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??

Another poster idea - Mums feeding second and subsequent babies, not just first borns.

So maybe a Mum sitting on her sofa feeding, with her toddler sitting next to her 'breast feeding' her dolly, and another older child playing with his legos on the floor and laughing at his little sibling doing the pretend feeding. So BFing is a 'family' thing, not a 'Mum and Baby' thing.

I totally agree about better(and consistant) training for health care professionals, I too have heard the phrase 'top them up with formula' used loads of times.
I would also like to reinforce the point made earlier about more realistic information given to pregnant mothers about BF, I was made to believe BF would be a straightforward and easy experience that my body would naturally be able to do. So when in reality I found it the most stressful part of being a new mother I constantly thought I was a failure and hated having to keep admitting I was struggling with it. (For example if I had known cluster feeding was normal and had the reasons for it explained I wouldn't have had constant worries that I wasn't making enough milk for my baby).
I also encountered some really unhelpful comments from MW's including the cracker 'don't cry, he'll taste it in your milk!'

Also, why is there not a commercial type thing on TV about the benefits of BF. The government produce quite a few now (ie: anti smoking). Not only would this help give information but might help with the image of seeing a BFing mother become more everyday.

Yes, a few mums I know didnt feed subsequent abies-'toomuch work'.

family alleating at atble with baby bf- 'Lunch with the family' ? something l;ike that would be good

If they dared televise it, a certain type of viewer would lose it.

I like the one about the teenage mums. Frankly if you could crack this 'market' I think the rest would follow. Charlotte Church has done some great work here.

I used to sit at music college with my first at the age of 19 and bf - the other students used to gather round and stare, because they had never seen anything like it before, and were fascinated. Hopefully that spread the word a bit - these things go in fashions.

All these have probably been mentioned but:

1. Better training for midwives/HVs. GPs & obstetricians get no formal training whatsoever in breastfeeding so this is definitely an area to target.

2. The idea of a breast-feeding wing to maternity units is a lovely one. We have lost the attitude of being kind to women who have given birth. Many midwives seem reluctant or too busy to give any more than the most basic help to women who have given birth. The drive seems to be to get the boxes ticked and get new mothers out of hospital ASAP.

3. Normalise BF in the media etc.

I think it would take one or two generations of effort and investment to change the cultural attitudes in the UK towards breast-feeding. But every single woman who breast-feeds where her mother or MIL didn't is making a small difference.

There did seem to be an attitude amongst some of the MW's on my postnatal ward, of 'stop making such a fuss' in regards to birth, post birth and b'feeding. I think because they see women doing this all day every day, if someone is having a hard time, there is a 'tut, what makes you think you're so different' attitude. I say 'some' mw's, because I did come accross a couple who were fantastic, unfortunately, I would see them for a few minutes, and then not see them again. I think there were only 2 who talked about b'feeding as something they had done themselves.

Last night I wrote down all the things i had stuggled with during my attempts to b'feed, so that i would have some record of it. When I asked my mum why she had b'fed my sister, but not me, she said she couldn't remember, but she thinks she was told she wasn't making enough milk, because she was too skinny! If my daughters ever have babies of there own, I'd love to be able to feel I could provide the sort of no pressure, encouragement and support that will help them b'feed, and also help them find the help they need, if they are struggling. But hopefully things might have improved a bit by then!

I think christiana hits it spot-on with 'I really feels the NHS places URGENCY before IMPORTANCE. Breastfeeding might not be URGENT but it is IMPORTANT.'

And tiktok's stat about 9 out of 10 women who stopped bf would have liked to continue is very telling.

Really I believe it boils down to staffing levels in maternity units and improved training of staff.

Every midwife/health care professional knows bf is 'best' (sorry greenmonkies but you know what I mean!),however they lack the time and the practical knowledge to help women. As tiktok says, most women require very simple strategies/advice to continue feeding (unhurried, uniterrupted skin to skin at birth and on the postnatal ward, for example)

So- more midwives (and there are plenty of them out there job-hunting!) and better practical (not just theoretical, academic)training for mw's, hv's, nursery nurses, nursing auxilliaries, and GPs/other doctors.

My bfc has also interestingly spoken about an air of distrust that surrounds her at the local maternity unit- she almost never gets called in to help despite her willingness to visit to provide specialist help to women on the pn ward. The NHS's notorious hierarchy here is standing in the way of women receiving the help that is out there.

mamacita, that is your one free one, next time it's the stocks for you!

