Breastfeeding and Guilt
One of the most powerful arguments many health professionals, government agencies and formula company manufacturers make for not promoting and supporting breastfeeding is that we should "not make the mother feel guilty for not breastfeeding." Even some strong breastfeeding advocates are disarmed by this "not making mothers feel guilty" ploy.Because, indeed, it is nothing more than a ploy.
It is an argument which deflects attention from the lack of
knowledge and understanding of most health professionals about
breastfeeding. This allows them not to feel guilty for their
ignorance of how to help women overcome difficulties with
breastfeeding, which could have been overcome and usually which
could have been prevented in the first place if mothers were not so
undermined in their attempts to breastfeed. This argument also
seems to allow formula companies and health professionals to pass
out formula company literature and free samples of formula to
pregnant women and new mothers without pangs of guilt, though it
has been well demonstrated that this literature and the free
samples decrease the rate and duration of breastfeeding.
Let's look at real life.
If a pregnant woman went to her physician and admitted she smoked a
pack of cigarettes, is there not a strong chance that she would
leave the office feeling guilty for endangering her developing
baby? If she admitted to drinking a couple of beers every so often,
is there not a strong chance that she would leave the office
feeling guilty? If a mother admitted to sleeping in the same bed
with her baby, would most physicians not make her feel guilty for
this even though it is the best thing for her and the baby? If she
went to the office with her one week old baby and told the
physician that she was feeding her baby homogenized milk, what
would be the reaction of her physician? Most would practically
collapse and have a fit. And they would have no problem at all
making that mother feel guilty for feeding her baby cow's milk, and
then pressuring her to feed the baby formula. (Not pressuring her
to breastfeed, it should be noted, because "you wouldn't want to
make a woman feel guilty for not breastfeeding".)
Why such indulgence for formula?
The reason of course, is that the formula companies have succeeded
so brilliantly with their advertising to convince most of the world
that formula feeding is just about as good as breastfeeding, and
therefore there is no need to make such a big deal about women not
breastfeeding. As a vice president of Nestle here in Toronto was
quoted as saying "Obviously, advertising works." It is also a balm
for the consciences of many health professionals who themselves
did not breastfeed, or their wives did not breastfeed. "I will not
make women feel guilty for not breastfeeding, because I don't want
to feel guilty for my child not being breastfed."
Let's look at this a little more closely.
Formula is certainly theoretically more appropriate for babies than
cow's milk. But, in fact, there are no clinical studies which show
that there is any difference between babies fed cow's milk and
those fed formula. Not one. Breastmilk and breastfeeding,
which is not the same as breastmilk feeding, have many more theoretical
advantages over formula than formula has over cow's milk (or other animal
milk). And we are just learning about many of these
advantages. Almost every day there are more studies telling us
about these theoretical advantages. But there is also a wealth of
clinical data showing that, even in affluent societies, breastfed
babies, and their mothers incidentally, are much better off than
formula fed babies. They have fewer ear infections, fewer gut
infections, a lesser chance of developing juvenile diabetes and
many other illnesses. The mother has a lesser chance of developing
breast and ovarian cancer, and is probably protected against
osteoporosis. And these are just a few examples.
So how should we approach support for breastfeeding?
All pregnant women and their families need to know the risks of
formula feeding. All should be encouraged to breastfeed, and all
should get the best support available for starting breastfeeding
once the baby is born. Because all the good intentions in the world
will not help a mother who has developed terribly sore nipples
because of the baby's poor latch at the breast. Or a mother who has
been told, almost always inappropriately, that she must stop
breastfeeding because of some medication or illness in her or her
baby. Or a mother whose supply has not built up properly because
she was given wrong information. Make no mistake about
it - health professionals' advice is often the single most
common reason for mothers' failing at breastfeeding!
If mothers get the information about the risks of formula
feeding and decide to formula feed, they will have made an informed
decision.
This information must not come from the formula companies
themselves, as it often does. Their pamphlets give some advantages
of breastfeeding and then go on to imply that their formula is
actually just as good. If mothers get the best help
possible with breastfeeding, and find breastfeeding is not for
them, they will get no grief from me. It is important to know that
a woman can easily switch from breastfeeding to bottle feeding. In
the first days or weeks - no big problem. But the same is not
true for switching from bottle feeding to breastfeeding. It is
often very difficult or impossible, though not always.
Finally, who does feel guilty about breastfeeding?
Not the women who make an informed choice to bottle feed. It is the
woman who wanted to breastfeed, who tried, but was unable to
breastfeed. In order to prevent women feeling guilty about not
breastfeeding what is required is not avoiding the promotion of
breastfeeding, but rather the promotion of breastfeeding coupled with good,
knowledgeable and skillful support. This is not happening in most
North American or European societies.
Breastfeeding and Guilt. August 1997.
Written by Jack Newman, MD,
FRCPC
May be copied and distributed without further permission