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! :)

It should be made clear that it might hurt, none of this discomfort malarky, it hurts but it's worthwhile if you can get through those first weeks.

Definitely agree with the myth about it not hurting and the need for a supportive partner, I gave up every other night for the first six weeks and only my DH's unwaivering commitment to BF and his support of me kept me going.

In my experience, I had excellent support from the midwife immediately after the birth (establishing a latch and skin to skin), great support from a BF HCP before discharge and a fabulous team of HVs who found DD's tongue tie at eight days and arranged for it (within 12 hours)to be snipped two days later. DD's weight gain has been a bit slow and the HV's relaxed attitude and promotion of BF has made a huge amount of difference to me as a first time mum.

What would have improved my experience would be more practical info in advance eg. how your supply works (rivers not ponds), how long to feed each side, cluster feeding, three weekly growth spurts etc. I considered myself well prepared (NCT, parentcraft, read a fair bit) but still had ridiculously huge gaps in my knowledge which made things hard in the critical first six weeks.

Def agree with the point about cultural barriers too but have had no negative experiences when BF out and about having said that.

Formula being the first-line remedy for all problems when, according to NICE and everyone who knows anything about bf, it should be the very last.

DH and I were talking about this and basically we figured that if, 100 years ago, you'd have been looking for a wet nurse, that's when formula should be suggested.

Some women have so little faith in their own milk, they need reassurance but "top ups" undermine this (as well as reducing supply). It becomes a self-fulfilling prophecy and you can read about it over and over again on this board: woman goes to HV, HV suggests top ups, woman's supply dwindles. Just as well, says the HV, you didn't have enough milk...

MedicMoo - do I win a prize

If you want to talk to me in more detail then please do PM me. I volunteer in Thornaby, rates there are pretty low too. I can put you in touch with the local Breastfeeding Support Co-ordinator as well.

We are trying to address the low rates here, on a positive note the Stockton-on-Tees Bfing support service got rated nearly 100% in a UNICEF Baby Friendly audit

I have a friend who lives in Hartlepool who has bf both her boys and we often joke about her being the only breastfeeder in the town!

Agree with what everyone else has said.

Having unrealistic expectations about feeding frequency, pain etc. in the early days.

Not getting proper skin to skin after birth - they insisted on stitching me up straight away, that I couldn't hold him, could try feeding later, had an unsupervised trainee who had to re-do the stitches so took ages.

Unhelpful advice from HCPs - was encouraged to give formula in hospital to perfectly healthy baby to help him sleep so I could rest. Told to feed every 4 hours. Bottle feeding (either formula or expressed milk) was constantly pushed by midwives as the easier option - don't think it is actually easier than putting the baby on the boob.

A vague impression that formula was full of vitamins and minerals and perhaps my diet / stress levels / lack of sleep would mean my milk wasn't good enough - I guess I picked up this ridiculous idea partly from advertising of follow on milks.

Thankfully I had relations and a friend who had breastfed and talked me through the pain, told me it would get easier etc. And Mumsnet of course!

Also a supportive partner who although disappointed not to be getting more time with the baby realised that doing everything else in the short term was best for me and the baby.

So I guess if you have crap support from all around you and cultural pressure that formula is normal, its just too much after having given birth. I think also some women get pissed off with the pushing of breastfeeding while they are pregnant and automatically decide not to (have read that on here - not me I'm desperate to be a good girl!). And lack of decent maternity leave / convenient childcare means some people have to worry about getting them to take a bottle when they aren't around.

I am currently very happily breastfeeding my 4 week old daughter (first born). I come from New Zealand, where I think that our rates of breastfeeding are higher than in the UK - I don't have any statistics to back up this comment mind you, it is just my perception.

I think that the biggest barrier is the generational gap that seems to have occurred in the UK. That is for some reason in the 1960s, 70s and 80s the women who are now grandmothers bottlefeed, and this means that breastfeeding became less normal and women my age (in our 30s and younger) missed out on seening it as the way to feed a baby.

The difference in attitude is also interesting in that breastfeeding is seen as something special (which alienates bottlefeeders), rather than something that is normal. For example, as good as it felt, I don't think I would have been congratulated by some random woman when I was feeding in the park the other day. I have also never heard people talk about "trying to breastfeed" or "giving it a good go". The expectation seems to be that most people wont be able to do it and failure is common and to be expected.

