IFA member Catherine Roy has written an explosive new book, Maternity: An Ongoing British Scandal. In it she explores the connection between national policies pursued by successive governments from the 1990s onward and the widespread harms seen in maternity services.
Investigations into preventable deaths at Shrewsbury and Telford and Morecambe Bay NHS Trusts highlighted a culture of ‘normal birth at any cost’. However, neither made the connection between practices in those hospitals and national maternity policy of the time. Catherine’s book makes that link. She sets out the origins of the idea of ‘normal birth’ in the eugenicist and misogynistic theories of Dr Grantly Dick Read in the 1930s and how the NCT (then called the Natural Childbirth Association) was founded in the ’50s to promote his ideas. The book follows the development of the idea of ‘normal birth’ to the moment in the 1990s when through lobbying and activism by the NCT and the RCM it was enshrined in national policy and how governments have subsequently reinforced these policies.
Catherine’s book features a chapter on the idea of exclusive breastfeeding, something often missing from the wider discussion about maternity failings. She explores the connection between breastfeeding promotion and normal birth dogma, both ideologically and in the real world through campaigning and activism.
Like many of us in IFA, Catherine had difficulty feeding her newborn and he developed jaundice and needed phototherapy. In the book, she touches on her experience as an example of exclusive breastfeeding policies. She explains how her baby was not fed for over 24 hours when she had no colostrum and how staff planned simply to ‘monitor’ him while giving ‘breastfeeding support’. When he finally received formula supplementation, a sticker was put in his notes, which she reproduces in the book. The sticker shows that staff were required to tick boxes for ‘steps taken to protect breastfeeding’ and to ensure that the mother was ‘informed of risks of formula’ – including ‘susceptibility to illness’.
Those of us who have acquired our maternity notes find similar horrors – mine is a feed chart recording over and over again that my daughter was ‘reluctant to feed’, ‘not feeding’ or ‘not latching’ and how 1ml syringes of colostrum were considered an adequate nutritional replacement – however, we had not seen this sticker before. Catherine writes that ‘protecting breastfeeding came above making sure our son was fed adequately and therefore protected from possible brain damage’.
It is the idea of ‘protecting breastfeeding’ that Catherine focuses on in her chapter on infant feeding. She explores its origins in the WHO International Code for Marketing Breastmilk Substitutes in the early ’80s and how it morphed into the WHO and UNICEF ‘Baby Friendly Initiative’, launched in 1992. She describes this as the Code’s ‘concrete application in healthcare settings’.
The Baby Friendly Initiative began to be adopted in hospitals in the UK a couple of years later and is now the standard model of care that women receive in the NHS. It is structured around ‘Ten Steps to Successful Breastfeeding’ that hospitals need to put in place to be accredited ‘Baby Friendly’. These include enforced rooming-in and no nurseries, staff trained to promote breastfeeding, no imagery of formula or bottles and, as Catherine experienced, withholding formula supplementation from newborn babies. Writing about these developments, which paralleled changes in maternity care in the ’90s, she says, ‘The belief was that the so-called “biological norm,” of breastfeeding was under threat by a “cultural norm” of formula feeding’.
We have argued before that exclusive breastfeeding as the ‘biological norm’ is the same idea as natural childbirth or ‘normal birth’. Catherine’s book is the first in the UK to explore this relationship and to uncover connections that even we did not know about! Tragically, just as the book shows how national policies that replaced preventative medical care with a ‘social model’ killed and injured babies at birth, infant feeding policy has caused harm that has not yet come to light. We hope this book is the start and that it lands on the desk of the Health Minister and Baroness Amos as a matter of urgency.
Sue Haddon