Joan Wolf - Is Breast Best?

Last week, we attended a lecture at Kent University by US academic Joan Wolf who seeks to offer an alternative message in the debate around breastfeeding- that we need to “transfer 'it’s okay to not breastfeed' to the pantheon of Things Every Parent Should Know.”

There are many factors that come in to play when a woman is deciding how to feed their baby, including the needs of their existing family and their work commitments, not least whether or not it is physically possible for them to do so. Wolf argues that there is no universal perfect way to feed babies as breast or bottle will make sense in different circumstances.

In a guest post earlier this month, one new mum described how she was “made to feel so awful” after deciding to stop breastfeeding at six weeks. But the cultural pressure runs both ways. As Viv Groskop points out, “if you breastfeed past a certain number of months, you will get funny looks in public and questions about why the baby hasn’t grown out of it.”

Instead of this moral hand wringing, what women need is support. And there are many ways women’s choice around feeding can be supported- from the provision of accurate and impartial information about formula feeding to ensuring women feel comfortable breastfeeding in public and removing barriers to breastfeeding after returning to work, as advocated by Maternity Action.

An audience member raised a very important point during the lecture: the discourse around breastfeeding is often centred on health but it is also about women’s rights. Women’s reproductive choices and issues around care giving are emotive topics- but we must trust women to make these decisions for themselves and for their family.

bpas and Women’s Resource Centre International Women’s Day event

Women’s sector organisations working to influence policy have had a difficult time recently. The challenges posed by public spending cuts that disproportionately affect women, development of policy that doesn’t accurately reflect women’s needs and attacks on issues like abortion have all caused significant problems. However, there have been notable successes and the British Pregnancy Advisory Service and the Women’s Resource Centre invite all those working in and around the women's sector to a reception to discuss and share your experiences with colleagues.

We will hear from speakers about their achievements in campaigning for the women they represent and how we might learn from each other’s experiences. There will then be an opportunity to informally chat and meet other campaigners from organisations.

Speakers include Ros Bragg from Maternity Action and Hannana Siddiqui from Southall Black Sisters on the ‘Abolish No Recourse to Public Funds Campaign’

Date: 5 March 2013
Time: 6:30 – 8pm
Venue: Old Sessions House, Farringdon, EC1R 0NA (nearest tube Farringdon)

Drinks and canapés will be provided.

Admission to this event is free and open to all but please book your place in advance with abigail.fitzgibbon@bpas.org

I am not a breastfeeding mum. But I have no regrets.

Below is a guest post written by Emily, a mother who decided to feed her daughter formula milk after six weeks of trying to breastfeed. This blog is the first of two about this subject, with one to follow after a lecture by Joan Wolf, author of Is Breast Best?

Let me get it out there - I am a non breast feeding mum. I breast fed my daughter Daphne for 6 long weeks. Long for me and long for Daphne. It's simple. Breast milk did not agree with her. But, here I am, yet again, finding myself explaining why I did not breastfeed for the recommended six months. It's like I have to give an excuse, a plausible one at that, as to why I failed my daughter.  And it is considered a failure.

Let me start at the beginning.  After a lovely pregnancy and easy childbirth, our beautiful daughter, Daphne arrived on New Year's day. Well that settled my much-agonised over 2012 new year's resolution.

Within minutes of her arrival she latched on and breastfed.  Breastfeeding came very easily those first few days for both of us. But then the problems started, the breast milk jaundice, the rash, the vomiting and the endless screaming. There was support aplenty. Breastfeeding counsellors, breastfeeding specialists, breastfeeding cafes, breastfeeding drop in centres, breastfeeding helplines. You name it, it was provided. And, don't get me wrong, it was absolutely fantastic. It was support when I needed it and in every possible form. Yet, deep down, I knew the problem was nothing to do with latching on or what I was eating. We ended up in the hospital not knowing what else to do. Reflux was promptly diagnosed and medication prescribed. Here I was pumping Daphne with medication so I could breastfeed. The medication made no difference at all. The doctors' answer? Increase the dosage. It just felt wrong.

