MNHQ here: what you told us about breastfeeding... and why some of you stopped

[RowanMumsnet]

Hello

It's World Breastfeeding Week this week, and as part of our campaign for Better Postnatal Care we ran a survey with just over 1000 MNers with children under 5 asking them about their experiences of infant feeding. Many thanks to all who took part (it was a bit of a whopper).

We've got lots of really interesting information from you about breast and bottle feeding and your experiences of it, which we will use to inform our campaign - but for today we're focusing on the difficulties women encounter when they want to breastfeed (which 87% of respondents said they had wanted to do).

You can see the results here and our page about what we think the most common breastfeeding barriers are (based on the survey results) here.

In summary:

Among women who had wanted to breastfeed but had stopped within the first 24 hours, their reasons for stopping included:

The baby could not latch well: 41%
I felt I didn’t know what I was doing: 27%
I needed more help/support: 23%
It just felt incredibly difficult: 22%
Too physically painful: 15%

Among women who had initiated breastfeeding but had stopped by six weeks, their reasons for stopping included:

The baby wasn’t latching on properly: 56%
Worried I wasn’t producing enough milk: 42%
Breastfeeding was painful: 39%
I was overwhelmed/exhausted and something had to give: 34%
I found it difficult to express milk: 32%
I was worried the baby wasn’t gaining enough weight: 24%

Just ahead of the birth:

33% said they felt a lot of pressure to breastfeed;
47% were worried they would not be able to breastfeed; and
36% said they felt anxious about breastfeeding.

74% of respondents agreed with the statement: ‘There is too much emphasis on telling women why they should breastfeed, and not enough on supporting them to breastfeed.’

Among those who were still breastfeeding at six weeks, face-to-face support from healthcare professionals or breastfeeding counsellors was rated the most effective intervention, with 71% saying it contributed to their success. Partners' support was rated the best, with 81% saying their partners/spouses' support was excellent or good.

Many women found breastfeeding painful at first. Even among those who were still breastfeeding at 6 weeks, 31% agreed that ‘breastfeeding hurts/is uncomfortable’. Concerns about poor latch and milk supply also run throughout the survey results.

Among those who had stopped breastfeeding by six weeks, 34% agreed ‘I was overwhelmed/exhausted and something had to give’, and 22% agreed that ‘breastfeeding felt relentless’. Among all those who breastfed at any stage, 45% reported finding it difficult during ‘periods when the baby breastfed constantly or very frequently’.

Perhaps not surprisingly, women who had breastfed before were significantly more positive and relaxed about breastfeeding subsequent children. When compared with first-time mums, veteran breastfeeders were more likely to want to breastfeed (92% vs 87%), less likely to feel pressured to breastfeed (21% vs 39%), and felt much more confident directly before the birth about breastfeeding (54% vs 30%).

Have a look at our breastfeeding barriers page and tell us what you think - do our findings echo your experience? What can be done to really support women when they need it? What sorts of interventions did you have that helped you - or what would you have liked that you didn't get?

We will use these findings to work with health organisations to see if we can get better, more useful support for women who want to breastfeed.

Thanks
MNHQ

"Those of us who did breastfeed should apparently keep quiet so others don't get upset, according to you."

No, but if you've read the thread you should have the empathy to word your posts in a less dismissive way for the benefit of women who couldn't EBF, not didn't, couldn't.

I forgot to say as well that I had some great advice from the twins association BF counsellors on the phone. And Kellymom. And (carefully selected!) YouTube videos.

Plenty of examples on this thread of how women who BF are often made to feel that they shouldn't share their positive experiences. It adds to the feeling that BF should be something that you are ashamed of and cover up, which in turn can make less confident people feel perhaps they shouldn't be bothered or are doing something wrong.

But we have so few women breastfeeding their babies these days that we really need all the visibility we can get, if we are ever to be able to rebuild the vast amount of knowledge and support that was historically offered by women to other women over the generations.

For me it's like being relatively able bodied: I am grateful and feel lucky that I don't have significant health problems. I am conscious that some of my friends do have mobility issues and disabilities that affect their daily lives, but I don't feel ashamed of sharing the pleasure that I take in what my body can do (swimming long distances, doing a new thing at yoga). And I don't think that I should.

