Today has seen the release of a position from the RCM on infant feeding with a massive response from national media, much of which has seemed incredibly unhelpful! The Daily mail headline, “End of breastfeeding shaming: Midwives ordered not to judge new mothers who choose to bottle feed” is an example which makes it sound like this report is slamming midwives for their current practice.
In reality midwives strive to respect women’s choice in all aspects of care, from antenatal through to postnatal. This includes the choice of how to feed their newborn baby. It is a key part of midwifery practise to provide information so that women can make informed choices. This is especially relevant in feeding where, as the RCM statement reiterates, “For women, breastfeeding has been shown to reduce the risk of breast and ovarian cancer, osteoporosis and diabetes, and it can assist in weight management in the postnatal period”, and the NHS choices website informs us of the evidence of benefits for babies from receiving breastmilk, reducing the risk of infections, diarrhoea and vomiting, sudden infant death syndrome (SIDS), childhood leukaemia, type 2 diabetes, obesity and cardiovascular disease in adulthood. These are facts not understood by many women, and therefore it is part of the midwifery role to ensure women understand these benefits when making their decision about how they plan to feed their baby.
In the Nursing and Midwifery Council code of conduct, the organisation which regulates nurses and midwives, it states that nurses and midwives must be aware of, and reduce as far as possible, any potential for harm associated with our practice. This surely does include the need to brief women of the potential benefits to be had from breastfeeding in preventing harm. However it also should include the need to promote safe practice with bottle feeding, in preventing harm. For several years partly as a result of hospitals trying to attain “Baby Friendly” UNICEF accreditation, midwives have been strongly discouraged from teaching mums how to safely sterilize bottles and make formula feeds. Indeed mums have also been encouraged to bring their own formula milk into hospitals if they were going to choose to formula feed, often in a ready-made format, as there are no facilities to sterilize and make up bottles, or to be shown how to do so. The government also withdrew the “Start4Life guide to bottle feeding” leaflet in 2016 that was previously given to bottle feeding mums to explain the process of making feeds and sterilizing bottles safely. While this leaflet is still available online, not all women have access to the internet, and hospitals often do not encourage the vast amounts of photocopying that would be involved in printing out this leaflet.
A further issue raised in the RCM statement is that of adequate postnatal support for women especially in their chosen method of feeding, and this is an issue for mums who choose to breast or bottle feed. Many women have “6 hour” discharges from hospital after having their babies. Postnatal care in hospitals and the community has long been described as the “Cinderella care” of maternity services, with stretched resources often unable to provide the level of feeding support that many midwives would love to be able to provide. This can have an effect on women’s ability to maintain breastfeeding when difficulties arise, even for those women who desperately want to breastfeed, which can lead to issues with mental health for some women.
To summarize, I would emphasize that midwives do NOT promote breastfeeding as the only way, but do promote the benefits of breastfeeding. I do applaud the RCM statement release on infant feeding and agree with all that it is promoting, for better postnatal services for women, and the argument for midwives being free to support women with information on safe practice no matter how they choose to feed their babies.