Why midwives around Australia are not offering formula to new mums struggling to breast feed.

Josephine Martin’s second daughter has been bottle-fed since she was two days old.

For her first, born a little over two years ago now, that simply hadn’t been presented as an option.

“I was a new mum, I wanted to do everything right, and that unquestionably involved breastfeeding,” the 34-year-old Sydney woman told Mamamia.

“Even when I was pregnant, I was convinced breastfeeding was so natural, so important, and that was reinforced so heavily by the hospital, and everyone everywhere, really.”

But when the time came, like many new mums, she experienced difficulty – supply issues, latching problems and mastitis that made feeding a struggle and, at times, acutely painful.

For the first two months, Josephine says the discomfort was bordering on unbearable, but driven by the ‘breast is best’ ideology, she persevered.

“I remember one night I was shaking, crying, begging her to latch. My husband was crying, too,” she said.

Josephine was supported by a Breastfeeding Support Unit midwife at Royal Hospital for Women in Sydney’s inner west, but she says that, despite six months of distress, she was never advised to try bottle feeding.

“When I started introducing formula, I started to realise how much better my life became,” she said.

“My breastfeeding had really impacted my ability to feel joy with my daughter; every time she made a noise I thought ‘Oh f***, I need to feed again’.”

And so the night after giving birth to her second daughter in June this year, her baby screaming from hunger, Josephine asked for a bottle.

“The midwife stopped and said to me, ‘Are you saying that you would like me to give you some formula?'” Josephine recalled.

“She then told me they are not allowed to suggest formula, unless you’ve specifically asked for it.”

According to Cathryn Curtin, a 42-year veteran of midwifery, conversations like that are happening in maternity wards all around the country, often at the expense of the agency and wellbeing of mothers.

"Of course, we all want to encourage women to breastfeed. But hospitals these days are not going around it the right way," The First Six Weeks author told Mamamia.

"They're making women fearful, making them anxious and feeling guilty should they want formula. And more guilt is the last thing you need as a mum."

Josephine believes that staunch mentality is fuelled by a UNICEF and World Health Organisation global program launched in 1991, to which Royal Hospital for Women and 70 other Australian hospitals and health facilities currently subscribe.

It's called the Baby Friendly Health Initiative (BFHI) and, under the governance of the Royal Australian College of Midwives, is designed to "protect, promote and support breastfeeding", to "create a healthcare environment where breastfeeding is the norm".

But, like Josephine, Cathryn believes some facilities are taking an extremely hardline approach to the message and treating the guidelines like hard-and-fast rules. The result, she argues, is that the individual needs of women are not being met, leaving them and their partners confused and "very upset" about hospital care.

"When you have a midwife tell you that you're not going to breastfeed properly if you give that child formula, well, that makes the woman very fearful, because all she wants is the best for her child," she said.

"It's just not right. It's not right."

The BFHI is based on World Health Organisation advice that infants should be exclusively breastfed for six months, due to proven advantages such as lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods.

It requires hospitals and maternity facilities to implement the so-called 'Ten Steps to Successful Breastfeeding', and to have their adherence to them signed off by independent assessor every three years in order to maintain accreditation.

Among the steps:

• Step three, 'Inform all women about the benefits and management of breastfeeding';
• Step six, 'Give newborn infants no food or drink other than breastmilk, unless medically indicated' (for example, galactosemia, low birth weight, prior breast surgery. There is no mention of mental or emotional health as an indication for formula use.);
• Step eight, 'Give no artificial teats or dummies to breastfeeding infants'.

Cathryn says this is based on thinking that giving babies formula, rather than a breast, interferes with milk supply. It's reasoning which she and many others in the profession challenge.

"If you give baby some [additional] calories they tend to settle and sleep, they then suck better on the breast, and then the mother and baby are rested and do better," she said. "They also tend to breastfeed longer, and that is the aim of the game."

For severely sleep-deprived mothers, for those who are struggling physically and emotionally, Cathryn argues that a bottle can provide reprieve that ensures she and the baby remain happy and healthy.

"That’s not saying you’ve got to give babies formula all the time, just that they should have a top-up if they need one.

"It's not bad for the baby."

Breastfeeding vs bottle feeding for new mums. (Post continues below.)

The BFHI handbook does make it very clear that "at no time are mothers forced to breastfeed", and outlines that all receive individual support regardless of their choice of feeding method. It says that staff are guided to provide women using artificial feeding with instruction on the safe preparation of formula and a demonstration of best-practise for bottle feeding.

But...

It also stipulates that this is given "only to parents who need it; there is no group instruction" and that it's "done privately, away from breastfeeding mothers".

Meanwhile, the 'breast is best' message is allowed to flourish out in the open, to look down at women from the walls.

At Royal Hospital for Women Josephine earlier this year observed televisions featuring a series of slides about feeding that she described as "guilt-inducing" and, in some cases, "outright offensive".

Images provided to Mamamia show one that reads, "The first three weeks after breastfeeding are the hardest. After six weeks it starts getting easier. By three months, you feel sorry for mums who have to make formula."

And in another, an image of a baby with its hand shielding its mouth: "NO dummies or bottles please! I'm learning to breastfeed."

Josephine was so frustrated by the barrage of one-sided messages, that she wrote to the hospital.

"This is actually sick," her letter read.

"How dare you feature a poster that puts words into the mouth of a newborn to suggest that it is pleading with its mother to not use formula?

"New mothers are acutely vulnerable to any suggestions that they might not be doing the best for their child, and this poster exploits terrible feelings of guilt in any woman who might consider formula feeding."

She's since filed a complaint about the pro-breastfeeding culture at the hospital to the NSW Healthcare Complaints Commission.

Vanessa Madunic, General Manager, Royal Hospital for Women, last month responded personally to Josephine's concerns, and assured her the slideshow, created in 2015 to "normalise the choice to breastfeed" had been taken down.

In a statement to Mamamia, Madunic echoed that assurance.

"The educational slideshow on breastfeeding has been removed from the ward areas and website and is being reviewed. We have invited Ms [Martin] and other consumers to review the new slideshow before it is released," she wrote.

Madunic noted that the hospital has been an accredited Baby Friendly facility since 1999.

"As such, breastfed babies are not given breastmilk substitutes in hospital unless medically indicated or it is the parent’s informed choice – and a parent’s choice is encouraged, respected and supported.

"Every woman is supported to care for her baby in the best and safest way possible which, of course, takes into consideration the mother’s feeding choices and circumstances."

For Josephine that now means bottle only for her baby daughter, and she says she is happier, calmer for it.

“Now that we’re formula feeding, my husband is having the most wonderful experience," she said.

"Eleanora looks for him as much as she does me; it’s a shared experience.”

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