I DO have a health condition that means I will never be able to run a marathon. I don't feel funny when friends post about their marathon successes, or say that they think it's something everyone should do. Why should I pull them down just because I can't do it myself? On the contrary, it encourages me to do more of what I can do -- and I like to see how their posts encourage other friends to start traing for half marathons or running for the first time with Couch-to-5k or whatever it's called.

Penguin I don't think people had an issue with the positive stories. It was the way in which one positive story was presented.

Talking to some one who can't run a marathon about your marathon is a bit of a false equivalency. Being unable to BF isn't a disability. I would say that particular poster's way of phrasing things was like popping into a thread where someone was sick with worry about their finances and boasting about how much money you had and how you could understand why they didn't just get all their shopping at Fortnum's. It was a bit 'let them eat cake'.

Positivity is to be encouraged. I love to hear from friends who had a great time BFing and I'm glad for them. But it is hurtful and wrong to talk about how cheap it is not make your own milk and how proud you are of never having formula in the house to a group of women who have just shared very painful stories about not producing/ struggling to produce milk and having (not want to, having to) switch to formula. Can you not see the difference?

Sorry couldn't understand makes more sense!

Nanny, unfortunately I think the effect is to shame women who share positive stories about breastfeeding. Why silence those stories in favour of the negative ones?

It's sad to hear that that could be perceived as boasting, or hurtful. That's really what led me to draw the comparison with a disability, which means that one person may not be able to do what another can.

Do you not think that saying "I am a cheapskate. Why buy milk when you can make your own?" could perhaps be the trigger that helps somebody on a lower income see breastfeeding as a positive option, rather than something weird or unusual?

Should I be chastised for saying "Why drive if you can cycle; it's free too" because some people are unable to cycle and drive for mobility reasons?

It's not positive stories per se that are the problem, it's how they're presented. I can appreciate my friends running marathons but I doubt they'd post on Facebook that 'anyone can run a marathon'! Which is what you get from some of the BF stories.

My personal experience is that several acquaintances have been encouraged to mix feed because they've seen me do it and heard my story, whereas they had thought they might as well give up BF altogether as the baby had had some formula.

Eg a friend posted on FB and said she'd made it to a year BFing, it had been tough but was glad she'd done it. She got positive comments and likes.

If she'd put 'well I've BF for a year, why don't other women, you've just got to keep trying' then that isn't positive at all and doesn't recognise the difficulties faced by many.

"Should I be chastised for saying "Why drive if you can cycle; it's free too" because some people are unable to cycle and drive for mobility reasons?"

Depends - would you go on a thread full of ex-cyclists who'd been forced to give it up and say that?

Or would you not put it differently in those circumstances?

Nanny
You posted:
Don't be so silly. Lots of people have posted really interesting and positive BF stories. They managed not to be smug and boasty.

You misread the situation. It happens. But as someone who really struggled to BF and developed PND because of it I found your post upsetting

I don't really want to argue with you, as you're clearly upset but I can't let the inaccuracy of what you say stand.

There is no way I feel smug or boasty about the way I fed my children. I can't actually believe you've posted that. My post was purely about my experiences. I haven't criticised anyone else, I haven't compared myself to anyone else and I can only draw the conclusion that your own experiences are dictating the way you are reading some of the posts on here. I'm not the only person who has been pulled up for posting something positive about breastfeeding.

The comment I made about myself about being a cheapskate was intended as self-depracating. I am a cheapskate and I get ribbed by my family for it. I never throw food away, well I do sometimes but not often.

As I tried to explain to you, it's sometimes difficult to understand the intent behind posts on the internet as you do not have the extra clues of body language and tone of voice. If you find a post has upset you, perhaps you should step away and find something else to do for a while.

I think the state of the breastfeeding figures in this country are extremely worrying. I believe that the reasons for this are complex, as with many things. Staff get blamed all the time but midwives are overworked due to staff shortages. Their morale is low and they struggle to do the basics. Health visitors are in a similar position. With cuts to funding HVs are finding themselves overwhelmed with child protection cases, rather than out there supporting families with breastfeeding and all the other things they are trained to do.

