Admission of Failure? What rising neonatal admissions reveal about the evidence, safety and ethics of infant feeding
#AdmissionOfFailure
“She was just underfed. My body had not produced enough milk and those who were supposed to support me were unable to spot this despite multiple obvious signs.”
Emergency hospital admissions of babies under 14 days old in England have risen by around 60% in just over a decade. Hospital episodes for newborns admitted from home with jaundice as the main reason have more than tripled since 2008, even allowing for fewer births. Inadequate milk intake in the early days of breastfeeding is a recognised contributor to jaundice, dehydration and hypoglycaemia. Yet no national body has examined how often feeding difficulties lie behind these admissions, how many could be prevented, or whether current infant feeding policy is keeping babies safe.
At the same time, more women than ever have recognised risk factors for delayed milk production: older maternal age, caesarean birth, diabetes and significant blood loss. Many go home before their milk comes in. And NHS infant feeding policy, heavily shaped by the UNICEF Baby Friendly Initiative, measures success by breastfeeding and supplementation rates rather than by the health of women and babies.
Our report, Admission of Failure?, brings together national admissions data, the latest evidence on delayed milk production, a review of NHS guidance, the findings of the Ockenden review in Nottingham and the testimony of more than 830 women across the UK. It concludes that infant feeding policy must be judged by what it achieves for women and babies, and that at present, this is not being measured.
We extend our deepest thanks to the women who generously shared their experiences with us. Many of the stories told were deeply personal and clearly difficult to revisit. We are profoundly grateful for their honesty, courage, and trust. Their voices bring truth, insight, and the power to inspire change.
Every woman deserves the information she needs to make informed feeding decisions before her baby is born.
Summary of Findings
The report finds that current NHS infant feeding policy:
Coincides with sharply rising neonatal admissions
A national analysis found that most of the rise in infant admissions up to 2014 occurred in the first week of life and was accounted for by potentially avoidable conditions, especially jaundice and feeding difficulties. Admissions have kept rising since. Some of the increase may reflect changes in clinical practice, but no one has investigated how much is driven by inadequate milk intake.
Has not kept pace with today’s mothers
Women are older, caesarean births have risen from 26.5% to 45% of deliveries in a decade, and diabetes is more common. Many more women have risk factors for delayed milk production, yet NHS information still calls genuinely insufficient milk “very rare”.
Measures breastfeeding, not health
Baby Friendly accreditation expects services to reduce formula supplementation, but neonatal readmissions are not a specified outcome of its audit. A Public Health England-funded overview found minimal evidence that accreditation improves maternal and infant health.
Turns “informed choice” into a list of risks
NHS trust guidance warns women against supplementation even when babies have not fed, with claims about diabetes, weight loss and the infant gut that are contested or unsupported by trial evidence. One trust reviews staff training if more than 10% of mothers audited gave supplements.
Has been called into question by Ockenden
The independent review of maternity services in Nottingham documented failures to recognise feeding difficulties, severe weight loss and hypoglycaemia, and recommended a national review of “reluctant feeder” guidance.
Leaves women without meaningful choice
Breastfeeding is promoted proactively while formula and combination feeding information is held back until women ask or need it. The gap is filled by formula marketing, and the CMA found guilt pushes parents towards more expensive brands.
Our position
Feed supports every woman who wants to breastfeed, and we want the support available to her to be far better than it currently is. Breastfeeding can have real benefits for women and babies, and nothing in this report suggests otherwise.
This report does not argue that women should be steered towards formula, or that women who want to breastfeed should receive any less than optimum support to achieve that. Nor does it claim that infant feeding policy is the sole cause of rising neonatal admissions.
What it does argue is that infant feeding policy should be judged by its effects on the health and wellbeing of women and babies, rather than by breastfeeding rates alone; that every woman is entitled to balanced information about all the ways she might feed her baby; and that the evidence raises questions requiring urgent, independent investigation.
