BREAST FEEDING - How can we increase rates?

[HPNC]

This is the question writ large (very large, in fact) on the front cover of last week's British Medical Journal.

The BMJ is delivered to the home or work place of practically every doctor in the UK. It is read by many other health professionals.

I assume that the editor of the BMJ did not intend this as a rhetorical question. (It actually refers to an article in the magazine, which I thought was interesting).

I would like to offer 2 (humble) suggestions:-

1. Mumsnetters post their (constructive) comments/ideas/suggestions here.

1. Mumsnet Towers write to the aforementioned editor, and suggest that the BMJ readership log onto mumsnet and read the thread.

I think there is a real opportunity here to make the voices of consumers heard.

What do you think??

Sounds like a plan

Maybe the rates would increase if breast feeding mothers were portrayed in the media in a more positive light. Maybe if some actresses in the soaps that most of the nation are addicted to breast fed their babies. Maybe if there were feeding friendly places/policies everywhere so mothers didn't feel as if they have to nurse their baby in a dirty toilet, this would help.

Bumping b/c this is important!!

I am breast feeding my 14 week old and love it! The main reason a lot of my friends have stopped(5 out of 6 from our ante-natal group ) is the theory that formula fed babies can sleep better/longer and also the lack of routine that may accompany BLF(especially as these things can be true). This makes me sad - yes, BLF is difficult, but so worth it and in the long run for such a relatively short perid of time.

My DS is not a brilliant sleeper and I'm constantly being told to 'switch to formula' or 'top him up at night time with formula' to make him sleep better. When you are a sleep deprived unsure new mum, you may try anything that you think will help to make things slightly easier. So I suppose I'm saying I believe (and this is only my belief from my friends experiences - I may be way out ) some people may not BF, or switch from bottle as they are persuaded/convinced by others that there is an easier option (when this isn't always the case). I hope this helps, and I haven't offended anyone. I realise that both BF and FF have their pros and cons.

Great idea.

To increase rates we need to normalise it. More 'education' of benefits won't do the trick I feel. To do this we need:

1. A law that anywhere a women has the right to be with her baby she has the right to feed him. The fear of it being an issue puts some people off. The attitude that you should give them a bottle when out and about makes breast feeding close to impossible to establish properly.
2. Breast feeding the norm in films, TV etc (OK hard for govrenments to do anything about)
3. And my personal bug bear-dolls shouldn't be sold with a bottle included. Even my dd (breast fed nuntil 14 months with breast fed baby brother) always bottle feeds her dollies and seems to think we are doing it wrong breast feeding the baby. Nursaries have a role to play here too, they should role play breast feeding rather than bottle feeding dollies I feel (though maybe not everyone woukld be comfortable with this?)
4. Every NHS trust to have an REALLY expert lactation consultant (but just a nurse with some extra trainning) who can give advice, do tongue tie snips etc
5. more honest videos/pamfletc etc to give to antenatal mums. admit the problems so tht when they come along women don't think 'oh if i have problems I must not be able to breast feed'. also try and make it look less middle class and only for people who eat fresh fruit and fish etc etc. the pictures accompanying advice to eat a healthy and varied diet must put off your average person who thinks 'my diet looks nothing like that so I can't do it'. you can breast feed fine on fish fingers chips and peas, you don't have to eat a variety of pulses!
6. produce material aimed at fathers stressing their role

I meant NOT just a nurse with extra trainning obviously

Bf cafes in every surestart centre or attached to maternity wards open for at least a few hours every day so mums could pop in. How about bf counsellors attached to every maternity ward whose sole job it is to promote and establish bf in the wards. At the moment, the mws are all too busy helping women give birth(!) to spend time watching feeds or helping new mothers with latching on etc. When all said and done, it all comes down to funding

Agree with nicewarmslippers, in an effort to up bf rates, NHS to stop posting nice cosy leaflets about how great bf is and tell the truth: bf can be hard - much harder than FF in the first few months but worth it in the end. Most women dont give up bf because they are selfish but because they lose their confidence

from my perspective, two things helped me breastfeed successfully:

1. Seeing close friends breastfeeding helped me view it as a normal way to feed a baby. I only ever saw breastfeeding on one occasion as a child, and to me it was not a normal way of feeding a baby. i thought it was something only extroverts did.My friends helped me change my views.

1. Excellent midwife with specialist breastfeeding qualifications. If it hadn't been for her, I would probably have given up breastfeeding as I found it so difficult and painful despite attending a breastfeeding class during pregnancy.

