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Thursday, 23 June 2011

The Guardian, The Press Complaints Commission, and WHY I GAVE UP....

I thought I'd better put something on the blog about the recent 'clarification' from the Guardian regards this piece which they published in April entitled:

'Doctor Doctor I plan to mix feed my baby,
will she get all the immune system benefits if I do?'

** BTW - I understand totally if you don't feel particularly inclined to read the minutiae of the  incredibly tedious complaint process, so please feel free to skip most of this post!   However, I'd love it if you'd cast your eye to the section in red at the bottom, because I need your help!**

My complaint (which was made via the PCC website and further clarified in two emails)  centered around the advice given in response to a question about breastfeeding from a mum who had a 4 week old baby and an older child.  In a very brief reply, the doctor managed to state a surprising number of 'breastfeeding myths' as fact.  I don't know how many other people also complained about the piece or took part in similar correspondence to what follows below (please let me know if you did!).  My original complaint took issue with the following statements:

1/ 'Immune benefits cross over in the first few weeks' (those with a sharp eye will note that in the online version the word 'significant' has now been added to the online version, however, it was missing from the original, more on that later).  It is well-known that breastfeeding gives  a child's immature immune system substantial support for as long as breastfeeding continues.

2/ 'you have done enough on that basis already'.  I felt that this sentence implied that there was no point in continuing to breastfeed since she had already breastfed for 4 weeks.

3/ 'have you thought about expressing breast milk [...]? This will save time'.  As most breastfeeding mums will attest, a baby who is breastfeeding well will drain the breast far more efficiently than any breast pump.

So - to cut a very long story slightly shorter, there were several to-ings and fro-ings via the PCC about my complaint.  I responded to points made by the Guardian and they responded to one or two of mine (but by no means all..).  The Guardian stated that the mother who had received the advice was very satisfied with it - indeed they published a letter from her saying how happy she was.  They also stated that the doctor had been attempting in his reply to help her to feel 'less guilty' about stopping breastfeeding.

In their response to my original complaint The Guardian quoted the WHO and LLLI in regards to colostrum, including the following phrase:
'The colostrum gradually changes to mature milk during the first two weeks after birth. During this transition, the concentrations of the antibodies in your milk decrease, but your milk volume greatly increases. The disease-fighting properties of human milk do not disappear with the colostrum. In fact, as long as your baby receives your milk, he will receive immunological protection against many different viruses and bacteria'

(I suspect that it was on the basis of the above quote (which backs up part of my complaint...) that they elected to change the wording of the article to include the word 'significant') 
'in the interests of resolving this complaint, we would be happy to amend Dr Smith’s article by prefacing the first sentence with the word “significant”, so it reads: “Significant immune benefits cross over. . .”. Otherwise we do not regard this part of his response as regarding remedy.'

Problem is, I think that even with the inclusion of the word 'significant' before this sentence, the implication of the sentence remains that most of the 'job is done' by the colostrum.  As breastfeeding mums who have nursed their children through illness (never mind the science!) can attest, this is total rubbish.  Therefore the answer to the question 'will she get all the immune system benefits if I do?', is actually/ factually 'no'...

The newspaper explained that the doctor responding had sought opinions from a colleague and a midwife about his intended response, and both had agreed that it was appropriateThis actually worries me even more!  Three separate Health Care Professionals apparently felt that his reply was factually accurate despite it being hugely misleading in several areas.  I guess this might not come as a great surprise to many people who have sought assistance with a breastfeeding problem from their GP, or who have been reassurred by a midwife that the baby's 'latch' is fine despite their bleeding nipples...  It really does serve as a reminder that many GP's and even some trusted midwives are NOT breastfeeding experts!  Their training simply doesn't require them to be! 

The newspaper's response continued to address one of the other points I made in my original complaint - concerning the assertion that expressing breastmilk would save the mother time... 
'Dr Smith’s suggestion that expressing milk will save the mother time seems to us to be perfectly reasonable in the context of her letter. The length of time a baby takes to feed varies hugely (anywhere from 10 to 40 minutes per breast perhaps), with Bupa suggesting “as a rough guide, each feed may be 10 to 20 minutes per breast, but every baby is different so it may be longer.”
The time taken to express will also vary greatly but with an electric pump in can be as quick as 10 minutes per breast. Given that this mum refers to “the long time it takes to breastfeed” her baby (and this is the reason she wants to mix-feed), this is a reasonable suggestion for the doctor to make and we see no reason to correct this point.'

Ah yes, BUPA - those well-known breastfeeding experts.....

