Another year, another Maternal Mental Health Awareness Week and another opportunity to point out, once again, that UK infant feeding policies pose serious risks to maternal mental health.
Policies and practices in NHS hospitals and services shame women who use formula, employ emotionally manipulative tactics to persuade women to breastfeed, encourage women to accept excessive sleep deprivation, gaslight women by misrepresenting the realities of breastfeeding and, perhaps most egregious of all, allow avoidable infant ill health.
There is mounting evidence that breastfeeding promotion policies have a negative impact on maternal mental health. A 2019 systematic review of the impact of the Baby Friendly Initiative in the UK (the breastfeeding promotion programme followed in most NHS hospitals) concluded it ‘may promote unrealistic expectations of breastfeeding, not meet women’s individual needs, and foster negative emotional experiences’. Small studies show women reporting feelings such as thinking they are ‘a “bad mum” for not breastfeeding’ and being desperate to stop breastfeeding but feeling they have to continue.
But do we need evidence to state the obvious? We think the potential impact on women’s mental health is self-evident when you look at the policies that our healthcare authorities follow and the information sources they provide to new parents about infant feeding.
So, this Maternal Mental Health Awareness Week, we simply want to draw attention to five infant feeding policies or practices that present a clear risk to maternal mental health:
- Gruelling regimes and disregarding sleep
‘If a breastfeeding baby is given formula to supplement breast milk because of concerns about faltering growth, their mother should be encouraged to breastfeed before giving formula, at every feed, to stimulate her breast milk supply. Mothers should also be encouraged to express breast milk and to give any available breast milk before the formula is given.’
– NICE guidelines on faltering growth in babies
This feeding regime, often referred to as ‘triple feeding’, requires the mother to breastfeed their baby, express breastmilk and feed the baby top ups by bottle at every feed. Since newborn babies feed every two to three hours around the clock and this process takes over an hour, this gives the woman very little time to sleep, recover from birth or to do anything else. Our members who were advised by their healthcare providers to follow this regime describe it as ‘barbaric’ and ‘relentless’ and say that it seriously impacted their mental health.
Even without triple feeding, some of our members found exclusive breastfeeding after long or difficult births unsustainable. They say that their need for sleep after birth in hospital was not considered by staff, who prioritised round-the-clock exclusive breastfeeding. They explain that this contributed to subsequent mental health problems.
Is a negative impact on mental health not an obvious potential, even likely, outcome of extremely limited sleep and a gruelling feeding schedule?
2. Shaming
‘Written information on formula milks and how to formula feed…should not be on general display or left in leaflet racks.’
‘There should be no images which idealise bottle feeding; images of bottles and teats should only be used to reinforce technical instructions.’
‘All written information related to formula feeding must include a statement similar to the one below:
Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or to stop breastfeeding, it is possible to restart.’
– Baby Friendly Initiative guidelines on providing information to parents about formula feeding
Several of our members say that after breastfeeding complications led them to switch to formula, policies such as the above contributed to feelings of failure and shame and to postnatal depression and anxiety. Some cite the profoundly negative experience of having to click a notice that says ‘breastfeeding is best for babies’ to buy formula online for their baby who required it after breastfeeding failed. Others describe going to children’s centres for the first time with their new baby, feeling vulnerable and finding themselves surrounded by breastfeeding promotion posters and no mention of bottle feeding. To us it is clear that the guidelines are intended to make formula seem like the wrong choice and bottle feeding something that should be hidden from view.
Is shaming, with its consequent mental health impact, a bug or a feature here?
3. Emotional manipulation and coercion
‘Breastfeeding enhances mother-child bonding’
‘Breastfeeding also helps you and your baby to get closer – physically and emotionally. So while you are feeding your baby, the bond between you grows stronger.’
‘Breastfeeding is a brilliant way to continue to support your baby, nourishing them both nutritionally and emotionally.’
– Resources for parents from various NHS trusts
Breastfeeding promotion policy is coercive and undermining of parents’ autonomy to make decisions about infant feeding that are best for them. Parents are presented with a picture of the benefits of breastfeeding that is far from the established evidence. They are not told that most of the claimed benefits are based on studies that cannot prove causation. They are not told of any risks. They are presented with an unbalanced and erroneous narrative and therefore, they are not able to make fully informed decisions.
