"Breastfeeding advice unhelpful"- BMJ

[EauRouge]

Here. (Think this is what was being hinted at yesterday)

I agree that breastfeeding support in this country is totally lacking but I don't see how changing the advice will help- how about providing more and better support?

Oh man, that 'earth mother' thing ... I was accused of being one by a friend some years ago (for BFing a 3 month old!!) and it drives me bonkers.

I think there are certainly some groups of BF supporters who tend towards the view that BF is something that comes as a package, along with a certain set of attitudes and parenting practices. As if BF is of lesser value if you don't also co-sleep, babywear, do baby-led weaning, be a SAHM, etc etc.

Me, I think people are allowed to BF for whatever length of time they like and combine it with whatever attitudes, lifestyle or choice of dungarees they like !

I collect books on bf and babycare and I have checked my copies of the NCT Book of Breastfeeding (first published 1992, and there are pics of woman looking 1992-ish but none in dungarees :) ) It must be another one you have - can't think what it is. Nothing about stick insects - I agree that wording is a bit naff but no more than that!

catgirl - there is nothing wrong with showing DVDs which observe women breastfeeding without problems, and which observe the process. As I said, observational DVDs may well show women just sort of getting on and doing it - and that's as real an experience as striggling. The problem comes if this is the only form of bf preparation/guidance women get.

tiktok - Caroline Deacon, Breastfeeding for Beginners, p. 51.

A good book otherwise, I hasten to add.

My LO will be a year old in a couple weeks, and I still want to weep when I think of BF.
I had a c-section under general, and she was 5lb 8oz. After 24 hrs the LO was fed by a syringe. Then graduated to a cup. Then a bottle. I tried and tried throughout the hospital stay to BF, and continued to try when at home, expressing milk every 3 hrs for 8 weeks. But it was a nightmare, and as the weeks went on my supply fell and fell. Expressing milk in public is not something I much fancied, so effectively tied to the house. The first time I went out with LO a complete stranger stopped me in the street to ooh and ahh over her, then asked if I "was feeding her myself". I felt like every babychange place I went into had a poster up saying how good BF was (leaving me feeling like I wasn't giving my LO the best start she deserved).
IMO there's a vast amount of enthusiasm to get women to BF but I had bugger all help in learning how to actually do it.
I wish the HV had had the courtesy to suggest that if LO hadn't latched on by wk 6 then she probably never would. Actually I wish I could just shoot the HV: she never at any point helped me to get LO to latch on.

I think a lot of the problem is unrealistic expectations. FF is the norm, so the behaviour of FF babies is the norm. When parents are faced with newborns who feed very frequently, cluster feed, do not want to be put down, cry lots in the early days etc, they think BF is 'to blame' or that something is going wrong, such as they 'have a hungry baby' or they don't have enough milk.

As for HCP's... I kept BF in spite of them, not because of them. My HV's advice, when DD was a few weeks old and I had sore nipples was to try using nipple shields. That was it. No mention of latch, positioning, tongue tie etc.

I had no problem bfing to six months and beyond. It made night feeds much easier and I didn't have to worry about taking bottles outwith me. Never used formula. I did however start them both on solids at 23 weeks because they were more than ready for it. At the end of the day these things are just guidelines and you will meet very few people who have followed every single guideline to the letter.

bump :( :( :(

It's not true that if a baby has not latched on by 6 weeks then it's not going to happen though - I have known babies to latch on long after this. The key is to support you and help you feel in control of deciding when 'enough is enough' - not to tell you things that are not true :(

Keeping up a supply by expressing is very, very hard work - you can feel proud of what you did.

Who knows what the root cause of the difficulty was? But whatever it was, mothers in your situation need as much support as anyone else (maybe more).

boobmeister - can't find that book, though I do know it and have read it, not remembering stick insects though (or dungarees for that matter:) ). It is a good book.

My experience was similar to that of cerys - the breastfeeding session at my NCT class was all about how natural breastfeeding is and how the newborn just latches on easily and will find the nipple by himself if laid on the mother's chest immediately after birth. I specifically asked the question 'what about pain and cracked nipples?' and the response from the bf-ing teacher was 'that only happens if you're doing it wrong'.

