How to encourage/support women to continue bf?

[hunkermunker]

Breastfeeding initiation rates are, nationally, about three quarters of women. Different places obv have different rates within that - some considerably lower, some a fair bit higher.

However, only one in three week-old babies have had exclusively breastmilk and by 6-8 weeks, there's a big drop-off of babies having any breastmilk at all, compared to the original initiation rates.

I think it's a combination of things - poor support from health professionals, pressure from family/wider society, lack of body confidence (either with public breastfeeding or with knowing how to tell if the baby's feeding "enough") and a general idea that you give bf a go, but if (when?) it "fails", or "doesn't work out", you bottlefeed - and with all the other things I've mentioned playing a part, often it does "fail" or "not work out".

I do use the word fail advisedly - nobody "fails" at breastfeeding, nobody. I used it in part to say that!

If you stopped bfing before you wanted, what would've helped you to continue?

If you bfed for as long as you wanted, what helped you? And how old was your baby when you stopped?

Would/did better antenatal/postnatal information play a part? If so, what would you have liked to know? And how would you have liked that info to be given to you? Also, what support would you have liked? Help with the baby? Help with your chores? Supportive friends who knew about bf?

TIA.

Hi Hunkermunker,

in response to your questions:

I BF until DD was 17 months and only really stopped because her fiddling with my bits became somewhat unbearable. But I also think we were both ready for it at the same time and overall I don't regret stopping when I did / not stopping earlier.

What helped: Me being very stubborn and having found BF quite an easy thing to do as it fitted in well with our lifestyle. By stubborn I mean, like other people on the breastfeeding forum, I also came across some pressure to stop feeding earlier and find it quite disgusting that some people seem to think they have to interfere in your business and give advise when it's not wanted. Why anyone feels they have to tell Mums that it's time to stop is beyond me. But hey, it made me all the more determined.

What also helped is that I travelled around Asia a lot when DD was young and felt that she was better protected against the nasties when I do bf.

So I didn't really need any more info once I did establish BF but getting started was very stressful and again, I think I only continued because I was determined too. DD was born in a birthing centre so I would have thought that the MWs were more clued up about BF but I had maybe 4 MWs or so trying to show me how to BF and it just didn't happen. I felt immense pressure to get going, it would have really helped if someone had told me that DD wasn't going to starve to death if she didn't feed within the first few hours. Leaflets wouldn't have helped, I could have done with someone telling me what it should feel when DD is latched on properly.
What would have helped - someone going around the ward who is properly trained and who can explain the mechanics of BF in different ways.

Also had problems with feeding from left breast, baby just wouldn't latch on that side. Went to see a osteopath and it was sorted in one session.

Hope this helps?

I was lucky when bf'ing dd1, my mother who had bf my disi's and i, and came out to stay with me during my first 3 weeks bf'ing. I can honestly say she was the reason I was able to get going and continue.

She knew what was NORMAL!!!!

I fed dd1 until 9 months when I went back to work, and was doing 12 hr days and feeding her morning and evening, and tbh I was completely knackered, so stopped.

With DD2 we had a few more complications, DD2 fed well in labour ward then wouldn't feed after, mw came and helped me to hand express but DD2 was not intersted, 2nd mw came out and suggested formula (despite expressed milk not being taken), it was day 3 and I was anxious by this point so got refered back to the hospital.

Long story short- 2 weeks of hell in a distant hopital 9200 miles) with dd2 having bowel surgery and a diagnosis of Cystic Fibrosis, I expressed all the way through ( it was the only things i felt i could DO for her) when it came to reintroducing her to the breast we struggled, I asked for help and non was forthcoming- she was no longer offically under mw care and we were in-patients on a general paed surgical ward, and the bf trained nurses weren't on shift!!

Had dd2 been my first I would have given up there and then, but as I had a (limited)experience of bf'ing, I was determined tyo continue. I had a rubblish 24 hours but we got it together, and went on to feed til' she lost interest at 13 months ( despite a second 2 week period of surgery and not eating and mutliple admissions for antibiotics).

Coming up to a year old the paed dietician kept asking when I was planning to stop... to which I replied I wasn't planning anything!

Hunker sorry for the epic If you can find anything useful in this post i hope it helps, you do stirling work on mn so thankyou

200 miles not 9000 miles

Mumsnet! i'm sure it's no co-incidence that you quote so many women giving up at 6-8 weeks in classic growth spurt territory. I only ever heard about growth spurts on Mumsnet, never from any health professional & i had very good help in Baby Friendly midwife led unit at the beginning.

