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??

Message withdrawn

Yes, I know...that's why I included a quote with the UK 2000 figures in.

Pointless arguing, really. The fact is that child-friendly and bf-friendly corners at a Dutch airport do not reflect better support for bf in Holland. I happen to know from other sources that Holland is not really any better than we are - there are sound reasons for this, and for the fact that Scandinavian countries are much better, mainly to do with the marketing of formula and the training of HCPs. Holland's bf stats reflect the same social and economic factors as ours ie the older and better off you are, the more likely you are to bf and to bf for longer.

Ooo I found it - more recent BFing stats as collected by NHS:

www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/DH_073254

www.dh.gov.uk/en/Healthcare/Maternity/Maternalandinfantnutrition/DH_085657

I think there is a lot of focus on encouraging women to b'feed, but when you decide/assume you will, there isn't the support needed if things go wrong.

There isn't enough honesty about the reality of b'feeding, so people are not prepared for hourly feeds, cluster feeding etc. Books that people buy before having a baby, often jump into simplistic routines straight away, giving a false impression.

The phrase, 'If it hurts you are doing it wrong' should be banned. because it is the one I heard over and over again, along with 'your latch is fine, just keep on feeding' (latch wasn't fine, and dd wouldn't stay on to feed which was one of the many problems!)

Partners to be included in all b'feeding advice, as they are going to be a huge part of encouraging, helping out with other jobs and in my case being conscious after birth!

The whole formula thing is a huge one, because having used it for my dd's when b'feeding failed, I obviously see it as a necessary evil, and don't wish people to feel demonised for having/wanting to use it. But I do think it should only be able to be produced as a not for profit, unbranded product (in the same way that some medicines are).

Ok this is a difficult one, because i think that if my birth and postnatal experience had been a better one, then my b'feeding experience might have been better. So I think that the whole way maternity and postnatal services are run needs to be looked at. MW led units seem like a fabulous idea on the surface, but both times I started in one, I had to move to the traditional labour ward when things went wrong. Had I given birth in the MW led unit, I would have had access to the MW who had more training in b'feeding counselling. I would have stayed in a smaller ward, with better facilities, and more MW's per mother. Unfortunately I had to stay on an overcrowded ward with some crappy (as well as some wonderful) MW's, broken toilets and a buzzer which didn't work, all because I had a more difficult birth. Rather than siphoning off the money to these fantastic units, the money should be used to improve the trad wards.

More consistency of advice from mw's, bfc etc. Also someone who is willing to sit with you for a whole feed, not just watch you latch on then disappear

All MW's to hand out bfc cards when you leave hospital.

I think I'd better stop now, because I could go on all night!

sorry, I got a bit carried away

not re3ad the whole thing. but more education for HV woulod be good.

i had dd4 weighed six weeks ago after a 3 week break, and she had only gained 6.5 oz in three weeks. cue 2 hv's descending on me in clinic, quizzing me up about dd4 and if she weas feeding enopugh. she is a little chubster, and was/is doing fine. if i had been a first timer, iw would've been cioncerned i was starving my baby etc etc and might have switched to formula. dd4 was weighed again 4 weeks later, had gained 12oz. my usual hv said that the previous hv's shoul;dnt have acted luike thyey did over one lower reading, as dd4 is still following a reasonable curve on the breastfed from, birth chart i am using.

Northern Lurker,

There is a breast feeding friendly reflux medicine....it's called Domperidone (or Motilium)1g per 1ml suspension.
It speeds up the transit of the milk in the gut so it is in the stomach for a shorter time which means baby has less time to throw it up. You give it by syringe and it's only a few mls as opposed to having to force a bfed baby to take a bottle.

I tried gaviscon with my older daughter who had reflux (born 50%ile at 7lbs 12oz by 16 weeks had just reached 2%ile and was 10lbs by 17 weeks she was back down to 9lbs 12oz). Gaviscon made her poo marbles, which caused immense pain, screaming and tears to her bum.

Domperidone changed her from a baby who needed 6 changes of clothes, spare bedding for the pram, a change of clothes for me and at least 10 muslins to go to the town centre for a few hours.
Gone were the 45 mins-1 1/2 feeds with 20 mins break to clean up the sick and change her nappy. It was fantastic.

Ask your Dr for domperidone and don't take no for an answer!

Verity

Sorry for the rant but I got so fed up of not being taken seriously about her 'posseting' and of being told I wasn't feeding her right/my milk wasn't enough/formula was the only thing to give to a reflux baby......

By coincidence I spent this afternoon ranting gently about lack of BF support with a couple of friends I went through the baby stage with. I dont think about it much now the kids are a bit older but I was quite rabid at the time after a horrible experience with my first, and had no one to tell, so hello BMJ...

As a society bf levels have fallen below levels where women would normally come in contact with lots of other bf mums. Few of us for instance can look to our own mums for help as often they were pushed to formula feed.
The support everyone is banging on about is expensive but it is also essential. Another generation on and that support would pay off. I could now for instance offer lots of support to my own daughters, and as bf rates go up the need for state help would reduce. I spent a couple of years in rural africa surrounded by breastfeeding women everywhere you went, I cant imagine a new mum there being short on support and advice. My point being if you are serious about bf you need to build up a critical mass of bfeeding mums. It involve support, it will cost money.

