Articles published on this blog are my opinion only, and may not necessarily reflect the views of any organisations with which I am associated. Please be aware that articles posted on this blog are not intended as a substitute for professional medical advice. If you have a medical problem relating to breastfeeding, please seek further advice from a Lactation Consultant (IBCLC) or trained Breastfeeding Counsellor.

Friday, 11 February 2011

Moving beyond guilt

There are two phrases about infant feeding I've been hearing constantly over the past 10 or so years, and I can't stand either of them. One is "breast is best" (it isn't, by the way - it's normal), and the other is:

"Nobody should make a mother feel guilty for bottle feeding her baby."

As much as I loathe that statement, it's annoyingly impossible to disagree with, so I'm forced to admit that I agree with the sentiment itself: of course it is wrong to make a mother feel guilty for bottle feeding her baby. And you won't find me preaching otherwise. Ever.

So why do I hate that phrase with a passion?

1. It implies that somebody is making mothers feel guilty for bottle feeding their babies.

Whether we are conscious of it or not, that suggestion is embedded in the language structure of the phrase itself. Take a closer look:

"Nobody should make a mother feel guilty for bottle feeding her baby."

I've underlined "nobody" because that word is what puts the phrase into what is known in grammatical terms as the 'negative'. Look at what happens when this negative statement is converted into a (grammatically) positive one. For this particular negative: "nobody", there is a corresponding positive: "somebody". So mentally, we process that statement not only as "Nobody should make a mother feel guilty for bottle feeding her baby" but also as "Somebody is making mothers feel guilty for bottle feeding their babies."

In 1961, Walter Ulbricht (East German communist leader) famously announced that "Nobody has the intention of erecting a wall" ("Niemand hat die Absicht, eine Mauer zu errichten."). Evidently somebody did: just over a month later, the Berlin Wall was built. 

So, if "somebody is making mothers feel guilty for bottle feeding their babies," down with that somebody! Who is that somebody anyway?

Well, the media would dearly love you to believe in the 'Breastfeeding Mafia'... which is actually about as real as the Tooth Fairy (sorry to disappoint anyone).

2. It immediately closes any dialogue between bottle feeders and breastfeeding advocates.

Over the course of a discussion handling sensitive issues and uncomfortable truths surrounding infant feeding (the risks associated with formula feeding is highly explosive - for me it has been the hardest topic to face after formula feeding my first baby), it isn't long before someone says something to the effect of:

"Nobody should make a mother feel guilty for bottle feeding!"

Immediately, a wall is thrown up between bottle feeders, who perceive themselves as being made to feel guilty and resent it (I've been on this side of the fence), and breastfeeders, who end up justifying their reasons for tackling the issue and having to defend themselves by explaining they're not actually trying to make anyone feel guilty (and I've been on this side of the fence too). Everybody ends up feeling upset and frustrated.

I remain optimistic: even the Berlin Wall came down eventually.

Guilt is not a good emotion. Guilt is damaging. Guilt makes mothers blame themselves. Guilt makes us block out the truth. Guilt builds up barriers. Guilt stops us from communicating with each other, when in actual fact, bottle feeding mothers and breastfeeding mothers need to be working together on the same side. Because lactivism is not just about protecting breastfed babies, but is also a vital demand for the protection of babies fed on infant formula.  As long as 'guilt' gets in the way, mothers and babies are losing out.

Over and over again, the inevitable 'guilt' accusation pops up... but is 'guilt' even the right word?

3. It implies that what bottle feeding mothers should feel is 'guilt'.

I didn't breastfeed my first baby for as long as I'd planned to. After a brief, disastrous breastfeeding experience, I became a formula feeding mum. Deep down, I was devastated, but I kept telling myself it was OK. It had to be: from my perspective, my breastmilk clearly hadn't been good enough for my baby: I'd been told by a health professional that I had to formula feed. After all, I loved my baby, and everyone wants to give their baby the best, right? Somewhere in amongst all the leaflets and adverts I'd been handed I read that "Nobody should make a mother feel guilty for bottle feeding her baby", and not knowing what else to call that empty feeling deep down inside, I labelled it 'guilt'.

The growth chart, based on formula fed babies. The black arrow indicates the point at which we introduced formula (11 weeks). Look at what happens to the crosses plotted on the chart after that point. At the time, that "evidence" alone was enough to convince me that my breastmilk hadn't been enough for my baby. What might have happened if I'd been well supported in breastfeeding?

Now I've had the chance to analyse how I felt after my first breastfeeding relationship ended, I wouldn't describe any of those feelings I had at the time as 'guilt'. "Guilt is the wrong word"(1). Yet we keep on telling mothers "you shouldn't feel guilty" and in doing so we keep on handing them that "inaccurate and ineffective"(1) word: 'guilt'. And frankly, it's insulting.

Some well-informed mothers choose not to breastfeed. Other well-informed mothers "struggle unsuccessfully to establish breastfeeding, and turn to bottle feeding with a sense of acceptance"(1) because they know they did the best they could with the information and support they had at the time. And shared milk hasn't always been a viable option. Do we really expect these mothers to feel 'guilt'?