Thank you, thank you, thank you all - each post has given me further food for thought (it's incredible - you can think you know loads about how women think/feel about this and you'll read three or four posts in a row and tweak your ideas about it all - fascinating!).

I'm so sorry some of you have had such dreadful experiences. There's a link on my site to MOBI - Mothers Overcoming Breastfeeding Issues - in the right-hand side column.

Thank you again for your stories and suggestions. They're incredibly useful for something I'm doing in RL atm - am really very grateful to you all.

I'm still bf my 6 month old. At the moment it's mixed feeding, but was exclusive bf for 4 months.

What helped & kept the bf going:

--Having a doula / bf counsellor come in once a week for a few hours in the first 6 weeks. She particularly helped in the first days when DS couldn't latch on.

--Some of the mw at the hospital were helpful (but not all).

--The ongoing support of my DP

--my determination & also all the info that I read beforehand (and after the baby was here)

--calling bf support lines at various times when I needed help

--the fact that most of my friends are bf

What didn't help & has led to mixed feeding (which I'm not completely ok with, but have accepted):

--the fact that our baby is a naturally not-good sleeper. Exhaustion & endless sleepless nights meant that at some point we gave in & started giving DS a bottle of formula at 11 pm. And yes, it has helped...

--The fact that a lot of people (particularly relatives) undermine my ability to feed my child & make me constantly wonder whether my milk is 'good' enough

--the fact that exclusive breastfeeding means (that's how I see it) making some sacrifices that after a while can exhaust a new mother (especially when dealing with a bad sleeper like mine). So for example, I found that expressing during the day really helped increase my supply (and ensured I could go out sometimes) but I didn't do it as much as was necessary.

--so realistically, what also didn't help is that formula feeding is, to be honest, much much easier especially when tiredness hits... it's a big temptation, & is really pushed by our culture, & I've had to constantly remind myself of why I bf in order to keep going (and I hope to keep going as long as I can).

...and to answer the OP's question (and sorry I went on so long just above). What I think would help women bf is support support support. Help around the house. Making a cup of tea for the new mother (and the a-few-months-down-the-line mother). Listening to them & their problems with bf & not lecturing them about the 'evils of formula'. Being there as a friend, because a new mother often feels overwhelmed, alone, & unable to function due to tiredness. Not hammering on about the benefits of bf but being open to hear the real ambivalence that many women experience. Many more peer supporters & experienced, kind bf counsellors (not purists or fanatics) would be great. Better trained & better paid midwives that are able to really help in hospital especially in those dreadful first nights when new mothers are left alone to tend to their babies. If a midwife had helped me with changing my newborn's nappy that first horrible night (I kid you not, changing his nappy filled with meconium seemed like a nightmare for me at that moment in time) it would have meant a lot, & would have encouraged me with other things, e.g. my effort to bf.

I don't believe treating formula as the work of the devil is a solution. I believe much much greater support- especially community support- is the solution.

Hunker, thank you for starting this thread and thanks to everybody who replied! So interesting to hear about other women's experiences.

DS1 EBF to 6 weeks, then mixfed until weaned on to FF aged 5/12.
DS2 born at 31 weeks gestation, EBF via NG tube, later bottle and mixfed as I v quickly did not manage to express enough for him. On FF @ 6/12. He never took to actually feeding on the breast.
DS3 EBF to 5 months, since my return to work mixfed, now 10 months old - still BF (absurdly huge smug proud ).

What would have helped me:
If somebody would have told me that BFing CAN BE HARD and not everybody enjoys it!! Also I had no confidence in my body's ability to feed my babies. I always assumed I would BF my children however I ended up really not liking all the things I previously considered advantages of BFing:
-milk always with me - I hated how physically intrusive BFing was
-No obsessing about how much DC was drinking - how diconcerting.
-Simply did not like to ALWAYS have to have baby with me - I suppose part of me struggling to come to terms with my new role as a mother.

BFing DS3 has been my most satisfying BFing experience, mainly due to stubbornness: I had decided that I was jolly well going to BF him, no matter what!! I still found it v hard, v time consuming, did not particularly enjoy it.
Support of DH, my parents and lots of HCP was superb!

And even though I still do not love it, I already know I will be sad when it ends..

What helped me get this far:
being over 30, confident, stubborn, and having an arsy streak a mile wide, especially when faced with ignorant medics. And more biomedical knowledge than most of them. Plus a Travelcard and public transport obsession, to get to the neearest support.

