New guidelines: "Bottle-feeding mums need support too"

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Breast is best, but mums who can't, or choose not to breastfeed need support too, says the Australian Medical Association in new guidelines released this week.

"Breastfeeding is the optimal infant feeding method, with current Australian guidelines recommending exclusive breastfeeding until six months," AMA President, Dr Michael Gannon, said in a statement. "But mothers and other caregivers who cannot or choose not to breastfeed must have access to appropriate care and assistance to formula-feed their child."

In a new position statement, Infant Feeding and Parental Healththe AMA notes that while 96 per cent of new mums start out breastfeeding their babies, by the time they're four months old, only 39 per cent of infants are exclusively breastfed. And this number drops to just 16 per cent when infants are six months old.

But while breastfeeding is the optimal feeding choice, with breastfed babies at less risk of infection, sudden infant death syndrome, and diseases like asthma, eczema, and hay fever, the AMA acknowledges that it may not be the best choice for all families. "There must be a balance between promoting breastfeeding and supporting mothers who cannot or choose not to breastfeed," they write.

Mums unable to breastfeed may feel "a sense of guilt or failure" Dr Gannon said, adding that GPs and other medical practitioners need to help remove stigma around bottle-feeding by reassuring women about the "efficacy and safety" of using formula. 

And while the Marketing in Australia of Infant Formula (MAIF) Agreement, which restricts companies from promoting and marketing breast milk substitutes, exists to "protect and encourage the promotion of breast milk as the optimal source of nutrients for all infants", the AMA stipulates that efforts should be made to ensure that parents who are unable or choose not to breastfeed still have access to support and information to allow them to effectively feed their babies.

"Although it is different in composition, infant formula is an adequate source of nutrient," Dr Gannon said. "Parents seeking to bottle feed their infants need support and guidance about how much and how often to feed their infant, how to recognise when to feed their infant, and how to sterilise and prepare formula."

The new position statement also highlights the "complex" relationship between breastfeeding and postnatal depression, which affects around one in seven new Australian mums. "Discordance between the feeding intentions and actual feeding experience of a mother may increase the likelihood that she will experience PND," the statement reads, "whilst women who are able to breastfeed in line with their intentions have a reduced risk of experiencing PND."


With regards to breastfeeding, the AMA advises that mums should also receive appropriate information around infant feeding patterns, perception of milk supply and infant feeding cues, given feeding patterns and behaviour can vary substantially - even between siblings. 

"Parental anxiety around feeding can contribute to feeding difficulties, which may further exacerbate the parental anxieties," they note, reiterating that support is needed to traverse these concerns during the newborn period.

"Perceived insufficient milk supply is commonly cited as a reason for the cessation of breastfeeding," the statement reads, adding that in actual fact the number of women who experience low supply is "relatively low". "Women who believe they are experiencing insufficient milk supply should consult their general practitioner or lactation consultant, and if necessary have their milk supply assessed," says the AMA. The same applies for parents concerned about "anatomical" barriers to successful breastfeeding and formula feeding, such as colic, tongue tie or swallowing disorders.

New mums should also be encouraged and supported by their hospital, birthing centre, early childhood nurse or GP,  to join mothers' groups, which the AMA argues provide a "valuable, peer-support network for new parents, as well as a learning opportunity through exposure to differing parenting styles."

And while in those early months of new parenthood, mums and dads are typically focused on caring for and prioritising the needs of their newborn, they should also be mindful of their own health and wellbeing too - and seek help from their GP where necessary.  

"The transition to motherhood is a physically and emotionally demanding period, the AMA says "and many mothers experience myriad mental and physical changes."