication, feedback when a referral takes place, concentrating on shared goals and support.

Because the study has used an existing model for social cohesion (made popular by Ted Cantle nearly 15 years ago) they are able to look at several different impacts of peer support. They show that peer support breastfeeding can help women create bonds with other similar women that last beyond breastfeeding; it can also create bridges between people with little else in common and form links between mothers and people with more power.

The inherent tensions between professionals and volunteers are given space within the report and anyone who has worked in a system including both professionals and volunteers would recognise that when working well, everyone wins… but it can be hard to keep it working.

The study shows that clear communication with professionals and proving how peers support them helps the peers maintain good relations with health professionals.

‘“I think at first the health visitors were the hardest but now they’re great. Because it’s showing them how you can help them as well, that you’re there to support them, that’s what it’s about.”’

The main sources of tension were when there was a lack of communication, conflicting advice, feeling there was no common agenda or negotiating hard cases such as a baby losing weight.

Previous research suggests that peer support for breastfeeding can do harm as well as good, particularly by inducing guilt or imposing pressure, so the feedback that the peers in Blackpool were non-judgemental and approachable is valuable, to indicate that they’re avoiding some of the pitfalls.

In the full report you can read more about how the service was set up, how they changed it and how they made the peer role flexible so that people with caring responsibilities are included. There are also details in the references to the recent Cochrane review on the effectiveness of skilled support on increasing the duration of breastfeeding and other research on the subject.