As a public health doctor, I always just assumed ‘breast is best’. I wasn’t surprised that during my pregnancy I was flooded with information about the benefits of exclusive breastfeeding and directed to multiple sources of breastfeeding support. I was shocked then, when my five-day-old daughter was readmitted to hospital with serious health issues due to feeding difficulties that could have been avoided with formula milk.
It all started shortly after her birth. Less than 48 hours after becoming a mother, following a forceps delivery, I went home with my healthy (albeit slightly jaundiced) daughter. I attempted to breastfeed her, but she rarely seemed settled after a feed. The nights were particularly arduous, as she latched on to my breasts for hours, falling asleep only for short periods in between.
A midwife visited us and encouraged me to keep going, but the issues continued and I was increasingly worried. My daughter’s lips looked drier every day, she had a small number of wet and scantly soiled nappies (but within what is considered ‘normal’), her cry became increasingly screechy and the jaundice did not seem to be decreasing. I was worried that my milk didn’t seem to have ‘come in’, but multiple google searches told me it was normal for it to take five days.
By day four my concerns peaked. I called the UK national breastfeeding helpline. My mental health was at rocket bottom and I was struggling to bond with my baby, because every interaction we had was so stressful. As I described my ailments, the volunteer down the line assured me that my problems were common and gave me advice about latching.
I felt a phone call could not accurately describe what was happening, so I called the local infant feeding team to ask for a home visit. As I described my issues, I was again reassured that what I was going through was ‘normal’. Nevertheless, a health professional visited that day and watched me breastfeed. Again, I was given advice about latching and encouraged to keep going.
It was on day five that a midwife visited for the routine health visit. She weighed my daughter and realised she had lost 25% of her birth weight. She was more jaundiced and showed visible signs of dehydration. We were referred immediately to A&E.
After a fraught dash to hospital, the immediate intervention was to offer formula milk, which my daughter drank with relish. After a few hours, we had a different baby: calm, content and sleeping like a newborn should. But the weight loss was so dramatic that we were advised to stay in hospital to make sure she fed properly and to exclude a possible infection. My daughter had to have intravenous antibiotics, multiple blood samples taken and she even had to have a lumbar puncture (when a needle is inserted in the back, between two vertebrae, to take a sample of liquid).
After a day, the jaundice started to fade and physical signs of dehydration dissipated. No infection was found. The diagnoses at discharge, three days after admission, were hypernatremic dehydration and hyperbilirubinemia. She was just underfed. My body hadn’t produced enough milk.
The paediatric consultant who saw us told me she saw babies like this ‘all the time’. I was not the only new mother going through this horrendous experience. Since then, I have learnt that there is very good evidence breastfeeding can cause serious harm in some circumstances.
Why wasn’t I aware of this? Why did every health professional I spoke to encourage me to keep going and not consider the harm to my baby? Among the hundreds of leaflets I was given when pregnant, why was there nothing about the risk of dehydration? Why does society insist breast is best when the evidence is so poor?
At four months old, my daughter is now well and thriving, fed exclusively on formula milk. So far, we have not detected any long-term consequences of the under-nourishing in her first week. Hopefully there will be none, but I know all families are not that lucky. Nevertheless, those first five days were nothing less than traumatic, and as I write this, I am in tears. The guilt is overwhelming. How did I allow things to get that bad?
This experience has made me reflect on how public health professionals, including myself, think and work. I took for granted that breast was best and that formula companies were an ‘evil’ profit-seeking cabal looking to harm my baby in order to sell a product, very much like tobacco companies. I now realise it is much more complex than that. Formula milk saved my baby’s life and greatly improved our life as a family.
Pregnant women need to know about the risks of exclusive breastfeeding, and health professionals need to be more open to alternative feeding options. Maybe then we will stop harming babies on this scale and paediatricians will stop seeing babies like this ‘all the time’.
The author of this blog has asked to remain anonymous.