I think you need to tell him that you are prioritising your health and your baby's. I think he will be quite shocked when he sees the wealth of medical evidence for bf. I wonder if he'd be persuaded by the fact that in the UK 95% of women doctors choose to bf their own children!
You could print this article off and read it out to him. It's fully referenced and comes from a reputable source:
Breastfeeding: Overcoming The Barriers
Caroline Deacon, NCT Breastfeeding Counsellor
Almost all women are physically able to breastfeed, and in countries such as Norway where few barriers to breastfeeding exist, rates are over 95%. In Britain, less than two thirds of women choose to give their babies any breastmilk at all. Although this figure is higher than it was thirty years ago, it still implies that the ?breast is best? message is not being absorbed by a significant number of women, in particular, those whose babies need breastfeeding most; the poorer sections of society. While 90% of women in social class I breastfeed, only 50% in social class V, 47% of single mothers and 44% of teenage mothers, breastfeed.1
As research shows that formula fed babies have significantly poorer health outcomes, these low breastfeeding rates for disadvantaged socio-economic groups is cause for concern. The Department of Health has calculated that, if all women breastfed their babies, the NHS would save, per annum:
- £35m treating babies with gastro-enteritis
- 400 women?s lives from dying of breast cancer
- 500 pre-term babies from developing necrotizing enterocolitis, 100 of whom die.2
The real eye-opener for health workers is what happens post-natally. After six weeks breastfeeding rates have dropped to 40%, and 90% of those who stop say they wanted to breastfeed for longer. Once again, drop off rates are higher for disadvantaged groups; by four months only 13% of social class V babies receive any breastmilk at all. 3
It is therefore obvious that we as health workers have two problems to tackle. Firstly, significant numbers of women, particularly those from disadvantaged backgrounds, are opting out of breastfeeding altogether. Secondly, those who do start are finding barriers to continuing for as long as they and their babies want to.
Why is breast best?
Bottle fed babies are:
- five times more likely to be admitted to hospital with diarrhoea
- twice as likely to be hospitalised with respiratory disease
- twice as likely to suffer from otitis media.
- five times more likely to develop a urinary tract infection
- twice as likely to develop atopic eczema or wheeze.
- premature babies fed formula are twenty times more likely to get necrotizing enterocolitis.
In addition, some research has suggested that bottle fed babies are at risk of:
- higher blood pressure
- insulin dependant diabetes mellitus
- childhood lymphomas
- inflammatory bowel disease
- multiple sclerosis
- dental occlusion
- coronary heart disease.
Mothers who do not breastfeed are at increased risk of:
- ovarian cancer
- hip fractures
- pre-menopausal breast cancer 4
Tackling uptake ante-natally.
It is tempting to think that all we need to do is to extol the health benefits of breastfeeding to disadvantaged mothers. However, other health education campaigns, around smoking for instance, typically haven?t been acted upon by this group, and ?nagging? or ?pressure? can have the opposite effect to that intended. Instead, we need to tackle known barriers to breastfeeding.
Many factors influence the decision to breastfeed; the most significant of which is partner?s attitude. If fathers strongly approve, women are 33 times more likely to breastfeed. 5 A way to improve uptake rates, therefore, might be through involving partners ante-natally, making sure partners attend check-ups where feeding is to be discussed. Apart from research-based facts about the effects of formula, the financial costs, time and effort involved in bottle feeding, can be highlighted.
A factor to recognise is that breastfeeding has personal and cultural significance. Women?s breasts are not seen as primarily for feeding babies in our society. As demand feeding will inevitably mean feeding in front of other people, both in and outside the home, the decision to breastfeed will invariably be tied up with feelings about sexuality. When discussing breastfeeding with patients ante-natally, it is important to bear this in mind, and women find it useful to be able to discuss the practicalities of feeding in public, for instance.