Our culture doesn't support breastfeeding. Breasts are seen as fashion accessories by the media, yet if a mother tries to breastfeed in public some people complain and she is asked to go to the toilets. Really, does anyone want to eat their dinner in a public toilet? I've read about people being disgusted at the thought of drinking human milk, yet isn't human milk intended for humans? Surely drinking cows milk is disgusting? I don't really think that but I'm just trying to make a point.

Baby milk manufacturers are also hugely to blame in all this. Yes there are rules about advertising but these guys are way too clever and get around this hurdle with ease.

Many women no longer know how to breastfeed. At one time breastfeeding was the only way to feed a baby, so other mothers, sisters and grandmothers were there to support you and even feed your baby for you if necessary.

My mother bottle fed me and my older sister. My older sister bottle fed her children. I chose to breastfeed and I was lucky enough to succeed. I say lucky but the early months with my first was extremely difficult. I had problems with an unsettled baby. He was slow to gain weight and I had all the usual comments from the HV. I had two cases of mastitis which needed antibiotics and the GP suggesting I give up and I had a baby who woke for hours at night and wouldn't settle and this went on for months and months.

Every which way you look, it feels that everyone is screaming at you DON'T BREASTFEED, bottle feeding is the answer to all your problems.

I know many mothers are desperate to breastfeed and it doesn't work out for them. That's really sad but I do believe the figures should not be as low as they are. In other countries far more babies are breastfed. I'm done.

Breast feeding is such a great bonding between me and my children. And I believed that breastfed children are healthier and stronger immune system.

Gothic, have you read the thread? Or even the opening post by MNHQ?

Knowing I was expecting twins I felt I needed my energy and needed as much help feeding as possible. I breastfed and expressed a bit for the first 3 weeks until my milk dried up but also used formula from day 1 with one twin (as she was under 5lb and delivered by planned c/s so my milk didn't come in til day 3 - she needed food) and day 2 for other twin (who had only allowed me 1 hour of sleep the first night in hospital). I felt much more myself when I stopped breastfeeding and had more energy to look after the girl. They got into a good sleep routine much earlier than many other babies - maybe that was just luck but in the early days topping them up with formula certainly helped with sleep. My husband was able to help make up the bottles of milk and friends and family could help feed or I could feed both at once much more easily than tandem breastfeeding which is almost impossible on your own in the early days even with special b/f pillows (once one baby unlatches it is a struggle to get them back on!). We are very lucky in the UK to be able to choose safe formula and safe b/feeding or a mix of the two.

I was a six weeker. I was determined to stick with it but try as I might he was not feeding well. He fed every 45 minutes day and night and in the end the health visitor felt it would be best for me to stop as I was exhausted and he was losing weight. My sister in law fed brilliantly, her baby would latch on and feed until he had drained the boob and often a bit of the other. Most of the successful breastfeeding mothers I knew did this, unlike me who would squeal in pain every time he latched on and then cry when he came off again having barely taken a sip. Whilst I understand posters who are saying its not easy you have to recognise that for some mums it just doesn't get any easier than those first few days and the pain/upset and exhaustion are not good for either mum or baby.

Very good research and campaign Mumsnet, fairly balanced too in comparison to some others we're seeing for example this article in the Guardian

www.theguardian.com/lifeandstyle/2017/aug/01/uk-attitudes-to-breastfeeding-must-change-say-experts?CMP=share_btn_fb

Without spending ages debating and dissecting everything, this particular line is dubious
Unicef and the WHO publish a new report warning that thousands of babies are dying across the world and economies losing billions of dollars for want of breastfeeding.

Where exactly are thousands of babies dying due to lack of breastfeeding, surely not in the UK and other countries where clean water, well regulated formula and hygiene standards exist? Why is lack of BF linked to death of babies in such a scaremongering way when real reasons, location, circumstances and relevance to UK are not explained?

Furthermore, this outlandish claim
Breastfeeding “offers children unparalleled health and brain-building benefits. It has the power to save the lives of women and children throughout the world, and the power to help national economies grow through lower healthcare costs and smarter workforces. Yet many societies are failing to adequately support women to breastfeed,” is frankly insulting. It is not backed by any actual convincing medical evidence but it implies that formula feed children are or will be unintelligent underperformers who cost the health system and even the economy in general (!). I know quite a few FF babies and children who are highly intelligent and healthy and I've also seen some sickly average kids whose mothers BF them. I am not however claiming in national media that BF makes them ill and stupid, that would be wrong.

