Barriers to breast feeding - Your thoughts wanted please!

[MedicMoo]

Hello

I am a Medical Student doing a presentation next week on the "Barriers to Breast Feeding" and I was wondering if you'd mind sharing some of your thoughts?!

What makes you think twice about breast feeding or puts you off?

Any and all thoughts much appreciated! :)

For me, first time round I had totally unrealistic expectations mainly derived from HCP including GPs, HVs and midwives. These mainly involved the words 'routine', 'rod for own back' and '3-4 hour feeding schedule'. None of these words should be said within earshot of a new mum trying to establish bf as it is a recipe for disaster.

Instead, we should be told by all especially paeds and GPs (who seem to me to be the ones least au-fait with bf unfortunately) that we should expect to feed a lot in the first few weeks/months and that feeding frequently is no indication of supply rather it is totally normal. Babies should be routinely checked for tongue tie and it should be snipped immediately, not referred on and in the meantime, both the baby and mother struggle with feeding. Skin to skin post birth should be the norm. Being told to stay in bed in the first week with the baby (siblings permitting) should be encouraged. We shouldn't be up and about straight away in Tesco doing the weekly shop.

Above all, it should just be considered the normal way to feed a baby. Nothing more, nothing less. I even get slightly annoyed at the words breast feeding. To me it's just feeding, end of story.

I say all this having had a shit time feeding ds1 and giving up after 10 weeks, but having found MN I fed DS2 for 10 months and loved every minute of it.

HTH.

One of the biggest barriers is poor knowledge and support in HCPs, especially midwives and HVs who should be able to support breastfeeding mothers! I find it unbelievable that infant feeding isn't a major part of their training.

Also the way HCPs suggest formula at any hint of a problem without trying to find/fix the cause.

There is plenty of NHS breastfeeding promotion before the birth, and very little support once you actually have a baby.

I echo eastendmummy - unrealistic expectations of what a baby 'should' do around feeding and sleeping which make mothers feel like they are doing something wrong if their baby won't stay on schedule or wakes int he night - both of which are entirely normal.

HCP advising anxious or tired mothers to top up with formula or introduce a bottle before bed. This is extremely detrimental to bf both in terms of establishing supply and making woment feel confident that bf 'works' and will be sufficient for their baby - even if such advice is kindly meant.

Have to go and rescue baby who has backed himself under a chair!

"What makes you think twice about breast feeding or puts you off?"

This makes it sound as though you think women don't breastfeed because the thought of it puts them off. Most women want to breastfeed and do initially (almost 80% I think) but then most have stopped by 6 weeks. The question should be what is sabotaging breastfeeding.

Agree with RitaMorgan - your title in itself takes a very negative view, unnecessarily so IMO.

I had a very positive experience with breastfeeding, so I will list the things that made it so, as the reverse situation would have made it very difficult for me to bf.

• Stayed in hospital for 5 days post-labour;
• Skin-to-skin contact for two hours after birth, with DS encouraged to latch on immediately;
• Midwives, fully trained in breastfeeding, were available to me 24h a day to help with latching on, relieve engorgement and most of all reassure me that I would get the hang of it eventually;
• No formula pushing at all. Once I told them I wanted to breastfeed, that was that, no-one suggested top-up bottles or that colostrum was in anyway insufficient;
• DS was in the room with me at all times;
• No mention of routine. I was told repeatedly that I should just put DS to my breast as often as possible;
• Constant encouragement.

All this is standard in public hospitals in Belgium, where I gave birth. I can't stress the importance of those 5 days enough. By the time I got home, my milk had come in and I had a good idea of what a proper latch was. If I'd been discharged 24 hours after labour I really don't think I would have breastfed for as long as I did (6 months). I had terrible engorgement and DS had trouble latching on; if I didn't have someone there to help me with every single feed, I would have given up. I know some people hate spending time in the hospital post-birth, but to me it was invaluable.

i also had very positive experienes of breast feeding my 3 dc... this was despite receiving consistently VERY bad advice from supposedly qualified people like midwives, paeds, nurses and health visitors while in hospital.

examples:

'just give him a bottle now then we'll try breastfeeding later'
'you haven't got enough milk, we need to give him a bottle'
'you can't have the baby in bed with you ALL THE TIME' (immediately post birth)
'you've already been feeding him for 20 minutes you need to stop and not feed him again for 3 hours'

Poor advice from healthcare professionals, including a maternity care assistant who told us to give DD formula and suggested that I wasn't trying my best when I was bfing her (and topping up with ebm) and she was losing weight. We also had not great support in hospital, even when DD was discharged from SCBU to transitional care on the antenatal/postnatal ward specifically to get feeding going.

Lack of access to appropriately qualified professionals. We randomly got to see a MW who happened to be an infant feeding specialist and she helped hugely - thanks to her DD had her first really good bf at 10 days old. We then asked to see her again and couldn't, which I still think is absolutely awful! We had to go an NCT BFC for further help.

What RitaMorgan said.

Most women do want to breastfeed.

Many of them give up in the first six weeks, whilst still under the care of their midwife and health visitor. The majority of those mothers say this was sooner than they would have liked to stop. Whats going wrong there?

Apologies if anybody thought the question I posed was negative - I was just trying to expand on my initial question and pose some thoughts that some people might find easier to relate to.

I agree that most women do want to breastfeed, however there are an increasing number of women who flat-out refuse the idea for a variety of reasons.

Thank you so much for taking the time to share some of your thoughts :)

Are there an increasing number of women who flat out refuse? Increasing from how many to how many, over what period of time?

Unfortunately there hasn't been any published research on antenatal breast feeding opinions so I can't give you any statistics on the matter.
My comment was based on the opinions of HCPs I have spoken to in the region of the UK I am currently based in and some of the mothers I have seen ante/post natally.
I should point out that the area has the lowest number of women breast feeding, with 59% (compared to 76% in the UK overall) attempting to breast feed and only 30% continuing to do so after 5-6weeks.