My perspective (based on my experience as a bf mother and as someone working on postnatal ward)

1. Increase homebirth rate. Women who have their babies at home are signficantly less likely to experience interventions that make bf more difficult. They are also less likely to experience pressure to supplement with infant formula while establishing breastfeeding.

2. All staff working with expectant and postnatal women should undergo Unicef training in breastfeeding support.

3. Increase opportunities for antenatal breastfeeding education for all women, including second and third time mums. It would be best if the voluntary agencies were involved in this training as they are better at empowering women to overcome poor hospital practices in bf initiation.

4. Every postnatal ward should have a bf counsellor available, (or a midwife with additional training in lactation support) 24 hours.

5. Ban all formula advertising.

6. Make staff sign for formula on postnatal wards and document the reasons why it's being offered to bf mothers.

Message withdrawn

"Is there an issue of guilt from midwives and HV's that they didn't bf their own children, meaning that they really don't see the harm of ff being introduced so quickly, hence the 'well, you did your best' type comments? "

Yes - absolutely.

People who train as bf counsellors with the voluntary agencies are usually required during training to reflect on their own experiences of bf and analyse how it might impact on their practice. I really think midwifery training ought to include more reflection on midwives' own birth/postnatal experience.

One of the m/w I was working with the other night told me she had done a bit of bf but had mostly bottlefed all of her 7 (!) children. Later on I observed her giving a mum (who had expressed the wish to bf) a bottle for the baby, telling her 'It will do your baby a lot of good'..... This baby had been reluctant to latch on, having been given bottles from very early on. No attempt had been made to help the mother express.

Do some research to find out the truth about thrush. I think it plays a big role in women giving up and yet many health professionals (such as my GP) don't actually believe it exists. MN has been really helpful to me on this but I'd really like to see some research done on prevention and alternative cures to massive doses of anti-fungals. According to the bfn website, it's unlikely that the original manufacturers of fluconazole will do any further research to get it licenced for this use as it's now available generically so not worth their while.

I think the NHS should concentrate on the women who want to breastfeed rather than trying to 'convert' those who don't. If the figures below quoted below are correct, keeping those 9 out of 10 mums who want to continue going, getting them out into the streets and cafes and sporting events would do far more to help normalise it than any poster campaign. And can I make a plea that if there is to be advertising, could it be a little more humorous? All those posters are so dreary-- if you're going to spend the money on advertising then get some sh*t-hot agency to come up with something a bit more eye-catching. The best ad I ever saw for bf was the Marmite one but that got pulled after about 5 minutes.

A more joined-up attitude between the various health professionals you see after birth would make a tremendous difference-- I was amazed after having each of my dc how these varied. Everything from a mw who, when I told her how much I'd been expressing, chided me with the phrase, "Well we would expect a baby to be taking x ounces of formula by now" to the HV who, despite my being half an hour late to my appointment, sat patiently helping me to latch him on, trying various positions and adjusting my hold and posture until I was comfortable. I don't think with any other condition (yeah yeah I know having a baby isn't a medical condition)you would encounter such disparity of approach between hps.

I agree that there needs to be some pressure applied to the media-- I remember a while ago mners contacted a soap en masse to ask why a character wasn't breastfeeding and the producers responded that they were trying to reflect the reality that character's social situation. They should not be allowed to get off that easily! I used to live in East London and I can tell you it wasn't only the Dot Cottons puffing away, so someone at Eastenders has made the decision not to reflect the 'reality' of the vast numbers of teens and young people smoking.

Finally, get those 'follow-on' formula ads off the telly. Now.

duffpancake have you seen these posters? Some are a bit but they aren't dreary!

Totally agree with thrush research from the bottom of my (probably thrushy, am riddled with it!) heart.

Short term:
More role models on TV. Hell, any role models on TV!

Ban the phrase 'breast fed babies feed roughly every 3 hours, formula fed ones every four hours' - this is in all the NHS leaflets and convinced me I was doing something wrong if my newborn needed it every hour or two.

Stickers for cafes etc to put in their windows saying "Breastfeeding customers welcome here!"

Longer term:
More midwives, more HVs, more lactation consultants.
I got excellent help all day in hospital, and abuse and ignorance at night - which I'm sure is because the night midwives were almost all locums which the NHS had to recruit from the shallow end of the locum pool.

Found out the other day that the reason two of the local HVs are useless is because they aren't HVs - there are only two HVs (who are pretty good), and the other two doing HV jobs are 'healthcare assistants', qualified to weigh your baby and that's about it. Which explains why when you say 'I'm having trouble bf' they said 'Use formula then' and when asked about bf help said they'd never heard of any such thing! Given that I live in an area with the highest birth rate in the country, the two HVs must have a few thousand babies each!