And then there are mothers like I was, who are not well-informed. They struggle unsuccessfully with breastfeeding and end up bottle feeding because they lack support, receive poor information, are given bad advice, and are bombarded with misleading advertising claims. But these women, too, are doing the best they can with the information and support to which they have access. These mothers end up formula feeding not through informed choice, but because they are failed. These women are failed by a system which does not value breastfeeding enough to mandate sufficient qualifications in breastfeeding for healthcare professionals offering support and advice to breastfeeding mothers. These women are failed by a government which does not protect mothers, babies or its healthcare system from aggressive advertising from the infant formula industry. And yet these women are supposed to feel 'guilty'?

Years later, I realise that I ended up bottle feeding my daughter not because my breastmilk wasn't good enough, but because the advice and support I received wasn't good enough. I now understand that with better information and support, I could have been the breastfeeding mother I wanted to be. How do I feel about it now? Guilty? Certainly not!

When Diane Wiessinger posed the following scenario:
"You have been crippled in a serious accident. Your physicians and physical therapists explain that learning to walk again would involve months of extremely painful and difficult work with no guarantee of success. They help you adjust to life in a wheelchair, and support you through the difficulties that result. Twenty years later, when your legs have withered beyond all hope, you meet someone whose accident matched your own. "It was difficult," she says. "It was three months of sheer hell. But I've been walking ever since." Would you feel guilty?"(1)
 women replied that they would feel "angry, betrayed, cheated"(1).

Let me pose another scenario:
A pregnant woman hopes for a natural birth at home, but at the end of her pregnancy her health care provider informs her that she needs an induction. She goes into hospital to be induced, but the induction fails and she ends up having a C-section delivery. It wasn't the birth she wanted, but the hospital staff supports her through her birth and helps her to cope with the difficulties she faces as a result. Years later, she meets a mother who was told she needed to be induced under the exact same circumstances, but she gave birth naturally at home. "Challenging the system was probably the hardest thing I've ever faced," she explains, "but I did my research thoroughly, evaluated the risks, stood my ground and got the birth I'd hoped for." Should the first woman feel guilty?
Would you even consider saying to this woman "Nobody should make you feel guilty for the way your birth turned out"? After all, that woman achieved the best birth she could with the information and support she had at the time. Perhaps the words angry, betrayed, cheated might fit this scenario too? Perhaps you can think of other words?

Although 'angry, betrayed, cheated' are a much better description of how I feel about ending up bottle feeding my daughter, they don't quite cover it completely.

After the birth of my second child, I wanted to breastfeed again, this time with better information and support. I succeeded in breastfeeding him for 1.5 years, which was a very empowering experience, but it didn't resolve how angry, betrayed, and cheated I still felt as a result of my first breastfeeding experience. The problem was, although I'd done it again (and successfully this time), I could never get my breastfeeding relationship with my first child back. It was gone forever, and I still felt a deep sense of loss.

And then the realisation hit me: what I'd felt all those years was, in fact, grief.

All those years, I'd been grieving the loss of a breastfeeding relationship.

Recognising that I felt grief was the start of a journey towards finding peace with my first breastfeeding experience. Understanding that I felt grief was like having a heavy weight lifted from me:
It was suddenly OK to feel angry.
It was OK to feel hurt.
It was OK to feel disappointed.
It was OK to feel cheated.
It was OK to feel betrayed.
It was OK to evaluate my experience in its own right, rather than compare it unfavourably with other peoples'.
It was OK to explore my feelings rather than believe I needed to block them out. In fact, I realised that labelling them as 'guilt' and suppressing them hadn't helped me in the slightest. That women should feel 'guilt' and just 'shut up and get on with it' is convenient only to a society which does not want to admit that it does not value or protect mothers and babies enough.

Knowing I felt grief allowed me to explore infant feeding issues with eyes unclouded by guilt. I learnt about the risks of infant formula feeding, and this time I felt shocked and angry: why did nobody inform me that the infant formula I'd fed my daughter had been recalled earlier that year? Why is there no public demand to subject infant formula to more rigorous testing and make it safer for our babies? I learnt about the impact of infant formula feeding on developing countries, and this time I felt shocked and angry at what the money I'd spent on infant formula had contributed to: why aren't more people campaigning for these irresponsible companies to operate ethically?

After I allowed myself to be true to my own feelings over the loss of my breastfeeding relationship, I began to notice them gradually changing.  I'd have good days, when I'd feel more accepting of what had happened, and there'd be bad days, when I'd feel really low and tearful about it. But as time went by, and I opened my eyes to the lessons learnt from my experience, my feelings developed into something positive.

And I was more than the grief I felt from the loss of my breastfeeding relationship: I trained as a breastfeeding peer supporter and began to offer other mothers and babies the information and support I wished I'd had after the birth of my first baby.

It was OK to find peace with my breastfeeding loss.

So let's stop handing mothers the word 'guilt' and start talking with them to find out how they really feel about their breastfeeding experiences. We need to validate mothers' feelings and experiences, and accept that it's OK for mothers to grieve the loss of a breastfeeding relationship. We need to accept that it's OK for mothers to be true to their own feelings and find peace with their breastfeeding loss.

Then we might all be able to move forward in creating positive changes in our society for the benefit of all mothers and babies.

(1) Wiessinger, D (1996) Watch your language Journal of Human Lactation, Vol. 12, No. 1, 1996