Medway, sorry - had DD on my lap nursing at the time.

Barriers to BF? The whole 'I/DH/the milkman was FF and turned out fine' attitude.
MW and HVs who, rather than giving details of local BFCs and groups, tell the mother to top up.
this fallacy that babies should be sleeping through at some arbitrary age.
The fear of BF in public and that someone might give them a hard time (not something that's ever hapenned to me and I'm still nursing the 2 yo in public)

Fantail, quite.

www.guardian.co.uk/theguardian/2011/mar/07/my-breast-milk-ilady-gaga

Whether hilarious stunts like this help or not is another matter, but anyway..

1. Worried about people catching a glimpse of my little norks (so not important but at the beginning i felt so self concious)
2. Poor post birth support in hospital (on postnatal ward, midwives were too busy and brash when i tried to ask for help)

3.'potential tongue tie' which specialist midwife said to 'wait and see what happens'

1. Midwife(at home after 3 weeks) telling me I was not the right sort of person to breastfeed (was very anxious and becoming depressed).
2. When phoning the postnatal ward for advice, being told that as my son had not regained his birth weight within 2.5 weeks, that 'you better make sure that you are pumping 3oz every 3 hours' I could hardly pump anything as he was permanently emptying me.

On the positive side, the labour ward gave me fantastic support with skin to skin, initial latch etc. One of my HVs was amazingly helpful and supportive. LLL and NCT were fabulous when I phoned them, but by then it was a bit too late as I was going loopy with PND (another problem actually, as my GPs knowledge of BF and medication was very poor).

I had DS in a midwife-led unit and at first he wasn't latching on. Lovely midwife suggested staying in another night to get bf established. It was a bit difficult (though I found bf uncomfortable, not painful at first) but we got through it, and I think the extra help at the beginning was important.

In contrast I have two friends who both left hospital with bleeding nipples because of a lack of postnatal help to bf. That makes me really cross when I think about it.

I am currently on baby number 2 and the most detrimental aspect I find is the apparent 'baby rooms' in places such as Boots or Mothercare. Which are actually empty cubicles next to the public toilet sheilded by a shower curtain. Both appetising for my boy to eat in a toilet and really encouraging for me to sit there listening to other peoples functions. Don't get me wrong,if he wants to feed I will happily feed him anywhere,but a person who may not be as confident feeding in public may not feel the same and want to seek the sanctuary of a comfortable hygenic room,not a public toilet. Grim!!!

For me a problem with my first was ludicrous amount of milk. I was constantly soaking wet for the first four months and spent a fortune on breast pads. I got confused about the advice to try the baby with the other breast after the first because she never wanted it and then I would go around for the next 3 hours with one huge 'unmilked' boob and one flatter one. Problem was solved next time round 'cos I had twins!

I wonder if the whole 'dad feels left out' thing is true. I find it odd that men actually really feel like this but it does seem to be given as an excuse by a lot of women... 'I wanted my husband to be able to feed the baby too so we've started giving a couple of bottles of formula' etc.

Medic, I assume you're already using the stats from the last Infant Feeding Survey and here? There's a section that looks at reasons for giving up and also predictive factors for initiation. The two that stood out to me (enough to include them in a recent lecture on the topic) involved the predictive power of whether the woman herself was breastfed and whether the woman's friends with babies were breastfeeding. I think this really speaks to a lot of what I've seen in the North East (I live here too!) in terms of a formula feeding culture. It's deeply, deeply ingrained, even within the health care professionals here. And now they've seemingly stopped training peer supporters around here, I can't see it changing any time soon.

Did think I had prepared myself for bf-ing prior to having DS1 - read up, decent ante natal advice from Midwives (Middlesborough/top of N Yorks) and my Mum being brutally honest. BUT still surprised how much it hurt.

I got thrush after 2 weeks and would have been sooo much better off if I had had warning about this. And could even have had some stuff at home ready to deal with it as soon as it started. Instead had a nightmare few days and only managed to keep going by expressing. (Was late Nov and had to battle snow to get to the surgery).
So my advice would be:
Get prepared with:
Breast pump, nipple shields and ice packs(totally saved my life to give nips a break)
Thrush kit - oral gel for lo and Flucanozole tablet for you.