Then one day I broke, after days of deliberations that put the UN to shame, my husband and I decided we would try Daphne on comfort formula. Our lives changed literally overnight. We had a happy and ever so contented baby. We took her off the medicine and she had a big beaming smile after every feed. A far cry (excuse the pun) from what we had just been through.

Due to the breastfeeding pressure I decided to try to mix feed - the difference between the two feeds was remarkable. In simple terms:

              Breastfeed = rash flared up + Daphne screaming
              Formula feed = rash substantively subsided + Daphne happy

Yet having made the decision to formula feed I felt so alone and it is this loneliness that has prompted me to write about my experience. 

The breastfeeding propaganda must end. I am a confident person who will happily stand up for my rights yet I was made to feel so awful once we decided to stop breastfeeding. I hate to think how more vulnerable people feel. 

There is no support for bottle feeding mums.  I had one thing that helped - the internet. That person-less place, but it was that that taught me what bottles were available, how to sterilise, handy hints on preparing bottles etc. I also finally found a lovely health visitor who deserves a mention, Karen. She was the first health visitor that I felt did not judge my decision and just sought to support me. I can tell you, she is a rare breed. 

Look, I am not having a dig at health professionals or the breast feeding support network. They all do a first class job. But all I ask is that non breastfeeding mums are not dealt with as second class citizens. I can look my husband in the eye and know that we took the best decision we could have done based on what we thought at the time. And do you know what? No regrets. None whatsoever.

And just like that, I will stop apologising for our decision.

Articles that caught our eye last week.

The BBC’s Panorama, The Great Abortion Divide, produced a flurry of articles over the last week with a variety of takes on the programme. For the Guardian, Sarah Ditum suggested that in striving for "impartiality" it was "vulnerable to distortion":

What did we learn from this Panorama? Largely, that some people feel profoundly different things about abortion, but not much in terms of facts that would help us weigh these competing claims. Whatever you think about abortion, surely it's too important to be forced into the wonky framework of false balance.

The US based website Jezebel also covered the issues raised in the documentary in their typically frank and funny manner and suggested that the real question the documentary raises is "why can't we cut the bullshit and let the woman decide regardless of her circumstances?"

The brilliant Education For Choice released their report on abortion education in schools last week. It revealed that:

Some teachers and external speakers delivering lessons on abortion have been found to be using materials which are inaccurate, biased, and often stigmatise abortion as a pregnancy option... Young people responding to our survey of abortion education reported lessons which were distressing and left them feeling upset and confused.

The report was cited by Libby Brooks in her article for the Guardian highlighting the growing crisis in sex education:

It's an ongoing poverty of provision that is beyond baffling, when we know that evidence-based, relationship-focused, age-appropriate teaching, delivered by specialised staff, has been proven by decades of research to reduce teenage pregnancy and STI rates while developing young people's confidence to say no as well as yes – and to access the services they need when they need them.

There was also a very moving piece on Salon written by a man whose wife experienced a miscarriage:

As an expectant father, you quickly get used to being a bystander. You stand by when you announce the pregnancy to her family, and even when you announce it to yours. If all goes well, you stand by in the hospital room encouraging her to keep going, to push harder.

But you’re never more of a bystander than when you don’t see a heartbeat on the ultrasound monitor. That was the worst part for me, the utter helplessness, knowing that there was no way to stop my wife’s suffering, or my own.

And finally pro-choice campaigner Clare Laxton argued that supporting a woman's right to choose is an "inalienable facet of feminism"

Looking back through the history books and feminists’ many achievements, and the battles we continue to fight, securing reproductive rights and choice has always been a vital part of feminism. Having a choice when faced with pregnancy, and society supporting that choice, is a feminist way of thinking. We support women and respect them – there can be no other way.

We will be posting a round up every week so please do share any articles or blogs you find interestin via email or Twitter

Event: Abortion, motherhood and the medical profession

A conference organised jointly by bpas and the Royal Society of Medicine's Sexuality and Sexual Health Section. London, Wednesday 12 June 2013.

The full programme is now published, and tickets are now on sale with a favourable early bird rate.You can see the full programme and book tickes here.

