"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?

I'm chuckling to myself at the cuddly knitted boobs, Everton. I never experienced the straws in oranges though.

Onebirthplan - I really agree with you about mum's needs being important too. We seem to have swung the other way from it being very much about looking after the mum in my mother's era - early 70s - to it all being about the baby's needs at a terrible cost sometimes to the mother's health and wellbeing.

I was struck by something an earlier poster said about the situation in Sweden just being more relaxed and less of a crusade - I think there is something in this too.

There's just not much kindness it seems around this issue towards all the women who are trying so hard to get it right - and I know I certainly didn't know how to be (or think I had any right) to kindness at that point in my early days and weeks as a Mum.

Kipper - expressing is no indication of supply, I could hardly express at all with my first (and just a bit with seconed) but both where exculsivly BF didn't lose any weight at all. So no problem with supply yet hardly anything come's out when I express.

I think this is a good discusion about low milk supply and why many women do actually end up with a suppy issue but they probably wouldn't have is things hadn't have gone wrong to start with.

www.analyticalarmadillo.co.uk/2012/03/discussion-clare-byam-cook-low-milk.html

On a lighter note: <a class="break-all" href="http://www.google.co.uk/imgres?q=Knitted+boob+hat&um=1&hl=en&sa=N&rls=p,com.microsoft:en-gb:IE-SearchBox&rlz=1I7DKUK_en-GB&biw=1440&bih=675&tbm=isch&tbnid=gDb-ChlB25y94M:&imgrefurl=knitmeapony.tumblr.com/post/7345659383&docid=Fs3Gi1dWfVb7RM&imgurl=farm6.static.flickr.com/5112/5912079371_5c1c1f0ff2_o.jpg&w=205&h=195&ei=UrNjT9GbD8j98QPC0NCuCA&zoom=1&iact=hc&vpx=868&vpy=326&dur=16&hovh=156&hovw=164&tx=106&ty=49&sig=101504012441125010186&page=1&tbnh=156&tbnw=164&start=0&ndsp=19&ved=1t:429,r:16,s:0" rel="nofollow" target="_blank">I give you the bood hat

boob even, FFS

I think Fanjo alluded to this above, but what I have found astonishing is the difference in ante-natal and post-natal approach of the HCPs I have seen. At my ante-natal class, we had a full hour on the benefits of breastfeeding (and no time on the practicalities of latching on, positions etc), and were told that 'this is a baby led hospital and breast is best for babies, therefore we will not support you in anything other than breast feeding', along with 'everyone can breastfeed and there should never be a need for anything else'.

Fair enough you may think, and I fed my DD beautifully after birth. Afterwards I checked whether I should wake her because she had slept for 2 hours and hadn't fed (she was only 5lb 11oz) and was told categorically no, so by the time we got to the post natal ward she had low blood sugar and was whisked off me and fed formula from a cup, and later on a tube as she brought it back up. I wasn't given the chance to breast feed her to see if that would increase he blood sugar level, and her bs was only just below normal, but it was made to seem as if formula was the only way her bs would rise. Maybe I shouldn't have allowed it, but it's my first baby and I was 4 hours post (traumatic) birth, all alone and terrified. It's nothing compared to what others have been through but I am welling up just thinking about it.

Anyway, enough about me - what I am trying to say is that I agree there is not enough support post natally, but to add that I also think there is disagreement amongst HCPs - midwives will tell you 'breast and ONLY breast is best', but once you're in HV care the response to any issue at all (in my experience and that of many friends) is 'top them up with formula' or 'wean them early'. 9 months of being told BF is the only way, followed by 'well why don't you just give them formula'? And they wonder why we are confused!

Incidentally, after 2 weeks of feeding, expressing and topping up I spoke to an AMAZING BF counsellor at a charity in Berkshire and in the space of a 20 minute phone call got all the advice I needed, and am still BF (without the top ups and expressing) at 16 weeks.