Most manipulative of all, is the idea that breastfeeding is necessary for bonding. This is not based on any evidence and is as outrageous as it is cruel. Many of our members say that after extremely difficult breastfeeding experiences, the idea that introducing formula or switching entirely might impact their bond with their baby had a profoundly negative impact on their mental health.
Is the cruelty here not clear and unacceptable to anyone who cares about mothers, babies and their families?
4. Gaslighting
‘Nearly all women produce enough milk for their baby.’
‘When you first start breastfeeding, you may worry that your baby is not getting enough milk. It can take a little while before you feel confident that your baby is getting what they need.’
The information on the NHS website implies to women that, while breastfeeding is a ‘skill that takes time to get the hang of’, it is nearly always possible. Successful breastfeeding is a matter of confidence, perseverance and mindset, not physiology or luck.
It is clear from government statistics that while a large percentage of women attempt to establish breastfeeding, few end up exclusively breastfeeding. Breastfeeding advocates will say that this is because they ‘didn’t get enough support’, and it seems the government is taken in by this idea, since it has committed £50 million to breastfeeding support. But our members are clear that this was not the case for them. They say that chronic low milk supply, persistent pain, intractable latching problems, infant complications, severe mastitis, excessive sleep deprivation or a negative impact on their mental health and on their relationship with their baby led them to introduce formula or to stop breastfeeding entirely. This was despite breastfeeding support.
Our members find that when they explain their very negative experiences of breastfeeding – to their healthcare professionals or later as research participants or on social media – they cannot be heard. Their reports of breastfeeding simply being intolerable, impossible or not conducive to good mental health are heard as examples of women ‘not getting enough breastfeeding support’. IFA co-founder and clinical psychologist Ruth Ann Harpur wrote about her own experiences of this in a previous IFA blog:
‘As someone with a clinical interest in narcissism, I know all too well the damage that gaslighting can do and I don’t use the term lightly. I make no allegations of intentional emotional abuse in my case and I suspect ideology induced blindness, rather than malice. However, there is an uncomfortable familiarity in seeing my accounts of my experience denied and twisted to push me to continue breastfeeding, when it caused me significant harm. It seems to me that such psychological gymnastics serve to protect the reputation of powerful health institutions, public health policy and, most of all, breastfeeding itself as always optimal and good.’
5. Allowing avoidable infant harm
‘Give newborn infants no food or drink other than breastmilk unless medically indicated’
– Baby Friendly Initiative ten steps to successful breastfeeding
Government and healthcare authorities know that admissions to hospital for newborn infants in the early days of life for jaundice and other feeding complications have been increasing for several years. How do policies, such as the above, that encourage withholding food and hydration from newborn babies, potentially for days, contribute to this concerning trend?
Several of our members experienced highly distressing hospital admissions for their newborn babies shortly after initial discharge from postnatal wards, where the insufficient milk intake of their babies had been overseen by staff promoting exclusive breastfeeding. Formula supplementation had not been mentioned until the situation was critical.
What is the impact on parents of entirely avoidable episodes of infant ill health and hospital admissions for newborn babies in the early days of life?
Last year for Maternal Mental Health Awareness Week, IFA made an intimate video about our bonds with our babies called We Are the Magic. We intended to show that, despite being undermined by infant feeding policy and experiencing related mental health issues, we survived and thrived. However, this year, honestly, we feel exhausted and frustrated. We are tired of having to continually demonstrate, explain and provide evidence for the obvious: why the policies above are so clearly a risk to maternal mental health.
So, for this Maternal Mental Health Awareness Week, we simply wanted to share the policies and say to authorities: imagine what triple feeding is like for a mother recovering from a traumatic or exhausting birth; consider how it feels to read ‘breastfeeding is best for babies’ on the back of the formula bottle at every feed when your baby has been made ill by breastfeeding failure; think how it impacts you to hear that breastfeeding is connected to bonding if you are struggling with poor mental health which stopped you breastfeeding; try to perceive what happens psychologically when your healthcare professionals cannot hear you and claim that your intractable breastfeeding complications just need ‘more support’; finally, imagine discovering your baby is not getting enough to eat and this has made them ill, despite the prior encouragement and cheerleading of your healthcare professionals.
How do you justify these polices and still claim to be concerned about maternal mental health?
Sue Haddon
Maternal Mental Health Awareness Week runs between 1 and 7 May 2023
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