Published: 26/05/2005, Volume II5, No. 5957 Page 19

I have watched Breastfeeding Awareness Week come and go with great sadness. Breastfeeding mothers are not increasing at the hoped for rate, and now the pressure is really on.

I read countless articles promoting breastfeeding as the one and only way a good mother feeds her brand new baby.

I consulted the Department of Health's breastfeeding website with its 'It makes you feel so special', 'It just feels like the right thing to do', and 'I do not think either of us realised how great it would be' banners.

I admired its row upon row of photos of women beaming beatifically as their babies sucked.

Then I looked for the DoH's advice on bottle feeding. There were no smiling women there. The emphasis in the literature for the bottle-fed baby is not on joy and fulfilment, but on safety and sterilisation. The only pictures I could find were of bottles being scrubbed.

is not this the same department that is promoting patient choice?

The same department that promised in its election manifesto that by 2009 all women will have a choice over where and how they have their baby and what pain relief they use?

But when it comes to a highly politicised area such as breastfeeding, any notion of real choice is dismissed.

I do not dispute that breastfeeding brings benefits to mother and baby (although many claims, such as increasing the future child's IQ, are either exaggerated or unproven). But I can also see many reasons why a woman may choose formula instead.

Other adults, particularly partners, can take turns in feeding the child and develop a close relationship with them. The mother can take a break from childcare, and return a refreshed and possibly better parent.

Some women may even find breastfeeding so difficult and uncomfortable that all the tender bonding it is supposed to arouse is completely absent and it becomes, quite literally, a pain.

In particular, I can see why many women might, if they were given a real choice and not hounded by the 'breast is best' mantra, choose a combination of breastfeeding and formula. But in all the breastfeeding awareness literature, giving a bottle as well as a breast is considered almost as wicked as formula alone.

My own attempts to mix feed were thoroughly disapproved of in the maternity ward. When I had my twins, the girl took to the breast immediately while the boy, a string bean of a baby, would not breastfeed at all.

Naturally, I was concerned to get some food into him. But the stream of midwives, about whom DoH literature boasts - 'whatever you decide, the midwives are there to help you' - insisted that if I gave him the demon bottle in his first few hours he would be forever condemned to refusing the breast.

I was made to feel as if giving him milk made from powder would be tantamount to poisoning him.

After 24 sleepless hours of putting him to the breast with no success, the midwives agreed I could at least cup feed; a cup would not ruin him like a bottle would. But his tiny mouth just grazed the edge of the plastic beaker. Now I realise how ridiculous and dogma-driven this was; no newborn can drink from a cup.

I was told I could not be discharged until my baby's feeding was 'established', by which they meant he was being breastfed. The policy seemed to be to starve him into submission to the breast. My requests to try a more lenient approach led to me being branded a failing mother.

It was recorded in my notes: 'Seems not to be bonding with boy twin, favouring girl'. This was a judgement based only on dogma, not a considered clinical assessment.

The reason I was thought to be rejecting him was because he would not breastfeed.

For his first 48 hours in this world, my poor boy starved. Neither I, nor he, were being given any real choice at all. Eventually, his father went out, bought a bottle and defiantly put the teat between his lips. The baby boy took it immediately. We went home the next day. The day after, he started to breastfeed.

My last impression as I fled from the maternity ward was watching another new mother of twins in the bed opposite being berated for stating right from the start that she was going to bottle feed. Her decision was continually challenged.

She was a rational adult who had made an informed choice, yet she was treated as a recalcitrant child.

Four months later, exhausted by two babies, I gave up breastfeeding.

According to the DoH, that was two months too early.

Could I have been better informed or better supported to carry on? No.

All the professionals I came across - from midwife to health visitor - thrust a breastfeeding brochure in my hand and insisted breast was exclusively best. But I still chose to stop.

The campaign to promote breastfeeding is not working. This is not because new mothers are not aware of the benefits, do not have the necessary support, are economically deprived, or are simply too lazy, but because many of us simply do not want to only breastfeed for a full six months.

The important point is not which choice women make, but that their choice is respected whatever it is.

If a woman, with all the breastfeeding leaflets spread out before her, still chooses to use a bottle, then do not treat her as if she is stupid or selfish or both. She is not.

She is exercising that very ability that the government wants to promote - informed patient choice.

It just happens that she may not be making the choice many in the health service want her to. .

Dea Birkett is a writer on health and social care issues. She can be contacted through www. deabirkett. com.

Dea's next column will be published on 30 June. Next week's columnist is Simon Stevens, president of UnitedHealth Europe and the government's health adviser between 1997 and 2004.