As several previous posters explained through their painful experience, pressure to BF can and does lead to some very bad outcomes for baby and mother both physically and mentally. In my case I never bought into the "breast is best" mantra and stopped as soon as I've seen it's not really working but many women do buy into it and are told to "persevere" by BF gurus, HCPs, friends and even family. I have wintessed in recent years several relatives and acquantances spending months in utter misery over this, instead of enjoying the time with their newborn had someone told them that formula is perfectly acceptable and even quite good for babies health and growth. This is the time they will never get back.

For as long BF is treated with such cultish reverence (as it is in many circles today IME), chances are the statistics as well as experiences will overall be poor. It's reverse psychology coupled with objective personal circumstances and informed choice or preference. Those more cynical might say that the campaigning is to do with seeking funding but I wouldn't go so far to claim that. To me it seems like faith or a dogma which has taken a life of its own much like the natural birth movement(s)- yes it has some obvious positives and it works for some women but it also has negatives and does not work for many.

Spring, you'd expect the guardian to report with an international perspective and as for the World Health Organisation, the clue is in the name .

Clearly the seriously excess mortality is in countries and situations where many babies simply cannot be bottle fed with any reliable safety. I don't see why this means we should not be concerned in the UK - where we have studies showing measurable health differences related to feeding in infancy. The health service has a role in communicating this though they have to do it sensitively.

@NotMyPenguin

I wonder if *@MNHQ* could put together some information based on TWO sets of surveys?

1. Women who stopped breastfeeding -- what were the challenges they faced? How could these challenges have been better supported?

1. Women who continued breastfeeding -- what did they get support with? Who/where was it from? How was it funded?

I think if you are just focusing on women who stopped breastfeeding, you might miss some of the fantastic sources of support and information that some of the rest of us managed to find by luck or accident. And the combination of those two things could add up to a wonderful list of resources, a better understanding of what can help, and a wishlist that we can campaign for in order to improve the accessibility and quality of the support on offer.

Hello - sorry to get to this late - yes absolutely. We're going to ask our survey team to do further crossbreaks on the data that we've already got (the survey wasn't answered only by women who stopped bf) because we've got so much potentially useful info in there.

Thanks for the comments on this and really useful insights. We've got further plans so please stay tuned!

wow, interesting discussion and lots of thoughtful comments.

I find it really hard to say "what would have helped" or "what really helped" because, as people so often say, you don't know what would have happenned if you had done XYZ... the tape only gets run once.

For my first, I just think more experience of knowing what babies are like. I really had no clue - I had never even changed a nappy! I don't know how you manage that in modern society, maybe antenatal classes and BF education could be more practical? It was very idealised and simplistic, the woman just said, oh you leant back and had the baby on you and they latched automatically and that was it basically. Maybe just even, watching a video of a real newborn baby latching, and the different positions mums could use, might help?

There was no discussion or mention whatever of any problems that babies might have. (or you might have). There was this image of the smile curve of their weight dropping but it was all explained that the baby then gained again and got to their birth weight by 2 weeks and everything then was fine. No discussion that sometimes mothers' milk doesn't come in, that some babies don't latch well whatever you do, that there are a whole variety of situations and that really, it is pretty damn important that babies get enough milk and if everything has been tried and "isn't working", really the baby being fed has to come first. And even, that combo feeding is totally doable and practical and works well for many families. For all of their own individual reasons.

That would be my big suggestion - I totally agree with some of the points above that the messaging is so elitist and idealised with respect to, 6 months exclusive BF etc etc etc. Why not accept that combo feeding works for many and some BF is better for the infant health than none? Otherwise, something I know has happenned to many families, they bring in one bottle because they feel they need or want to, and then feel they've "failed" and there is no benefit to continuing BF - while, actually the bodies which are putting out the official communications could be much more accepting of this and in turn, this could well support much higher BF rates overall. (Which would then have a good impact on infant and maternal health).

