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??

That is very sad, Grendelsmum.

It is one of the reasons why i think it is important to get involved in ways to improve bfeeding support for women, especially if you have tried and failed. If my dd's have children and want to b'feed, i hope I will be able to be honest about any problems that may arise, without being 'horror story' about it, whilst encouraging them and providing practical support, if I can.

I grew up with my mum regaling my 'horrific birth story' at every oppurtunity, how many stitches she had, how she has suffered with back pain ever since, how it was all because I was a huuuge baby (11lbs!)I was terrified before i went into labour.At the same time I had friends who were very honest (and practical) about their births, and they made me feel more prepared than scared.

It is a fine balance I know, but I think it is important to treat women as adults and talk in a sensible fashion about 'what ifs' when it comes to birth and b'feeding, they are huge things for your body to go through, so I think it is important to have knowledge of what could happen, and why not to panic if you do have any of the problems that can arise.

(sorry for another long and rambly post!)

So the BMJ blog did link to this thread.

Maybe we need a thread about people's experiences, good and bad, of midwives helping them start breastfeeding, which Mumsnet could bring to the attention of the Nursing and Midwifery Council. And similarly for HVs with whatever their professional organisation is.

There is a mountain of research of people's experiences of breastfeeding, of the failure of HCPs to help with it, of the lack of training. All the professional organisations and the people within them who deal with training acknowledge there is a massive gap.

Sending a thread from mumsnet anywhere will only echo what is already known - fine to do it, but it is not proper research, which as I say has been done many times.

We have NICE guidelines on supporting and enabling bf. Clearly, for whatever reason, they are not in place or they are being ignored. Hospitals have high-minded breastfeeding policies and strategies, but varied success in putting these into practice.

This is known, too ie that policies and stategies are not always followed.

just want to say hi and that i am a student nurse, currently on a maternity ward doing my clinicals. I am going to suggest this site as a "supplement" (pardon the pun) to my patients and that reading many of the posts have given me great insight and realizing different attitudes....will be checking in periodically for advice, thanks mucho!

Sorry - must confess have not read all previous posts and may be repeating! I had an ECS and had no that this would delay my milk coming in. I was put into a 6 bedded bay in hospital and ended up discharging myself against medical advice (DS had dropped too much weight - just) as hospital environment was just not conducive to trying to BF (had to go get your own meals, my roommates had huge amounts of visitors at visiting time so I could get no rest...). I had signed up to a BF peer support worker who really helped me through but I know if I had stayed in hospital (as advised) I would still not be BF today. At least at home my DH could take DS for the half a millisecond brief periods between "feeds" and I could eat properly. Knowing about the delay would have eased my expectations and made me far less stressed!

Doctors, midwives etc to stop pushing mums into topping up. Also quicker referrals for help with reflux. In our case gaviscon not working and making ds constipated. Gp won't prescribe anything else or refer until ds is failing to thrive. He has already dropped from 95th centile at birth to 25th centile so really did not want it to get any worse. We were already topping up so tried switching to anti reflux formula which worked was a massive improvement, but ds cant keep down any breastmilk so we are now giving up on breastfeeding because he now associates it with being sick all the time. I would have liked to continue breastfeeding but seeing him get so upset and now just refusing the breast altogether, and dropping centimes every week since he was born (now nine and a half weeks) I had to try something. Gp said she wouldn't refer yet as he wasn't officially failing to thrive yet (very almost) but I couldn't sit back and weight for ds to get worse so am giving up.

A paediatrician referral for help with reflux would have helped us to continue breastfeeding.

I think, in terms of getting people who start breastfeeding to continue, more honesty is needed about how bloomin hard it actually is to breastfeed! I know that it is painted as this wonderful thing to try and encourage people to actually start, but in the end this is what hindered me.

I was SO naive about breastfeeding while I was pregnant. I had dutifully gone to my NCT workshop and had been shown these pictures of women happliy breastfeeding everywhere - in a sling, in the park, by a lake, all with big smiles on their faces. Any concerns that we had about it were glossed over, and th emphasis was very much on how great it is. I thought I would easily breastfeed until 6 months and beyond, and saw myself proudly breastfeeding in public. I was so looking forward to cuddling him as we bonded. It would be nose to nipple, open mouth and off we go!

I was also incredibly judgemental about mothers who formula fed. I didnt understand how people could 'give up' so easily - how hard could it be? If someone had told me that my son would be on formula by the time he was 3 weeks old I would have never beleived them.

I really think this naivety about breastfeeding was what caused me to give up - I think I was so shell shocked by how hard it was and how much I hated it that I didnt have the strength to carry on. The first couple of days were fine, midwives told me he had a lovely latch and all was good. However, then the pain and sore nipples started and it went downhill from there. I just wasnt prepared for the pain, the cluster feeding, and I got myself in such a tizz about which boob to offer next, same boob? other boob? both in one feed? because I was worried about my supply. It was all just so unexpected.

It looked like DS ws doing it right, but it cant have been right as it was so painful. I rang a breastfeeding counsellor who, although was lovely, wasnt really able to help me as it seemed like we were doing everything she said. My friend had been to a breastfeeding session, but said it was just full of women happily breastfeeding, so that put me off. Everytime I looked at my shredded, bleeding nipples I just wanted to cry. I was dreading feeding DS and every time I got my boob out to feed him I felt sick.

In the end I switched pretty quickly and it was definitely the best decision for all of us - if I hd carried on I could see myself going down a PND road. However, I still think that if I hd been more informed about the realities of how hard breastfeeding can be, I would have been more prepared for the difficulties, and therefore more committed when it didnt go well straight away.