4 weeks wait to see a lactation consultant makes them pretty useless. And they (and ideally HVs/ midwife-bfcs) need to be able to prescribe drugs for thrush and mastitis. Being diagnosed and then having to fight for a GP appt and then argue for drugs adds days to painful bf. I'm simply lucky that my baby will latch onto anything and was happy to get back on my breasts after 4 days off!

notcitrus, I think you are misremembering about NHS leaflets, fortunately. I don't think any of them say the rubbish about feeding every 3 hours, do they?
Nothing like that www.breastfeeding.nhs.uk on there.

Have you perhaps had a local leaflet with outdated info on it?

Tiktok, i don't know if it says it in the nhs leaflets, but when I had dd's most of the MW told me that dd should be fed roughly every 3 hours, apart from the 2 who I mentioned previously (who talked about their own experience of b'feeding).

hazeyjane, it's a common misunderstanding I know, but I don't think it is written down officially any more. Information leaflets from the NHS and DoH are much, much better than that, on the whole.

I also think it is crucial to find out why a mother doesn't want to breatfeed, whteher it is phobia, ease, because no one else has done.

A good breastfeeding leaflet given to every pregnant mum free. There was a link to one on hunker's blog - I was so impressed at the info in it - most of which I had found out over two years reading kellymom and mumsnet.

Specific info about the medical benefits to babies and mums. Also the emotional connection and how that must pay off in later life after bf stops.

Educate healthvisitors. I was grateful to one for persuading me to keep exclusively bf at four months when I was hoping it would help her sleep if I ff a bit. But at twelve months the same HV when I said I was still feeding dd; "they don't need it now you know".

Stay in hospital till bf established. Agree with whoever it was who said NHS are more interested in URGENT than IMPORTANT. Need more emphasis on IMPORTANT.

Less emphasis on "weaning" at six months. Try and get across the "introducing solids" message across more.

More people like me who are still feeding at 3y actually letting HV, doctors, everyone else know that. If I was a bit more open about it, then maybe people who know me would keep feeding a bit longer!

Much of this has been said already but:

1. Stop making it some kind of gold-standard. It's got to be the normal, default thing to do. In practice that's going to take generations, but in the short time we can change the language used around bfing and ffing.
2. Those of us who are bfing, to do it in front of as many kids as possible, thereby helping to make it normal!
3. Yes, support, as you've all said, and the health professionals absolutely have to get their act together and ditch the myths.

LeninGrad, for most babies you are right - frequent weighing is not necessary (though 'feeding regularly' is not a sign, necessarily, of well-being...plenty of happy healthy babies feed at very irregular intervals!).

There is no doubt that once everything is seen to be going ok, babies are weighed ridiculously often in the UK.

But some weighing is very helpful - at the beginning, it's part of a careful assessment that milk is going in. After the first few weeks, healthy babies don't need weighing very often.

As I said, it 's not weighing that's troublesome, but the inept interpretation of what the weights say, that causes the anxiety!

Don't agree with 'keep mothers in hospital until bf is established' or 'don't discharge early'....the research is all the other way, showing the quicker you are out of hospital, the more likely you are to bf longer! To be honest, the longer you are in hospital, the more time they have to mess up your bf

Early discharge has to be coupled with good community care, of course, which does not always happen.

My considerable Bf problems were started by staying overnight (just the one night) in hopsital, but that was because I couldn't co-sleep and had a very high-contact baby. If I find myself in hospital this time around (and I hope I'll get the home birth I'd like) I'll get DP to borrow an airbed and I'll sleep on the floor to keep the baby next to me. (Although I'm feeding a 2.8yr old so it didn't stop me bfing .

BUT I know that wasn't everyone's experience. It's not hospital per se that's the problem/solution, it's what happens when you're there, isn't it? Doesn't it come back again to the anguished cries for more (and better informed) support, in whatever context? In hospital and in the community? Although heaven knows where the resources are going to come from to achieve that.

It has all been said, but I totally agree the main issue is support, support, support. The postnatal care staff (midwives/hv) MUST be trained properly with regards to breastfeeding.
I won't bore everyone with my own experience here as it would take a few pages, but I feel that had I been given different (proper) advice in the early days I would not have experienced the problems I did.

Also ban formula advertising, especially that atrocious cow and gate advert