Biased? Me?

Posted on: 31/03/2011

Image courtesy of NHS Choices

I thought it was about time I posted something about the antenatal teacher training I’m doing. (I’ve inadvertently written rather a lot.  You have been warned!)  I’m trying to do an assignment which involves writing a teaching plan for a breastfeeding class, and to do this one of the best things you can do is go and watch a professional breastfeeding counsellor teach a class or two.

I’ve seen many, many breastfeeding classes now.  It’s a bit of a weird one, teaching about breastfeeding before the baby’s out.  A bit like trying to drive a car without actually getting in the car and having a go.  Especially since everything you learn during such a class will fade to the back of your memory while you’re going through the physical act of having your baby.  Only afterwards are you likely to think, OK, so what did so-and-so say during that class?

renjith krishnan /

You're unlikely to see one of these in an NCT breastfeeding class

But the initial thought that springs to mind whenever I observe a class is the comments after a course is over, from people who either intend to bottle-feed, or for various reasons have given up breastfeeding very early, and feel judged by the mere existence of such a class.  It doesn’t seem to matter to them that bottle-feeders simply need to follow the instructions on the tin of baby food.  Or that to provide a bottle-feeding demonstration in a class contravenes the WHO guidelines.  They still feel judged.

But if you compare pushing a shopping trolley round a supermarket to driving a car, would you really need lessons to use the trolley?

At no point in any classes have I ever seen a lecture about why breast is best. Everyone knows already, and pushing the issue down someone’s throat is like having an evangelist spouting their opinions to an agnostic.  They could be right, but to have someone confront you in such a way would just make you dig your heels in more, as well as resenting the person who forced the issue.  Even if you are in a position where you know the good that breastfeeding can do, it’s nobody’s business but your own how you choose to feed your baby.

The WHO's publication: click to link to the document

The WHO's publication: click on the image if you want to read it for yourself

Interestingly, the WHO is fairly militant about breastfeeding.  There is a document online that lists acceptable medical reasons not to breastfeed.  This includes maternal HIV or herpes, or medication that would be too strong for the baby to cope with, or a drug user, and so on.   To be fair, they are taking the entire world into account, and I’d like to think that people wouldn’t dream of saying formula feeding is OK to use in hot, disease-ridden countries where every micron of immunity from the breast milk gives a baby a bit more chance of survival…unless there was such a medical reason.  Fair enough. (And if you want the broader politics, have a look at

So what the classes do cover is stuff that is handy to know whether you’re breast or bottle feeding, such as how tiny a newborn baby’s stomach is and why it might not be quite so surprising that they feed so often, and throw up so much milk if there’s only room for a teaspoon’s worth in there in the first day or two.  And then they go on to talk about positioning, and what partners should look out for if it hurts, and such like.

In my opinion, there are two main reasons behind those who choose not to breastfeed in the UK. Firstly, they don’t like the idea of it.  They haven’t been brought up with it, they feel embarrassed about it and the whole concept is all a bit icky.  Secondly, more likely than not, it hurts when you first get started.  Your breasts have to get used to it.  Positioning is seriously tricky, and breasts are very sensitive.  It takes six weeks to for breastfeeding to be fully established, after all.

koratmember /

Once upon a time, breastfeeding used to be controversial. Nowadays, especially in middle-class circles, the tide has turned.

People tend not to cite such reasons first time round.  To be honest, the problem is, they feel they have to give a reason. Even though it’s totally OK to give up for any reason.  It’s a personal choice.

But, how do you deal with this in a breastfeeding class?  People who already don’t want to breastfeed can’t help but feel judged.  Even though it’s none of anyone’s business but theirs how they feed their baby, and the class leader will have said so right from the start.  There is a real stigma where bottle-feeders can feel really alienated without anyone even saying anything to justify it.

The problem in the class is that those who do not want to breastfeed don’t feel able to voice their opinions in such an environment.  All the teacher can say is, it’s up to you. I will not judge you. It’s none of my business what you do with the information I give you.

Often, for the person who wants to bottle-feed, such a statement will not be believed. And unfortunately, teaching about such a sensitive and personal subject, we can only do so much about how people receive the information we give.  There are many aspects of antenatal classes that can have this effect.  There are frequent opportunities for people to misconstrue the way in which a subject is taught, and to feel that a class is biased, especially when it comes to NCT classes where preconceptions are rife, and people are sensitized to anything that could challenge their opinions.

This is an ongoing issue for pretty much all antenatal teachers.  It’s not going to go away.  If childbirth and parenting were so straightforward we wouldn’t have been motivated to teach them in the first place.  We can only do our best: give the facts, teach evidence-based classes, and help people to make the right decisions for them.


2 Responses to "Biased? Me?"

People who already don’t want to breastfeed can’t help but feel judged.

That will be good practice for them, then. As soon as their baby is born they’ll be subjected to an endless stream of pro-breastfeeding advocacy from a variety of well-intentioned professionals, peers, friends and family. Might as well get used to dealing with it!

How true! Actually what also happens the moment you nurse your baby in public is trigger off an ‘I couldn’t breastfeed my baby because of X’ from the nearest mum. Feeling judged again you see…

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