I gave DS1 a bottle of EBM per day from 10 days old - meant I could have a sleep and DH could feed him occasionally. Also meant that he would take a bottle. At 8 weeks he went through a growth spurt and the EBM became FF and have combination fed since then.

DS is now 5 months and has 2 ff bottles in the day.

As for BF when out and about - I try to use a muslin - but DS now pulls it off so I tend to just get him plugged on as quick as poss. If this means someone gets a nip flash - well it's just their lucky day! TBH everyone I speak to is really supportive - and this is usually in Teeside park as it;s my nearest source of coffee/shops

We have a poisonous situation in this country in which women feel considerable moral pressure from hcps to breastfeed and most women offer breastfeeding at the start, but when they encounter difficulties the hcps who made them feel they should breastfeed don't have the knowledge, skills or time to support them to sort things out. Many women then start supplementing in the early weeks in order to stop their baby crying and by 6 weeks most babies are on a diet which is mainly or exclusively formula. Often by this point their mothers feel a range of negative emotions about why bf-ing didn't work out including sadness, guilt and anger. And perhaps unsurprisingly they feel defensive about the fact that they are now giving bottles which they feel are second best. They may feel antagonistic towards both the unhelpful professionals and other mothers who are still breastfeeding whom they may perceive as smug (and sadly sometimes they are smug). Mothers who have persevered through difficult times may equally feel antagonistic towards mothers who switched to bottles and perceive them as lacking commitment (I hope this attitude isn't common but we get wanky threads like this on here sometimes so it does happen).

This is shit because it means lots of women start motherhood feeling like they have failed, and also feeling like they want nothing to do with the two groups of people (HCPs and other bf-ing mothers) who stand the best chance of being able to help them if they want to bf in the future.

Fretting about initiation rates is pointless. If more of the women who want to breastfeed are supported to do so and successful breastfeeding becomes more common initiation rates will pick up of their own accord. But if all you've ever heard about breastfeeding is that it is painful, difficult and the people who do it are invariably smug middleclass lentil-weavers then why would you even bother trying?

Other things that might help - lose the weight fixation. Of course checking babies are gaining weight is a good idea, but weighing babies seems to have taken the place of actually spending time building a relationship with the mother, making her feel able and comfortable to talk about what she is finding easy or hard. Two of the MWs who came to see me in the days when DD was slow regaining her birthweight literally came through the door, demanded I whip DDs clothes off, pronounced her weight gain unsatisfactory, gave me instructions about spacing feeds (which it turns out were all bollocks!) and then told me they'd give me 3 more days to turn things around before coming back. It left me feeling like a complete failure. . It also felt like the purpose of the visits was to evaluate me and DD not to help us.

Veronica - I think you have summed things up very well, it is a poisonous situation.

Frozen - that is a real shame but from talking to SPB and Indith it doesn't look like they are even using the Peer supporters they have! Fortunately where I live we are still running the courses.

Duelingfanjo - that is an excellent point about the Dads. However what they forget is the novelty for some dads soon wears off and it is mum who left making up lots of bottles of formula, which is extra work for her! And there are lots of ways that dads can feel involved, nappy changing, winding, playing with the baby, or even just carrying the baby while mum catches up on some sleep!

RitaMorgan said: 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.

Sums up how I feel about our situation. With a terrible first-time BFing attempt behind me, I don't know if I would try so hard with DC2 if things didn't slot into place quickly. There is so much promotion about BFing when you're pregnant, but without adequate support after the birth (and after a difficult birth) from midwives, HVs (and people being able to spot tongue ties asap!) it can make a difficult situation even more hellish.

And as Fantail said - the generational gap! Knowledge about BFing and support that is needed isn't always there from the grannies and extended family...

I think most of the women I know who didn't bf fall into 2 categories.

The ones who feel under pressure to 'save' their breasts as sexual objects and its somehow unfair on the father to deprive him of breasts in order to feed the baby. Often (ime) this applies to young women in slightly unstable relationships.

