Clinicians’ Guide to Supporting Parents with Guilt About Breastfeeding Challenges

Written by Dr. Ruth Ann Harpur, Clinical Psychologist

A systematic review of the scientific literature indicates that women who intend to breastfeed but who later feed their babies formula consistently report feelings of guilt, anger, worry, uncertainty, and a sense of failure despite the relief that introducing formula after experiencing difficulties with breastfeeding may bring (Lakshman, Ogilvie, & Ong, 2009). Recent research also indicates that this group of new mothers are at particular risk for postnatal depression (Borra et al., 2015).

Clinicians are uniquely placed to provide compassionate care at a vulnerable time for this group of parents. Their attitude and words can invoke a sense of shame, judgment, and failure, or they can inspire compassion, reassurance, and emotional healing.

Lacking any widely published evidence based guide on to how to best attain the most emotionally supportive clinical environment, the Fed Is Best Foundation has developed these suggestions in collaboration with parents in our support group and a clinical psychologist with expertise in mental health.

Florence Leung, 32, vanished on October 25, 2016 after driving away from her New Westminster home. She was suffering from post-partum depression and her body was eventually discovered in the waters near B.C.’s Bowen Island. Her husband subsequently posted the following on Facebook, “You are Not alone. You are Not a bad mother. Do not EVER feel bad or guilty about not being able to ‘exclusively breastfeed’, even though you may feel the pressure to do so based on posters in maternity wards, brochures in prenatal classes, and teachings at breastfeeding classes. Apparently the hospitals are designated ‘baby-friendly’ only if they promote exclusive-breastfeeding. I still remember reading a handout upon Flo’s discharge from hospital with the line ‘Breast Milk Should Be the Exclusive Food For the Baby for the First Six Months,’ I also remember posters on the maternity unit ‘Breast is Best.’ While agreeing to the benefits of breast milk, there NEED [sic] to be an understanding that it is OK to supplement with formula, and that formula is a completely viable option.”

SAFE SPACE

Create conspicuous signs of a welcoming environment for all safe feeding choices. For instance, place leaflets about inclusive feeding in a visible location or display “all forms of infant feeding welcome here” in the waiting area. Ensure that information about both breast and formula feeding is freely available to all parents.

UNDERSTAND

Understand what parents have been through and how they are feeling if their original intention to breastfeed did not work out. Parents’ sense of shame and failure may prevent them from openly discussing this unless you enable them to feel safe and invite them to express their feelings.

Understand and validate the parents’ reasons for introducing formula. Parents may be feeling that they have “failed” or should have “tried harder”. Validating their reasons for introducing formula can help them to feel more confident in their decision.

Understand that parents may have concerns about formula such as the implications formula feeding has for their baby’s health or their bond with the baby or they may feel they are to blame for feeding difficulties.

PROMOTE PARENTS’ PHYSICAL & MENTAL HEALTH

Support parents to recognize that their physical and mental health directly impacts their ability to care for their baby. Making decisions about feeding methods that care for a mother’s well being is not selfish. It is the wise and loving thing to do for both mother and child.

Acknowledge any difficult feelings of the patient may have adjusting to change and relate that many dedicated and loving parents also feel this way. If they are feeling happy and confident with their current feeding method let them know you are happy they feel positive about their decision.

PROVIDE EVIDENCE BASED INFORMATION

Identify and address parents concerns about using formula.

Inform parents that many of the claims made about the benefits of breastfeeding are exaggerated. Explain the role of confounding variables in research comparing breast and formula fed children. For example, one study comparing breast and formula fed siblings found no differences on any cognitive/educational achievement measures, behavioural indicators (including parental attachment) and most physical health measures (including BMI and obesity). The only difference found was that breastfed siblings were slightly more likely to have asthma (Colen & Ramey, 2014).

Inform parents about the prevalence of issues such as low milk supply and reassure that this is not their fault.

OFFER INDIVIDUALISED SUPPORT

Know current recommendations for safe formula preparation in your area and ensure parents are confident to prepare formula safely.

Offer information and support with combination feeding if required. Ensure local breastfeeding support services support combination feeding.

Invite parents to contact you and/or other relevant services  with any further questions or concerns. The Fed Is Best Foundation offers many resources on inclusive feeding. You may direct parents to https://fedisbest.org/resources-for-parents/.

REASSURE

Reassure parents that formula feeding is a safe, nourishing and nurturing way to feed a baby. A baby will feel no less loved and will love their parents no less for being formula fed. A baby will not experience any adverse health for being nourished with safely prepared formula.

Encourage parents that they are doing a great job whilst also attending to any difficulties they report. Reiterate that what a baby needs most is loving attention and to know they are loved and cared for. A mother’s smile means more to a baby than breast milk.

TREAT Postnatal Mental Health Difficulties

Assess for postnatal depression or anxiety. Be aware that parents who have experienced health crises such as a baby needing hospitalisation for jaundice or other serious medical issues or who have had a traumatic birth may be traumatised and need skilled assessment and treatment from a mental health professional with expertise in trauma.

Refer promptly via local protocols for medication and/or psychological therapies as needed.


Ways YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  3. Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  7. Send us your stories. Share with us your successes, your struggles and every thing in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
  8. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.
  9. Shop and Fed is Best Foundation will earn cash back! We hope to develop our online safe infant feeding classes with these funds.
  10. If you need support, we have a private support group– Join
Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

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