If we saw a bit more of this: www.mirror.co.uk/3am/celebrity-news/miranda-kerr-and-the-debate-about-breastfeeding-in-public-105623, and saw breastfeeding as an extension of pregnancy, perhaps attitudes would change.

frankly as most women have given up by 4 months, weaning age is a pretty irrelevant discussion (though evidence is that 4 months is fine in the UK)

heavy formula advertising on TV..

crap BF support in hospitals/ from MWs/ HCPs

general culture of FF

are the things that are relevant. for a woman struggling to BF a newborn, the next day is the big target....

MigGril - maybe that point needs clarifying, I meant expressing as the action of giving it a little squirt/squeeze with your fingers, not with putting a pump to it to prove whether it's there or not. But most new mothers or mothers well established with regular breastfeeding at one or two months should not really have a problem getting a supply - unless they are seriously ill (like a heart attack, I don't mean the flu, or the rare conditions Ms Byam Cook has mentioned.) But yes, when I mentioned theoretically putting it into a bottle to measure the amount, then I meant using a pump. Of course, nobody actually has to measure how much goes in in a feed - there's no need.

What she also mentioned about the kinds of feeders - the babies who feed 'little but often' versus the babies who feed for a long time but less frequently is also quite true, as I've found. But many professionals don't tell new mums that this is something they have to work out about their babies, just like you would work out a house guest's routine about how often they take their meals. Sometimes the baby can adapt their feeding habit according to mum's schedule, eg if mum has other children and needs to do things like getting kids to school or running errands, and they seem to be able to fall in with what suits their mums. MIdwives and doctors often just give a standard pronouncement of "3 hourly" or, as I was told : "3 to 4 hourly". "But baby is not gaining weight on 4 hourly". "4 hourly is insufficient". "So it should be 3 to 3 and a half hourly". "No. 3 to 4 hourly." "But you just said..!" (In fact during that period it turned out that it should have been 2 hourly but the midwife had no idea!)

Clare Byam Cook's stuff is good, surprisingly I found Gina Ford's suggestions for breast feeding (just ignoring her routines for the moment!) quite helpful too. In a way, feeding a baby is kind of a bit like preparing food for adults - you just learn what works for your baby, you learn what things you can do that suits your strengths too. Breastfeeding in a way is a bit like learning to cook meals for your family. You read these books like you would recipe books - you learn what is right for you, and what isn't. Some people couldn't manage with an pump and expressing milk. Others couldn't manage without it. You find out what suits you. I think like a lot of other things about childbirth, breastfeeding has been "medicalised" like some sort of mysterious operation which is shrouded in mystery and is either described as terrible or easy, and both are misleading. But actually it's no worse than cooking - you have to learn it, you don't wake up just knowing how to do it even if it's a natural thing to do. And yes, it's a bit of work, just like cooking, it doesn't happen by itself if you just lie there and close your eyes. You do have to pick up baby and make sure baby is with you. But once you get used to the initial unfamiliarity and the odd pain or discomfort (like when we've all cut or scalded ourselves when cooking) , it's pretty okay after that.

I agree that current attitudes to breastfeeding in the UK/US are a hangover from the 60s/70s medicalisation of childbrearing/childbirth/childrearing. Most modern-day grandmothers were advised to leave childbirth to doctors/bottle feed/get their babies sleeping apart and this is continuing to resonate today.

It's also down to a unhealthy, "kiss me quick"-yet-prudish attitude in this country towards breasts/motherhood, which leads many women to feel embarassed/unattractive/uptight when breastfeeding in public. When I lived in Spain, I saw women breastfeeding in public far more than here and the (mostly male) estate agents who showed us flats assumed our 10 month old baby would be sleeping in our bed. When I stayed with a family in Indonesia, the baby slept between her parents.

But I also think women are too bothered about what other people think. I've breastfeed in all sorts of public places (pubs full of men watching football, restaurants, buses) and people have barely noticed: I've not had one strange look or comment. But, having had looks and comments about all sorts of other things (such as having a drink in a pub with a black man when I'm a white woman), I've learnt to ignore other's woeful views. Of course you have to get used to it and, especially, once the first few (not necessarily 6) months of exclusive feeding are out the way, it shouldn't restrict you in any way.