It was a load of garbage basically and my DH and I still joke about how out of step with the reality of bf-ing it was. I used to have to wrestle DS to get him on to the nipple and keep his head in place, stop him twisting and turning (and ripping my nipple off in the process). It was a nightmare. The midwife and bf-ing counsellor who saw me did their best to help but he never latched on well and still has problem sucking, even from a bottle now. He is a wriggly squirmy chap and never liked being swaddled etc. It's just the way he is so I was happy to go with him and let him be how he wanted to be rather than fight him and cause us both pain. I think my GP was correct when she said he had a small, 'rosebud' mouth so tended to kind of sip at the nipple rather than gulp the breast, despite chin/lip-ticking etc so that meant he wasn't getting enough supply and was causing me immense pain in the process. In yon olden times, I'd probably just have hired a wet nurse. As we have formula today, I was able to supplement with that and he has been FF since 8 weeks.

Anyway, this would be a very long thread if we all posted our individually disappointing experiences of bf advice and training. I think the most important way to get bf established is real-life role models e.g. mothers, sisters etc. Many women don't have that and so the vague and unrealistic advice given by bf-ing counsellors just isn't enough. I was also disappointed in how all or nothing the bf advice was, like the article says. It was 'you either EBF for six months or you may as well not bf at all'. Yet in reality only about 30% of women manage EBF for six months.

Ha, yes, I've been 'accused' of being a BFing earth mother too! Ridiculous that BFing has that image

I have been unspeakably lucky in that BFing has been an absolute breeze with both DCs. Where I live there is tons of support that I have never needed and BFing rates are well above the national average. However I have three close friends who found BFing very very hard (and eventually gave up relatively early on), all of whom said that they got too much conflicting advice.

One friend said that she had three different health professionals in one day all giving her different tips and trying to help and it just got so bewildering and stressful when what she really wanted was just to spend time alone with her DH and new DD. She was made to feel so guilty that she waited until her MW had her Christmas break before giving up so that she wouldn't find out until it was too late.

It's a real shame when resources are being put to good use that ante-natal care can still get it wrong. All of my friends would've found it easier if there was just one person - the BF counsellor perhaps - responsible for their welfare.

I do agree that the 6 month advice is there for good reasons. However I would prefer to see an "every feed counts" type message as this would perhaps encourage people to give it just another day, week etc. when they have difficulties and sometimes that is long enough to fix issues. If not, well, they did their best and should know that their perseverance to that point still benefited them and their baby.

Trying to persuade people who just don't want to bf at all to try and give it a go is a total waste of limited resources.

I agree wasabipeanut, at my NCT breastfeeding class we were told that any breastfeeding is beneficial and at the time I felt that 'diluted' the message, but when I struggled to BF my son and he lost a huge amount of weight, I switched to mixed feeding and felt able to see the good in what breastfeeding I did or had managed.

I think mothers would benefit from being offered more of a 'try it and see - just doing it in hospital is fine/better than not at all' approach to relax the pressure.

I would also like women to be told that it is difficult - that never occured to me, but nearly every breastfeeding mum I know had a period of days or weeks where they struggled for one reason or another, although most went on to do it for well over 6 months. In fact (hugely middle-class of me, I know) every mum I know started trying to breastfeed, those who switched to bottles did it not because they didn't want to breastfeed, but because they could/weren't supported to.

Tiktok, I apologise. Flicking through the book now and I can't see anyone in dungarees
There's a baby in dungarees but I don't think that counts.
either I'm hallucinated it, it was a different bf book or another book in the series. can't check as ironically enough am BFing. But I maintain that there can be a culture surrounding BF that I think can be offputting to many, and the stick insect comment is a case in point. Might be something for breastfeeding advocates to consider when trying to reach a wider audience.
Like Napacab have hurt this advice that 'if it hurts you're doing it wrong'. I suffered pain and cracked nipples but the MW said my latch was fine. I pushed on through and nothing has changed except the pain has gone. I don't know why advice is so contradictory but however expert somebody is, surely when they are talking about how BF feels, they have to draw on their own experience which can only ever be quite limited and personal, and yet every woman and every baby is different?