Hugely supportive partner who told me when I was giving up that he was so impressed with the 5 weeks I'd done so far, especially as my nipples had been so sensitive before birth, and I was bloody fantastic giving A such a good start.

One lovely HV who encouraged me to feed A with him lying on the desk in her office. Not great for my back but wonders for confidence being able to feed him outside the house.

Local midwife-bfcs setting up groups around me. Since A has been born, 3 new ones have been started which is slightly late for me but will help others no end.
Good GP telling me to demand help from all friends and family. While the pain was bad, it was the lack of sleep causing hallucinations that was the main factor in my getting formula out, so someone else could look after A for a few hours while I slept. After a couple days of someone else looking after A in between every feed so I could lie down or sleep, I could cope again.

I'm convinced many women who give up bf do so to get some sleep.

What didn't help:
The myth in every baby book including NHS ones that bf babies on average feed every 3 hours. This might be true by 4 months but not for newborns. I thought I knew everything I could learn from books, but nowhere was it written that newborns often feed hourly and don't sleep in between either! And all of my antenatal class said the same.

Health visitors who have never heard of Baby cafes, breastfeeding support groups, the LLL, etc. In areas like mine where most of them are locums, they should be given sheets with times and contact details of all local support groups.

Lactation consultants and midwife-bfcs and possibly even HVs should have the power to write relevant prescriptions. When you've got thrush/mastitis and a small baby, the last thing you need is to have to fight the phone system the next day to see a GP, even if your GP is clued up on bf and you don't need to argue for the scrip.

More training for HVs - one locally told me they have a 1-year part time course, ie about 6 weeks full-time, which is why they know so little about most things.

Lack of antenatal classes. Luckily I could afford £260 for the NCT and signed up early, otherwise I'd have had none at all, like most women in my area.

Acknowledgement that some formula isn't the end of the world. Almost all the bfers I know ended up giving formula a couple times during a rough patch, but many threads here imply that if you've fallen off the bf wagon and coompromised the 'virgin gut' you might as well not bother bf or that you're unlikely to be able to. It was only giving up bf for a night, under the impression that I'd probably never be able to bf again, that enabled me to be able to bf afterwards. I'm very sceptical that one bottle is likely to corrupt the supply of a struggling mother more than the exhaustion and pain she's already got.

Hmmmm.....

Wonder where all these bf militants are who come into contact with new mums desperately struggling to establish bf and 'lecture' them on the 'evils' of formula, or imply that if you give the odd bottle you may as well not bother continuing trying to bf.

I don't remember coming across any threads on here implying that giving a bottle is 'the end of the world' either.

Or maybe raising any concerns about formula use in any capacity is now verboten.

My own experience is that the more you know about both artificial feeding and breastfeeding, the more likely you are to bf successfully. I think all women should be given really detailed information on the health issues - something like the MIDIRS Informed Choice leaflet - and then taken through it properly by a midwife quite early on in pregnancy so they have a chance to get answers to their questions about what these issues mean to them and their babies. Later on in their pregnancy they should be given details of peer support groups in their area and all women wishing to bf should be invited along to meet other local bf mums and those who wish to bf. This should be done in addition to them having a 3 hour bf session with a bf counsellor, to which their partner should also be invited. I honestly think this would make more difference than anything else.

Postnatally..... hmmm..... double the number of midwives on postnatal wards and have a resident bf counsellor full-time, day and night, on every unit. Up the postnatal visits to three a week for all women for the first two weeks - but only from midwives who have done some extra training in bf support, otherwise they can do more harm than good!

Wanted to say, re: exclusive breastfeeding, I used 'the odd bottle' with my first, but I really wish I hadn't had to. I shouldn't have had to, if I'd been properly supported with establishing bf in the first place - I'd wanted to exclusively bf and I think I should have been supported to do what was right for me. Personally I feel a bit about reassurances that it's 'fine' to use the odd bottle, as that is surely something that is down to individual opinion. Fine for you, but I'd rather have exclusively bf. My dd (the only one not exclusively bf for 6 months) is my only one with excema and I do often wonder, when I'm watching her claw at her legs, whether 6 months of exclusive bf might have made a difference.

skimty and cherrychoc, i agree with your posts. our society does not value bf and in fact much about mothering, lots of pressure to get back to 'normal' (this is now my normal i reply) ie to go out and enjoy yourself (get drunk).

And how i wish i knew that almost constant feeding was normal, rather than 'he can't be hungry again, i'll take him for a walk to settle him' or kind relative offering to take him off me for a rest. i should have just gone to bed with the baby.