This one-day conference will explore topical issues in the management of pregnancy and women’s reproductive decision-making. Speakers will address the impact of new developments in pregnancy testing for abortion care, miscarriage, fertility treatment and ectopic pregnancy; the role of fetal imaging in discussions about abortion and the regulation of pregnancy; the impact of policy debates about information, counselling and the abortion law; and the generational experiences of doctors working within the abortion service. Clinicians, medical students, social scientists, medical ethicists and policymakers will benefit from attending.

Sessions include:

—Fetal imaging, and imagining the fetus
What scans can and can’t tell us about abortion; what the impact of the cultural visibility of the fetus is on pregnancy regulation and abortion care.

—Information, counselling and the law
What do women need to know, and why? What does ‘informed choice’ mean in practice? What has been the impact of confusions surrounding the abortion law?

—Testing positive, negative, and in between
How the semi-quantitative pregnancy test could transform the management of abortion, miscarriage, fertility treatment and ectopic pregnancy.

—A new generation of abortion doctors –challenges and opportunities

Speakers include:

Paul Blumenthal, Professor of Obstetrics and Gynaecology, Stanford University; Stuart Derbyshire, Reader in Psychology, University of Birmingham; Katharine Elliot, medical student, University of Newcastle; Roy Farquharson, consultant gynaecologist, Liverpool Women’s Hospital; Jane Fisher, Director, Antenatal Results and Choices; Joanne Fletcher, Consultant Nurse, Gynaecology, Sheffield Teaching Hospitals NHS Trust; Patricia Lohr, Medical Director, British Pregnancy Advisory Service; John Parsons, consultant gynaecologist; Richard Lyus, doctor, British Pregnancy Advisory Service; Carol Sanger, Barbara Aronstein Black Professor of Law, Columbia Law School; Sally Sheldon, Professor of Medical Law and Ethics, Kent Law School; Zoe Williams, columnist, The Guardian; author, What Not To Expect When You’re Expecting

For further information, email Jennie Bristow or call 07976 414751

Doctors are not breaking the law. They are caring for their patients.

Below is a copy of our letter to The Times' Editor that was in today's print edition and can be found on The Times website (behind the paywall) here. The letter is in response to a piece published in The Times by the BBC journalist Victoria Derbyshire about abortion law in the UK.

Victoria Derbyshire states that the abortion law is "being circumvented or broken" when doctors in England provide abortion to a patients who requests the termination of an unwanted pregnancy ("Our two-tier abortion law is failing women", Opinion, Feb 4). She is wrong. Ground C of the Abortion Act allows an abortion when two doctors agree that "the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant women." Pregnancy and childbirth are not risk-free, especially when the pregnancy is unwanted to the point that the woman prefers to end it in abortion. Many doctors believe "in good faith" that an abortion procedure carries less risk to the woman than would its denial. Such doctors are not circumventing or breaking the law; they are complying with the law, exercising their clinical judgment and caring for their patients.

Our response to some of the points raised in last night's Panorama on The Great Abortion Divide.

The impact of the protestors outside clinics

When interviewed, the protestors outside our clinic in Brighton said that they were there to “inform society” of the truth about abortion. It is difficult to understand then why they target individual women in this way. They say they are there to stop abortions, but we know that they are not in fact preventing women having abortions- they just make what can already be a difficult day much harder. We see women every week who have been frightened and intimidated by this group. For the protestors to deny in this programme that they are adding to women’s distress is quite frankly ludicrous.

The rising number of repeat abortions

While it is true that the proportion of women undergoing abortion who report a previous procedure has increased slightly from 36% in 2011 from 34% in 2010, it is important to put this in perspective.  Our rate of “repeat” abortion remains comparable with rates in France (35%) and lower than those in Sweden (40%) and the US (50%).

Women have reproductive lifetimes of 30 years and may well be exposed during that period to unwanted pregnancy on more than one occasion, particularly as more women postpone motherhood. The proportion of women reporting previous abortion is highest in the older age groups, who may have been exposed to unwanted pregnancy in their teens or early twenties and again after they have completed their families.