*heard this advice...

I think the advice is unrealistic; the midwives in the hospital are urging you to do it, once you're out every HV I had was trying to get the babies on a bottle as I was clearly struggling.

Expressing was torture and I'm fairly sure I had d-mer.org/ which is when you basically feel insta-depressed when you get your let down, I received no help and so it was all a bit rubbish.

It's like saying - get your car serviced every year if you want to do the best you can for your car but then once you've driven off the forecourt all the garages disappear overnight making it difficult to do so, but as you're trying to do the best you can you go to buy a Haynes Manual and its says "meh, the car will probably be OK, don't worry about it". You look at people who somehow manage to fix the cars themselves or who find a mechanic to help and berate yourself for not managing the same, or the mechanic hasn't got the right spanners for your car..... Woah, that was possibly the ropiest anaology going.

There is a campaign like that, here, although I haven't heard much about it recently- maybe the funding has been cut.

I found the post-natal help with BFing was pretty inefficient, and the idea that if your milk doesn't come in in three days, there is something wrong. I, and several friends, didn't get milk in until the fifth or even sixth day. But after a very trying first week where we got readmitted to hospital, I established BFing fine and happily did it for around 8 months.

But I did introduce the odd bottle of expressed milk from about 2/3 months in, mainly so I could go out now and then, and didn't find this affected my supply or my baby's ability to breast feed. So I do agree that inisisting on "exclusive" BFing would have been hard, and as I didn't wean until 6 months, or give her any formula, I do feel like my baby was as good as exclusively BF.

Ultimately like others have said, midwives, health visitors and counsellors could do more to help. But no-one should feel they have failed if they don't BF.

I did go to a BF babygroup as part of my attempts! The people there were LOVELY, (except for the one who accused me of feeding my baby beer when I had to bottle feed, but he was only about 2..!). But it was all full of lentil-knitting types arguing over which type of sling was best. I can see Conchita's point re: perceived culture of BF from that one experience at least.

Ha ha Smethwick I like the analogy!

And then in the end you give up and buy a horse instead

Nothing in my entire life has made me feel as miserable and inadequate as the comments I had when I struggled to feed my oldest son. The skilled professionals seemed to think I wasn't trying hard enough, my GP said my breasts were the wrong shape! My mother went on and on about how I'd gone straight from the breast to a cup at 6 months. Having exhausted the resources of the NCT, midwife, hospital breast feeding advisor etc.etc. and endured mastitis and cracked nipples (GP advice - "try sitting with your back to the wall and brace yourself") he went over to being bottle fed at 5 weeks, it was either that or starve. It was a very positive experience and I didn't try to breastfeed at all with DS2.

I think that in attempting too hard to aspire to the ideal of 6 months women just end up making life incredibly difficult for themselves, and being martyrs.
If you manage to bf for any time at all that is great, if people got a pat on the back for 4 weeks rather than being made to feel failures more of us would try.

I really get angry/sad/despairing at the divisiveness about feeding - and how people criticise what they say is the image of it.

Interesting you thought the book had women in dungarees in it, conchita , and it didn't! That was in your head :) But you were so certain, until you checked. But even if it had - so f***g what! There are zillions of pictures of women breastfeeding - in all sorts of different clothes, settings, hairstyles, shoes - because guess what, zillions of women breastfeed, and if they happen to wear something different from what you would feel comfortable, then can we not be adult about it and realise that there is no 'uniform' or 'lifestyle' that has to go with bf?

bumperella, you say the group you went to was full of "lentil-knitting types arguing over which type of sling was best" - Women meeting other women talking about the different merits of slings - how dare they?!

I doubt very much they were 'arguing' - though they may like knitting and eating lentils and you don't - so what?! And yet you say these people were lovely, but somehow you could not relate to them....well, we can't always relate to everyone in life, but you have mixed all this up with your sadness about not breastfeeding happily, and it comes out as snark towards the people who do breastfeed.

