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??

And consistency in training would be nice. A common complaint is that mums get told 8 different things by 8 different people - positioning, one-sided or two-sided, how long a feed 'should' last. It would be helpful if some national conference could just sit down and spend a couple of days hammering out the language everyone should use with new mums so at least everyone is singing from the same hymn sheet with as little variation as possible. Then bang out leaflets to every labour ward etc. So even if full bf training can't happen immediately at least every midwife is saying the same thing about what a good latch looks like and using the same phrasing.

Hi I have'nt read the whole thread but just wanted to drop in and share my view based on my experiences.

arly on I decided I wanted to BF mainly due to everyone I knew having FF and a lot of people going on about how much easier it is and how you can get into better routine's blah de blah, so of course being 19 I took on their opinions as gospel.

By the time I was 30 weeks I had just settled into the idea never even thought twice about it, now looking back at that appointment with the MW I realise that their advice could've benefitted me so much.

At my 30 week check my MW asked me if I'd considered feeding options etc, my immediate answer was well I know nothing about BF and everyone I know FF so I'll stick with that it's safe territory, to which the MW replied that is fine we'll just leave it at that then.

When I think on that now I wish that I had atleast been offerred some information or advice about BF and what it involoved, obv it does'nt sound that difficult but to me it was not knowing that put me off.

So I would like to see MW offering general advice to first time mums, especially younger ones as it can be daunting there are so many things to think about with your first, I know there are leaflets etc but to me when that question was asked with the answer I gave it was clear I knew nothing else surely if a MW had said well I don't want to push it on you but here's sme information about BF and you can have a think about it and maybe have a little chat about it in terms of what it usually involves etc.

I would also like to see it prmoted more as I know here in Scotland there is an NHS advert but it has actually been on about once a week if your lucky for the last 2 years so whilst we are shown 'follow on' milk in abundance there is a seriouslack of promotion for BFing, as well as how it's portrayed in Soap's etc how many times have we heard the line 'oh I'm just glad to get my body back' or similair after about 2 weeks of feeding, this needs to change as for some people as sad as it may sound I guess TV does actually influence them lot and if you are hearing that you automatically think oh god must be bad.

And I genuinely believe that if I had known of this website I would have had a go at it as the lvel of support and advice on here is fantastic for those who need it somaybe a leaflet containing details of here would be useful as I think the ones for 'breastfeeding adivce' can come over as a bit scary where as here you can relax and genuinely talk through it.

Sorry for rambling

Another thought ... how about unlimited free loan of pumps and other useful BF equipment via baby clinics and HVs?

I haven't had the time to read all of the posts (yet!) but I just wanted to add this...

I agree with all of the suggestions for more education/facilities/HCP training etc, and strongly believe that society needs to view breastfeeding as 'normal' in order to make new mums feel more comfortable.

My main point though, from my own personal perspective, is that all I knew/heard of breastfeeding before dd was born was that it was 'difficult', 'painful' and a horde of other negative attributes. However my own experience has been the opposite, my dd fed from birth with no problems, her weight gain is textbook, she is exclusively breastfed and long may it continue...

I wish I had heard more positive things about breastfeeding before she was born, unfortunately one tends to hear very little from people who DON'T have problems (perhaps they don't want to sound smug, I even felt a little guilty writing the above). Surely to encourage take-up of anything, people need to hear the upsides, and not just the NHS breast is best leaflet, but personal stories from real people about how great breastfeeding is if you are lucky enough (or determined enough in some cases) to have it work for you and your baby. I know in my heart that if I had encountered any real problems I would most likely have switched quite quickly to formula, mainly because my expectations of breastfeeding were so low and I EXPECTED it to be so painful and difficult. However if I had been exposed to more positive breastfeeding messages(and unfortunately MumsNet and the like were not on my radar before becoming a mum, which I think is probably common for a lot of people) then I would have had more drive to overcome any difficulties had they occurred.
Does this make sense to anyone?!
Er if not please put it down to 17 weeks of non-sleeping (one aspect of breastfeeding it may be best NOT to advertise!)

