I did everything by the book. Within minutes of my baby's first breaths I held her to my chest and watched her tiny mouth begin to suckle. As a health writer and medical student I was very pro-breastfeeding. I'd done classes before birth and read the long lists of everything breastfeeding had and could do compared with formula. I had also naively accepted maternity care's new dogma: that people who didn't breastfeed weren't really educated, interested, or, worse, had been tricked by the marketing of wicked formula companies.
Three days later it was a very different story. My baby suckled for hours at a time, only to pass out, exhausted, for an hour before needing to feed again. She had lost about 13 per cent of her birth weight. When a midwife gently suggested we offer some formula, I felt sick. She may as well have been suggesting I give my baby Coca-Cola.
Combination feeding can make mothers feel racked with guilt, confused, and judged by healthcare providers.
I began begging breast milk from close friends, subjected my daughter to (controversial) surgery to cut a tongue-tie, was told to limit her formula to tiny amounts that left her constantly screaming for food, and took large doses of a stomach medication that causes lactation as a side-effect. Nothing worked. Instead of bonding with my daughter, every feed became a torture, her screaming and scratching at my breasts.
Trying to get evidence-based advice was almost impossible. You are told you "can't overfeed a breastfed baby" (breasts, of course, could never possibly not work perfectly), but you are terrified of overfeeding with formula and unsure of how to manage both. I still grimace every time I have to reveal my dirty formula secret to a new health professional; am left distraught from an arched eyebrow or disapproving tone.
Thankfully, the Australian Medical Association has recognised we have a problem. It has released a new position statement which says that, despite breastfeeding being optimal, "there must be a balance between promoting [it] and supporting mothers who cannot or choose not to".
AMA President Michael Gannon says mothers who use formula may feel a sense of guilt or failure "and it is important that their GPs and other medical practitioners reassure them about the efficacy and safety… and work to remove any stigma". Our obsession with breastfeeding is not only hurting women, it may be putting babies at risk, and if it is not checked could lead to a backlash. Already in Britain, campaigns such as "Fed is Best" are focusing on preventing extreme cases in which breastfed babies have been seriously injured or died from undernourishment.
I watched as government lactation consultants allowed one friend's baby to lose nearly a kilogram in his first weeks of life – a third of his birth weight – in the name of establishing exclusive breastfeeding. "I thought I had such an unsettled baby, but he was just starving," she told me after a paediatrician told her she must offer formula.
US journalist Hanna Rosin has argued that breastfeeding has become the ultimate signifier of social status, and the new way of shackling women to domesticity.
Along with this breast-is-best faith has come exaggeration of the benefits of breastfeeding and the harms of formula, which, we are led to believe, will leave us with obese, sickly, stupid children. Rosin describes her shock in discovering how popular representations of breastfeeding drastically overstate its importance, based on often patchy, poorly conducted studies.
Breastfeeding does have clear benefits, but in the developed world they are often small, and may potentially be achieved without exclusive breastfeeding, or breastfeeding for a year. Some areas, such as IQ or weight loss in the mother, show no definite advantage.
Breastfeeding advocates often claim that between only 1 per cent and 5 per cent of women cannot breastfeed exclusively, despite many more believing they have insufficient milk.
Yet this statistic appears based on little strong evidence; more of an educated guess from experts who have patronisingly decidedinsufficient milk occurs only in developed countries and so is probably just a modern hysteria.
Research into the causes and prevalence of this problem is woefully inadequate, with few studies actually examining rates of low milk supply. Many researchers now use the term "perceived insufficient milk" and simply assume that any woman who believes her supply is low is "lacking in confidence" or knowledge. The next step is developing interventions to improve women's "perceptions" without even using reliable methods to ensure those perceptions aren't actually correct.
There is work to do to ensure pro-breastfeeding ideology does not lead to misinformation and stigma. Months later, my friend whose baby had lost a kilogram went for a check-up for her healthy, bouncing formula-fed baby boy. The GP commented on his size, saying that he was large because formula was "like giving him Mars Bars".
I wish I had been told that not everyone will successfully exclusively breastfeed; too many women don't find out until too late. But even more important is that, when this occurs, we are able to receive evidence-based, non-judgmental health care.
Amy Corderoy is a freelance journalist and medical student.
This article first appeared in the Sydney Morning Herald.