I wish women would see beyond image - it's irrelevant, really. And enough already with the complaints about dvds and posters and whatever showing women breastfeeding happily and easily - that's a reality, too!

DS had a very minor posterior tongue tie and it wasn't diagnosed at the hospital. Got a lactation consultant in when he was about 5 days old and I was FFing, pumping milk, crying with pain at every feed, etc, and she showed me how to feed lying down so the sore part of my nipples could heal and helped me get an appointment to get his tongue tie divided.

If the TT had been diagnosed and clipped while we were all in the hospital (for 2 days!) it would have meant my first week would have been SO much easier. I wouldn't have blamed any woman for giving up in my shoes. If we hadn't had the seventy quid it cost to get a lactation consultant to come over, I think it would have been the end of breastfeeding for us, and that simply shouldn't be the case.

That said, even if DS hadn't had a tongue tie I think I would have experienced some pain in the first few weeks because I had very flat nipples. Not inverted, but very flat. After 18 months of feeding they're not (!) but they used to be, and I imagine DS had to do some work stretching the ligaments. God it hurt. Separate to the Tongue Tie, that aspect hurt.

A midwife had seen my flat nipples and suggested I try breast shells before DS was born to help stretch those ligaments, but I hadn't clocked that the stretching would be such an ouchy experience.

I live in the USA so I'm sure my experience is a bit different, but the BEST thing anyone said to me in the whole dramatic first week of DS's life was "Every breastfeed you do is wonderful, and any time you've had enough is fine too. Just take it one feed at a time."
She was the hospital lactation consultant, (and while I wish she'd diagnosed DS's tongue tie) I will always love her for saying that. It took the pressure off!

I am really interested in this as only recently some friends were chatting and said "I bet people who bf are secretly jealous of how easy bottle feeding is" obviously forgetting me and my other friend bf for a long time - I was completely non-plussed because, if anything, I used to think "do they think I'm a freak?" and "that looks a faff" so our responses to the whole bf/bottle feeing debate are going to be as diverse as we are but (I am getting to my point honest) in the countries where there is a bigger proportion of women bf at 6 months, why don't they think the advice is unrealistic?

oh dear, I kept using the word 'ligaments' and I know that whatever little thingies kept my nipples flat weren't ligaments. Sorry!

Suffice to say, best breastfeeding advice and support I got came from
(1) Sis and SIL who BFed happily and made it normal in my extended family. First generation to do it for 3 generations!
(2) The lactation consultant
(3) a bf group I found in my home town
and (4) and SO important as it was available at all hours, on the most tearful nights- THIS BOARD! this was my first 'help me!' thread and I remember reading your lovely replies bawling at the support. I definitely wouldn't have made it to 18 months bfing without it.

I was very ill after the birth as well and with hindsight I can see that I was unlikely to ever get BF established, but I had an enormous amount of support in trying. My HV advised me which BF clinic to go to (the support groups were described as inappropriate for me as they would deal more with morale than physical problems, nothing to do with types of people, just types of problems) and they were brilliant, the right match for the advice I needed. I almost regret that resources might have been wasted on the lost cause I was, but I don't feel any sadness about FF when I look back as I know I did absolutely everything I could. My NHS ante-natal feeding workshop was fairly useful and men were welcome (of our group of 9, all but me are BFing at 12 weeks, 6 exclusively - which probably is down to the support in place). None of the group fir the lentil-y stereotype being described or are judgemental when I FF.

However, I think one of the problems I did witness was that people were so desperate to get off the wards and home that they gave in and resorted to formula if things weren't going well. Also, it is a real shame there is nothing richer that would mean the babies being given formula when their mums are ill only needed a small volume. By the time I had any milk at all, a trickle on day 7, my baby was already used to large formula feeds and I was playing catch up - this was the case for all the women I saw in high dependency, so those who have been most ill are also starting at a disadvantage.

But to that I would add that I think it is entirely counterproductive for people to be made to feel guilty for not bf or mixed feeding. We have a strange thing going on in this country I think where you feel slightly odd if do bf beyond a couple of months but guilty if you don't. No-one wins.