I have just moved to Australia, and bf here is normal for at least a year and it is fabulous. i was here 6 weeks before i saw anyone bottle feeding a baby.

the differences are:
there is no emphasis on bf for 6 months, i think in the uk people (inc my family) get confused that the advice to 'exclusively bf for 6 months' means only 6 months and after that there is no benefit. here a year is accepted as the aim, and probably once a day i see an older child being bf in park or somewhere.

there is very good funded bf support. if you are having problems you can go to a bf centre all day, any day for help with latching, soreness, supply issues whatever and they will help you sort them out. also people here are quite used to paying a bit extra to top up their health care (to go to the gp, for example, is not free) and so are happy to pay for a private lactation consultant to visit them, and this is not an unusual thing to do.

people do not expect your baby to be sleeping through the night early on, i think in the uk people have unrealistic expectations about this and stop bf as they think ff might help.

the uk needs to educate more mw and hv, not to scare people off co-sleeping so much and not allow follow on formula and the advertising of it. the single best thing for me was a good bf support group. we need more, and more awareness of them - i have many times told a mum who is asking in the hv clinic about the local ones when the hv doesn't know.

Mrs demented, I'm sorry but the OP asked what helped US and what didn't help US. So when I wrote about certain people lecturing me on the evils of formula, I was talking from my own experience. Specifically, I once called a bf helpline (not important which one) & I was in tears because my boy was on a nursing strike. The woman went on and on and ON about my latch being problematic (while actually it was fine, at 3 and a half months) & then when I told her 'I really don't want to give formula' (while crying) she responded 'no, don't give formula. You will introduce serious health risks'. I found that attitute very very unhelpful, and unfortunately it's an attitude I've come across quite a few times. Another example being- when I asked my HV about what to do because I was so exhausted from lack of sleep I couldn't think straight she smiled & said 'sleep when the baby sleeps'. When I said to her the baby sleeps only 30 mins or so in the day, she had no advice to offer. I know this example doesn't have to do with being 'purist' or 'militant'(and ok, those words may be a bit harsh)... but I do think one of the main reasons give up bf or end up doing mixed-feeding has to do with exhaustion. Which is why lots more support is needed, especially for women who live i a relatively isolated way, with no extended family around them.

I am lucky and have bf for as long as I (and dd) wanted - she's 18m and showing no sign of stopping

things that helped:

• MN
• two degrees in biological science (so I could bandy about the term 'physiological norm' with confidence and read proper peer-reviewed research)
• a wildly supportive DH
• NCT bf class
• what was, in retrospect, a piss-easy birth, with no drugs
• sweet patient (and I realise now unqualified) nursing auxiliary who helped me with the first feed
• being allowed, nay, encouraged, to cosleep in hospital after the birth
• baby cafe
• bloodymindedness militancy confidence about feeding in public
• smugness knowledge I was doing something amazing for dd
• HV who, when I consulted her re dd's poor sleeping, said 'Oh well we won't mess with the bfing, you're doing wonderfully' when I'm sure another HV would have suggested a bottle.
• old ladies in M&S cutting up my scone for me
• work being v accommodating re expressing
• nursery being v accommodating re ebm - when their freezer failed they rang to consult me before even thinking of giving her formula

things that didn't and might have caused someone else to give up:

• dd being a poor sleeper
• HV at dd's 8m check telling me she was 'dropping off the curve' because she was bf too much when in reality she was fine
• friends who weren't so much unsupportive as utterly baffled by bf >6m
• having to go back to work
• the difficulty of conversation with friends who gave up bf - what to say in a mixed group that doesn't dismiss their struggle, condemn ffing or belittle those still bfing?

DD was BF until she was 18 or 19 months.

What helped me:

• DP and other family's support to BF(although we live near no other family). Also a certain expectation from them I guess
• Hands on DP
• My own stubbornness
• Not having any formula in the house on those terrible nights when I really would have given up.
• An inherent laziness that made me believe, rightly or wrongly, that making up formula was far more hassle than BF
• The same laziness, which meant while I was BF I could not possibly be expected to do anything else other than cuddle my baby/ watch telly/ read a good book.
• A desire to protect DD against allergies which I suffer from (though DD has excema and possible asthma, despite my efforts)

-A feeling of intimacy with my daughter

• Really cosy BF rooms in some local departments stores. The only conversations I had some days...

What didn't help me:

Not that much really. After the first month, and a few awful nights here and there, I found bf a very positvie experience. There were these few points.