Message withdrawn

Christiana - I also stayed in hospital five days after a normal delivery (in Belgium), and had good help with breastfeeding for all of that time.

Totally agree with all of the above.

I am also constantly amazed at the number of friends, family etc that I have to explain the supply and demand concept of breastfeeding to. Many midwives, health visitors etc seem to be very pro "topping up" babies for a multitude of (IMO) unnecessary reasons without explaining the concept of - if you feed more/ longer you will naturally (in the majority of cases) produce more milk. Whereas if you rely more and more heavily on the "top ups" this will never happen.

These mothers are then left feeling that they are failing to provide for one of their baby's basic needs and switch to something they feel will do the job better than they can.

This point basically goes back to better support and education IN THE HOSPITAL. Realistically, how many mothers pick up the phone to contact a breastfeeding advisor when they are exhausted, have a screaming baby and are feeling inadequate at home compared to those who think "I can't breastfeed" and reach for formula?

I was exceptionally lucky (although only realised it in hindsight), I had a very good midwife on the ward and was kept in for 4 days due to a difficult birth. However, from the experiences of friends and family this seems to be a rarity.

I also feel that when training, midwives and HV should also have more education about when formula should be suggested as an option (as of course there are cases when it is completely necessary) and when there should be better breastfeeding support as well as enabling them to have the time where they can actually give this support.

I would say as well as the above points, scrap lads mag culture/lap dancing bars which encourage men to see breasts as purely sexual. It didn't stop me bf but I know someone who said 'bf felt pervy' so she didn't try. Maybe if we saw more bf esp with people in the public eye/in soaps etc then it would balance things. Also, scrap midwives etc getting freebies from formula companies, my MW was showing me how to latch DS while clipped on her pocket was an Aptamil pen.

A lactation consultant on every delivery ward (24/7).
Follow up visits to every mother.
Breast feeding supporters working along side all HVs.

I am not especially bothered about persuading mothers to try breastfeeding. There's enough of a job available giving knowedgable support and removing the barriers to the mothers who already want to do it

This requires proper planning. It will be years before there are enough lactation consultants on every ward 24/7, and actually, I don't see that as being as helpful as ensuring the people whose job it already is to help bf to be effective. That is, ensure midwives do their jobs properly! Very few women have problems beyond the competence of an ordinary midwife, and the majority of women just need to be enabled to breastfeed (keeping baby close, learning about realistic expectations, positioning using positions that won't hurt....basic stuff).

Similarly, to have a bf supporter working alongside every HV is not possible. Not enough of them, and if they are to be paid, not enough money. Just ensure the HVs know about bf and how to support it. It's their job

The stories on mumsnet about the poor information mothers have from m/ws and HVs show the massive gaps in their education and training. This is known to the NHS. NICE guidelines have better training and support for HCPs as one of the main areas for bf improvement.

To force health visitors and midwifes to receive regular training on breastfeeding and to bring in some sort of strict guidelines to penalise them if they go against what they have been taught in order to continue spouting myths that are simply not true.

I am a new Mum exclusively breast feeding my 13 week old ds.

Things that have helped me to bf:

1. Mumsnet: During pregnancy I read a lot of the threads on here about different difficulties that people had had and lots of the advice came back to me when I had problems in the early days. I've continued to read the threads and ask my own questions when I've needed to.

1. Great support in the hospital: My son was in NICU for his first 6 days. I was given loads of support by the staff to hand express every 3 hours for the first 2 days and then pump every 3 hours after that. When we went back to the PN ward, the midwives were incredibly calm and supportive. DS wouldn't latch on at first and I was despairing thinking I would never be able to feed him. They reassured me that he would learn, helped me to try to latch him on in different positions and helped me to cup-feed expressed milk in the meantime. Sure enough, after the first 24 hours or so he got the hang of it.

1. Supportive dh: He has read loads about the benefits of bfing for ds and is really keen for us to continue.

Things that might have stopped me bfing:

1. Cluster feeding: It's only from MN that I know this is normal and even knowing that it's normal I still often find it discouraging when ds is latched on for yet another evening from 7pm to 11pm when I feel like he 'should' be in bed asleep at 7pm so dh and I can 'get our evenings back'. I would actually love to have more time with dh in the evenings but I think we're both trying to focus on this being a short-term thing. I would also have thought that my milk was no good if I hadn't read MN.

1. Lack of routine: I haven't really got much of a routine for ds as he feeds so much in the day. I would like to have more routine but am now thinking that it will have to wait a while.