I think women should be encouraged understand their attitudes to breastfeeding. Luckily, I was told from a young age that my great-grandmother breastfeed all 11 of her children until 3 years while landlady of a busy pub. Perhaps this is why I've breastfed all three of my sons until a similar age while still working/going out/being 'normal'.

The thing that intrigues me most is that the people who are so quick to condemn pregnant women who ignore advice on drinking/smoking while pregnant are less quick to criticise women who ignore advice on breastfeeding. I wonder if calling formula 'fake breastmilk' and dummies 'fake nipples' would help reframe the debate. Not that I think badly of anyone who doesn't breastfeed - each to their own.

And I'm amazed at the ignorance about growth spurts and 'not producing enough milk'. Luckily, I ignored the midwife who told me that if my first son needed feeding more at 2 months, I should give him a dummy. I don't think the obsession with weighing helps. I've never had my babies weighed - or weighed myself. You know when your baby's healthy and growing. Just like you know if you're getting unhealthily overweight.

I do hope things change for my children's generation.

I have just read a small proportion of this article which clearly isn't evidence based at all.
The main issue with women 'being able' to breastfeed is a lack of understanding of how it works, feeding in public due to the sexualisation of breasts and generally the expectation that babies should go 4 hours between feeds.
In my experience of carrying out antenatal visits, once women realise that feeding every 4 hours as not normal for babies, that there are ways around feeding outside the home and they understand that the baby must feed lots to stimulate supply, along with the need to feed at night .............most of them cope fairly well with breastfeeding and the difference in breastfeeding rates with antenatal visits as compared to just a new birth visit is phenominally different. Much poorer rates with the latter approach.
As for professionals giving 'poor advice' in both trusts in which I have worked all members of the team had 2 days training in breastfeeding support provided using the UNICEF guidelines, so all mothers will be provided with consistent support which is approved practice and current. Unfortunately some practitioners will sadly fail to go by the guidelines.
Another issue is mothers not being encouraged to feed lying down ..........who wouldn't want a partner to feed the baby if every feed had to be sat up/ awake. In one trust they do inform parents of safe co-sleeping guidelines, yet another they don't.
Also, families are usually seen between 6 weeks and 3 months so the breastfeeding issues should be highlighted then at some point??
If the growth spurts are not discussed then of course mothers assume they have not got enough milk and move to formula................if you have explained at the antenatal that a human adult generally puts something (food or drink) into their mouths approximately 14-17 times per day and ask why a baby would require less, most people then see clearly that it is normal for humans, not just babies. . They seem to have more patience with feeding then.

Sunworshipper at how you were treated! And at all the difficulties you went through. Maybe Asia might be a good place to give birth! - I hear the mums in Hong Kong and Singapore are treated with a lot of respect and support, like you are doing a valuable and wonderful thing giving birth. And you get support and encouragement whichever way you choose to feed. Once again, I think there is a culture of inferring blame (even when there's nothing to be blamed for!) in this country, blaming the mum when anything doesn't go to plan! (You'd never see them treat male patients like this.)

AnxiousElephant, you're hoping for the moon if you think an antenatal mention of the frequency with which babies may feed is going to change much :( ("if you have explained at the antenatal that a human adult generally puts something (food or drink) into their mouths approximately 14-17 times per day and ask why a baby would require less, most people then see clearly that it is normal for humans, not just babies.") People might nod and agree and see the point - but they may not truly take it on board.

Acceptance of the needs of babies to be close, to feed a lot, and to do it unpredictably may mean a profound challenge to expectations of everyone around the mother as well as the mother herself - there is a deep cultural belief that frequent feeding is 'too much' and it means the mother 'doesn't have enough milk'......we see it expressed every day on mumsnet, for example.

Altering perceptions and expectations is an on-going task and it needs to be combined with easy access to skilled, knowledgable help with problems.

I don't think reading about celebs breastfeeding makes much difference at all, either. It's not 'attitudes' that will change things, but serious, effective help for the 80 per cent of women who start off breastfeeding so they have a good experience and breastfeed for as long as they and their babies want to. There is nothing more influential than that.