-Although HV didn't discourage BF, she did tell me that there was a very low rate in my area and she didn't really do anything to encourage it. I suppose this made me more determined, but it wouldn't make everybody feel like that
-I am the first of my friends to have a child and I could tell some of my friends didn't feel that comfortable with me BF in front of them. Didn't bother me too much though.
-Those posters that make out that the best reason to breastfeed is because you lose weight (though this was a pleasant side effect)

Personally, I would love to see more women BF in public. Although I did go to specific BF rooms to begin with, I never felt the need to lock myself away in a toilet or such like and soon enough just began to do it anywhere. I think the sight of a woman BF is a beautiful thing and I think it would encourage other new mums to give it a go if those of us who are doing it had the confidence to do so in a less clandestine way!

Starlight - would strongly agree with everything you say. Also - not just to review what goes into Bounty packs, but also for baby magazine editors to show a greater sense of responsibility. I read these mags regularly (in the newsagent - can't bring myself to pay for them) and regularly find myself infuriated by how appalling their bf coverage is. 'BF guides' with pictures of badly latched on babies, stories of bf failure relayed where it's really obvious that the mum got terrible care, but no comment is made on the quality of care by either the mother or the editorial team - which is awful as it normalises bad practice. Most mags will have 10 pages+ of formula and bottle ads and maybe 2 pages on breastfeeding. And as I said, the bf coverage is crap. Also doing things like giving away bottles to readers.

I also do think that peer support is crucial, and actually I'm sure that there's some recent evidence that in statistical terms it's very effective in reducing drop out rates when done properly.

A friend who gave up bf on the dot of 6m because of a misunderstanding of the 'exclusive till 6m' guideline wrote for one of said baby magazines.

after that nothing surprised me

I refuse to look at them, let alone pay for them. Lot of rubbish

I look at them to purposely infuriate myself.

I'm like that. A bit bonkers really. Keeps me radical though!

I stand there at the magazine rack in Sainsburys going huffing and puffing, and muttering 'offs!' to myself as I do it.

WRT Bounty packs, they should be abolished completely. They are pure advertising.

As for baby magazines, pfft.
The law should move inline with the WHO and not allow ANY baby food products to be advertised (Did you know they can just advertise the brand but not the product? Yet another way to get round it). There was a MASSIVE spread in one mag about BFing, fab article, by Medela but the picture of the baby breastfeeding left something to be desired, it wasn't actually latched on, certainly not a good image to show new breastfeeding mothers!!

Haven't read the whole thread yet, but just wanted to add my experience.

After two miserable attempts at bf-ing, I have come to the conclusion that the only thing that would have helped me to continue was if I had had 1-2-1, 24 hr bf-ing support from a kind and very experienced person for as long as it took to get me established and happy ( which could have been several months).

And that ain't ever gonna happen, is it?

Seriously. I had help from bf counsellors and midwives and HVs and MN and other parenting sites, plus my friend who is an NCT bf counsellor and my mum and step sister (both extended bf-ers)...nothing helped. It hurt. I kept getting mastitis. I hated it. I am not the only one.

I have two friends who had very similar experiences, too, btw

MrsMattie - not all bf counsellors or supporters or midwives are equally skilled at bf support.

Some bf counsellors are very good in many ways but don't have the technical skills to diagnose or help with really difficult bf problems.

In other countries it's the norm to see a lactation consultant who has the equivalent of a degree in lactation support, and who has specialist training in addressing complex problems with bf.

I think it's a scandal that most of these consultants work in the private sector in the UK - their expertise ought to be freely available to ordinary women.

Thank you more!

CBB and SM, raises an excellent point - I've often wondered whether anybody would take a PCT to court for failing to provide support/failing to train their staff/failing to ensure even basic knowledge with the upshot that their baby is given formula because it's the easy option for the less-than-skilled health professional?

Women suffer tangible grief when bf doesn't work out - can lead to PND, etc - am very sure there are some out there who could claim.

[class action]

hunker - it interests me that people who are fairly savvy in relation to persuing expert advice when it comes to other health problems will expect to get appropriate care for complex bf difficulties from a generalist. If you had a really painful, ongoing problem with - say - your bunions, and your GP had treated you and not been able to help, would you just say 'oh dear, well I'll just have to stop walking', or would you say, 'right, I need to see a podiatrist'? Why don't people know that there is such a thing as a health professional who has a special expertise with lactation? And even if they do know, why do they use them so infrequently? Even if they have the money? I wonder if it's basically down to the bottom line, which is as a society, we don't really value bf or acknowledge the difference between bf and ff.