The censorship of this picture of All Black Piri Weepu bottle-feeding his daughter Taylor has stirred up a storm. And first-time parents discover that it isn’t the only no-no. Kathryn Powley investigates the tyranny of childbirth

As wide-eyed parents-to-be, Lydia and Matthew Whitehead enrolled in that ritual of Kiwi parenthood - antenatal classes. They joined a bunch of other expectant mums and dads eager to learn more about the mysterious, exciting and down-right scary months ahead. They went in knowing nothing and came out with one thing clear in their heads: natural is best. Painkillers during birth? Avoid. Epidurals? No way. Caesarean? Dirty word. Bottle-feeding? Not even mentioned. Pressure to conform? You bet. Not even All Black hero Piri Weepu can escape the force of conviction that goes with that all powerful unwritten rule: if you don't do what's "natural" then somehow you're a bad parent.

Weepu has unwittingly ignited an inferno by the seemingly innocent and loving act of feeding his daughter a bottle of milk. A clip of that moment was deemed too damaging to the breast-feeding "lactivists", the La Leche League and Plunket. That image has been talked about all week but, till now, has not been published. Today, the Herald on Sunday publishes the image at the top of this page. For the La Leche League, it will confirm all its worst fears. It shows a gorgeous, healthy baby girl in the embrace of a loving dad. To La Leche, this image glorifies bottle-feeding.

We, the public, were deemed too silly to watch the clip in an anti-smoking ad without wanting to make a beeline to the nearest supermarket to stock up on evil baby formula. New parents hear repeatedly that "the choice is yours" - if they use painkillers in labour; if they have a caesarean section; if they bottlefeed. But the reality can be a little different. The reality is that a woman can choose how she gives birth and feeds her baby - but there is enormous medical and social pressure to make"the right choice".

As it happens, the tiny sleeping baby cradled in Matthew White head's armswould have done the antenatal class teachers proud with the way he entered the world this week, weighing 3655 grams. Asher Eden Whitehead, a little brother for 3½-year-old Jayden, was born at Birthcare after a five-hour labour. "We were lucky because we only used gas, so it was great," says mum, Lydia, 34. Her sister said to her, "'You're so lucky. I had to have a caesar.' It was almost like she thought her birth was inferior to mine because she had a caesarean. But if you can get a baby out, that's all that matters," Lydia says. Matthew, 35, says there's a strong "undercurrent" promoting all things natural in antenatal classes - so it's hardly surprising Lydia's sister felt that way.

One mum told the Herald on Sunday she received condolences after having a caesarean. "Congratulations on the arrival of your baby boy", the card said on the outside, but inside the sender had written "Sorry to hear about the birth".

It's not that the Whiteheads are opposed to the"natural"way. In fact Lydia has gone to considerable lengths in the name of breast-feeding. When Jayden was 5 months old she returned to work but, instead of putting him on formula, she opted to express milk at work. She would dutifully cart bottles, sterilising equipment and a breast pump to work at one of New Zealand's biggest companies, head for a private room every three hours, produce milk and set it in a fridge alongside other people's lunches. Some colleagues were good about it, others thought she was unfairly getting extra long lunch breaks, and some complained about the whirring from the pump putting them off their work. She laughs now. "It's crazy. How did I ever do that? I have no idea." The answer is because she could, because she knows breast is best and because she loves her son.

But does that mean bottlefeeding mums don't love theirs? Not a chance. One mum, Kelly Wynn, tried for two weeks to breastfeed only to find that her baby girl had an undiagnosed cleft palate. The"breast is best" message had got through loud and clear, but the hole in her baby's mouth meant she simply couldn't suck. And Wynn had already been through hell. She'd been desperate to have a "natural" or vaginal birth and felt gutted when told, after four days of labour, that she would need a caesarean. Antenatal classes had convinced her that natural birth was best, but it was ultimately her midwife's decision to keep her home for "three fricken' days".

By the time the baby arrived Wynn was exhausted, so she and her husband were beside themselves when their newborn baby didn't suck and nobody seemed able to figure out why. Worried her baby was starving, Wynn asked for formula and although she managed to get the baby to drink a few millilitres, was left with the impression that she would never succeed if she gave formula.The frantic parents persisted, feeding expressed milk by teaspoon and tiny amounts by breast until, on day 12, they noticed the hole.

The midwife, who then realised what was wrong, arranged a specially designed bottle and life changed for the better immediately. Even so,Wynn felt a failure and says the experience left her traumatised for a couple of years. But she had another daughter, whom she breast-fed until 3 months, supplemented by a bottle of formula given by her husband every night. "It allowed me to have a decent amountof sleep.Heloveditandlooked forward to it. It was his quiet time withher and nothing can compare to that."

Sonia Grey, mother of twins Thandie and Inez who turn 3 in March, believes most pressure on mums and dads comes from wanting our peers to think we're doing a great job. But sometimes a comment from a stranger can be cutting. She will never forget the woman who approached her out of the blue in a cafe and said, "You've got to get rid of that dummy, it's addictive, bury it." Gray, 38, walked off, shaking her head but couldn't help being upset. "In the end," says Gray, "you have to stick to what you feel is important because most of it is out of your control."

The Big Wednesday TV host is a former breast-feeding ambassador for the Ministry of Health. "I do believe in it," she says. "I wanted to encourage people to do it, but you should do whatever gets you through." Every mum, every dad, wants to be the best parent they can to their tiny, vulnerable infant. But they also want family, friends and neighbours to recognise what a good job they're doing, she says. And that's the crux of it: it is at the most vulnerable times in our lives that we're most malleable, most open to suggestion and peer pressure.

