Breast isn’t always best
...and we have to stop bashing mums who choose the bottle, says our resident GP Dr Ellie Cannon
THERE are few subjects I have written about that are more incendiary than breastfeeding. It provokes a constant – and fierce – debate, not only about whether to do it or not and for how long, but also where and when it is appropriate.
As a GP, I ask mothers as part of a standard health check how they feed their baby. If a woman has chosen ‘the bottle’, I rarely get a simple answer. I get justifications, reasonings, apologies, and guiltladen narratives accompanied by tears and defensiveness.
If I was ever under any illusion about just how emotionally charged this is as a topic, it was all brought home to me a few years back when I wrote about how breastfeeding a child over a period that extended for years isn’t medically necessary (think Tamara Ecclestone, who last week claimed she would continue nursing her four-year-old daughter Fifi even after she starts school).
A group of breastfeeding ‘activists’, whom I half-jokingly dubbed the Breastapo, attempted to have me struck off the medical register while others trolled me on social media, sharing the address details of events I was speaking at and calling me ‘a dumb b***h’ who ‘needed a kicking’. Nothing happened, of course. As the debate has rumbled on, my weekly appointments continue with new mums beside themselves with anxiety that they are somehow doing wrong by their baby for not breastfeeding. For the record, they are not. So I was understandably intrigued when I was offered a preview of Breastfeeding Uncovered, a documentary on TV tomorrow night that examines why UK breastfeeding rates are so low – 80 per cent of all British mums
ACTIVISTS TROLLED ME AND TRIED TO HAVE ME STRUCK OFF
want to breastfeed but only 30 per cent are doing so at six months.
According to the programme, our breastfeeding rates after 12 months are the worst in the world – but should we be concerned?
The Channel 4 Dispatches episode is presented by Kate Quilton, host of the Food Unwrapped series and the mother of an 11-week-old son.
I spoke to Kate, 34, who nursed her son throughout our conversation, to find out what she thought.
She is a passionate breastfeeding advocate who believes that the reason many women don’t do it is because they don’t realise the benefits to their health, and that of their baby.
She also claims a lack of support from health professionals, prudish attitudes and the marketing of formula milk have also contributed to our ‘poor’ breastfeeding rates.
Kate has been subject to nasty criticism from disapproving onlookers, which is upsetting.
She says: ‘A few weeks ago I was in a park and had just finished feeding my son under a muslin when two women came to me and said “it was a funny way to breastfeed”, and that “women should feed at home and indoors”. I was shocked.’
For the film, Kate went out and breastfed at numerous locations including on the London Underground, in public parks and on a busy high street in Chelmsford, Essex. The reactions of shoppers in the town were unpleasant, with one person commenting: ‘It isn’t a spectator sport.’
As a mother who breastfed both my children, I’m upset by this – although I have to admit, it’s not the kind of thing I ever encountered.
And, ironically, in my own experience, by far the most prejudice I hear about is towards women who bottle-feed, from other women telling them they are harming their babies. I was recently faced with a teary single mother who was warned by a so-called friend that her child would end up obese as a result of the formula milk she was feeding her child.
BREAST MILK ISN’T A MIRACLE CURE-ALL
IN THE film, Kate calls formula milk a ‘processed food’, while breast milk is a ‘miracle elixir’, and Sue Ashmore from the Unicef Baby Friendly Initiative – a charity campaign to support mothers to breastfeed – claims our low breastfeeding is a ‘public health crisis’. She also suggests that there are higher rates of cancer and obesity.
I was baffled as to what exactly was meant by this but producers clarified it: she was referring to increased rates of breast cancer in women who do not breastfeed and higher risk of obesity in children who are not breastfed.
In the film, researchers at Imperial College in London explain that there are thousands of nutrients in breast milk which prime the infant’s immune system, protecting them against infections and diseases for the rest of their lives.
But is this really the case? Studies do show that five per cent of breast-cancer rates are attributable to not breastfeeding. So there is an effect – but it’s small and I don’t believe it poses enough of a risk to be a worry for my patients who do not breastfeed.