Oh and lastly, (and then I will shut up as I can reaaaaallly go on and on about this); tell it like it is. Do NOT let new mums approach breast feeding in a blissfully unaware fluffy cloud of loveliness. IT DOES NO ONE ANY FAVOURS. Outline in detail the issues that people can struggle with and then furnish them with solutions and a list of places to go and get help.

Oh yes, I also think more women who failed to b'feed when they were desperate to do so, should be encouraged to join in the debate. Especially if they feel they were let down by lack of support or misinformation. It is very easy to be defensive when you have ended up f'feeding (I know I have done it myself), but I think it's important to be part of the discussions, which is the reason why I get involved in the breast/bottle feeding threads, even though I often feel quite upset by them.

Better support for mothers who want to b/f. I heard the staff giggling about my hugely engorged nipples when I was trying to b/f in hospital. It made me cry (I was in a bad state anyway), and made me feel even more that I couldn't do it. I gave up two agonising weeks later.

Errrr Verity - think you've got me mixed up with someone else - I never said anything about reflux did I? Very interesting post though!

Gotta disagree about the weighing.

It's not the weighing that's at fault (though too-frequent weighing is a waste of time) but the way weight is interpreted, often badly

Verity I think that message was for me? Thanks, I will ask the GP about that med next time we go.

I agree with the need to make antenatal classes provide new mums with more realistic expectations of what breastfeeding entails: cluster feeding (like other posters, its only mumsnet that made me understand this), more frequent feeding than you may expect, problems you can have latching on etc, and where to get support. There are a myriad of reasons why people give up breastfeeding and so I think its important you advise new mums that having problems at the start is normal - you are not a failure if it doesn't fall into place immediately - but there is plenty of support you can get to help.

I do think health visitors and midwives need to be better trained. I had a midwife in the maternity nurse who was really supportive and said some really encouraging things that stuck in my mind and helped me keep at it, but the lack of knowledge/effort about simple things like how to get a good latch was, in retrospect, shocking.

I'd like to see trained breastfeeding counsellors visit each mother in the maternity wards to help them one-to-one and make sure the latch and positioning is established before they leave the ward, if breastfeeding is the way they want to go.

I agree with Cathpot- a big investment now will pay dividends in the future. It's about a change of culture IMO. More women BFing now will snowball into more women BFing in the future.

Also, she is absolutely right about providing honest information before you begin about possible problems and the way you can overcome them- Maybe they should make a DVD of mums who (have) breastfeed talking about the trials, tribulations and successes as an encouragement/ source of info.

Also agree about training for HV/ MW/ GPs etc AND with having someone sit with you for the whole feed, not watch for 30 seconds, say "lovely", and sod off. I had a HV who didn't care about DSs weight gain because she could see he was feeding well and looked perky, despite the fact that his weight loss was slow (compared to FF babies). More of them should be this informed.

Message withdrawn

I think that normalising breastfeeding would be the biggest single thing that would improve breastfeeding statistics in the UK. muppets like Dr Hilary Jones should be stripped of the membership to the GMC for spouting nonsense and the media should promote breastfeeding as normal.

even if advertising of formula for babies is banned, a new mother is still told to get bottles, formula, steriliser etc JUST IN CASE she cant BF.

I do agree that there are some circumstances where BFing isnt working and have personal experience with DS1 being unwell and physically unable to latch on. I dont understand why someone would prefer to give their baby cows milk rather than breastmilk out of choice and feel that if breastfeeding was the norm, then with it would come support from family and partners.

Am not sure that any of this is going to happen in our generation. Bottlefeeding is such a culture within the UK and because little time is spent educating healthcare professionals about breastfeeding, they are not able to pass on knowledge.

have just read my post and am not criticizing formula feeders but its just a personal opinion as mothers obviously want the best for their baby yet certainly where I live the number of mums i see breastfeeding is far less than the number of babies i see being given bottles.

Message withdrawn

I agree with previous posters who say that it doesn't always work to increase public education and awareness, the biggest problem in this country seems to be women lacking confidence in their ability to breastfeed. Not being able to breastfeed is much more common than it should be, and I believe this is due to lack of support. Most women who choose to formula feed before their baby is born choose to because they have previously been unable to breastfeed, or they know someone who has stopped due to having difficulty. Therefore I believe the way to increase breastfeeding rates is to encourage and support women who have already decided to breastfeed. It follows suit that the more people who succeed, the more normal breastfeeding will seem and rates will eventually increase.

Practical realistic suggestions:

• Include lactation in the national curriculum under human biology. (Most people have no idea how milk production works - even a vague or subconscious memory of something learnt at school would be an improvement.)

• Every maternity ward should have access to one midwife trained in breastfeeding support. Every Health Visitor team should have access to one health visitor trained in breastfeeding support. (Preferably, eventually, all midwives and HVs should be trained to support breastfeeding but at least one per area should be more acheiveable cost-wise.)