As you can imagine, I did respond (in great detail!) to their response.  Here is part of that response:
'The La Leche League (who the Guardian referenced in their response to you) have this to say on the subject of expressing breastmilk:
'Express in a comfortable setting; avoid distractions or interruptions. Take your phone off the hook and ask those around you not to disturb you while expressing. If you're at home with older children, distract them with an activity that doesn't require your full attention'
http://www.llli.org/nb/nbjulaug07p168.html
This being the case, I fail to see how such advice is going to be of assistance to a mother whose primary reason for contacting the doctor was apparently a problem amusing her older child? Perhaps a suggestion to nurse the smaller baby whilst wearing a sling would have been more helpful since it would at least have left the mother's hands free?
QUOTE: 'the doctor suggests expressing in response to the idea that breastfeeds are taking a long time. 'Given that this mum refers to “the long time it takes to breastfeed” her baby (and this is the reason she wants to mix-feed), this is a reasonable suggestion for the doctor to make and we see no reason to correct this point.'
Perhaps the doctor is not aware that extended feeding sessions often occur when milk transfer is poor? The primary suggestion of someone with a good understanding of breastfeeding would be to suggest consulting a breastfeeding professional in order to establish whether there is an underlying problem affecting milk transfer.
 By failing to suggest this I believe the doctor and the Guardian newspaper let both the questioner and readers down and showed a poor understanding of breastfeeding. A baby who is breastfeeding efficiently will usually consume a larger quantity of milk than a pump can extract. To quote an internationally recognised expert in breastfeeding, Dr Jack Newman 'a pump is not as efficient as a well-latched baby and so a baby who breastfeeds well is the best pump'. http://www.drjacknewman.com/help/Expressing%20Milk.asp
There is also the possibility of an undetected medical issue underpinning the poor milk transfer (for example an undiagnosed tongue tie) and the doctor failed to suggest a referral which may have helped to resolve the problem swiftly.
In addition, women who express milk often report a belief that they have a supply problem, when in fact they do not. They frequently get disheartened when they find they cannot fill a bottle quickly.

'if you cannot pump a lot, this does not mean your milk production is low. Do not pump to find out how much you are producing. This is an inefficient way to judge milk supply and often results in emptier breasts for baby to feed.' http://www.drjacknewman.com/help/Expressing%20Milk.asp

Many people just don't 'get on' with expressing. If this mother were to find she was unable to express much milk (which is often the case even for women with an excellent milk supply), her confidence could be further diminished and breastfeeding would be even more likely to cease. For this reason I feel the doctor would have been kinder to make a referral to a breastfeeding expert in order to avoid reducing this mother's confidence further. 
I appreciate that the mother concerned wrote to the doctor thanking him for his advice. However, it is possible that an even better outcome for this individual and her baby might have been acheived, and certainly I still feel that the newspaper printed some very misleading information about breastfeeding to it's wider readership with this response.'

My next contact from the PCC made it clear that the Guardian wished to address none of these other points - points which I still feel are entirely valid.  The Guardian clearly felt that their offer to include the word 'significant' should be enough to make the 'crazy breastfeeding woman' disappear... ;)  The PCC's next email to me also suggested that the PCC was not going to push them to clarify these points.   I'm afraid once it became apparent that my other points were going to be ignored (unless I went to the committee) I told the PCC that I would resolve the matter there.  Yup, I rolled over.  I gave up.

My reason?  I simply don't believe the PCC take their responsibilities regards the health issues connected to infant feeding, seriously.  I don't believe some doctors do either.  I don't think my complaint would have been taken seriously by the PCC committee under the current guidelines.   The PCC ARE going to put something on their website about this correction/ clarification.  Wording to be decided.  However nothing will really change that much I'm sure about, but at least it's something.

I also gave up because I'm also a mum with a 2 year old to take care of and a sizeable bump.  It takes time and energy to chase complaints in this way.  The folks at the Guardian and the PCC get paid to spend time dealing with these things, I don't.  You can prossibly begin to see how much effort went into making a complaint about what was a very short piece - not even 'headline news'.  Now imagine trying to counter every piece of misinformation churned out and printed every day through the current system... 

Remember this?   I didn't even attempt to address the amount of guff which was printed by the press in the light of the BMJ 'review' in January - perhaps now you can understand why. 

Until the PCC agree to change their editorial guidelines to offer protection against misinformation such as this I believe efforts such as mine are simply drops in the ocean.  Frankly a bit pointless!  I feel fobbed-off, and despite getting a small change made I pretty much was fobbed off....  It's ok, I can take it ;)

Here's what we've ended up with:



OK - so it's better, (and apparently this sort of correction is something of a 'first'...)  However, it's still going to make - pardon me - sod all difference at the end of the day! 

Now, I'm not saying you shouldn't make the effort to complain (far from it - I'd love it if the PCC and OFCOM were getting a letter a day about inaccurate breastfeeding information!), but I do think we need to start changing the way we campaign about this issue.

