The Lady Garden

Tea and Strumpets

Since when does a guideline become a rigid rule?

Cross posted

More on breastfeeding, and how those silly naughty mothers are just wilfully doing the wrong thing. This time it’s an article in the NZ Herald, coming out of the “Growing up in New Zealand case study”: NZ mums ignoring breast feeding advice.

An official guideline that babies should be fed only breast milk for their first six months is being challenged after a study of almost 7000 babies found the vast majority of mothers ignore it.

The director of the study, Dr Susan Morton, runs through some of the reasons for many mothers not breast feeding exclusively for six months, including the pressures of work, and the reality that in our developed first world nation, the water supply is reliable. She points out that the directive for women to breast feed exclusively for six months sets many women up for failure.

That seems to me to be a useful way to reflect on the advice handed out so freely to new parents. Instead of always pushing the ideal, let’s think about the practical realities, and see if we can develop guidelines, and support to help parents to with achieving the goals of the guidelines.

But the Children’s Commissioner is having none of that.

But the Ministry of Health and Children’s Commissioner Dr Russell Wills are standing by the official guidelines. Dr Wills said Dr Morton’s comments reflected a classic “authority’s dilemma”.

“What should authorities advise when what good science says is best for baby is not what most parents do?” he asked.

“If you compromise and say that something is fine when it’s not, you are misrepresenting the science and selling parents short.”

Hmm… let’s focus on that word, “authorities”. Yes, people can be authorities, and experts in their field, and someone that other people turn to for advice. But the way that advice is translated into practice often turns into on-going policing of parents, and in particular, women, and instead of being a guideline, the advice becomes a rigid rule.

Let me tell you a story. When my younger daughters were tiny, my Plunket nurse kept up home visits for a long time. For people overseas, Plunket is a child-health service, designed to support new parents and babies and young children. In the first few weeks after your baby is born, a Plunket nurse will visit you in your home, and offer you advice and assistance.

My Plunket nurse was, for the most part, excellent. She was unintrusive, she quietly made some very helpful suggestions about how I could manage my infant twins, and she had her eye on my elder daughter too. Of course, I would find it all comparatively easy having a visiting nurse in my home, because I am white and middle-class, and any judgements she was making were likely to be positive. I felt assisted, not assessed.

But one thing puzzled me. By the time my little girls were about 18 months old, they were fully weaned, and drinking cows’ milk. Not a lot, because they weren’t big milk drinkers. One little girl was drinking about 400mls a day, and the other about 500mls. “You should really try to get them up to 600mls,” the Plunket nurse said. “That’s the official guideline.”

Then, “What about your elder daughter?” At that time she was aged about four, and she was drinking somewhere between 800mls and 1,000mls a day.

“Too much!” said the nurse. “She should only be drinking 600mls a day.”

So it turned out that in my Plunket nurse’s mind, what was supposed to be a guideline was in fact a rigid rule. Children should drink 600mls of milk a day, no more and no less.

This to me is a large part of the problem with the rules about breastfeeding. What is intended to be a guideline is interpreted as a rigid rule, with no flexibility for the needs of the individual baby, nor for women’s and families’ varying circumstances.

I think that the “authorities” need to engage a little more with the realities of women’s lives, instead of turning guidelines into hard and fast rules, and then wondering why women ignore them.

5 responses to “Since when does a guideline become a rigid rule?

  1. Emma March 25, 2012 at 2:41 pm

    I recently discovered that my partner and I had quite different views about the permeability of “guidelines”. Basically, he thought that if you allowed the rule to be broken once, it fell apart and ceased to exist. And I believe you can make any number of (sensible) exceptions, and the guideline still stands.

    Our son was definitely ready for solids before he was six months old. We probably waited a bit too long trying to get to the accepted Solids Commencement Date. I’m not sure why, with babies, it’s so hard to remember that all organisms of any species have natural variation and quite naturally develop at different rates. It’s like Plunket’s graphs: they want all kids to be on the Average. There are naturally children at the 95th percentiles, and that’s Just Fine. Certainly not worth making parents cry over.

    Also. Having worked in, basically, Comms and customer service for about a decade, if you’re failing to get your message across to your audience? That’s YOUR fault, not theirs.

  2. muerknz March 25, 2012 at 7:42 pm

    I think most healthy babies will tell you if they are ready for solids, if they watch you eat with a hawk-like gaze, start moving their mouth to copy yours and start grabbing for your fork, then they’re interested in solids. Has anyone else had this experience? Also I completely agree with Emma about natural variation, whilst I think having guidelines is a mostly good idea being too rigid with them doesn’t take variation into account.

    • Emma March 25, 2012 at 7:45 pm

      I saw it yesterday. An acquaintance’s baby, who was around six months, just stared at his mum the whole time she was eating with avid interest, leaning as far towards her as he could get. And yes, it was the food, not his mother.

    • hungrymamanz March 26, 2012 at 10:37 am

      I think this is true to a certain extent but the difference between a baby who is generally interested in what is happening and one who is really ready for food can be quite subtle and a parent who is excited about starting solids or feeling pressure about it could quite easily mistake one for the other.

      I think we run into difficulty when we present these sort of guidelines as a number without also telling parents of the science behind the recommendation and the constellation of signs which show a baby is ready. A baby who is six months old might be ready – one who is eyeing mum’s plate, sitting easily, hungrier than previously and has no tongue-thrust reflex almost definitely is.

  3. andie March 26, 2012 at 5:44 am

    I alway thought a guideline was a “rough idea” so that people aren’t trying to give three week old babies solids and such.

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