Yes BM - agree about the pump idea. If there could be somewhere to go to post natal (with baby at any age) where you could test different pumps (try before you buy?) & be shown how to hand express.
I know so many people who gave up bf-ing because they 'couldn't express'. I could not with certain pumps, but could with others. So glad I was encouraged not to give up at the first failure.

Jackstini, you would think baby clinics would be able to do this sort of thing.

Interesting about the pump loaning idea - in my experience (just of people I know, so not a huge sample here!), it was those who bought pumps and a bottle 'to express' who ended up realising that baby taking a bottle is easier (in some ways), and ended up using said bottle for formula feeding within a few weeks.

I thought it wasn't really reccomended that you start expressing and bottles until BFing was pretty well established? Or are you sugesting that women who have BFing for a while and are going back to work be loaned pumps, rather that Mums of newborns?

Not sure really.
I always used pumps mainly to get round the sore nipple/mastitis thing, and also to build up a handy frozen milk bank so I could have a few hours of freedom, but maybe it's different for other people.

How were breastfeeding rates in this country increased from the lows of the '60s and '70s?

I bet the NCT had a lot to do with it.

Good question, drama...there were social changes which took in stuff like eating more 'naturally' with more wholemeal foods (I am not joking - there is a slide somewhere showing the graph of sales of wholemeal bread mirroring the rise in bf which happened from the mid-70s); volunteer organisations like LLL and the breastfeeding counselling activity of NCT continued the focus on supporting women to bf; women stayed in hospital for less time postnatally - a two week stay was not unusual in the 60s, and the longer you are in hospital the more time there is to mess up your bf; the women's movement took in maternity issues, so there was more emphasis on what women wanted to do about birth as well as feeding (campaigns against routine induction and episiotomies happened more or less at this time - late 70s).

But there was no real public health drive to support bf - or rather the public health drive followed these changes rather than led them.

The nadir of breastfeeding initiation was in the early 70s and then it started to turn. Off top of head I can't remember the stats but it was under 50 per cent, and women stopped bf very soon.

Ah, so NCT creation was a symptom rather than a cause then?

Do you think increased length of maternity leave was a factor, i.e. non-existent for some people and a maximum of 12 weeks for others, up to the present 6 months (paid) now??

Yes, I agree, BoffinMum - NCT bfcs were an effect of the return to bf, and then bolstered it NCT bfcs first 'emerged' late 60s, though, so in the vanguard, nevertheless! The numbers were pretty small at first, though. Even now, there are only about 300 NCT bfcs and probably the same number in total from the other vol orgs, so hardly thick on the ground, with huge swathes of the country with none at all.

Makes me smile wryly when I read posts suggesting that 'every mother should see a breastfeeding counsellor' or 'every maternity ward should have breastfeeding counsellors' - 600,000 births a year and 600 very part-time volunteers ???

I don't think maternity leave had anything at all to do with it. I mean, it's a good thing, and we should have lots of maternity leave, and it does seem to affect the length of time women breastfeed, but studies show it has little effect on initiation.

I agree that b'feeding should be shown in a positive light, but my experience was the opposite of yours bzzbee, in that all I saw was the lovely glowy posters, and of my friends who had b'fed most had had no problems, and the one who had, didn't go into details (didn't want to put me off, I think), but said I'd have no worries as I am a pretty determined person with a high pain threshold (Ho ho ho!)

I could have done with some knowledge of tongue ties, thrush and extremely sensitive nipples (all of which affected me). I did read a lot, but think my brain must have filtered out the bad bits!

I remember asking my nhs antenatal class teacher, what to do if b'feeding isn't working, she showed me something involving a straw, an orange and an explanation of why all babies wiil naturally get the hang of it, told me not to be so negative and sent me on my way - great!