Many mothers aspire to a "natural birth" - whatever that is. There is no correct answer. Student midwives are asked to write essays on the meaning of natural childbirth. According to Sam Thurlby-Brooks, a doula (birthing partner) with Joyful Childbirth in Auckland's Mt Roskill, "natural birth" means no painkillers, no epidural, no medical intervention whatsoever. With the changing funding structures and politics of childbirth, about 75 per cent of women choose a midwife as their publicly-funded lead maternity carer, according to the NZ College of Midwives.

The College standards for practice state: "The midwife upholds each woman's right to free and informed choice and consent throughout the childbirth experience." The College also boasts: "Midwifery care results in less chance of complications, fewer interventions and healthier births for themselves and their babies." The question is what happens when freedom of choice and "natural childbirth" collide? What happens when the mother-to-be asks for nitrous oxide gas, then a pethidine injection, then an epidural? What happens if she wants a caesarean?

Statistics provided under the Official Information Act reveal that the likelihood a mum will have a caesarean varies depending on where she gives birth. In Auckland, one in three mums is given a caesarean; in Counties Manukau or up in Northland, fewer than one in five is given a caesarean. Then, when mother and baby are recovered from the birth for the baby's first feed, it is made abundantly clear that breast is best-whatever the mother's inclination. It was only through sheer determination that Gray managed to breastfeed her twins. She persisted through four bouts of mastitis and having to express until the girls, who were born at 34 weeks, were 4 months old and able to feed properly. "Sometimes it's worth persevering but don't feel bad if you don't do it," Gray says. "Being a parent is the most wonderful thing you can do, but it's also the toughest."

That's something brand new parents Eliza and Jeff Davenport are finding out. Their daughter Addison Rose was born in Auckland City Hospital at 10pm on Waitangi Day, weighing 2800 grams. They loved their antenatal classes, and Eliza, 37, was intending to have a "natural birth" with pethidine and gas. Then came the induction. Doctors were worried Addison had stopped growing; Eliza, a nurse, and Jeff, an engineer, were happy to take their guidance. But the medication brought on severe contractions. "I couldn't even swear I was in so much pain," she says. It caught her by surprise and she knew she needed an epidural, which she received with relief within 20 minutes. But resting in Birthcare a few days later, Eliza feels disappointed in herself and worries her pain threshold isn't as high as she expected. Yet she doesn't want to go back. Natural or not, she'll definitely have an epidural next time round.

Perhaps it's time new parents took a deep breath and tried to relax and shrug off that pressure to be natural and perfect. Pat Tuohy, the Ministry of Health's chief adviser on child and youth health, certainly thinks so. "Just because a couple decide to bottle-feed their baby doesn't mean they can't be fantastic parents. Even if you get an F in bottle-feeding you still get an A in parenthood." There is clear evidence that breastfeeding gives mums and babies extra nutrients and antibodies, but Tuohy says it's not the end of the world if theywind up formula-feeding. He says every health professional in the neo-natal field has to be an expert in feeding babies, no matter how they're fed.

Of course, they always encourage woman to choose breast first. "But no hospital is going to let a baby starve or a mother remain in pain from some slavish adherence to breast-feeding." Before her milk came, Lydia Whitehead tried her darndest to express enough to feed baby Asher. Her and Matt's families live out of Auckland but thankfully they have an incredible friend network for support.

They also find the Plunket helpline and support from their midwife and Birthcare invaluable. It seems weird to Lydia that in her mum's generation, babies were taken away at night so new mothers could rest while nurses fed the newborns formula. "I'm not saying that's right at all,but we all survived, we're all healthy, and the difference between doing that and the amount of time and stress and pain that they're expecting now for a millilitre or half-a-millilitre, I find really interesting."

Postcode lottery of childbirth

Three out of four women who go to Auckland City Hospital to give birth get painkillers so strong they barely feel a thing or are wheeled into surgery for a caesarean section. In Counties Manukau, only one-third of labouring mothers were given an epidural for pain relief and 20 per cent of births were by caesarean. The numbers are even lower in the provinces. Auckland City Hospital women's health general manager Kirsty Walsh says just 7 per cent of caesareans at the hospital are non-medical and requested by the mother.

But Northland District Health Board clinical director of midwifery Dr Roger Tuck regards the Auckland rate as very high. "Without being too politically incorrect, the women here view the world differently from an Auckland lawyer who's having her first baby at the age of 35," he says. If a woman requests an epidural in Northland she is given one - but the drug can only be administered at Whangarei Hospital and Tuck says many women opt to be closer to home instead.

Mother-of-two Anna May has given birth once in hospital and once at home. For her first, she was given an epidural to control her blood pressure, then needed a last-minute caesarean. "In a big hospital, it becomes a cascade of intervention. It's one thing after the next," she says. When her next baby came along 18 months later, May was determined to have a natural birth, without any drugs. "There's a whole lot of fear around birth, but our bodies are made to do it. I think if you're given the right information you'd generally choose to have a natural birth."

But Eliza Davenport, who gave birth to daughter Addison in Auckland Hospital this week, says she was glad to get an epidural when she asked for it. "They probably saw I was in severe pain and I needed help," she says. "It was like having a leg chopped off. When I asked, they came within 20 minutes and it was like a godsend." Royal Australian and New Zealand College of Obstetricians spokeswoman Dr Emma Parry says fewer than one in a million women suffer permanent disability from epidural, but caesareans are more troublesome.

-Celeste Gorrell Anstiss