I was also very naive about BF. I genuinely believe we have succeeded this far (4 months) mainly through luck (and MN). I had a very medicalised birth and was sent home from hospital several hours later without DS having latched on. The following night was a bit of a blur but I know I didn't feed DS until 36 hours after his birth when a fantastic, young midwife sat with me patiently for ages and got DS latched on. From then, DS took the lead and seemed to know what he was doing! After the initial visit, I saw several different MW, none of whom were as patient or knowledgable as the first, so I feel lucky that she was the person who saw me on that first day.

Aside from that, I think my inability to listen to my baby cry saved our BF relationship. I knew the boob would shut him up so just put him to the breast every time he cried because I just couldn't handle it. The sad thing is, I felt guilty about doing it (rods, backs etc). I believed he should be on a 3-4hr schedule and that I was doing something wrong by feeding him so often. It's only when I discovered MN/Kellymom etc I realised I was doing everything right. So I'd agree that there needs to be better, more honest info on BF for pregnant mums.

More transparency is needed about the potential difficulty.

More at-home support in the days after birth. I had a doula at my home for a week, and she is the reason breastfeeding has been such a breeze. My son was born in meconium, and barely latched on at the hospital. Had I not received the at-home guidance, who knows where we'd be now.

This may sound somewhat ridiculous, but in order to reach the demographic that looks down upon/thinks breastfeeding is gross (teenage mums, low-income mothers), a celebrity campaign featuring all those b'feeding supermodels (Miranda Kerr, Doutzen Kroes etc) wouldn't go amiss.

@Tarma and other midwives. - really simple idea to help;

When you give the new mum the phone numbers for help with breastfeeding, how about you give them an idea who will be answering the phone and when the phone lines are open? I had no idea if I would be phoning a call centre or interrupting someone at home, if I could only call in office hours or if it was a 24 hour help line...it really put me off calling.

Also, maybe the breast-feeding counsellor could call new mums to see if they need help? I realise this could be difficult if numbers are high but midwives could perhaps pinpoint those who need extra help. When you're a bit shell-shocked and sleep-deprived following the birth of your new baby, the last thing you're (I'm) capable of doing is getting myself to a breast-feeding drop-in centre by a certain time.

Oh yeah, if baby is admitted to hospital for weight-loss, doctors should investigate the reasons for it and automatically refer for help with breast-feeding. Simply advising formula top-ups and giving no advice on when or how to BF just doesn't make the mark.

I think the fact that breastfeeding is free should be emphasised. Especially when the world is economically down the toilet, it would be good to see some stats about the money you can save by breastfeeding.

(Although one of my friends lives somewhere where some mums in her area think ff is better than bf because it does cost money and so is "premium" and desirable. Her friends there think she is, well, a bit cheap for bf. So the "free" message would need to be handled carefully.)

And I'd also like to see more discussion in government returning to work information about breastfeeding. I work full-time and since I came back to work, I have met one other woman who breastfed while working and even she has stopped. I try to mention when talking about my 14mo son that he still breastfeeds at night but most of my workmates are shocked I still do it. I refuse to lie but I have never told anyone without them saying "wow - when are you planning to stop?" It's normal for people to talk about stopping breastfeeding like it's something you should rush towards.

I also had very bad midwife aftercare following birth. My son was topped up with formula because he was dehydrated and my milk hadn't come in yet. He latched on for 8hrs non-stop one day and even the breastfeeding councillor was no help. I got terribly engorged and three different midwives gave me conflicting advice at home. All the midwives expressed surprise that I'd want to keep breastfeeding given the trouble I'd had. And one said that given that he'd been topped up in hospital, I'd ruined his virgin gut anyway so might as well move onto the bottle.

100% of the women I met at baby groups who moved quickly onto formula did so because they thought frequent feeding meant their child wasn't "getting enough". As good mothers, they did not want their child to starve. So an important part of midwife education should be explaining that almost non-stop eating is normal for a newborn. Some of these women were happy to move to formula because they found bf all the time was not for them, which is their choice, but lots did it simply because they were good mothers anxious about their new baby.

So my main things are: emphasise it being free; make it a normal part of working women's lives; and train midwives consistently and better.

Oh and ps....

...as well as bf being free, it wouldn't hurt to emphasise how it helps you get back into shape or can be helpful to your stomach shrinking etc.

I must confess that I have paid more attention to sunscreen since I understood that sun damage caused wrinkles (). Perhaps an appeal to our inner vanity on the breastfeeding front might also help.

Oh, and combating the idea that bf makes your boobs look horrible afterwards too. Lots of people have asked me if I have "dogs' ears" for boobs after breastfeeding for 14mo - especially men. So it really doesn't help that some blokes think their girlfriends/wives will be unattractive as a result of bf....

Have been thinking a lot about is thread since I read it.

One thing that always surprises me is how a lot of pregnant women buy tclbb or another book about routines as a matter of course while pg, but not a good book about breastfeeding - my copy of the womanly art of breastfeeding has been so valauble to me these past 9 mo even though I find the title slightly nauseating. I think it helped to counter the naivety and lack of knowledge that has been mentioned a lot in this thread - so why is such book not a standard purchase in pg in the same way that you would buy a cot or pushchair? Is it because we assume it will be natural and easy and therefore do not need instructions? But this runs counter to the idea that for many people bf is seen as something hard and unattainable. Sorry, just thinking aloud!