And just claims that aren't true when you check out the scientific papers - (which I have done I have to confess) like that insufficient milk supply is rare. In reality, there are few studies that have tried to examine this in any kind of rigorous way and the only decent ones actually seem to show it's not rare that mums can not make enough milk. It might be a continuing thing or it might only be temporary (ie delayed onset of milk coming in) but either way, it affects the baby and this information should be given to mothers. How else are they supposed to care for their baby properly?

This is turning into a bit of a rant, but I completely agree with spring81 and I think this has to change for the UK to get anywhere with supporting more mums who want to, to BF. Unfortunately the tide is going in the opposite direction with the groups and people involved in putting out the messages, unfortunately, and I think that is only deepening the problem and creating more stigma, confusion and anxiety amongst mothers.

More scientific accuracy, more attention to detail, more acceptance that not all families and women are the same and more support for different ways of doing things.

I would also love to see a clear explanation that we do not have all the answers scientifically - many things are unresolved, even very important questions (like many aspects of newborn physiology, eg how much weight loss is acceptable before you hit problems). eg for my own case, I had a "colicky" baby who would never settle even though she fed constantly, and had brilliant weight gain, no signs of reflux or allergy type problems. But I was on the verge of a breakdown, really with the lack of sleep and the continual feeding, round the clock. It was about 3-4 months before she settled down. Some explanation of this type of problem and that science does not have the answers - and willingness to fund work which can actually address what these problems are and how to fix them - would be useful.

In that vein, given that most mums report they stop BF for real physical problems they experience - eg, pain, low supply, baby not latching - there is vanishingly no proper scientific research into why these things happen and what can fix them. LC's and BF support people and all the support websites will give you a million things you "can do" to try to fix them, but (I've checked) hardly any of this is actually scientifically tested. If we want BF rates to increase, let's actually do some decent quality research on this and give mothers proper, evidence-based solutions that we can tell them will work. (statistically, even if not in their particular case). And let's stop the gaslighting that says "all this is in mothers' heads" - I think if mothers say they are in pain, they ARE, and if they say their baby is constantly unsatisfied, that may well be actually true. The claims that it's all the fault of the baby books that mothers stop BF (because they expect their baby to be perfect and feed every 4 hours - and they're not) -- frankly, this is rubbish. If a mother says she's exhausted to the verge of collapse because of feeding her baby (and then she uses formula because of it), let's not turn this into "she used formula because no one told her breastfed babies feed frequently and you just need to feed responsively".

Rant over.

That's interesting mamapeach. It's getting on for 9 years ago now so my memory might be a bit rusty but I remember during NCT classes we had two evenings on breastfeeding. One part which I remember was being handed a soft toy/doll and we were all supposed to hold them in whatever position we thought best to breastfeed. Almost all of us held them with the baby's body facing upwards, like you'd bottle feed. So that was useful because the BFC running the course pointed out that it isn't very easy to drink with your head turned to the side and a shoulder in the way, and showed us what the whole "tummy to mummy" thing actually meant (good job, because I could never quite work it out) and IIRC she also covered the point that babies can't swallow very well with chin to chest either, and that it's better to encourage them to tilt their heads back. I don't remember if she demonstrated alternative positions then but she might have done.

I don't remember what problems she went into, but I think she went into quite a lot, because I remember most of the women on the course feeling really daunted and saying that they felt it had been too negative. So it's interesting and shows that there is a need to show a balanced view.

I totally agree with all your points about scientific accuracy and evidence. And YES YES to listening to mothers who say that they are in pain or they are worried about their supply/baby's weight gain. It doesn't help to fob them off with "Lots of women worry about this but it gets better" - sometimes it doesn't "magically" get better, it would be beneficial to at least look for a cause of those problems even if one isn't found.

Interesting post, mamapeach, and lots of thoughtful sensible points :)

You're right about the 'remedies' for latching difficulties and soreness being untested. There are some small studies, but no big ones....I think understandably, because helping a mother with positioning and attachment is an art not a science and there can be no 'one size fits all method'. We can base our help on known physiology and an understanding of babies' needs though, rather than 'this worked for me so it's bound to work for you'. It also takes experience and great observation skills to help with this when it's already gone wrong.

