It is a truth universally acknowledged that breast is best for baby. Yet despite mammoth efforts by health professionals and breastfeeding enthusiasts in the UK, breastfeeding remains the practice of a select few. According to the Office of National Statistics, 35% of babies are exclusively breastfed at one week. This falls dramatically to just 3% at 5 months. Some commentators have claimed that the reason for low rates is because breastfeeding has been gentrified, with a small number of women being able to afford the time to feed on demand for 6 months. Others say it's due to consumerism with lower socio-economic groups favouring infant formula as a symbol of wealth. However, this does not explain how the percentage of women breastfeeding on discharge from hospital drops from 70% to 49% within one month. Why do women who want to breastfeed give up?
Breastmilk has many advantages over formula milk. It provides the baby with essential nutrients, adapting to the baby's needs as s/he grows. Since the baby has an immature immune system, breastmilk fills the baby with the mother's defenses, helping to protect him/her against illnesses and diseases. Breastfed babies are less likely to have colic, be windy, or have constipation. They are also less likely to suffer from skin conditions. Breastfeeding offers benefits to the mother as well. It helps the womb to contract to normal size, dropping pounds in the process. Breastfeeding can burn around 600 calories a day, the equivalent of two aerobic classes! It is also associated with a lower risk of cancer than women who do not breastfeed. Furthermore, nothing can ease a screaming upset baby half as fast as a suckle on the breast. It is the ultimate bonding between a mother and a baby, a great time for both to learn about each other. Not every mother gets to experience this joy and I can see why. I read every leaflet the NHS provided, watched the supplied DVD, googled and even purchased books on breastfeeding. All told me about the benefits. None told me that it would take patience to establish. If women are to feel empowered to breastfeed, they need to be told the truth. The key to successful feeding is perseverance through the first fortnight, confidence and support.
The first two weeks are tough for most women. Engorged breasts, cracked or bleeding nipples and toe-curling pain when the baby latches on are common experiences. What many women are not told about is that these do not last. Instead, they compare their experience with that illustrated in the books and on DVD and when it doesn't match, they think they are doing it wrong and give up. Tender nipples, dreading the next feed and thinking your child must be the offspring of Jaws from the Bond movies are all normal reactions. But somehow magically at 14-16 days, it all stops. After that it no longer matters if you have a Dyson for a baby or that the little one has iron clad clampers for lips, you don't feel a thing. The first 6 weeks are the hardest with a baby anyway. Both of you are adjusting to each other. Baby is trying to get used to the big bad world and you're exhausted and still recovering from birth. But stick with it. Two weeks in and your breasts are in order and in 6 weeks you'll have established a breastfeeding routine.
Lack of confidence in producing breast milk is a much cited reason for giving up breastfeeding. "I breastfed for 3 weeks", said a mother of a 11 month old girl, "but I had to give up. All the literature the midwife gave me said that babies come off the breast when full. My daughter never came off. She would either fall asleep or I would have to break the suction myself after an hour. I got very depressed. I was sure I wasn't making enough milk for her."
Contributing to this lack of confidence is the fact that women are not told for how long they should breastfeed. It's very hard to determine if you're doing it right if you have no idea what feeding time should be like and how long should it last. After the third day (when your milk comes through), babies typically spend between 20 and 45 minutes to feed. Some may even take an hour, especially big babies. This is fine if the baby is feeding the whole time but sometimes the baby finishes and starts using your breast for comfort. After a week or so, you will learn when your baby is feeding by watching the jaw movements, when s/he has fallen asleep and so break the suction with your little finger or you may see your baby's mouth reduce in size to suck your nipple (at which point break suction unless you want a sore nipple!) Women will produce enough breastmilk for their baby. It is what nature has intended. The milk is brought on by the baby's sucking. Some women can feel milk run through their breasts at 'let down' but most can't. A good way to assess if you are producing enough milk is to feel your breasts at the start of the feed (they may feel hard) and feel them again at the end. You will notice that they are considerably softer and may even be flatter. Alternatively, ask someone to look at the size of your breasts at the start, go away and look at them again at the end. They may look smaller!
Feeding on demand is the recommended practice but women need to be informed that this should be done within reason. Spending all day in bed with baby suckling at breast every couple of hours is fine for the first few days to help bring the breastmilk on but this is difficult to continue. Many first time mothers make the mistake of feeding every time the baby cries. They end up depressed and exhausted.
"My son would stay on all day if he could", said a mother of a three month old boy, who weighed 10lbs at birth. "I told the midwife that the only time he stopped feeding was when he fell asleep. I sat under him all the time. She just said that to him the breast is everything, comfort as well as food. I told her I was afriad I wouldn't have enough milk for him as he was so big. She told me that as long as I was eating, drinking, resting and relaxing, I'd be fine. She was shocked to hear that I hadn't eaten or slept in 24 hours. How could I! I had been breastfeeding!"