This can represent a particularly profound example of the problem with the term “repeat abortion” – which implies back to back procedures born of carbon copy circumstances, which is very rarely the case. As one of the contributors to the programme Folake Segun, Croydon Healthwatch Pathfinder, said, “You could have one at 17 or 15 and you could have one at 45 so your reasons might be v different at both ends of the spectrum but statistics would still have you down as having had a repeat abortion.”

“Are some women using abortion instead of contraception?”

This was a question posed and not really answered. However, at bpas we can strongly say that we have no evidence that women are using abortion instead of contraception. In fact, more than half of women contacting bpas with an unplanned pregnancy were using contraception when they became pregnant. No method of contraception is 100% effective, and women who use contraception may still find themselves facing an unplanned pregnancy. It is incorrect to imply that women use “one or the other.”

Time limit and the survival rate of babies born under 24 weeks

One of the key issues in the debate around the abortion time limit is the survival rates for premature babies born under 24 weeks gestation. Whilst the expert medical bodies have concluded that there has been no change in the viability of babies born under 24 weeks, as Victoria Derbyshire said, not everyone accepts what the medical experts say. Nadine Dorries MP stated that the figures around survival rates cannot be used as these are “figures of babies that were born prematurely and they were born prematurely for a reason and that reason is often because those babies are very poorly. Now when you show me babies that have been born at 20 weeks who were healthy , from healthy mothers and then have a look at how many of those babies survive then you can compare like with like.”

It is incorrect to suggest that babies are born prematurely because they are poorly. In reality, babies who are premature are “poorly” because they are premature. The chances of a baby’s survival below 24 weeks extremely low because before 24 weeks these babies have not developed enough to survive outside their mother’s womb.  It is incredibly sad that despite advances in medicine this has not changed.

It is very disappointing to see people misuse statistics around this issue for ideologically driven point scoring about abortion. 

'We can trust women to make decisions that are right'

The inquiry into abortion on the grounds of disability is seeking solutions to problems that don’t exist – and ignoring those problems that do

It is customary to welcome Parliamentary inquiries into contentious issues when one has nothing to hide or be ashamed of.

But I don’t welcome the Parliamentary Inquiry into Abortion on the Grounds of Disability launched by the MP Fiona Bruce, who wants to establish whether the law should be reviewed to consider“medical advances and advances in our attitudes to disability over recent years”. The inquiry will assess the intention of the current law, how it works in practice, and the prospects for developing the law going forward.

The press announcement shows the inquirers' concerns. The current law permits an abortion to take place ‘up to birth’ if tests indicate that the child may be disabled when born, while there is a legal limit of 24 weeks for abortions on other grounds.

It questions if this is discriminatory following the passing of the Equality Act 2010. It is concerned with the impact of the current law on disabled people and their families.

Any proper inquiry into ‘Ground E’ abortions for fetal anomaly should start from a different point.

Normally we assess the provision of clinical care according to its effect on the person who needs it, not how others (unrelated to the putative patient) feel it affects them. So the starting point of any inquiry into the abortion law should be concern for the woman who requires the abortion and this inquiry should start from concern for the woman (and her family) who discover a pregnancy is affected by fetal abnormality.

Were the inquiry to focus on the woman faced with such a diagnosis they would find themselves with a different scope of issues. Among these would be:

- Fear of stigmatisation if she opts for abortion

- Concern about the support services that will be available for her child if she continues the pregnancy

- Shortage of specialist midwives means a lack of emotional support

- Lack of services available in hospital because doctors are afraid to perform later abortions

- Lack of choice of method in how pregnancy can be ended – many women do not want to go through labour

We will all have different views on abortion for fetal abnormality. They are the most controversial of abortions and arguably the most tragic for often they involve wanted, planned-for pregnancies.

But we can trust women to make decisions that are right and responsible. And we can trust doctors to act in ‘good faith’. The last thing doctors, or their patients, need is the scrutiny of an inquiry concerned, not with the care of women – but with the presumed political impact of people’s personal decisions.

This article was originally written by our Chief Executive, Ann Furedi, for the Telegraph’s Wonder Women section.