I disagree that mothers switch to ff because of unrealistic expectations, however. This is only one of many reasons why someone might stop breastfeeding, but it does exist. Mothers are sometimes floored by the whole neediness of their babies, and it is often the case that they think frequent feeding, irregular feeding, and babies who are only soothed by being close to or on the breast, are symptoms of poor milk supply. However, they should not be told 'it's all normal' without the whole situation being explored. Sometimes, needy babies are getting insufficient milk - perhaps because for some reason they cannot access the milk supply effectively.

We're back to the importance of skilled help when and where it's needed, I think :)

I absolutely HATED breastfeeding. I managed it for about 10 days with baby 1. I had cracked nipples, and found the whole thing incredibly painful. I cried when the baby cried because I knew I had to feed her, and I found the whole experience prevented me from bonding with the baby. The thing that really finished it off was the baby being sick with pink milk sick, because of the blood from my bleeding nipples.

DH took the matter into his own hands and bought bottle feeding paraphernalia, and I was so, so grateful to him for taking the decision out of my hands.

I felt afterwards that the midwife put far too much pressure on me to carry on, try different creams, nipple shields etc.

I didn't even try to bf baby 2. I fully intended to, but when they asked me if I wanted to feed her after she was born, I just couldn't do it - I just couldn't stand the thought of all that pain and upset again.

Both girls are now in their 20s, happy and healthy, and were never ill as children. In fact, when DD1 went to the GP at 18 to ask for the contraceptive pill, that was the first time they'd seen her since her childhood vaccinations!

Tiktok perhaps we read the post differently but I thought mamapeach was saying that false expectations (from baby books etc) are NOT a reason that mothers stop BF and that they should stop being thrown around as reasons because it doesn't make sense.

BertieBotts yes, that is roughly what I meant - although I would add the word "generally" ie, in a general or widespread sense (obviously some may, but "to a degree widespread enough to explain non BFing at a population level" - I very much doubt it. In the sense, none of the survey studies or qualitative research studies actually seem to indicate this type of thing as a factor. (societal expections for "how babies ought to be" making mums give up BF).

The difference is between "mums coping fine but giving up BF because society tells them their baby should be different" (which some BF supporters are saying is a major factor, but I doubt) versus "mums give up because they AREN'T coping fine (no sleep, exhausted, constantly feeding)" - which I do think happens, a lot.

the evidence thing tiktok - I could yadder on as to why we need to do better both in generating proper data to support interventions AND admitting the limitations of our knowledge when supporting - but I don't want to derail the thread (any more).

Sorry my mistake. There is a DON'T missing from my post. I meant I disagree that women DON'T switch because of high expectations. I think they sometimes do.

I have two children who both breastfed up to around 15 months. Both times it was very painful at first. The first time I had great (a bit rough but very effective) help from a MW at home when my baby was 6 days old - she basically fixed the latch manually and I understood it properly for the first time. The second time, I knew what I was aiming for and kept going till it worked. Neither of my babies had formula - I took 9 months ML the first time and 12 months the second time and it was never necessary for me to express at work (which would not have been possible).

I feel in many ways very lucky to have had this great experience but I think the exhaustion is under-addressed. In theory, if you have a baby (or a baby and a toddler, or more children) in the same house with two adults, there is no way the non-breastfeeding adult is ever going to run out of useful things to do to take the pressure off the bf-ing adult. In practice, men use the fact that they can't bf, and can't do night feeds, to look after themselves, not to look after you and your children.

Over time, the toll that bf-ing and round the clock responsibility (even when working full time outside the home + bfing + pregnant) took destroyed a large part of me and destroyed our relationship. I am not sure that breastfeeding was the right thing to do as in a sense the exhaustion, the focus, and the lack of time or energy to think about other things, destroyed me, at least as the person I was.

Some people don't agree and think that bf-ing is easy, or no harder than looking after a baby is ever going to be. I don't agree, because a. I do think it makes you physically tired (or at least me); b. Without bfing you could in theory share it with the other parent.

I think that talking about supporting bf-ing should also get into this question about how women can bf and be practically supported not to entirely disappear.