The ones who think its the hardest thing in the world that only a lucky few will manage. Often threads in the feeding topic start along the lines of 'I am planning to try to bf, but obviously I might not be able to so which formula/bottles/steriliser should I buy?' Its difficult when you start of with the attitude that you will probably 'fail'.

I agree with DF about the dads. People often give a bottle 'so dad can be involved'. Often this if ebm which the poor mother has spent hours pumping so the dad can give a 5 min bottlefeed. For many women all this pumping is unsustainable and they end up giving formula. There are loads of threads started by pg women about how they intend to express for this reason and I think the men have a massive cheek making their partner do all that extra work when they are already busier than they have ever been in their life.

The thing about dads being involved in feeding is one of the things that symbolises the reluctance to just admit that there are nice things about bottle feeding. It's like there's a taboo and we must always say it's shit. It isn't.

When you are exhausted, having someone else be able to feed your baby can be a massive psychological relief (and by the by, because feeding of any sort is an act of love, the dad quite enjoys it). It just doesn't cut the mustard to list the other things a father can do (nappies, cuddles etc) because in a lot of couples he is doing those some of the time anyway. They are not a substitute, because we're talking a temporary lifting of a psychological burden, not 'how to get dads to spend time with their babies'. I don't know what the answer is but I always find it irritating to read that little list - it shows that there is a misunderstanding about what motivates people to use a bottle.

(Mind you, the figures for mixed feeding, expressing feeds etc do sort of bear out what I'm saying, I think.)

Hey, wineclub, I think you're being unfair on some dads. Some of them want to feed so that they can look after the baby for more than an hour or two alone! My DS was EBF till we started him on solids: I expressed when I got the chance so DH could give him the odd bottle so that I could go and do things I wanted / needed to do for a couple of hours. We didn't do it nearly regularly enough and at about 3 months he refused the bottle, and we never got anywhere with it after that. I'm now back in FT work and DH is SAHD, and the feeding thing is frankly a bit of a nightmare (DS is now 8 months, won't take a bottle or a sippy cup, and can't quite reliably drink from a normal cup). If I'd known it would be such a problem, I'd have prioritised expressing earlier on and made sure DS had a bottle every single day. DH's life is now much harder than it needs to be because he's spoonfeeding DS when I'm not about, and mine is pretty miserable too because all I ever seem to do is work and BF.

In answer to the OP's question, I was one of the lucky ones - had a good and helpful MW in hospital who helped with the first attempts at latching on, and then had a peer supporter who visited me at home in the first couple of weeks. I'd also been given advance warning that it hurt like hell to begin with, so when I had really sore nipples I didn't think anything had actually gone wrong. DS didn't gain any in his first 2 weeks, but the HV never suggested a bottle - she observed him on the breast, said everything looked fine and that I should just bring him back the following week to check he was starting to gain weight.

With hindsight, if I had another one, the thing that might put me off BFing is the pressure of being the breadwinner. There was no way I could have had more than 6 months' ML, and our experience with DS suggests that it might have been better for us as a family if we'd mixed fed from early on.

Cross-posted, Prunnhilda - I agree with you. There were times in the early days of BFing when I would have given anything for someone else to be able to feed DS.

From my experience - I had a shocking birth, needed a blood transfusion, couldn't sit down for a couple of months, so poor post-natal health was the main factor in not BF. But I am entirely happy with my decision, so not all bad.

MedicMoo; I see someone has already mentioned the Infant Feeding Survey (which I'm sure you're aware of). I thought I'd mention some of Prof. Mary Renrew's recent reasearch:

Henderson L, McMillan B, Green J, Renfrew MJ. Men and Infant Feeding: Perceptions of Embarrassment, Sexuality, and Social Conduct in White Low-Income British Men. Birth 2011; 38(1): 61-70.

Dyson L, Green J, Renfrew MJ, McMillan B, Woolridge M. Factors influencing the infant feeding decision of socioeconomically deprived pregnant teenagers: The Moral Dimension. Birth 2010; 37(2): 141-147.

Both of which might be of interest to you.

Although i agree with however said we need to support those who are stopping, not comcentrate on those who aren't starting. But I might feel differently with a 50% initiation rate.