1. Advice about sleep: I worried so much in the early days about creating bad sleep associations and thought I was ruining any chance of ds ever being able to sleep well. However, without me doing anything much, he has slept from 11pm to 7.30am 3 times this week so I'm hoping he is settling in to his own sleep routine.

1. Gaviscon: My GP has diagnosed ds with reflux and I have to give Gaviscon 6 times every 24 hours before feeds. It seems to help a bit but I absolutely hate giving it to him. To start with I gave it mixed with water from a syringe but he spat it out and screamed so the pharmacist told me to mix it with ebm and the GP said to give it from a bottle. This meant buying a breast pump, steriliser and bottles and I now have all the inconvenience of sterilising etc without actually bottle feeding and it is still a battle to get ds to drink from the bottle which spoils the start of our cuddly feeding times. It would be so much easier to shake the medicine in with a bottle feed.

So, from my very limited experience I think bf rates could be increased by:

1. Excellent post-natal support in hospital including when babies are in special care.

1. Encouraging women to access supportive communities of bfers (whether online or in RL) so that they can hear about other people's experiences and be reassured that things like cluster feeding are normal.

1. Honest information in ante-natal classes about the realities of demand feeding and reassurance that cluster feeding is normal and doesn't mean your milk is no good.

1. Less pressure to get your baby in to a routine very early and fewer stories about how your baby will never be able to sleep alone if you let him fall asleep when feeding.

1. Supportive partners.

1. Reflux treatment that is easier to give to a breast-fed baby. (This may be impossible!)

This is only from my very limited experience and I really hope I haven't offended anyone or been insensitive. I hope this thread will help people who want to bf in future.

I think nicewarmslippers is absolutely right about dolls. My children and my friend's children have all tried to breastfeed their dolls when they have seen us feeding their siblings but the overall message that come with playing with baby dolls is bottle feeding. How much time do we spend saying to our children 'ooh give baby a bottle' There are dolls sold which cry - and stop crying when you plug in the bottle or the dummy. What sort of constant message does this give?

I don't know what can be done about it but it's surely an area for consideration?

I would like to see more midwives for starters

Educate ALL health professionals who come into contact with pregnant women/new mothers - especially midwives/HVs/GPs/paediatricians. So many so-called professionals seem to spout absolute rubbish that contravenes the NICE/WHO guidelines - honestly, they seem to make it up as they go along rather than admit 'I don't know about that'.

Provide proper support for b/f women on the NHS. Absolute disgrace that anyone with any problems has to rely on hopefully finding a volunteer counsellor. Why the hell do the authorities not think this is a core responsibility for the NHS?

Stop being so militant about it because that is hugley offputting and scary.

Five - being passive and saying anything goes hasn't done much to help our children to date so I think a little militantcy is warrented?

Personally I've breastfed three children without major problems - as much by luck as good management. The degree of ignorance, incompetence and neglect that some of the mothers posting on here encounter from health care professionals is a worthy subject for anger imo.

The number of women who have had family members, friends or complete strangers criticise their breastfeeding is a worthy subject for anger imo.

Sorry if you find that scary

That's the thing, FiveGoMad, so many people report feeling lectured or bullied about 'you MUST b/f' and yet when people try and face difficulties, health professionals let them down.

(Pixsix, 50% 0f babies with reflux improve or stop refluxing totally when cows milk is removed from thier diet, going dairy free for two weeks will tell you if your DS is one of these babies.)

Baby dolls with bottles and dummies are one of my one of my pet hates. I have asked my DD's nursery to remove the bottles from the role play box but they don't. I even asked Toys'r'us if they were going to make a play breastpump for thier baby doll range......

But yes, enforced training for all healthcare staff who have contact with pregnant women, new parents and babies (so, GP's, MW's, Ob/Gyn's, HV's at the bare minumum) no ready-made formula haded out on post-natal wards (except for medical reasons, ie; mum can't bf) and proper honest info about infant feeding, talking about the risks of formula, not the benefits of breastfeeding. And a total ban on the phrase "Breast is Best". Any one caught using it to be put in stocks and pelted with water balloons whilst listening to a transcript of this article. Formula only available behind the counter in Pharmacies, not on supermarket shelves and in corner shops etc.

That would be a start.

How do I draw this thread to the attention of MN Towers? (I don't really want to report myself).

Do people think that my suggestion of writing to BMJ is feasible?

I am not saying be passive but to be honest some of the people on here and in RL can have such a bullying attitude towards people who FF or give up BF, I think the ideal is Tiktok who is incredibly supportive and comes up with practical ideas.