Whether it is "normal" or not is not always the point. It is also normal for human beings to live in community with one another, yet this isn't the experience for a great many women in this country any more. Frequent feeding can be very difficult for women with poor social support networks.

I was advised when my supply was low (very poor weight gain, falling off the charts - not just in my head) to feed two hourly and express in between, then refeed what I had expressed. This essentially equates to feeding around the clock. We had no family to help, dh was at work and often away and I didn't know anyone else with kids AND I was battling mental illness.

It's all very well saying that it's normal for babies to feed all the time but it is EXTREMELY hard work for some women and I'm sorry, but the typical formula fed baby does not follow this two hourly round the clock pattern, and even if they did, preparing the bottle doesn't take as long as expressing.

This is not to say that breastfeeding isn't a wonderful thing, I did enjoy it.. but reading comments such as those above suggesting that women "ignoring" breastfeeding advice should face the same "stigma" as those who drink/smoke while pregnant is just infuriatingly unkind and almost misogynistic given the severe pressure some women feel when they are struggling to breastfeed and don't have community support to ensure their own physical and mental health is maintained during this time.

i bottlefed dc 1-3 i was actually terrified by the horror stories i had heard of bleeding nipples etc. at that point in my life 6 days seemed too much let alone 6 months.
when dc 4 came along life was different, i was older and more confident in myself so i tried it out thinking ill just try a few days and see how it goes. that became a week, then a month and then 6 months and actually ended up being 14 months which was halfway through the pregnancy with dc 5 and dc4 jyust seemed to lose interest.
dc5 is now 1 month old and breastfed i found the first 48 hourd hard but as soon as the milk came in it improved hugely.

I think more emphasis needs to be placed on small goals a day of breastfeeding is better than none and i think making women proud of what the achieve no matter how small would take away the fear of failure you often see.

I spent the first 8 weeks of Ds's life battling with oversupply issues and came close to giving up BF'ing many a time. I continued because I felt I had to, not because I necessarily wanted to. If I had given up, I would have felt like a failure. I cried on numerous occasions as I had an image, which I now realise is far from the norm, in my head about how the BF'ing experience should be. Luckily, we are on the road to a reduced milk supply now(!) and I see no reason why we won't continue as he is 10 weeks and thriving. I wish I had been given more realistic advice during the ante-natal period, I was just told how to latch baby on and to listen for swallowing - there was no info given about the potential problems that can arise and where to go if you need help. I got in contact with a lactation consultant who has been a great help, but I had to pay £75 for an hour's consultation - absolutely disgusting IMO. It's no wonder so many mum's give up as the personalised help just isn't there - BF is a hard slog to get right for most and takes time, dedication and perseverance - if I had been armed with this before starting out, I would have been alot better prepared and the first 8 weeks would have been alot better. I have now come to realise that BF'ing isn't right for everyone and I won't beat myself up if at any time in the future, I decide to give it up if I feel it is best for my baby. Take one feed at a time, chill out and be happy - that is what is best for baby, whether it be fed by bottle or the boob.

Gosh Sunworshipper you poor thing. That's awful. I've been pretty lucky to have loved bf. Although the first few weeks were also complete agony.

onebirthplaneveryminute I feel like you are saying, very eloquently, what I feel and think, thank you.

Decent support for me to breast feed would have been

• 'NCT counsellor level' of breastfeeding support in hospital day and night. I felt like the midwives could only really cope with a limited range of cicumstances
• 24 hour phone/visit support at least at home for the first couple of weeks
• husband off for 6 weeks (not just two especially for my second child) We have no other family support

I think I was just too afraid to continue breastfeeding. It felt lonely, miserable, painful and I knew that I just couldn't handle it. Giving my baby a bottle of formula was one of the most empowering decisions I made as a Mum and I just remember thinking "I can do this now'.

Kipperandtiger and mrssweetpotato - thanks. I did actually make a formal complaint about my post-natal care and the lack of breastfeeding support so I wasn't a complete wuss. We had a very good meeting with the Head of Women's Services, the Head of Midwifery and the elusive Breastfeeding Coordinator who all acknowledged that there had been major failures on their part.