How about making breastfeeding counsellor a paid job - same conditions of practice, but paid.

We don't ascribe any value to bf because we don't value the people who provide the best support (except if we've benefited from their knowledge and then there's not a salary in the world that could describe it). But as a society, we don't value things you get for free.

I know my idea of making bf more normal in society wasn't seen as as important as providing support for the women who already want to bf, but (and this is kind of what hunker is saying) do the two not go together? Improving the "image" of bf, and making it quite rightly seen as the normal way to feed a baby should see the money follow it, as taxpayers are happy to see money spent on it, and health organisations get a kick up the bum to make it happen - because that is what people are demanding? And it doesn't have to be one following the other, they (more support vs normalising it) will naturally bolster each other.

Sorry hunker - I think I put a lot of words in your mouth there! What I'm saying is that if society values it, there will be money for support so more women bf successfully. The more women that bf successfully, the more society as a whole will value bf, and see ff as something that is done as an intervention.

HPNC

SOrry, don't have time to read whole thread as DS is just waking up but YES lets do that...

Then why don't they train HVs as bf counsellors?

Good question BoffinMum, even a cut down version of the course would be well worth it surely? About £2000 at the most?

Plus follow ups every few years I suppose...when I'm in charge of the NHS

Just as an illustration that bfing is seen as an ideal that some silly women just insist on carrying on with in spite of putting their babies' health at risk...

have a look at this

Now of course we don't want babes getting seriously ill, but it's the tone of the last sentence that I find rather depressing. Although the emphasis on more support is encouraging.

The NHS has to deliver mass healthcare. In our area peer supporters are available - sporadically as always, as they're volunteers - on the maternity ward and to take referrals from HVs and MWs. And do you know how many referrals we've had in the last 18 months? 2. It's easier and quicker for extremely over-stretched HPs to suggest formula top ups etc than to provide additional support.

That surely has to be addressed before anything else can happen. Lawd knows how...

In my experience I found bf was easy when I had help at home but once I was on my own and had toddler DS to look after I hated it and it got in the way. Real 'pressure' needs to be put on dads to make them realise they need to help out if their partner wants to bf. My exP didn't do enough and it made bf so difficult .
HV's and midwifes just visiting aren't much good. Can't they help out for 20 mins and at least allow the mum to get a shower? Idealistic I know, but I found it impossible to juggle everything and it all went wrong until i switched to ff.

I would love to see paid breastfeeding counsellors - but who would pay them? The NHS is stretched enough as it is (though over time if breastfeeding rates increased, overall they would save money - it will take a while to implement though.) And it doesn't seem fair to expect individuals to pay. The breastfeeding charities/organisations only have limited resources as well.

The same with the Health Visitors just visiting. I didn't realise just how stretched they were until I phoned up one day to see if I could change what time my HV was coming to weigh my baby and was told she didn't have a spare 5 minutes to rearrange, all week. However I think there is a service - homestart? - in some sure start areas which offers some home help.

I think better, and non-judgemental support is important, but that this is such an emotive and far-reaching issue that it will be difficult to change people's feelings quickly. Being honest about expereinces of breast-feeding as many women find it to be, is not necessarily going to convince others to try it.

My mum tried to breast feed me, and found that it wasn't working (yes, probably a different sort of help and support were needed, but she kept going for about 3 months) - it was one of the most distressing experiences of her life, and when she thinks of my early years, that's what she thinks about, and what she talks about. I've grown up with stories of how terrible it was, how all the medical professionals looked down on her for failing me, how she failed to look after me, how she failed to know what was wrong, the pain I was in, the pain she was in, how desperate my dad was, etc. Because of that, I associate breast feeding with pain, failure, desperation, stigma, etc (and of course, I associate my arrival in her life with all those feelings - "I ruined my parents lives").

I suspect that there are people across the country who think of breastfeeding and associate it not only with shame, which is the obvious problem, but with pain, guilt and failure.