The World Health Organisation (WHO) and UNICEF set out objectives in their Global Strategy for Infants and Young Children Feeding, which have been adopted into UK policy. These highlight the need ‘to create an environment that will enable mothers, families and other caregivers in all circumstances to make and implement informed choices about optimal feeding practices for infants and young children’

Taking an 'informed choice' approach to decision making around the long and short term health and happiness of a child, means that families are engaged to make knowledgeable decisions, which may reflect their own culture, values and views. It is based on access to comprehensive, unbiased and evidence-based information, about their full range of options. Without access to impartial information, this process is not possible.

Parents and parents-to-be quite often want and need more information than they are given by health care professionals (HCPs). In pre-natal care, HCPs generally have a strong commitment to giving information but opportunities are rarely maximised - sometimes because of a lack of knowledge of the topic, sometimes because the HCPs feel they are restricted from discussing certain topics because they are supposed to encourage breastfeeding, but most often because of a lack of time and capacity. This has proved to be particularly true for disadvantaged women. Information flow is reported to be most effective when there was a relationship of trust between a pregnant or newly delivered woman and her HCP; however, constraints within the maternity care system often serve to prevent such relationships. Without that trust, there are likely to be fewer requests for information, and less opportunities for decision making with the end result likely to be the mother's initial compliance with the 'right' choices but little 'buying in' to that choice.

Because there are limited opportunities for discussion, health care professionals may stereotype women, making assumptions about their information needs. Fear of litigation is also common amongst all professional groups: this results in a tendency for health care professionals to 'steer' women towards making decisions which are seen as the 'right' choice, or will, for example in infant feeding, help the area achieve a target of higher breastfeeding initiation. Such decisions ensure informed compliance rather than informed choice, and mean that the newly delivered mother might have no personal reason to continue breastfeeding past the time of discharge from hospital - once she is out of sight of the midwives who have ensured her compliance. A mother who has chosen to formula feed might equally not have any reason to maintain the pretence of making up bottles in the safest manner possible, if she does not understand what the risks of making up bottles without following the guidelines may be, or understand the guidelines themselves.

Without knowing and understanding the benefits or drawbacks of a given course of action, which is information which should be impartially given and based on research and evidence rather than anecdote and marketing, how are parents to make these choices? And in something so important to the health of the infant as the manner in which they derive their nutrition and health for the first 12 months of their life, informed choice is particularly crucial.

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Guilt is a big factor in being a parent: and informed choice is the best way to get over it. By making sure that you are doing the best that you can, in your circumstances, for your family, you can let go of the guilt.

Guilt is a state in which one experiences conflict at having done something that one believes one should not have done: it gives rise to a feeling which does not go away easily, driven by conscience. It is really something we feel when we know we've done something deliberately wrong, and this doesn't usually apply to infant feeding, when most parents work out what's likely to be best for them and their baby in their own particular circumstances. For example, if breastfeeding didn't work out well with an existing child, understanding what happened can help, as can considering where you might get support if there's a next time with another baby.

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