There just seemed to be a lack of coordination / initiative / responsibility in the big teaching hospital where I had my ante-natal appointments and where I had my DD. For example, I never saw the same midwife twice even though I had an appointment every other week throughout my pregnancy as there were complications. When I got to 26 weeks I asked at every appointment to see the bf coordinator so we could deal with my concerns in advance and each time I was told that my message would be passed on but apparently it never was. I attended the breastfeeding classes at the hospital and told the midwife who ran them about my concerns and she agreed that I needed to see the bf coordinator so a plan could be put in place and said she would sort this out but it never happened. I attended the NCT antenatal classes too.

I guess that for all I tried to prepare, nothing actually did prepare me for the reality of becoming a mother. Tbh I was terrified of my daughter and terrified of starving her. There is evidently some good advice out there but often it is being given (or not) to someone who is feeling extremely vulnerable, who is trying to learn a new skill at the same time as coping with some big emotions, someone who is feeling almost frantic with sleep deprivation. It is not the best set of circumstances to calmly listen to yourself, look for your baby's cues, trust yourself etc. There is something about not just being taught positioning etc with breastfeeding but actually someone very calmly and gently sitting with you for as long as it takes helping you to get to know this new little person and understanding what some of the things that it does actually mean. Too often, breastfeeding support comes in at crisis times and there is no sense of working together with a mother within her own context and circumstances. BF support also needs to go on for a lot longer than the first few weeks because there are so many changes and developments which require small adjustments but which can throw you when you have no idea what to expect.

Oh, one big thing that the hospital have incorporated into their breastfeeding care since my experience, I was told, is that they now have a breastfeeding coordinator on the ward between 7pm and 2am which is when most women have most difficulties post-natally. This was good news to hear.

I love breastfeeding but but I think that most new mums don't have a clue how time consuming and knackering it is to begin with. There is fear about how painful it will be, whether you'll have enough milk, fear about feeding in front of people and a myriad other things to 'learn'. The advice given by midwives can be unreliable and conflicting; breastfeeding counsellors or peer supporters are much better informed. When talking to a pregnant woman it can be hard to know which is better - telling her that breastfeeding can be a nightmare to begin with unless you have great support to help you and your baby master it (and risk putting her off trying at all) or saying 'it's easy' as it's clearly not for lots of us.

I feel lucky that I've managed to breastfeed my four children well beyond the recommended six months, despite some difficulties at first. I think for me it's partly my obsession/determination to do it and arming myself with absolutely tons of information about normal infant feeding behaviour, partly having a very supportive family and not having to worry about rushing back to work full time. That's not to say that there haven't been lots of occasions when I was tempted to jack it in but knowing that my babies refused bottles left me with little choice.

There are so many pressures on mothers that breastfeeding can end up being an unrealistic and unachievable feat beyond a few weeks for many who have to snap back into a busy lifestyle. I have a busy lifestyle too but I can be flexible with it which made it easier for me to let breastfeeding be a priority.

In defence of health care professionals I can honestly say in my opinion I was never bullied into breastfeeding or made to feel that not doing so would be 'failing', if anything I had the opposite experience. Most health care professionals have assumed I'm bottlefeeding and expressed surprise at my breastfeeding.

In an ideal world I'd love if more of us breastfed our babies up to and beyond six months; as a peer supporter myself I try to help mothers work through any issues if they really want to breastfeed. Perceived competence really affects motivation to persist so having someone to give reassurance can help someone keep going a day/week/month longer if they want to. Every day makes a difference to the baby.

We need to have access to the WHO's advice and of course health care professionals are going to promote it - it would be an insult to women if they didn't, but it doesn't mean that it's the law and anyone not adhering rigidly to it is a bad person.

It's all about choice and I'd never (I hope) make someone feel bad if they didn't want to breastfeed or if they chose to stop breastfeeding because they felt it wasn't working out well for them.

