If you share our concerns about infant feeding policy and practice, write to your MP.
We have prepared the template letter below to give you the evidence to pass on to your MP. You can include your personal experiences, add your own subject line and rewrite the letter, if you wish. Personalised letters make a greater impact.
You can email your MP through a website like this one, or find their address and contact details online.
Dear ………… ,
My name is ………… and I am a constituent of ………… . I am writing to you today because I am concerned that public health policies to promote breastfeeding are causing harm to women and newborns. This is an issue that is important to me because
[Provide your reasons and personal experiences if you wish. Try to keep these to under a couple of paragraphs , as in the following example.]
[EXAMPLE] because of my distressing experiences after my daughter was born. I was severely sleep deprived after a long labour, but NHS midwives encouraged me to exclusively breastfeed. Since I obliged, no discussion was had about options. I could feel that my baby wasn’t latching on well and I received breastfeeding support. Never did staff express concern about my baby’s health or my exhaustion. Alternative options were not mentioned
Less than 24 hours after we got home, a midwife visiting us found our baby had lost 13% of her birthweight and was jaundiced. To our great distress, we were readmitted to A&E. Paediatricians explained she was underfed and needed formula supplementation. My husband took on night feeds, so that I could finally sleep. I believe that this pragmatic, shared approach is what we would have chosen for our family had we not experienced breastfeeding interventions, and had we been fully informed about our options. This would have saved ourselves and our new baby needless suffering.
Unfortunately, this was not an isolated incident of poor care, but care in line with national and international guidelines, such as from the UNICEF Baby Friendly Initiative and the British Association of Perinatal Medicine (BAPM, 2024; UNICEF, 2014). I understand that these guidelines are well-intentioned, however, they do not acknowledge that breastfeeding is not the best option for every newborn or every family. Professionals following these guidelines often place undue pressure on women to breastfeed, even though evidence clearly shows that low milk supply and poor milk transfer are common (Wilde, 2021). In fact, there is no evidence that the Baby Friendly Initiative improves health outcomes in the UK (Fair et al., 2021).
The reality is that exclusive breastfeeding is a well known risk factor for infant hospital readmission (Flaherman et al., 2018), as it can lead to underfeeding, excessive weight loss, jaundice and life-threatening conditions such as dehydration and hypoglycaemia. Emergency readmissions to hospital for newborns with jaundice and feeding complications have increased year on year over the past three decades (Jones et al., 2018; Keeble and Fisher, 2020; Keeble and Kossarova, 2017). This coincides with the roll-out of exclusive breastfeeding promotion guidelines.
Hospital readmissions like these are distressing for families and costly to the NHS. However, they are not the only cost. Between 1995 and 2010, the NHS paid £162 million in compensation claims for 25 cases of brain injury from hypoglycaemia (Hawdon et al., 2016), and hypoglycaemia is just one complication of underfeeding that can cause brain injury.
Analysis of the problem of increased readmissions has so far assumed the cause is a lack of breastfeeding support or early discharge of women and babies from hospital after birth (for example, see Keeble and Kossorova, 2017). However, there is no evidence to support these assumptions. Based on my experience and on the existing evidence, I believe that exclusive breastfeeding itself is not a safe or achievable goal for many women and therefore it should not be a public health priority.
As well as the risks related to underfeeding, I am concerned about other potential harms of breastfeeding promotion. Cases of sudden unexpected infant collapse (SUPC) and in-hospital falls have been linked to the policy of ‘rooming-in’ and exhausted mothers breastfeeding around the clock (for examples, see Infant Feeding Alliance, 2023; see also Bass et al., 2019). There is also evidence that the Baby Friendly Initiative fuels stigma and shame around formula use and may have a negative emotional impact on women (Fallon et al., 2019).
Despite all this evidence of harm, the promotion of exclusive breastfeeding has been rolled out with no monitoring of adverse events and no warning to parents of its risks. I believe that, at the very least:
1) pregnant women should be informed of the risks of exclusive breastfeeding, and
2) adverse events need to be closely monitored so any harms to newborn babies can be revealed and acted on.
I would greatly appreciate it if you could outline what you can do to address these concerns. If you’re unable to address them personally, I would like to request that you escalate my letter to the relevant minister or department.
Thank you in advance for what you can do. I look forward to hearing from you.
Yours faithfully,
…………
References
BAPM, 2024. Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant (Birth – 72 hours): BAPM Framework for Practice. Available from: https://www.bapm.org/resources/identification-and-management-of-neonatal-hypoglycaemia-in-the-full-term-infant-birth-72-hours. Accessed date: 1 July 2024.
Bass, J., Gartley, T., Kleinman, R., 2016. Unintended Consequences of Current Breastfeeding Initiatives. JAMA Pediatr. 170 (10):923–924. https://doi.org/10.1001/jamapediatrics.2016.1529.
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.
Fallon, V.M., Harrold, J.A., 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. 2019 Jul; 15 (3). https://doi.org/10.1111/mcn.12778.
Flaherman, V.J., Schaefer, E.W., Kuzniewicz, M.W., et al., 2018. Health care utilization in the first month after birth and its relationship to newborn weight loss and method of feeding. Acad Pediatr 18 (6), 677–684. https://doi.org/10.1016/j.acap.2017.11.005.
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.
Infant Feeding Alliance, 2023. Rooming-in: where is the outrage in the UK? Available from: http://www.infantfeedingalliance.org.uk/2023/01/28/rooming-in-where-is-the-outrage-in-the-uk/#more-2004. Accessed date: 3 October 2024.
Jones, E., Taylor, B., Rudge, G., et al., 2018. Hospitalisation after birth of infants: cross sectional analysis of potentially avoidable admissions across England using hospital episode statistics. BMC Pediatr. 18, 390. https://doi.org/10.1186/s12887-018-1360-z.
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.
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.
UNICEF UK, 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: 3 October 2024.
Wilde, V.K., 2021. Breastfeeding insufficiencies: common and preventable harms to neonates. Cureus, Oct 13 (10), e18478. https://doi.org/10.7759/cureus.18478.