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SUBMISSIONTOTHEINQUIRYINTOPERINATALSERVICESINVICTORIA‐NAMEWITHHELD‐ThankyoufortheopportunitytomakeasubmissiontotheInquiryintoPerinatalServicesinVictoria.InJulyIbecomeafirst‐timemother,havingmychildinaprivatehospitalinMelbourne.Astheclichégoes–nothingcouldhavepreparedmefortheimpactofhavingababy.Whileithasbeenwonderful,ithasalsohadasubstantial,sometimeschallengingimpactonotherfacetsofmylife‐myphysicalandmentalhealth,mysleep,lifestyleandrelationships.Thischangeleftme,particularlyinthefirstfewweeks,rawandvulnerable.Ilackedconfidence,Iwasexhausted,andIwasterrifiedaboutwhetherIwasdoingtherightthing.Isoughtinformationeverywhere,andwasheavilyreliantontheadviceandassistanceIreceived–whetherfacetoface,overthephone,orontrustedgovernmentwebsites.Itwasthequalityoftheservicesandadvicethathasledmetomakethissubmission.QUALITYOFADVICEIreceivedalotofwellmeaning,andsometimesuseful,advicefromnurses,midwives,andlactationconsultants,immediatelyafterthebirthofmychild.However,muchoftheadvicewasalsocontradictory,opinion‐basedandsometimespaternalistic.Thisincludedadviceabouteveryaspectoflookingafterthebaby(feeding,sleeping,caringetc).Myexperiencewasparticularlydisappointinginthat:

theconflictingadvicewasprovidedbystaffinthesameinstitution,sotherewasclearlynointernalguidelinesaboutkeyquestionsthatanewmotherwaslikelytoask–oriftherewere,theywerenotenforced;

theadvicewasoftenprovidedinadogmaticway‐asifanyotherapproachwouldbecatastrophic.Italsoappearedtomethatsomeofthemidwivesandlactationspecialistsprovidingthisadvicelackedempathyortheabilitytolisten.Iwitnessedotherwomencryingasaresultoftheantagonistictreatmentbyoneparticularlactationspecialistinadevotedbreastfeedingroominthehospital(inthecontextofawomantryingtogetherbabytolatch,thespecialistyelled“don’tyouEVERputyourhandonthebackofababy’shead…..whydowomenINSISTondoingthis?”);

Muchoftheadvicewasbasedonopinionratherthanfact,wasrootedinfear(ifyoudothis,thenexpectthisterribleoutcome),wasbasedonanecdotalexperience,ratherthanevidence‐basedapproaches.

Motherswerenotgivenfact‐basedinformationthatwouldenablethemtomaketheirowndecision(basedontheirpersonalcircumstances,risktoleranceetc.)butwererathertoldwhattodo.Someofthisfelthighly

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paternalistic,asifmothersarenotcapableof,orcannotbetrustedwith,makingadecision.

Ihadasimilarexperienceafterleavinghospitalandcontactingtwoprivatelactationspecialists.Thesechargedapproximately$150‐$200forthefirstconsultation,andvariedconsiderablyinquality.Whilethepost‐nataladviceindustryisfullofpassionatepeoplewhocareaboutwomenandchildren,itseemsthatitisalsoadhoc,withdifferenttypesofservicesandvaryinglevelsofprofessionalism.Itisstillnotcleartomewhatlevelsofqualificationsoraccreditationsarerequiredbythosewhopracticeinthepostnataladviceindustry.Whiletheseconcernsmightseemminor,inatimewhenanewmotherneedsstrongsupportandassistance,thisadviceis,atbest,counter‐productiveandatworst,couldthreatenanewmother’smentalhealthandabilitytocopewithhernewcircumstances.BREASTFEEDINGDOGMATISMIamsurprisedanddisappointedthatthereissolittlenuanceintheinformationprovidedaboutbreastfeeding.Instead,itseemsthatmanyhospitalsandwebsites(includingGovernmentones),reflecttheAustralianBreastfeedingAssociation’sstrongmessagingaboutbreastfeedingi.e.thatbreastfeedingshouldbeundertakentotheexclusionofallelse.Iambreastfeeding,andampleasedandgratefultobeabletodoit,butamangryatthelackofalternativeinformationoutthereforthosewhocannotbreastfeedorbreastfeedexclusively.Whileweallunderstandthatbreastmilkisbest,thisdoesnotmeanthatexpressing,orsupplementingisproblematic.Nordoesitmeanthatexclusiveformulaisahighlyproblematiceither.Infact,theactualscientificbasisformanyofthebreastfeedingclaimsarefairlyloosecorrelations,andsomeclaimsarejustnotsupportedbytheevidence1.Forexample,itisclearthatthereisaconsistentpositivecorrelationbetweenbreastfeedingandlowerratesofearandgastrointestinalinfectionsintheearlymonths.Manyotherclaimsarebasedonobservationaldata,whichisunabletocontrolforallfactors.Whileitisfairtosaythatbreastfeedingisthehealthiestchoiceforsomereasons,itseemsthe(low)risksofthealternativesmightbeinsomecasesoutweighedbythebenefitstoamum(lesspainandstruggle,bettersleep,bettermentalhealth).