Key Recommendations
The forthcoming National Maternity and Neonatal Action Plan is an immediate opportunity to act. Feed calls on the UK, Scottish and Welsh Governments and the Northern Ireland Executive to:
1
Guarantee informed choice
Proactive, balanced information on breastfeeding, formula and combination feeding for every woman, with risks and benefits in absolute terms. NICE should revise its postnatal care guideline so this is offered to all women, and every woman should know how to recognise inadequate milk intake.
2
Measure health, not breastfeeding rates
Judge infant feeding care on infant nutrition, neonatal illness and readmissions, women’s wellbeing and the quality of decision-making. Investigate rising neonatal admissions in every UK nation, starting by recording feeding method and weight loss at readmission.
3
Commission an urgent, independent review
Examine the evidence behind current guidance, including Baby Friendly accreditation. Pending the review, withdraw NHS England’s March 2027 accreditation target and suspend requirements to reduce supplementation, and act now on Ockenden’s call to review reluctant-feeder guidelines.
4
Protect families from formula marketing
Implement the Competition and Markets Authority’s recommendations without further delay, and give every woman impartial, brand-neutral NHS information on formula feeding, including that all infant formula meeting UK regulatory requirements meets babies’ nutritional needs regardless of price.
In women’s words
What the evidence shows
Babies are being readmitted for problems that start with feeding
In 2024, jaundice was the primary diagnosis in 26,348 hospital episodes involving babies aged 14 days or under who had been discharged home, compared with 8,773 in 2008. Feeding problems were recorded as a primary or secondary diagnosis in 12,535 episodes. Most babies with jaundice recover fully, but readmission can mean repeated blood tests, separation from their mother and invasive investigations, and severe cases can cause permanent brain injury.
“I was not told that insufficient breastfeeding causes jaundice and dehydration and could result in my baby being hospitalised... which is what happened. I was not told this was a risk associated with exclusive breastfeeding. Even when my baby lost 16% birth weight I was told breast is best […]. I was happy to use formula and extremely angry that I was discouraged from doing so until [my] baby was [at] risk for brain damage from inadequate milk intake.”Rebecca*
Women at risk of delayed milk are not being told
A 2026 meta-analysis of more than 39,000 women found that delayed onset of milk production affected around 30% of participants. Women aged 35 and over had more than twice the odds, and caesarean birth raised the odds by half. Delayed milk usually resolves, but it happens in exactly the window when most of the rise in readmissions has occurred, and increasingly after women have gone home.
“I had a planned section and wasn't told my milk could be quite delayed coming in. In the end we ended up in a&e with a very unhappy 4 day old and no clue what to do.”Imani*
Staff feel unable to mention formula
Staffing pressures and early discharge play a part, but they do not explain why staff who were present felt unable to raise supplementation. Women describe midwives who said they were not allowed to suggest formula, or who offered advice only unofficially. That is a consequence of policy, and it is the part of the problem policy can change.
“At shift change another midwife then said to me ‘if you want to get out of here you need to ask me about formula or expressing, I can’t suggest it to you it has to be your decision’.”Eliza*
Information that exists is not information received
The NHS does publish guidance on making up feeds, and Baby Friendly requires services to support formula feeding safely. But NICE’s own evidence review found women wanted information on both feeding methods during pregnancy, and its committee still concluded it would not be “feasible or practical” to give formula information to women not already considering it. By six weeks, more than half of babies in England are no longer exclusively breastfed.
“I went to an NHS antenatal course specifically to learn about combi feeding and how best to achieve it. They told us all about breastfeeding but when I asked about formula feeding and combi feeding I was told they weren’t allowed to tell us anything about it.”Laura*
It can be done differently
Some women described care in which their wishes, breastfeeding support and appropriate supplementation were treated as compatible rather than in competition.
“[…] When however, my baby required additional support, they asked my permission to give formula top ups and stressed how important these were, whilst also ensuring that I was able to return to EBF once my baby’s condition had improved.”Lucy*
Infant feeding policy should be judged by what it achieves for the health and wellbeing of women and babies, not simply by how many mothers breastfeed.
*Names have been changed. Unless stated, women’s accounts come from a survey of more than 830 women across the UK carried out by Feed with The Lowdown in March 2025. Feed is run by volunteers and accepts no funding from any company that profits from infant feeding.