As a nation we have one of the lowest breast feeding rates out of the developed countries, and the lowest in Europe.

Eg. Norway ? 99%
Egypt ? 95.8%
Thailand ? 92.1%
Saudi Arabia ? 91.6%
USA ? 73.9%

Any thoughts on specifically why?

Honestly I think women who don't want to breastfeed shouldn't be the focus at this point - there are so many women who do want to breastfeed and are being failed by the NHS, that should be the priority.

I expect a lot of women who have an awful time with their first don't want to go through it again.

TONGUE TIE
should be checked for and remedied asap if the baby eg isn't able to stick tongue out

HCPs not banging on about their own experience but rather, singing from the same hymn sheet and acknowledging that mixed feeding happens and is not fatal, but that starting off that way is not going to get breastfeeding established as well as exclusive breastfeeding.

RitaMorgan Wed 30-Mar-11 13:51:07
"There is plenty of NHS breastfeeding promotion before the birth, and very little support once you actually have a baby."

YES.

For young women there is a thing about breasts being sexual. My daughter is a 20 year old who BF for 10 months, and often got the response of either "only my boyfriend gets to put them in his mouth" or else "i wouldnt do that, it will make them all saggy and floppy".

Medicmoo - you wouldn't be in Mewway would you? Apparently their initiation rate has gone down to mid50s recently :(

Mewway? Sorry I'm even sure I know where that is!

For me it was the complete surprise that it hurt! (for about the first 2 weeks and at the beginning of each feed when baby latched on).

All the literature I had read said 'if it hurts you're doing it wrong', so in the hospital I panicked, unlatched and re-latched time and time again until a very sensible midwife said 'it's toe curling isn't it?'

Once I knew what to expect it was fine. Before giving birth breastfeeding for me was a complete no-brainer, and luckily we got on fine with it. But I can see that the pain could really put people off, especially as it's really not mentioned (and I did read a lot before the birth, and went to a breastfeeding course)

I guess talking about the pain (or possible pain) could put people off, but I'm the sort of person who likes to prepare in advance, and this definitely threw me a curve-ball.

I think the problem (from what I read on here) is a lack of consistency in breastfeeding advice. There are Health Visitors and doctors all saying different things, which is confusing and counterproductive.

There's a mindset in the media and elsewhere that breastfeeding is difficult. I was determined to breastfeed, but I was scared about that (completely un-necessarily as it turned out).

A lot of childcare information is passed grandmother to new mother. Don't forget today's grandmother's were fed a lot of bullshit information they wouldn't nowadays get on breastfeeding and formula feeding. My mother is still surprised, four grandchildren later, that none of them have settled into a four-hourly routine (!) and my mother-in-law feels that breastfeeding is borderline irresponsible because you can't see precisely what they're getting. Educating grandparents on what breastfeeding looks like would be very helpful.

I'm wondering if MedicMoo is in Teesside actually. Hartlepool has the worst breastfeeding rate in the country.

As to barriers I would say :

Bottle feeding being so prevalent - people around you, babies being bottle fed in the media, dolls always come with bottles.
Lack of support in the first 72 hours of the baby's birth.
Unrealistic expectations of what breastfeeding is like (mainly because the mum may not have experienced it until she had bfed herself)
The sexualisation of women's breasts.

I come into contact with a lot of new mums (bfing peer supporter volunteering with Surestart) and I do find it frustrating that by the time a mum comes to me for help, she has already been given so much crap information from friends, families and HCPs she doesn't know what to think.

I think Britain can still be quite a prudish country and raised eyebrows when bf in cafes are still all too common unfort

Lack of support is still a big problem.

For some reason bottle feeding is still seen by some as 'eaiser' (not in my experience infact the opposite!)

Thank you so much everybody - really interesting comments and thoughts.

And yes KaraStarbuckThrace - got it in one.

Just in my immediate experience I've found there can be a strong cultural element. The people (family and friends) I know who have flatly refused to attempt bf'ing at all are those who feel very uncomfortable with feeding in front of other people, esp. male family members. They are generally from sorts of family that read the Sun (sounds silly but true) and prob been brought up to see breasts as entirely sexual devices for consumption by men rather than as feeding devices for babies - therefore bf is slightly disgusting to them. Not their fault, just awful conditioning.

The other is that there isn't enough info about what to expect in the early days and beyond. There can be a lot of 'is this normal'? It would be great to have some guidance about how feeds are very frequent in the early days but also show that there is progression through to just a few feeds a few months on. That would give people some hope that it gets easier and is worth sticking with. I'm not surprised lots of people give up around 6 weeks as that was the point at which I found I started to feel completely overwhelmed (prob due to 6 week growth spurt etc) but things did calm down again - I have a very supportive partner which makes a big diff too.

Other Mums I know are also often struggling on their own without any practical support for other kids etc and bf can be incredibly time-consuming and feel a bit unfair when the partner is sleeping through every night and you are up doing 2/3 hourly feeds and then looking after baby and other kids during the day. Some women for various reasons just can't cope with all the burden being on them and feel guilty if percieve other kids are feeling neglected. Other women find it manageable and can keep all the plates spinning really well. Don't know what to suggest re that issue apart from extra help with childcare and more breast-feeding/family friendly places to spend time in during the day would be lovely.

So I suppose lots more info about how a typical feeding relationship with a baby works out at diff stages would be massively helpful. BUT please not with those grim awful off-putting colour pictures in all the literature I recieved about bf'ing from the NHS. They actually made me feel a bit queasy. I don't know why as people bf'ing obv doesn't bother me in the slightest