"The decision of whether or not to breastfeed is a woman’s choice and must be respected"
With the new position statement issued by The Royal College of Midwives in June 2018, we thought that we should stick our stake in the ground and also ask our Baby Feeding professional – Geraldine Miskin a few questions to shed some light on what this now means.
We’re inclusive of everyone here, so feel comforted by the fact that we love breastfeeding (our Mama-in-Chief breastfed for 9 months after a tough old start), but we also love bottle and formula feeding.
So, at The Parenting Chapter, we think that the change in position is a much needed step towards parents having choice, but without as much guilt wrapped around it. The word ‘respected’ isn’t ‘accepted’, as we would like it to read, but it’s a step in the right direction. It will hopefully give new parents the permission to create a plan a and plan b if they wish to try breastfeeding, but then need or want to revert to combination feeding or formula feeding.
However, practical support and training must be given to those who educate parents - antenatal classes, GPs health visitors, breastfeeding experts and midwives - on how they deliver this message and this shouldn’t be an optional process. This should be presented in clear terms and with hypothetical scenarios addressed, so the professionals can hit the ground running. What will potentially hold them back, is the fear that parents will now revert to formula feeding without first considering breastfeeding. And I do get this fear, but I think they need to reframe it as parents being empowered to do what they think is best given their situation and physical and emotional wellbeing. My belief and experience of life in general, is that when people are given equally weighted and detailed choices, they make more informed decisions. Nobody can argue with the benefits of breast-milk to mum and baby, so perhaps we’d see more parents giving breastfeeding a go if they want to and being better equipped emotionally, to navigate through the tougher stages and come out the other side. But as many people have stated before, we’ve got a job on our hands when it comes to education on breastfeeding and bottle feeding.
So what can we do to support the professionals who work with parents when it comes to this change? My suggestions are as follows and this of course needs investment financially and time:
- Professionals who run classes/groups/drop ins, should be directed to rename sessions on breastfeeding to ‘how to feed your baby’ and teach parents to breast and bottle/formula feed in EQUAL levels of detail – with no bias whatsoever. How to sterilise bottle feeding equipment is key, but bottle manufacturers and all the products that go with it, shouldn't be marketed en masse - too much choice equals confusion!
- Encourage parents to consider why they want to feed their baby in the way they have planned and to review the ‘why’ every week in the first 6 weeks, but again when baby hits the weaning stage (from 17 weeks) and again, when mum is starting to plan to go back to work
- Parenting professionals should be much more transparent about how breastfeeding can impact a mother AND father emotionally. Those who provide practical support to help mothers to breastfeed should be given training on mental health, including the signs of a disturbance and the action to take. But of course….investment needs to be made into this area as well.
I also think that focus needs to be on mums returning to work. Should employers build how to breastfeed when you’re returning to work as part of their Keep in Touch (KIT) days? Yes. The reality of going back to work after taking time off can be overwhelming. So how you feed your baby can take a backseat and mothers may rush into a decision to cut back, or give up entirely ‘because they have to’, when this isn’t the case. Breastfeeding doesn’t have to stop!
Finally, dads. It’s really interesting that the Royal College of Midwives states that ‘the decision to breastfeed or not, is a woman’s choice’. They do go on to reference fathers in the PDF, but not in the headline. What about dads? Aren’t they 50% of the child? Dads matter too and I think we have to remember the concept of community and how dads are a crucial part of this. Also, how they also have a physical and emotional reaction to the birth and care of a baby. Dads commonly feel left out when a partner is breastfeeding, but this doesn’t have to be the case. Do they know how else to bond and grow with baby as baby grows?
So here’s what our very own Geraldine has got to say on the change....
So G, if you’re a pregnant mum assessing her choices for feeding her baby, what should SHE and her partner now take into account given the change in POSITION?
Well firstly, isn’t it nice that all mums can now choose, with the support of their midwife, a feeding option that works for them, without judgement and bias, be that exclusive feeding, combined feeding or formula feeding..
When you take away feelings of inadequacy and guilt of not breastfeeding exclusively, you are able to really consider what is right for you and your family.
Questions to take into consideration at this stage would be:
- What you would like to achieve on a broader perspective? For instance, how long would you like to feed your baby and how do you see yourself doing this? Once you have a good idea of what would work for you, break that down into mini steps or goals, so that it is manageable and you enjoy the journey, regardless of whether it goes to plan or whether you need to reassess or take a diversion.
How you feed your baby is a personal choice and as a parent, you’ll want to do what is best for your baby within your personal abilities. This is important to know and remember as some babies just aren’t able to breastfeed, some mums just aren’t able to make enough milk. Yes it is unfortunate, but if this is how things are and you know that you’ve done your best, it makes the tough decision to move away from breastfeeding a little easier.
- How do you envisage your day with your baby? It is helpful to consider what your day might look like and create a few different outcomes as every day with a baby is unique. Some days you’ll be stuck to the sofa feeding baby, unable to put bub down for even a minute. Other days, Bub will be happy to do short feeds, giving you more flexibility and maybe even taking a bottle or two without fuss. You won’t know what you want until you know what you definitely don’t want, so be open and flexible to changing your mind so that you do what works for you.
- Are you happy to do what it takes to get breastfeeding working for both of you? Sometimes breastfeeding takes time and perseverance until both you and baby get breastfeeding right. For some mums and babies, this can take a lot more time and effort, so know what your boundaries are and at what point you need to consider alternatives. Setting these goals before your baby arrives is helpful but not set in stone.
- Have you created your personal feeding route? It’s important to know where you are heading and what your options are until you are able to achieve or reach your feeding goal. When creating your personal feeding routine, consider what your ultimate feeding goal or plan A would be. Also consider what plan B, C, and D would be and when you might change tactics and move onto the next plan.
