Successful breastfeeding: are you getting enough support?

It’s World Breastfeeding Week (WBW) 2016 so my planned series of breastfeeding blogs are fitting in very well with it, I’ll just have to do a bit more writing than normal to fit them all in to this week! One theme that is coming out of WBW is that it’s time we stop laying responsibility for the success/failure of breastfeeding on individual women who try to breastfeed, and acknowledge that it takes a community and having systems in place to support breastfeeding mothers.  So if a breastfeeding mother fails to meet her goals, she didn’t fail, the system failed her.

My last blog was about breastfeeding and how having a breastfeeding “culture” can make all the difference to breastfeeding.  This blog is more about sources of help and support – what mechanisms exist to help you through those early days, and whether they’re adequate.  I touched on it briefly at the end of my last blog, so now I’m going to expand on that a bit more. Last week I mentioned that a substantial number of women start off breastfeeding.  In Northern Ireland, initiation rates are around 65%, but these drop sharply within the first few weeks; many mothers give up before they want to.  One reason for this is the lack of breastfeeding culture, there isn’t the understanding of what is “normal” when it comes to breastfeeding.  The other big reason why women give up is because they don’t get enough support.

Non-professional sources of support

These can be particularly useful if you don’t have a pre-existing culture of breastfeeding.  So in other words, if you don’t have family or friends who have breastfed successfully and can tell you what normal breastfeeding behaviour is, then you will want to try to find other sources of support.  Some hospital trusts employ peer supporters – these are women who have breastfed themselves and who are available to give you moral support and reassure you that things are going well.  They won’t give you advice but they can sign post you to further help if you need it.  You can also access support from your local breastfeeding support group.  Breastfeeding support groups are attended by a health care professional (midwife, health visitor) or a trained support worker (either a maternity support worker or a breastfeeding counsellor).  While there may be advice given or a breastfeeding topic discussed, the groups are also there to provide the peer support that you might not get from your own circle of friends.  Some mums find the groups beneficial for helping them breastfeed for longer, other mums find that the groups give them confidence to breastfeed in public.  For some, it’s just an opportunity to get out of the house for a chat and some cake!

You may also wish to consider hiring a postnatal doula.  A doula can be a great source of support and practical help in those first few days.  From talking to mums who have had their babies, a lot of mums wished they would have had something like this in place, but don’t realise how valuable it is until after the baby is born.

Professional support

You may find yourself looking for help and support from your midwife, health visitor or GP.  I’ll focus mostly on the midwife here, because I am one so because I know more about our training, and we work with women in those crucial first weeks, when breastfeeding rates fall most steeply.  I think as midwives we need to acknowledge that we are responsible, in part, for the steep drop-off rate when it comes to breastfeeding, as we are the professional who predominantly helps women breastfeed in the early days, so there must be something we could do better. I know a lot of women say that they don’t feel the support they get from their midwife is sufficient.

When you attend your antenatal appointments, it is likely that a midwife will discuss breastfeeding with you, and almost certainly a midwife (or several) will help you with breastfeeding when the baby is born and in the following days.   Midwives do receive substantial breastfeeding training; I spoke to one student midwife recently and posed some common breastfeeding problems to her.  I was impressed with the extent to which she was able to answer these questions; I think the breastfeeding training probably has improved since I did my midwifery training 15 years ago.  However, breastfeeding is only one small component of midwifery training, midwives focus substantially on pregnancy and birth, midwives are the “experts” in normal birth but I’d argue that they aren’t the experts in breastfeeding (more about that in my next blog), even though currently they are the default professional for helping women to initiate breastfeeding.  I do believe that the training midwives get is sufficient to ensure that most babies can breastfeed successfully.  So, for example, midwives are now well-versed in the importance of skin-to-skin care and how this can be used to facilitate a baby to breastfeed.  Midwives are knowledgeable about recognising feeding cues and the importance of feeding on demand. Furthermore, midwives receive information on positioning and attachment and how to help mums hold their babies in order to feed them comfortably.  If babies are allowed to feed as often as they want, and they are well positioned so that they can latch on easily, MOST problems can be prevented and MOST babies can breastfeed successfully (more about the ones who have problems in the next blog).  The help and support midwives give in the early days can be invaluable in helping a mum initiate breastfeeding successfully.

Unfortunately, with increasing cuts in service provision and with increase in workloads for midwives often the help and support you need just isn’t available.  When I first qualified, most first time mums stayed in hospital for at least 3 days if they’d had a normal birth and at least 5 if they’d had a caesarean section.  We were on hand day and night to help mums with breastfeeding.  Now mums often go home after a few hours, often with the baby only having breastfed once or twice; occasionally, not at all. Midwives don’t visit women at home as often as they used to either, as a student I remember visiting women every day for the first 10 days, now you’ll probably only get 2 or 3 visits before day 10.  It’s frustrating for us as midwives because we know that having the extra support does make a difference and often, we’re just not able to provide it.

A lot of women often say that midwives, even if they are available, aren’t always very supportive of breastfeeding.  I think this might be because a lot of midwives have little or no experience of breastfeeding outside of a clinical environment, so it becomes reduced to a medical process to be evaluated and managed, rather than being seen as a normal process and part of normal family life.  As a result, midwives are very good at assessing whether breastfeeding is going well, and suggesting formula if it isn’t, to ensure that babies stay hydrated, don’t get too jaundiced, don’t lose too much weight, etc.  Our main focus is often NOT to promote breastfeeding and ensure that babies breastfeed as long as possible, but rather to ensure the “safety” of babies and that guidelines are adhered to.  I don’t think that this priority is ever explicitly stated, but I think if we examined our motives about the advice we give, I think we would see that often safety rather than breastfeeding success is our priority.  Of course we need to keep babies safe, but there are often ways to facilitate breastfeeding and prevent other problems from developing, without always resorting to formula.  Some midwives are great at finding these solutions and sometimes formula IS indicated, but often formula is the first port of call, when it shouldn’t be.

I realise I sound very critical of midwives.  I’m a midwife myself and I know that my attitude and knowledge about breastfeeding has changed over the last few years, especially since my own experience of breastfeeding, so I can’t help but think that some of our failure as midwives to support successful breastfeeding comes from the system we work in (which doesn’t prioritise breastfeeding as vitally important) but that also our own experience and beliefs about breastfeeding come into play.  I think for some women, the advice and support that midwives give is enough to help them breastfeed and meet their goals, but for others it isn’t enough, so if you AREN’T getting the support you need, make sure you look to other sources, be it a breastfeeding support group, a breastfeeding counsellor, a postnatal doula, or a lactation consultant, who is an additional professional who can help, but most women don’t know about (the subject of my next blog).

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