From one of the emails I sent to the PCC during our discourse:
'I wonder if you might consider that this is not an isolated situation, poor breastfeeding advice and information is very common in the press. Were it to be poor advice about another health-related issue I believe the press would take greater care with their standards of accuracy.'
From this post:
'persons of colour, religious groups, homosexuals, and other minority groups are protected from irresponsible reporting in the press by special guidelines. [...]
People are naturally coloured, they are naturally gay or straight, people are also naturally breastfed. It is the norm. It shouldn't need to defend itself but it does. It's still OK to bash breastfeeding and breastfeeding mums. It's ok to lie about breastfeeding facts and call breastfeeding advocates names. It happens all the time with impunity. But WHY? Why is it still ok to do this?
Actually, it's not ok.. I believe the press has gone beyond criticising 'bullies' and is now on dangerous ground. Ground that actually puts mothers and their babies at a considerable disadvantage. [...] Despite the fact that some newspapers will now print 'balance' pieces and perhaps even have to print retractions, they KNOW that the headline was worth it. It's the headlines that people remember.
Perhaps some of you will think that by comparing breastfeeding mums to other minority groups I'm exaggerating. Imagine if someone was thrown off a bus for wearing a turban? Or if a gay man felt so intimidated that they went to eat their dinner in a toilet? These things happen to breastfeeding mums - and if you breastfeed for long enough, the chances are that you will - sadly - have a negative experience associated with it eventually. Racism still exists in the UK, but it is tolerated far less than it used to be, and the press do not inflame it. Imagine if they were allowed to - what sort of headlines do you think the Daily Mail would print?
I would like to see the media forced to stop their sensationalist headlines and treat the topic with the care that it deserves. All mothers and their babies deserve respect and access to good information. I believe that issues related to infant feeding deserve the same respect given to other issues'
I want to make something crystal clear.  I didn't complain to the PCC because a mum didn't want to keep on breastfeeding her baby and I 'disapproved'!  My only desire is that mums be allowed to make properly informed decisions.  Properly supported decisions based on a breadth of sound information.  Even though this doctor was giving personalised advice to one individual, that advice was being read by thousands of others - and I believe that he should have borne this in mind when responding. 

It is not fair to assume that judging the quality of information in circulation is the same as judging other mums for the decisions they make.  Totally not the case.  Mums are all doing their best - I'm just not convinced that society currently does it's best to support them. 

I am, however, absolutely certain that mums who do try to breastfeed are swimming against the 'social tide', and I think it's high time that the press and some medics stopped making it harder!


I don't know exactly the means by which we can campaign for 'special consideration' for breastfeeding in the press and on tv - however I have asked the PCC for their advice on this.  I will let you know what they say.  I have also drawn their attention to OUR PETITION, which currently stands at just over 1,200 signatures.  It needs more!

In the meantime I do have a request:

If you have had negative experiences in public whilst breastfeeding, or if (perhaps as a result of misinformation in the press or from a medic) you have come under pressure to wean off the breast, I'd like to hear from you.  If you feel you have been marginalised or discriminated against because of breastfeeding I'd like to hear from you.  If you have experienced prejudice (perhaps at work) because of your decision to breastfeed, I'd like to hear from you. 

I'd like you to put a few words together (short is fine!) detailing your experience and send it to bcboobies@hotmail.co.uk


I won't be able to reply to you all (I know that for sure!) and I have no idea when or how these testimonies will come in useful, but I have a feeling that we are going to need a 'body of evidence' to show how this issue really affects breastfeeding mums and new mums in order to take the campaign forward.  I want to be able to prove - should it be necessary - that breastfeeding mums are a minority group who experience some marginalisation within our society.  I'm going to put the testimonies 'on file' to be used at some point in the future.  To understand why these testimonies might be important in bringing about change, take a look at this webpage under 'protecting the vulnerable'.  I consider breastfeeding mums (especially new ones!) and their babies to be extremely 'vulnerable'!


I don't believe we can tackle the huge amount of misinformation in the media by writing letters to the PCC and OFCOM.  The system itself needs to change.  It has changed before, and I hope it can again.

*please note, all bolds/ italics are mine.

3 comments:

  1. You are just amazing! I know how utterly draining complaining is - believe me, I've tried.

    What gets me is if this doctor had suggesting medicating unnecessarily with a drug with possible side effects, the fall out would be immense. But apparently, we are not allowed to point out that formula is an intervention in the normal physiology that carries proven and significant risks. All so we don't make women feel guilty?? Do I need to feel guilty for breaking my leg, or suffering from asthma? No. I need medical help, informaation and social support.

    I am fed up of being called the 'breastapo', 'tit nazi' and any other numbers of outrageous terms. As terms like this were applied to any other group, the proverbail would hit the fan!

    I sometimes wonder if we shouldn't sue for group defammation of character. Perhaps if they had the lawyers breathing down their necks, they might think before publishing abusive terms.

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  2. I think you have done extremely well to get the official correction printed that you did. If you look at the press more widely, even people who are at the wrong end of really serious misreporting of their situation are lucky to get that much of a correction printed - don't underestimate what you did achieve here!

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  3. You've done an amazing thing here. As Claire says, don't underestimate what you've achieved. It's incredible.

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