1HaelleT.,WillinghamE.,“TheInformedParent,AScience‐BasedResourceforYourChild’sFirstFourYears”,2016;Callahan,A.,“TheScienceofMom:AResearch‐BasedGuidetoYourBaby’sFirstYear”2015,seealso,https://scienceofmom.com/2012/06/08/why‐care‐about‐breastfeeding‐research/#more‐1603;https://scienceofmom.com/2012/05/25/bottle‐feeding‐and‐obesity‐risk/

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HoweverthisisnotanarrativethatisencouragedinmostoftheAustralianliteratureonthesubject.Thebestonegetsisathrowawaylineaboutalternatives,afterpagesofinformationonthebenefitsofbreastfeeding.Thelackofcomprehensive,impartial,evidence‐basedinformationaboutalternativeapproaches(forexample,mixedfeeding)is–atbest–patronisingtowomen,andatworst,dangerous.Manywomenstrugglewithbreastfeeding,duetosupplyorlatchingdifficulties,strongbreastpain,sleepdeprivationorpastemotionaltrauma.Theimmensepressuretobreastfeedsuccessfully,andguiltifitfailsorisdifficult,canbetheworstpartofthefirstfewmonthsofababieslife.Womenshouldbeprovidedwithimpartialinformation–includingkeyinformationabouttheevidencethatisavailableonparticularquestions,thelimitationsofthatevidence,aswellasevidencethatsuggeststhatotherapproachesareOK.Womenshouldbetrustedtomaketheirowndecisions,basedontheirrisktoleranceandpersonalcircumstances.Spectressuchas“nippleconfusion”;“breastrejection”;poorhealthoutcomesforbabiesshouldnotbeusedtopushawomanintoexclusivebreastfeeding–unlesstheseissuescanbesupportedbyevidence.Itappearstomethatthesupportofbreastfeedingseemstotakepriorityaboveeverotherconsideration,includingamother’s–andsometimesachild’s–physicalandmentalhealthandhappiness.RECOMMENDATIONS

‐ Peoplewhoprovidepostnataladvice,particularviaourhospitalsshouldbesubjecttoconsistentaccreditationandprofessionalstandards;

‐ Hospitalsshoulddevelopclearinternalpoliciesabouttheadvicethatshouldbegivenonkeytopics.Thisadviceshouldbebasedinscience,notopinion.Wherethereisnoclearevidenceavailableinrelationtoparticularquestions,amothershouldbetoldthis,andallowedtoherformherownviewonbeststeps.

‐ Ideologyandopinionshouldberemovedasmuchaspossiblefromtheinformationprovidedtowomenaboutbreastfeeding.

‐ Morecomprehensiveinformationshouldbeprovidedtowomenwhochoose,forwhateverreason,tomixfeed,ortoformulafeed.Womenshouldbeempoweredandencouragedtomakethechoicethatisthebestforthemandtheirbaby,takingintoaccountallfactors.

Thankyoufortheopportunitytoexpressmyviews.