And should parents keep on reviewing their feeding choice in the early days? And how often?
Yes, review where you are on your feeding route emotionally and physically once per week. You want to see that you are feeling confident and empowered about what you are doing. If you feel like you are constantly missing your goals and dreading feeding your baby, you need to reassess what you are doing and find a solution that is better for you and baby. This may be a temporary change until you and baby find your feet, so don’t see making changes to what you are doing as negative. Instead, if you have to make changes to what you are doing, recognise that you are still moving closer to your ultimate goal but just taking a slight diversion to ensure that you get to where you want to be.
What do you think needs to change when it comes to the message given out to parents at antenatal classes and when health visitors come to check on the new parents and baby?
Breastfeeding when it works, is the easiest way to feed your baby and giving it a proper go is really in your best interests. When breastfeeding doesn’t work and you move onto combination feeding or even exclusive formula feeding, know that any breast milk your baby has had will make a positive impact on your and baby’s health. Recognise that you have done your very best for yourself and baby within your abilities, regardless of the outcome, and nobody can ask any more of you than that. Most importantly, be kind to yourself and if you feel like breastfeeding is not working, do something about it and find what works without feeling guilty or like you have failed in some way or another.
Dads are mega important to us and we feel that it IS essential for dads to be as informed as mums about feeding choices. What honest information or advice would you give to dads specifically about feeding their baby by breast or bottle?
It’s important to know why breastfeeding is recommended and why formula feeding comes with language that is caveated, so that both mum and dad can be on the same page when it comes to making choices and decisions. Mums need support more than ever, so dad’s your support is really important and your opinion matters as you can view things objectively. You know your wife or partner better than most people, so gently encourage her if you know that all she needs is a confidence boost and self belief and support her in her choice to move away from breastfeeding. Most importantly, nobody will know or care whether baby was breast or bottle fed in 5 years time, but what will be clearly apparent is how happy and secure he or she is, so do what you need to support that.
Remember that breastfeeding doesn't indicate that baby loves mum more! So when emotions are high, it feels as though you're not needed. But take it back to basics - we all need food and water on tap and if we skip this, we can get grouchy and become focused on finding food or a drink and everything else is secondary. Although it's cliched, having your own 'thing' with baby - winding, changing, bedtime, choosing their clothing before you leave and so on, really cements the bond.
If I’m a Mum and want to continue breastfeeding, but I’m finding it tough, what would you say to me to encourage me to keep going?
If you really want to breastfeed, don’t give up until it works well or you have tried everything you possibly can. There is always a reason for breastfeeding not going to plan. When you can find the root cause of the challenges you are experiencing and resolve that, breastfeeding usually falls into place. Many mums feel like they want to give up but along the way but persevere and are then so grateful that they did. It is worth giving it a really good go. Ultimately, you want to give up on a good day, when you feel at peace with yourself that you have done your very best and know that if there were a way to get your baby breastfeeding, you would have found it.
How can combination feeding look in reality? Can I just give 1 bottle in the evening and the rest breastmilk?
The great thing about breastfeeding is that you can pretty much do what works for you, provided you reach certain milestones that tell you that what you are doing, is beneficial to you and baby. For instance, once your supply is established, you can substitute some breastfeeds with bottle feeds and pump in lieu of the feed. This enables you to create flexibility so that you get more rest, whilst maintaining a healthy supply.
You might find the breastfeeding feels so much more manageable when you replace one breastfeed with a bottle feed. This allows you some time off and an opportunity to get more rest, ultimately enabling you to continue giving your baby breastmilk for an extended period.
You have a choice about how you feed your baby. Choose a way that works for you and stick to it until it doesn’t work, at which point you find a new way that does.
I want to bottle feed my baby. What would be on your shopping list?
- Bottles: what a minefield this is! Avoid the marketing and look for bottles based on what they can assist with. So for windy babies, Dr. Browns or MAM bottles are very popular. For teeny tiny babies, MAM do a great bottle.
- Teats: remember that bottle teats change as baby gets older. The hole or flow changes to allow them to feed more efficiently
- Sterilising fluid to wash all bottle and pumping equipment in
- Microwave sterilising bags: life saving!
- Steriliser unit (or the dishwasher does work, but we prefer to keep things separate)
- Formula prep machines: these have mixed feedback and need regular cleaning, but they save time for formula feeding parents
- Bottle brush: Dr Browns do a great brush and it enables you to get into the corner of bottles to give them a really good clean
- Breastfeeding pump: There are lots of options, but Medela have a great single electric pump
- Breastmilk bags: to store your milk in. Watch out, as if you fill these up more than halfway you run the risk of them falling over and spilling your precious milk
- Muslins galore!
- A bottle holder in your nappy bag
The Parenting Chapter offers online postnatal lessons covering the first 3, 6 and 12 months of parenthood and then takes parents into the world of toddlers. Our Chapter One course - for mums and dads - can be explored when parents are still expecting or going through a surrogacy arrangement, and accessed 24/7 for 1 year after baby arrives. So unlike antenatal classes, the same content can be referred back to whenever needed.
We have covered breastfeeding and bottle feeding equally - including how to feed using a bottle, a formula feeding schedule in the early weeks and recommended sterilising equipment. We also talk about problem areas and how to spot issues and navigate them, as well as combination feeding and how this looks in practice. This is delivered by Geraldine Miskin - Marina Fogle's go-to baby feeding advisor, and we also boast a library of parent interviews by film and podcast, who spoke to us about their experiences of breastfeeding, formula feeding, combination feeding and the ups, downs and OK moments and from the mum and dad perspective.