High-quality data from 2013 involving more than 17,000 children found no reduction in childhood obesity at age 11 among breastfed children, and other studies have found no effect on rates of asthma. As a medical professional, I agree breast milk is indeed the best thing to feed a baby: it costs nothing, has the right nutritional ingredients and – as the Imperial researchers say – contains antibodies that fight infections.
However, the protective effect is small. Analysing the data forensically reveals that for every six children breastfed exclusively for six months, one fewer will suffer an ear infection when compared to a group who are formula-fed. That’s great, but hardly a miracle.
If you tried to make these kinds of claims about a product, you’d fall foul of the law – there just isn’t the evidence to support it.
IS FORMULA MILK THAT BAD?
JUST because formula is manufactured – yes, processed – it doesn’t mean it’s unhealthy. Processed merely means ingredients have undergone a process (chopping a tomato is a process, as is heating soup).
In fact, formula milk is more than a healthy choice, and recent additions to ingredients means it now contains more essential fatty acids and pre and probiotics – all essential for both infant and longterm health.
One study by paediatric research-
ers at the University of Brussels found that when a prebiotic is added to formula milk, the health benefits for infants could be almost identical to that provided by human breast milk.
Another study published in the Journal Of Paediatrics showed breast milk that had formula added to it was more effective than exclusive breast milk for increasing the weight of dangerously small babies, and infants who received supplementary formula were less likely to be readmitted to the hospital.
Just as there’s no doubt that breast milk is full of health-boosting properties, it’s indisputable that formula milk is healthy too. Scientific evidence for the health benefits of breastfeeding is poor: when we study the benefits of breastfeeding we observe populations who are breastfed but we are not able to look at equivalent bottlefed people – in the UK, breastfeeding mothers tend to be more educated, higher paid, less likely to smoke, better eaters and more frequent exercisers – factors that strongly influence their offspring’s health.
What I want women to know is that, should their child get ill, it’s not their fault for choosing bottle over breast.
ARE BREASTFEEDING SUPPORT GROUPS THE ANSWER?
KATE told me she felt very lucky to live in a part of London where she has access to a breastfeeding support team –nurses, midwives and healthcare assistants dedicated to supporting women.
They helped her when she had difficulty with her son, who was born with a common condition called tongue-tie – the strip of skin connecting the baby’s tongue to the floor of their mouth is shorter than usual, which makes it hard to feed.
The programme calls for more Government funding for these services, in an effort to improve breastfeeding rates in the UK. But a British Medical Journal review published in 2015 showed that such services do little to improve UK breastfeeding rates.
In my clinical experience, women don’t breastfeed for a whole host of reasons: some find it difficult, or painful and don’t want to plough on like Kate did, others don’t produce enough milk, or find it reassuring that with formula you can be sure you’re providing the right amount.
Some women want their bodies back after nine months of pregnancy and a birth. Some want to share parental leave with a partner so need to be able to hand over the baby. Some women don’t like it. All these are valid reasons.
And as a GP, speaking to new mothers day in day out, I’d say there are bigger problems to address. Post-natal mental health is vastly underfunded and a crisis in this area is mounting. Surveys from last year revealed post-natal depression is commonly missed by healthcare professionals – though mandatory health checks are made on babies, their mothers’ wellbeing may well go unnoticed. It is protocol to ask if a baby is breastfed, but not if a mother is happy.
It’s a serious problem affecting half of expectant UK mothers, according to charity NCT. Let us not forget that suicide was the leading cause of death for pregnant and new mums last year. As for infants, studies looking at more that 11,000 children found maternal depression to be more harmful to a child’s mental health than poverty. Children of mothers who suffer from post-natal depression are up to ten per cent more likely to develop psychiatric illnesses and are more at risk of speech, learning and attachment problems.
At the end of our chat, Kate told me she felt strongly that women should be coming together to support one another rather than berating each other. I couldn’t agree more. But we need to ask why women are made to feel so guilty about bottlefeeding – something I find can have a huge impact on mental health.
I would argue the reason is the rhetoric that simultaneously overstates the benefits of breastfeeding and the negatives of opting for formula milk. Not breastfeeding does not put your child at risk of health problems. The choice to bottle-feed is more expensive, yes, perhaps less convenient also. But it’s not less healthy – and we have hard evidence to prove it.