Most newborn babies will breastfeed 8 to 12 times in 24 hours. Some will cluster feed, i.e. take a bunch of feeds in close succession and then go several hours without a feed. A baby could finish by himself, stop suckling, sleep or relax. You will eventually notice when they are finished and you may have to break the suction. Always offer the second breast. Many mothers feed on one breast, break the suction after 20 or so minutes, burp and put him on the other for another 20 minutes. Most babies will feed from both breasts at each feed. Using both breasts will stimulate milk production. Every baby is different and breastfeeding experiences differ from baby to baby. Mother and baby will find their own routine within 6 weeks but it will take patience, confidence and adaptablity. Something to consider though is if you are feeding your baby for a half hour but s/he only lasts an hour before looking for more milk, try breastfeeding for an hour but getting 3 hours between feeds. Feeding too frequently can leave you only producing the equivalent of skimmed milk while feeding less frequently but with longer feeds can let you provide full fat milk to the baby. At the end of six weeks, breastfeeding sessions average about 5-6 feeds a day. This will eventually go to four feeds.
The final - and most essential - element in successful breastfeeding is support. By this, I don't mean the list of breastfeeding support groups handed out by midwives to new mothers. Indeed, most women don't leave the house in the first 6 weeks and by the time they do visit them, the pattern of breastfeeding or bottlefeeding has already been decided upon and so it is too late. It isn't easy for a first time mother to join a group in the early weeks. She may not have the courage to ring the breastfeeding helpline. Health professionals and breastfeeding counsellors should be more proactive in reaching women. Upon discharge, a simple check could be made on whether or not women have someone to help them breastfeed at home. If not, arrangements should be made to have someone visit the woman every day for the first week. It isn't enough to say to people to call someone or where to go. Women will be less likely to give up if they have someone coming in to observe and answer questions during that crucial first week. A visit would also serve to help prevent post-natal depression. First time mothers in particular are prone to be depressed as it is such a life changing event. They are exhausted, their hormones are all over the place and they find that they are grieving their past life. Babies can also put a strain on relationships. If a woman can feel confident in that she is able to feed her baby, this can be a huge step in gaining confidence in her ability to be a mother. Today's society lacks the community support that women long ago had. Fewer women are full time mothers who could lend their wisdom and company. Fewer neighbours are available during the day to run errands for the home bound mother. It is up to the health services to help provide the support needed to help women give their babies the best start in life. In doing so, you are producing a generation of women who can in turn help their own daughters to breastfeed in the future.
Tips for Breastfeeding
1. When in hospital, ask the midwife or healthcare assistant to help you each time you breastfeed. Don't be afraid to ask if you are doing it right. They are skilled in breastfeeding so don't feel embarrassed to ask for their assistance. It is a good time to get your positioning right and get yourself off to a good start.
2. There are many different feeding positions for babies to feed in. The popular nursing position is not right for all as it depends upon the position and size of the nipple, size and shape of breast and the baby's mouth. You may need to try a few different positions before finding the one that is right for you and your baby.
3.Make television your best friend. If breastfeeding takes a while, make yourself comfortable on the couch with cushions and wile away the time with daytime television for company. Some women can read a book or magazine (others can't as baby gets nosey and stops feeding to look!) Some women have to hold their breast to make sure the baby's nasal cavity is free. If you have to do this, make sure you hold it with your thumb on top and your fingers underneath and that you're not squeezing it.
4.To combat the new mother syndrome of sitting under the baby, seek help from an experienced mother or imagine that you have another child demanding attention. It's alright to leave baby to go to the toilet! (Just as long as baby has been put in a safe secure place or is safe with someone). You should also make sure that you are taking your 3 main meals a day. You are eating for two afterall!
5.Every baby is different and some babies are hungrier than others. Purists may frown upon mixed feeding but if you have a hungry baby and you need some more time to make milk, it is alright to supplement breastfeeding with a bottle. I know many a doctor who exchanged the 6 am feed for a bottle feed in order to give the wife a break. I also know of women whose babies demanded 4 hourly feeds in 6 hours and they couldn't cope with it until they dropped a feed in favour of a bottle and ended up producing thicker stronger milk for the remaining feeds. Whether you use expressed milk or infant formula is up to you but don't feel defeated. You're still giving your baby all the benefit of your breastmilk. And it's better to do that than to give up completely!
Extra Tip: Lansinoh cream really works. Slap it on after every breastfeed for the first two weeks. A God send for preventing and treating cracked nipples!