Absolutes rarely apply to real life. At medical school we were taught the phrase “Always is always wrong, and never is never right”.

Yet despite such sound advice, auspicious health bodies around the globe insist on promoting the concept of “breast is best” to a level where it has become akin to religious dogma and questioning it equivalent to heresy.

Exclusive breastfeeding is advocated for at least the first six months of life, yet by this time less than one per cent of UK mums are doing so. Does this make them bad mothers? Certainly not. Have the benefits of breastfeeding been overplayed? More than likely.

Breastfeeding wasn’t always heavily promoted. For those born in the 1950s-60s, formula feeding was greatly encouraged, with messages that breastfeeding was old fashioned and perhaps even demeaning. Yet this changed around the 1990s and since then there has been a significant drive toward everyone breastfeeding.

Studies have gone to task regarding the supposed benefits, short and long term, for baby and mother, such that you could be convinced that not breastfeeding is denying your child the best start in life. Indeed, I expect that is how many new mums feel when confronted by a plethora of information, much of it biased.

Firstly, data looking at breastfeeding versus bottle feeding is observational. This means at best it can demonstrate an association between a feeding decision and an outcome, but not cause and effect. Women cannot and will not be randomised to a feeding method, the gold standard for conducting research, because it is such a personal choice.

Secondly, the presentation of statistics may be confusing. It is often said that breastfeeding leads to fewer admissions for chest infections and diarrhoeal illnesses in the first months. Yet figures show that for 2,000 infants in the first eight months, four bottle fed babies are hospitalised with an acute diarrhoeal illness, against one breast-fed baby. For chest infections, the numbers are 10 admissions in the bottle-fed group, six in those breast-fed.

Perhaps the biggest over-egging of the pudding is the claim that breastfeeding results in higher IQs. It was argued that breastfeeding resulted in a four-point higher IQ. Yet we know that breastfeeding mums tend to be older and from a higher socioeconomic status.

A sibling study, directly comparing children in the same household and hence removing all confounding factors, showed that an infant who was breast-fed had an IQ less than half a point greater than one who was bottle-fed, a negligible difference.

In terms of long-term benefits of breastfeeding, argued to include lower levels of cholesterol, diabetes, risk of heart disease and cancer, both for mother and baby, again the evidence is not strong enough to argue breastfeeding is a cause of reduced ill health.

Aspects of breastfeeding not often discussed are that it is incredibly hard work when a woman is already at a point of great emotional vulnerability, that it is not just a case of latching on, and that if breastfeeding is pursued exclusively yet is not working, there are significant risks to the child.

The post-partum period is associated with significant anxiety for some, and the thought of having the entire responsibility of feeding an infant by your own body when you may be in pain and more than likely are sleep-deprived, is a factor in the development of post-natal depression. Around one in seven women are not able to produce enough milk to sustain an infant’s growth. If a baby is dehydrated because they are solely but inadequately breastfed, this can lead to life-threatening dehydration and imbalances in blood salts.

There are also numerous conditions which make breastfeeding difficult, less suitable or even a definite no.

The children of the 1950s and 60s have not suffered from being bottle-fed, and if you were to walk into a nursery today, you couldn’t identify which toddlers had been breast-fed, and those given a bottle.

No one can deny the benefits of breastfeeding, but arguments that it is ‘the best’, or the ‘natural’ way do little to advance sensible discussion, or allow new mothers to make an informed decision.

Choosing not to breastfeed, or indeed commencing and then switching to formula, is not a ‘failure to breastfeed’, and all mothers and babies should be supported as their needs require, without judgement, to truly give the best start in life.

@AskDoctorZak www.doctorzak.co.uk askdoctorzak@gmail.com