Idealistic suggestions:

• More valid research should be done into the safety of bedsharing. The existing studies are flawed and inconclusive and anecdotal evidence supports that bedsharing leads to increased success and duration of breastfeeding.

• Formula milk manufacture should be strictly regulated, and ideally brands dissolved so that all the manufacturers work together, providing 2 or 3 different options based on cow's milk as well as the special dietary options already available as I understand not all babies thrive on the same type of formula milk. Formula should be sold at cost and advertising formula should be banned, especially within a medical setting. (I realise this would be a huge operation and I understand little of the pharmaceutical industry hence it being in the idealistic section.) I do think it should be available to buy at corner shops and supermarkets though for the convenience of the people who do use it for whatever reason.

1. Support, support, support. Not just at hospital (not all babies are born there and even if they are some Mums (like me) can't wait to get out of a clinical environment). Locally blessed with excellent support groups which run Monday to Friday so help is readily available. Ideally would also have drop in clinics on Saturday and Sunday too. Mix of professionals there including specialists in breastfeeding who will prescribe if appropriate. I can't say how much of a help it has been for me both with the struggle to get DD2 lactched on properly and our current battle with Thrush.

1. Better information ante natally about what to expect. Don't gloss over the difficult bits. My ante natal information was very unrealistic and painted an over rosy picture when in reality being honest about the problems would have been much more helpful e.g. noone mentioned Thrush to me ever so had no idea what was causing our problems until it was picked up by a HV at one of the support groups. Also agree with however said that "if it hurts the latch is wrong" comments should be banned.

1. Great point about dolls and bottles not something I'd thought of but now you mention it then yes it just makes bottle feeding the norm. DD1 though has rejected her doll bottle as "thats not how babies are fed", made me very pleased.

1. Agree that the law needs to be changed so that it is illegal to ask a BF woman to stop feeding in any public place.

1. Ban all formula advertising including for follow on milks. Be honest that FF IS the second best option and NOT just like breastmilk (disclaimer I do understand the sensitivity of this and that formula is necessary).

1. Train all HCPs, not just midwives and health visitors but GPs and anyone working in Obs and Gyny. Equip them with other solutions when a mother / baby unit is having problems than to just to suggest formula (although obviously that might be the right advice it shouldn't be the only advice profered).

1. Maybe some positive advertising campaign from the Govt. After all they are pushing healthy eating measures in all other areas but not this one.

Nice to see that doctors are interested in this subject.

I absolutely agree with hazeyjane about the phrase "If it hurts you're doing it wrong" - most unhelpful. It's not so much the intended message - because obviously, in time, and under normal breastfeeding shouldn't be painful and women need to be reassured of that. It is the message that gets through that is the problem - namely that the woman is at fault for not getting it right.

I'm not sure how it could be phrased better - perhaps something along the lines of:

"You may find breastfeeding a little uncomfortable for the first few weeks, while you and your baby get used to it. If it doesn't get better there may be something wrong, so don't be afraid to ask for advice." But more pithy.

As for improving breastfeeding rates to begin with, I firmly believe that this requires a shift in society's attitudes and this is going to be a long time coming. At the end of the day, many young women will follow their mother's advice when it comes down to it. I know a young woman who started out with every intention of breastfeeding, but after staying with her mother after the birth has ended up bottle feeding to a four hourly routine. Her mother's insistence on getting the baby in a routine has destroyed her confidence in breastfeeding.

A fundamental shift in attitudes could take two or more generations to come about IMO.

I agree with others who have said the 'pre' information for pregnant mothers is not always helpful or accurate.

When my first DC was 3 days old I rang a charity BF helpline in hysterical tears b/c DD was feeding every 1.5 hours and I was totally shocked and didn't know what to do. Although I got BF support in hospital (in Australia ), I didn't have accurate sensible information about what to expect in the early days of BF.

BF needs to be presented as something possibly challenging, but exceptionally worthwhile, rather than just something 'natural' and 'beautiful' (which of course it is too).

Along those lines, if we are going to have publicity posters, they need to be much better quality than those in the past, and well planned.

In my mind, BF posters seem to be stuck in a early 90s time warp, with a BF Mum feeding, gazing lovingly at her newborn, whilst Dad hovers about in the background looking cheesey, possibly bringing Mum a cup of tea. I think these type of posters actually alienate BFers, and also other people. They always seem to make BF look like some very exclusive thing between the Mum and baby - something private - even if the pictures shows BF happening in a public place.

I think we can do much better. What about showing a Mum BFing her baby whilst sitting with her DH/DP watching the football on the telly, and cheering on her team? (If it were a TV ad, Baby could look up and burp approvingly when the team scores a goal) Or a young (teenage, possibly) Mum sitting in a cafe B feeding baby and laughing with her mate over a text message or something? I think we need to show that BFing is a normal thing Mums do as a part of ordinary life, not some thing seperate to normal interactions and activities.

Publicity posters also need to show older babies feeding, not just newborns, and must show Mums of all walks of life, all ages, ethnic groups, classes.

And if the government were serious, publicity posters would not just go up in Surestarts and GPs, but in bus stops, magazines, cafes etc etc.