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Breastfeeding and Guilt
Written by Jack Newman, MD, FRCPC
(revised January 2000)
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.
It is, in fact, nothing more than a ploy. It is an argument that
deflects attention from the lack of knowledge and understanding
of too many 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 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, despite
the fact that 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, in fact, 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 that 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, has many 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 artificial 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ﾗhealth professionals' advice is
often the single most significant reason for mothers' failing at
breastfeeding! Not the only one, and other factors are important,
but health professionals often have influence and authority far
beyond their knowledge and experience.
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 almost, well, between
us, 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ﾗ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 who
feels guilty. In order to prevent women feeling guilty about not
breastfeeding what is required is not avoiding promotion of breastfeeding,
but promotion of breastfeeding coupled with good, knowledgeable
and skillful support. This is not happening in most North American
or European societies.
Jack Newman, MD, FRCPC
(revised January 2000)