Peer group discussions have also been found to be effective in increasing both initiation and duration rates, and intuition tells us that peer pressure is going to have more effect on younger and less well educated women. Ante-natal classes which build confidence and knowledge have also been found to be effective. Rather than lecuting about benefits of breastfeeding, ante-natal classes could focus more on encouraging participants to engage in frank discussion of issues, as well as using active learning methods for teaching specific skills.
However, if it is clear that a woman intends to bottle feed, after exploring any social pressures and ensuring that she has made a fully informed choice by being aware of health risks of bottle feeding, all health professionals should support her non-judgementally in her decision.
Why do women stop?
The commonest reasons women state for having stopped breastfeeding prematurely are ?insufficient milk? or ?my milk dried up?. ?Excess tiredness? has also been quoted. Although supply can be undermined by inappropriate use of formula, on the whole women?s milk does not ?dry up?, and remarks such as these imply lack of confidence and support as well as perhaps lack of knowledge about how breastfeeding works.
After the birth, mother and father are both present and receptive to ideas and practical help. Now is a brilliant time for midwives to spend on one-to-one education, explaining how to position and attach the baby to the breast in such a way that the mother can do this for herself in future. The mechanics of breastmilk production - supply and demand - can be explained, and with father there to hear these messages, he is less likely to undermine breastfeeding later by suggesting using a bottle when difficulties are encountered.
A final word on mixed messages. Gifts from a commercial company such as pens or diaries, free equipment or educational resources can seem harmless to the over-stretched and underpaid health worker. However, such gifts publicise the company name, and this influences your patients. After the Milupa Hearing Centre in Hillingdon was opened, quantities of Milupa formula sold in the area increased by nearly six times. Mothers who are given non-commercial discharge packs breastfeed exclusively for more than two weeks longer than those given commercial packs and are more likely to be breastfeeding at four months postpartum. 6 So don?t undermine your good work - remember there is no such thing as a free lunch.
Study hours: Prep made simple
Key reading
- Evidence for the ten steps to successful breastfeeding(1998) WHO Geneva.
- Dora Henschel with Sally Inch (1996) Breastfeeding A Guide for Midwives Great Britain: Books for Midwives Press.
- Royal College of Midwives (1991) Successful Breastfeeding London : Churchill Livingstone.
References
- Foster, K., Lader, D., Cheesbrough, S. (1997) Infant Feeding ONS. London: The Stationery Office.
- Wise, P. (1998) The Hidden Persuaders New Generation; Vol. 17, No. 3.
- Department of Health, National Breastfeeding Working Group. (1995) Breastfeeding: Good practice guide to the NHS. London : Department of Health.
- Littman, H., Medendorp, SV., Goldfarb, J. (1994) The decision to breastfeed: the importance of fathers? approval. Clin Pediatr, 33, no. 4, pp 214-219.
- Bar-Yam NB., Darby L., (1997)Fathers and Breastfeeding: A Review of the Literature. J Hum Lact. 13(1), 45-50.
- Informed Choice Leaflet: Breastfeeding or Bottle feeding - Helping women to choose. MIDIRS and The NHS Centre for Reviews and Dissemination.
© Caroline Deacon
article first appeared in Nursing times Aug 2000
1 Foster, K., Lader, D., Cheesbrough, S. (1997) Infant Feeding ONS. London: The Stationery Office.
2 Department of Health, National Breastfeeding Working Group. (1995) Breastfeeding: Good practice guide to the NHS. London : Department of Health.
3 Foster et al op cit
4 Informed Choice Leaflet: Breastfeeding or Bottle feeding - Helping women to choose. MIDIRS and The NHS Centre for Reviews and Dissemination.
5 Littman, H., Medendorp, SV., Goldfarb, J. (1994) The decision to breastfeed: the importance of fathers? approval. Clin Pediatr, 33, no. 4, pp 214-219.
Bar-Yam NB., Darby L., (1997)Fathers and Breastfeeding: A Review of the Literature. J Hum Lact. 13(1), 45-50.
6 Wise, P. (1998) The Hidden Persuaders New Generation; Vol. 17, No. 3.