Monday, 21 November 2016

Is Breast Best?

Breast vs Bottle - why one is no better than the other

Before pregnancy the breast vs. bottle debate is something you may be aware of, but is unlikely to be something you particularly care about. I certainly didn't. Once I knew I had a baby on board it became impossible to ignore it. Breast feeding was constantly pushed at check ups and antenatal appointments as beautiful and natural, something which only a particularly cruel specimen of humanity would deny their child. (And if that didn't convine you, there were those terrible posters about how breastfeeding would help you lose weight because, obviously, it's the only thing women ever worry about.)

The way that message was framed riled me on so many levels. 'Breast is Best' because 'Natural is Best', as though we recommend new parents also ditch shoes and electricity. Mother Nature, as wonderful as she might be, really doesn't care if you and your offspring die - whether from dehydration when you hit feeding problems, or tetanus contracted through something you step on - there are plenty more people around to keep the species going.

Don't get me wrong. Breast milk is good for babies, that's not something I'm disputing. Just look at this lovely NHS infographic:

Breastfeeding Benefits

And it wasn't so very long ago that if you couldn't produce enough breast milk, couldn't get the baby to latch properly, couldn't afford to employ a wet nurse, or even simply couldn't take the time away from work lest the rest of your family starve to death, your child's prospects were much grimmer.

Milk available on the open market was routinely contaminated and poor quality. Half a million infants died of Bovine TB in the UK in the period 1850 - 1950, and sour milk was a chief factor in infant diarrhoea, something which accounted for up to 20% of all infant mortality in the 1890s. (Source) The babies of the poor had to rely on condensed milk or bread sops; the infamous Wynne Baxter, London coroner, said in 1907 that they might as well be fed on flints and tin-tacks for all the former's nutritional value.

Another problem was the general lack of sanitation. Baby bottles and teats were difficult to clean, and proved a breeding ground for bacteria. They can still be dangerous today if they're not properly sterilised, just like breast pumps and feeding cups. Thankfully these days we have easy access to hot water and Milton tablets, even if standard NHS practice is only to advise on sterilisation if a mother indicates she will be formula feeding! Similarly, baby formula is strictly regulated - it's the advertising and promotion which preoccupies UK lawmakers in the 21st century, not concern over what is actually in it.

Victorian Baby Bottle
Victorian feeding bottle.

We are so lucky to live in a time and a place which offers safe alternatives to breastfeeding and what really irks me, I guess, is the attempt to remove maternal choice on the issue. Breastfeeding has advantages, but they're not so marked as to make it an imperative - and are notoriously difficult to separate from other factors into the bargain. Is it breastfeeding which results in the perceived long term health benefits around obesity and mental wellbeing, for instance, or the fact that take up of breastfeeding is higher amongst middle class women whose children can be expected to have better health outcomes thanks to their socio-economic status?

In the short term studies show there is a very slight reduction in hospital admissions for diarrhea and chest infections among exclusively breastfed babies, but on the flipside a 2013 study into severe neonatal hypernatraemia (dehydration, basically) found that of 62 cases over a 13 month period, only one was in a child which was exclusively bottle fed. Less than 5% of women physically can't breastfeed but that doesn't mean the other 95+% will pick it up without assistance - and when mothers are shipped off home within hours of giving birth, there's little time to make sure they get it. (source)

In other words, it's not as simple as breast good and bottle bad, and trying to present it that way only does the campaign to boost breastfeeding rates a disservice.

Because, for all the government's best efforts, people can still see - anecdotally if not in official releases - that breastfeeding is not the miracle cure to money troubles or sleepless nights or postnatal depression. For every positive there remains a correpsonding negative, be it the increased time demands it places on the mother above other care givers, the painful mastitis which continues to affect one in ten women who breastfeed, or the sense of failure engendered when breastfeeding simply doesn't work out for one reason or another. Right now, that is the default position - some 80% of newborns are breastfed, but that figure falls sharply to 34% by six months and 0.5% by twelve months. When it comes to exclusive breastfeeding at six months, the government's target, less than 4% of mothers actually achieve it.

I didn't breastfeed and if I could do it over again I still wouldn't. I was busy recovering from my near death experience - certain death if I'd gone au natural and refused the intervention of medical science - and then I was back at work to provide for my family. Even if I hadn't been, I don't see why anyone should be made to feel guilty for choosing formula, just as nobody should be made to feel uncomfortable if they want to breastfeed: in our first world society both are safe and healthy ways to feed babies. BPAS (British Pregnancy Advice Service) sum it up nicely for me when they say:

Policy needs to reflect the flexibility and open-mindedness that health professionals need when engaging with new mothers, and focus less on increased breastfeeding rates than the truly optimal outcome: thriving infants.

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