Earlier this year, we submitted to the Birth Trauma Inquiry. The inquiry published its report this month.
We focused on the role of exclusive breastfeeding promotion in our members’ distressing, even traumatic, experiences. We shared experiences around three areas: postnatal care and rooming-in; inhumane breastfeeding advice; and avoidable infant complications.
We highlighted a lack of evidence that exclusive breastfeeding promotion practices and the UNICEF Baby Friendly Initiative are safe or tolerated by patients. We questioned why they have been allowed to dictate the care of vulnerable patients and foster a culture of total disregard for women’s postnatal needs. This is what we wrote:
Introduction
Infant Feeding Alliance is a group of parents from across the UK campaigning for compassion, autonomy and safety in infant feeding policy and practice. Our members all had babies in the last two decades and had distressing experiences as a result of policies to promote and support exclusive breastfeeding.
These experiences compounded traumatic births in some cases, and in others were traumatic in themselves. The mental health of most of our members was in some way impacted by exhausting, painful or insufficient breastfeeding – totally avoidable by use of formula milk, which was advised against by healthcare staff.
Current government policy is to promote exclusive breastfeeding to all women. This is despite no evidence that attempts to increase breastfeeding rates over the last 30 years have led to any improvements in health, or that exclusive breastfeeding is safe for all babies. Nearly all UK hospitals have signed up to the UNICEF Baby Friendly Initiative (BFI) to ‘promote, protect and support breastfeeding’. This is now required by the Long-Term Plan for the NHS.
A recent review commissioned by PHE (now UKHSA) found no evidence that BFI leads to better health outcomes.1 Evidence is mounting that it has a negative impact on women’s wellbeing.2
BFI requires that hospitals ‘give newborn infants no food or drink except breastmilk, unless medically indicated’3. We suggest this protocol is likely contributing to the concerning increases in infant hospital readmissions for jaundice and other feeding complications.
In our experience, current policy and practice pushes women to pursue exclusive breastfeeding beyond what is tolerable to them or safe for their babies. This has the potential to compound birth trauma or to cause traumatic feeding experiences.
Postnatal care and rooming-in
Current policy encourages all women to exclusively breastfeed, no matter what their physical or psychological condition after birth. Newborns feed frequently, so women’s ability to rest, recover or sleep is clearly impacted by this advice.
As part of the breastfeeding promotion agenda, it is mandated that women ‘room-in’ with their babies and assume full care of them immediately following birth. Unless a woman is in a high dependency unit, she will be expected to care for her baby around the clock, whether immobilised after surgery, recovering from a birth injury or excessively sleep deprived.
There are no longer any newborn nurseries anywhere in the NHS, and women have no choice in the matter. We find this situation unconscionable. We question how a culture of total disregard for women’s needs following birth has been allowed to take hold.
Even when babies are being cared for in NICU, their mothers are expected to express breastmilk around the clock and keep the hospital supplied with it. This disregards their own wellbeing at a distressing time, as well as other demands they may have outside of NICU.
Stories from our members:
‘I had no colostrum after birth. A specialist midwife came and recommended massaging and expressing. Still no colostrum came out. I complained that this was very painful and there was nothing there, but no other solution was offered.
I was made to feel I was the main barrier to breastfeeding. I was even told my nipples were not the right shape. In fact, the massive obstetric haemorrhage I’d suffered explained the complete lack of colostrum.
No one mentioned this, or that I could use formula milk. I asked how long a newborn could go without food and no answer was given. Then, when my baby became jaundiced and needed phototherapy, regular formula feeds were suddenly prescribed. The staff’s rigidity in pursuing exclusive breastfeeding, when there were clear red flags, is unconscionable.’ – IFA member, London
‘My baby was in NICU. I told the neonatal nurse that I felt like the midwives were going to kill my baby, and that was why I couldn’t and wouldn’t sleep. I was not well! She suggested she give some formula, so I could get some good sleep and maybe even go home for a night. About ten minutes later, a midwife came in and said I needed to ‘stop all this silliness’ and express breastmilk for my baby because my baby needed my milk. As you can imagine, that really didn’t help my mental wellbeing.’ – IFA member, Somerset
Inhumane breastfeeding advice
Once women are discharged from hospital, inhumane treatment often continues in the form of breastfeeding support services. Some of our members were encouraged to keep breastfeeding through serious enduring problems and severe distress, leading to hospital admissions for breast abscess and sepsis arising from mastitis.
Extreme feeding regimes are regularly recommended by healthcare professionals, with no regard for women’s need for sleep. Many of our members were advised to ‘triple feed’ to attempt to increase milk supply. This means breastfeeding the baby, expressing milk and feeding the baby the expressed milk at every feed, around the clock. Since young newborns feed every 2 to 3 hours and this process can take over an hour, this leaves women with almost no time to sleep.
