Women must be given full support, regardless of whether they choose to breastfeed their babies or not, writes Marian Carroll.

Any discussion around infant feeding evokes strong reactions in people who seem to take a 'for or against' approach to breastfeeding.

But in the last month, we have seen an escalation of these exchanges in the national media to the point where one side is almost hurling abuse and outrage at the other.

Ironically, the heat of that exchange is far removed from the common ground, which both sides share - a position that allows mothers to make an informed choice about how to feed their baby while offering support in their decision.

As healthcare providers, we must play a leading role in making this a reality. Hospitals should have a no-blame policy, where it is OK for a woman to stop breastfeeding (or not start) as long as she has been offered the information and support needed to succeed.

Feeding rates

But while some commentators have suggested that there is too much pressure on women to breastfeed, we must not forget that most women say they gave up breastfeeding before they wanted to (90 per cent of those who gave up in the first six weeks), usually because of problems that could have been easily overcome if they had had skilled help in the early days.

I am the director of nursing for the largest NHS trust in the North West, and we run four hospitals. Breastfeeding rates were low in 1994 when work at the Royal Oldham Hospital began to implement UNICEF's baby-friendly initiative - the only structured programme that has been independently shown to increase breastfeeding rates.

At that time, only 29 per cent of women started breastfeeding (compared to a national average of 68 per cent) and almost everybody stopped before they left the maternity unit. Now, as a fully accredited baby-friendly unit, 64 per cent of mothers have started breastfeeding, with 40 per cent still going at one month.

A similar story occurred at North Manchester General Hospital, which is now also fully baby-friendly accredited, with rates rising from 29 per cent in 1999 to 61 per cent in 2006.

Our hospitals serve some of the most deprived areas in the country, with some of the greatest health challenges. The women choosing to breastfeed are doing so because they have weighed up the situation and made their own decision. Equally, so have those women who choose to bottle-feed.

Baby-friendly initiative

It has been one year since the National Institute for Health and Clinical Excellence issued postnatal care guidelines recommending that all maternity units should implement the baby-friendly initiative.

In August, UNICEF UK released figures showing how many hospitals in England have yet to heed that guidance. The charity is also writing to all NHS chief executives urging them to ensure full compliance.

The philosophy behind the baby-friendly initiative is to put the decision about whether to breastfeed or not back into the hands of the mother and - crucially - to ensure that staff are able to support her in successfully carrying out her decision.

She should be told about the health benefits of breastfeeding in an appropriate, non-pressurised way and, once her baby is born, given the opportunity to breastfeed as soon as possible. If she chooses to bottle-feed she should be shown how to safely make up a bottle on a one-to-one basis.

All midwives must be trained in how to help a mother breastfeed so that mothers who choose to breastfeed can do so for as long as they wish.

In my trust, we need to continue to foster a climate of support for mothers. Our two remaining hospitals are now working towards full accreditation.

In the meantime, we should trust women to make their own choices and support and respect those decisions.