I think the biggest obstacles to successful breastfeeding are found within the family, especially the older generation, but among partners too. Excluding family members from ante-natal classes that include breastfeeding education is ludicrous and practically ensures that mothers will often be left battling against the unrealistic expectations of the wider society about baby behaviour, especially sleeping and crying, within their own homes. It means that the little that is spent on breastfeeding ed and support essentially gets flushed down the toilet when the education is restricted to mothers so it's not even cost effective. Physical and practical problems of breastfeeding are only half the battle.

I think when it comes to what to aim for, the WHO aim should be stated and widely broadcast. That way the importance of breastfeeding can be emphasised, and maybe society would take it more seriously and start to evaluate what we do to encourage it for working mothers. When you aim low you get poor results. Aim high, educate properly, and educate the right people, and results will be better.

And kindness. YYY just plain kindness and care and respect you would think it was a no-brainer, but in many hospitals the experience of childbirth and starting your new relationship with your baby are inflicted on mothers almost as if they were a form of violent hazing. No wonder women find it is all too bloody much.

Very true. Perhaps we should have posters stigmatising people who make a fuss about bf (eg older people in restaurants asking for mothers to be moved and making complaints that they 'don't want to have to look at that'; ignorant people thinking mothers should miss their own hot meal and be banished to a bedroom/bathroom to bf rather than - heaven forend - 'offend' in the in-laws, that kind of thing). Plus more positive ones giving advice about how to support a bf mother, for example stating that initially babies may feed hourly so mothers will need a lot of rest; that it's a good idea to offer mothers a drink and a cushion; that it's actually a pretty selfless act; that historically children were bf for two years and this might be something to aim for.

It's a societal thing and we need to get the message out well beyond the healthcare system.

" i think making women proud of what the achieve no matter how small would take away the fear of failure you often see."

I totally totally agree. The 6 months exclusive b/f message is just plain cruel. It sets women up to fail from the beginning, unless they are fortunate enough to have a supportive partner and wider family, realistic expectations, a relatively straightforward time of it, or at least great professional support. In the absence of all of these it is a rare woman indeed who will "make it".

But what is making it anyway? 6 months falls well short of the WHO's 2 year recommendation. It is an arbitrary target which, as I said earlier, has been conflated with the weaning age recommendations (of course in an ideal world it's the same thing, but in the real world formula has generally reared its head making the 6 months exclusive b/f thing irrelevant at that point).

Every drop counts. THAT is the message that should be out there. If the Government doesn't promote it then every single charitable organisation should. A woman who gives her baby that amazing life-giving fluid, forged from her own body, should be damned proud of herself. Not made to feel like a failure because she didn't endure the pain and suffering for 6 months.

I love that idea! In fact, I've loved your posts on this thread, boffinmum

This has been your fangirlish appreciation moment. [shuffles off]

The '6 mths exclusive bf' is not an official 'target' for individual women - it is a national/international recommendation, and it is the responsibility of government, employers, HCPs and other agencies to enable it. It's a reflection of the way mothers tend to feel guilt whatever they do that some of them will feel they have 'failed' if they don't 'achieve' this.

There are no NHS/DH leaflets or websites that I am aware of that tell mothers they 'should' bf excl to 6 mths. I have just checked this one www.nhs.uk/Planners/breastfeeding/Pages/breastfeeding.aspx and it talks about intro'ing solids at 6 mths but nothing about what mothers ought to do/should do. I have seen a statement on a local NHS site I looked at which says 'Bf is recommended for at least 6 mths' which is not quite the same as 'exclusive' breastfeeding.

The evidence is clear - bf supplies all the baby (ie most babies) needs by way of food and drink for 6 mths. Mothers need to know this.

They also need to know that any breastfeeding makes a difference, and for many years, this has been the message, but not all women hear it....not sure why. NCT has had a 'reasons to be proud' factsheet (google breastfeeding reasons to be proud NCT for the pdf) for 4 years.

No one needs to feel they have failed a target, because there is no target :)

We were told about the 6 months exclusive breastfeeding advice at our nhs post natal group. The hv described it as "the gold standard"and in my view undermined the advice somewhat by making it sound idealistic and unachievable, but perhaps this could be seen as a positive thing as it doesn't set women up to fail???