Successful breastfeeding: is culture more important than knowledge?

A few days ago I posted about Sammy Wilson’s negative breastfeeding comments.  It must have struck a nerve because it was my most liked and shared post to date, so  I thought I’d follow it up with a more in-depth blog about breastfeeding. 

As I said in that post, breastfeeding is not something that is seen frequently in public in Northern Ireland, mostly because of our low breastfeeding rates.  A lot more women are initiating breastfeeding than ever before but the drop off rate is quite steep, so that by six months only around 1% of women are exclusively breastfeeding here in Northern Ireland (recommendations are to breastfeed exclusively for six months and then to breastfeed for as long as mum and baby want to, as well as introducing solids)1.  Presumably, if a large proportion of women started off breastfeeding, then some of those women must have stopped before they wanted to.  I think that a lot of this is due to a lack of breastfeeding culture in N Ireland.  Lack of adequate support is another reason, but I’ll cover that in my next blog.

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I think as health professionals we often get the focus of our breastfeeding promotion wrong.  Our breastfeeding advice consists of telling women about the benefits of breastfeeding and then telling them how natural it is and how much easier than bottlefeeding it is because they don’t have to make up bottles which is great at night time.  While all of this is true and may increase initiation rates it doesn’t really do much to help sustain breastfeeding.  I genuinely don’t think it’s enough to tell women the benefits of breastfeeding as this doesn’t equip women with the skills and confidence to breastfeed.  We have to acknowledge that we are a nation of bottlefeeders.  Our culture is predominantly bottlefeeding, it’s what feels safe and what we know.  We can’t really expect to change our culture to one of breastfeeding unless we look first at our expectations of babies, which has been influenced by the behaviour of bottlefed babies. 

So… what do we expect from babies?  Well, we’re used to a baby bottlefeeding every 3-4 hours, staying settled in between feeds and generally, achieving that holy grail of sleeping through the night as soon as possible.  If that is all you know, if that is all your family know, and you decide to breastfeed, it is more than likely that you find yourself with a baby who is 2 days old who wants to feed every hour (including night time) and basically won’t settle unless he is in your arms or attached to your breast.  It’s not surprising that your mum (who only bottlefed) will start to worry and say things like “I don’t think you have enough milk” and “I think he needs a bottle”.  And when you are tired and vulnerable and worrying about whether breastfeeding is working, it’s very easy to reach for a bottle, isn’t it?

We need to go back and understand that breastfeeding is the biological normal for babies, so the pattern that breastfeeding babies exhibit is the normal and the bottlefeeding pattern isn’t.  So a normal pattern for a breastfeeding baby would be to feed fairly infrequently in the first 24 hours (you may even have to encourage baby to feed).  Then at 24 hours they often “wake up” and often will feed very frequently (1-2 hourly is not unusual) until your milk comes in around day 3.  Thereafter, feedings may become more spaced out but it is very unlikely that they will go 3-4 hours between feeds, and they almost certainly will want to feed a few times overnight.

Not only do we NOT understand what normal behaviour is for babies, as a midwife I often see normal baby behaviour being blamed on breastfeeding.  For example, if a breastfeeding baby is unsettled or windy in the evening (which is very common in babies up to around the age of 8 weeks) often it will be seen as a result of breastfeeding.  I rarely see the mother of an unsettled or windy bottlefed baby blame formula.  Likewise, if a baby wakes frequently at night, often it is breastfeeding that is blamed, even though bottlefeeding babies wake just as frequently as breastfeeding babies.  Incidentally, it isn’t normal for babies to sleep through the night, this is another unrealistic expectation we have of babies.  Frequent night wakenings are normal, and can actually help protect against the risk of SIDS.  However, the point I’m trying to make is that because we have a culture of bottlefeeding, breastfeeding can feel scary and worrying and we tend not to “trust” it as much as bottlefeeding.

Breastfeeding in the first few weeks can be REALLY HARD.  I think as midwives we often gloss over how hard it can be because we want women to at least try.  But we aren’t realistic either.  We don’t tell women that it might be uncomfortable (if it’s painful, you definitely need expert help), that it’s a skill that has to be learned (even trying to work out where to put your hands is tricky), that babies are going to be feeding pretty much constantly and that mums will be lucky to get more than 2 hours of sleep at a time.  It does get a lot better and a lot easier, but in those first few weeks you’re also completely overwhelmed by EVERYTHING that is new about having a baby, you’re recovering from a birth and you’re entertaining a million visitors a day who expect you to give them tea and biscuits.  On top of this, you maybe feel the pressure to keep the house clean and tidy, and “get back to normal” as quick as possible. 

If you can, think of your breastfeeding sessions as nature’s way of telling you to put your feet up and rest.  Get comfortable.  Make sure that you have plenty of water (or juice or tea) to sip on, some snacks, the remote control or your phone next to you, and take advantage of the fact that you really can’t do anything else while feeding.  Use it to rest and recover, and enlist friends and family to tidy up, do the dishes, cook you meals and do the laundry, or hire a postnatal doula to help practically.  Lots of frequent feeding in the early weeks will set you up with a great milk supply and eventually you’ll notice you feed for a lot less time and with much bigger gaps between feeds.  Are the night feeds getting to you?  Try feeding on your side rather than sitting up, or consider using a co-sleeping cot.  Alternatively, you may wish to consider bed-sharing safely.  I know… your midwife will tell you the safest place for your baby is a cot, but you may want to read this and decide if bedsharing is a compromise that will help you breastfeed for longer.

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Why do I think a breastfeeding culture is so important? When I look at my circle of friends I’ve noticed something very striking.  I have one group of friends who have mostly breastfed successfully (even in the face of initial problems like slow weight gain in babies, tongue ties, reflux, etc) and another group of friends who have generally fed for a much shorter duration.  The first group of women are, for the most part, still breastfeeding toddlers and in some cases, tandem feeding toddlers and babies simultaneously.  The second group of women have mostly breastfed somewhere between a few days and a few weeks.  Guess which group of women are midwives?  Midwives, who have all the knowledge about breastfeeding, the benefits, how to latch babies on, how to assess adequate weight gain… If you think my first group of friends are the midwives, you guessed wrong.  The first group of women are my circle of friends who practice attachment parenting, none of them started off with any specialist knowledge of breastfeeding, they just had a determination to breastfeed and a different attitude to the needs and behaviour of babies.  Ok… just before I offend all my midwife friends I’ll point out that I consider myself to be an “attachment parent” and I was, right from the day my daughter was born.  In spite of that, I was still unable to breastfeed successfully, so it’s not a blueprint for success.  I also know that some of my midwife friends have breastfed for a long time, even if they weren’t particularly “attachment parents”, I’m just using it as an example to highlight how important culture and expectations can be when it comes to successful breastfeeding.

So… it’s really important for you to find a group of women that has a culture of breastfeeding and that can reassure you that what is happening is normal.  You need sources of support and help… What happens if you have no close family or friends who have breastfed and can reassure you that things are normal?

Your local breastfeeding support group is a good place to start, either the NHS group (I’m not sure how up to date this list is, but you should be given a leaflet with details of groups by your community midwife) or the La Leche League group.  You may also find that a sling group might be a good place to find like-minded people who understand the needs of breastfed babies (slings and boobs seem to go together for some reason).  If you really are struggling with breastfeeding and you don’t feel that your midwife is giving you enough practical help, consider contacting a lactation consultant (such as myself) who can give you specialist advice. 

Edited 02/01/17 – updated to include my qualification as an IBCLC

References

1.       http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/UK-Breastfeeding-rates/

 

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