Information about the common risks of exclusive breastfeeding was continually withheld from us and a false picture painted to get us to continue, e.g. ‘breastfeeding is a lovely way to feel close and strengthen the bond between you and your baby’4. We had postnatal appointments at children’s centres, where posters presented idealised images of breastfeeding and did not (by law) acknowledge bottle feeding.5
When our experiences of breastfeeding were brutal, painful and even traumatic (anything but ‘lovely’), this messaging could be described as ‘gaslighting’. It further impacted our mental health, as well as our trust in healthcare professionals.
A story from a member:
‘My healthcare providers were in total denial. After weeks of painful and difficult breastfeeding, despite lots of “support”, I was utterly depleted, on edge and exhausted to the point of not being able to function. At one point I was so sleep deprived, I fell down the stairs. But healthcare professionals said, “Oh, you’re doing so well to be breastfeeding”.
When I finally stopped breastfeeding and we were thriving on formula, they then said how “sorry” they were, and that I must not have had “enough breastfeeding support”. They were utterly disconnected from reality.’ – IFA member, Epsom
Avoidable infant complications
The policy of giving newborns ‘no food or drink except breastmilk’ meant many of our members experienced their babies struggling desperately to feed, while staff failed to mention other options.
In line with guidance, we simply received more breastfeeding support, although there is little evidence for how this can resolve intractable latching difficulties, low milk supply and painful breastfeeding.
As a result of this protocol, some of our babies were readmitted to hospital shortly after initial discharge with complications of insufficient milk intake, including excessive weight loss, jaundice and dehydration. In some cases, our babies required a totally avoidable and distressing SCBU or NICU stay.
We know that newborn readmissions to hospital in the early days of life for jaundice and feeding complications have been increasing year on year in the UK over the past three decades6, 7, 8. In rare cases, complications of insufficient feeding, such as hypoglycaemia9, severe jaundice and hypernatremia can cause brain injury and even death. We believe that the so-called ‘Baby Friendly’ policy of withholding food from newborn babies is likely a contributing factor to this disturbing situation.
A story from a member:
‘I knew my daughter wasn’t latching well, but staff just kept providing breastfeeding support and encouragement. No one ever mentioned formula. I was excessively sleep deprived and knew this wasn’t sustainable for either of us. I was desperate to leave hospital, but when they were getting ready to discharge us on the third day, I realised I didn’t know how to keep my baby alive. My mental health really started to unravel then.
A midwife visited us at home the next morning and found our baby had lost excessive weight, was jaundiced and dehydrated and she sent us to A&E. Formula saved us. Not only did she revive, but I could finally sleep, as my husband could share feeds. However, these experiences seriously impacted my mental health. I had what I now think must’ve been flashbacks – perceiving all round shapes in my home as baby mouths screaming to be fed.’ – IFA member, Kingston-upon-Thames
References
1. Fair, F. J., Morrison, A., Soltani, H., 2021. The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews. Maternal & Child Nutrition, 17(4), e13216. https://doi.org/10.1111/mcn.13216.
2. Fallon, V., Harrold, J., Chisholm, A., 2019. The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: a mixed-methods systematic review. Matern. Child Nutr. 15 (3), e12778. https://doi.org/10.1111/mcn.12778.
3. UNICEF, 2014. The Baby Friendly Initiative – the 10 steps to successful breastfeeding. Available from: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2014/02/10_steps_maternity.pdf. Accessed date 5 February 2024.
4. NHS website, 2023. The benefits of breastfeeding. Available from: https://www.nhs.uk/start-for-life/baby/feeding-your-baby/breastfeeding/the-benefits-of-breastfeeding/. Accessed date 2 February 2024.
5. Official Journal of the European Union, 2016. Commission Delegated Regulation (EU) 2016/127. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?from=EN&uri=CELEX%3A32016R0127. Accessed date 2 February 2024.
6. Keeble, E., Kossarova, L., 2017. Focus on: Emergency hospital care for children and young people. Available from: https://www.nuffieldtrust.org.uk/files/2018-10/1540142848_qualitywatch-emergency-hospital-care-children-and-young-people-full.pdf. Accessed date: 14 July 2022.
7. Keeble, E., Fisher, E., 2020. Can variation help to explain the rise in emergency admissions for children aged under five up to 2018/19? Available from: https://www.nuffieldtrust.org.uk/research/can-variation-help-to-explain-the-rise-in-emergency-admissions-for-children-aged-under-five-up-to-2018-19. Accessed date: 19 July 2023.
8. QualityWatch, 2022. Maternity care. Available from: https://www.nuffieldtrust.org.uk/resource/maternity-care. Accessed date 13 September 2023.
9. Hawdon, J.M., Beer, J., Sharp, D., et al., 2016. Neonatal hypoglycaemia: learning from claims. Arch Dis Child Fetal Neonatal Ed 2017 (102), 110–115. https://doi.org/10.1136/archdischild-2016-310936.