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Breastfeeding: new mothers' perspectives.

Community Practitioner spoke to five women from London who gave birth in late 2013 about their experiences of breastfeeding. Their stories shed some light on the support currently offered to new mothers by the health professionals involved in their care and how this affected their journey into new motherhood

Q: Are you breastfeeding your baby?

Chloe, 31: Yes, exclusively.

Sonja, 36: I breastfeed most of the time and use formula occasionally.

Natalie, 34: No

Laura, 34: No

Priya, 31: Yes, exclusively.

Q: Did you intend to breastfeed your baby before he or she was born?

C: Yes, I intended to breastfeed for bonding, the health of the baby and ease compared to bottle feeding. I just wanted to do what I thought was best for the baby.

S: I didn't really question breastfeeding. For me it's what you should do, unless there are overriding medical reasons not to. I never felt like it was a decision, I just knew I was going to.

N: Before I got pregnant I hadn't really considered whether I would breastfeed or not. Once I was pregnant and attended an antenatal class I decided to breastfeed as I understood that this would be best for my baby, particularly as I suffer from allergies. I hoped that breastfeeding would reduce the chance of my baby having these.

L: Yes, I thought it would be quicker, easier and healthier for the baby. I was predominantly interested in the health benefits, such as how it would help her to develop immunity to illness.

P: I always intended to breastfeed. Formula was never an option unless breastfeeding was going to be impossible. I wanted my baby to get all the immunity and gut flora from breast milk and also because I saw it as a necessary and important bonding experience.

Q: Did your midwife encourage you to breastfeed after your baby was born?

C: She helped with latching the baby on and to hand express, and she told me I shouldn't

go home until I was getting the baby to latch properly.

S: Yes, but without much assistance or support. I found a lack of focus on breastfeeding in hospital and I feel there should be more support postnatally; for example, a breastfeeding consultant should visit you before you are checked out.

N: A midwife put him to my breast but she didn't show me how to latch him on and I really had no idea what I was doing or whether my baby was feeding properly. When I got home the midwife who came round the next day spent a lot of time showing me how to latch and was very kind, helpful and encouraging about breastfeeding.

L: I had a fantastic community midwife who saw me during the pregnancy, delivered my baby and visited me afterwards. I had my daughter at home, and she and the second midwife spent at least half an hour showing me how to achieve a correct latch and different breastfeeding positions.

P: I was already doing 'skin-to-skin' so the hospital midwives just encouraged me to allow my baby to find my nipple and to hold her in the correct way. My community midwife visited me the next day to check all was well and she showed me some more breastfeeding techniques and holds.

Q: Did your health visitor (HV) encourage you to breastfeed after your baby was born?

C: She asked me how feeding was going but didn't encourage breastfeeding or really comment either way on what I should be doing. She was more interested that he was growing and plotting him on the graph.

S: There was encouragement, but I feel a lack of support and time spent showing you what to do.

N: I didn't discuss breastfeeding with my HV.

L: She recapped the benefits and answered some of the questions I had, but I found it frustrating that her advice differed from the midwife gave me. My baby needed to feed every hour to hour and a half, which I now know is a variation of normal in the early days, but the midwife told me to encourage the baby to drain the breast to reach the hindmilk. My HV told me to switch breasts every 10 minutes or so, which left me feeling a bit confused.

P: My HV didn't see me until week 4 as I was under the care of community midwives, but she was very supportive when I did finally meet her.

Q: Did your family or friends influence your decision whether or not to breastfeed?

C: My mother is a retired midwife and a strong believer in breastfeeding, and she totally influenced my decision.

S: I always found it weird that someone would even ask the question! When I answered yes, I found I got support from people, but for me it was a no-brainer.

N: I decided to give up breastfeeding on the advice of my mother, husband and GP.

L: Where I live breastfeeding from birth is popular and I have the perception (although I may be wrong) that bottle-feeding mums are frowned upon. In the past if I saw a very small baby being bottle fed my immediate reaction was one of judgement--why aren't they breastfeeding?! I now know there is much more to it than that.

P: My husband was hugely supportive but did not influence me as he wanted me to decide for myself. My parents knew I would be breastfeeding and encouraged it. Friends were not surprised either and have been supportive and made positive comments about my decision since the birth.

Q: Did you ever feel influenced by family or friends to give your baby formula ?

C: Formula has never been an option for me. I considered it briefly during the first week of the baby being at home when I was really struggling with the pain of breastfeeding, but I got over it quite quickly and I never really wanted to allow myself to use it. Despite the pain of breastfeeding I persevered. Once I had started I felt I needed to see it through.

S: I really wanted to avoid formula for as long as possible, but expressing after a while just became too much and I found it stressful. My mum and husband both encouraged me to switch to formula.

N: A friend suggested giving my baby a small amount of formula at night so that he might sleep longer. As he fed a lot more than usual he didn't keep it down.

L: Very much so by my own mother (I was formula fed). I didn't know about growth spurts, cluster feeding or overtiredness so I was feeding my baby at every peep, but it never seemed to be enough. I was desperate to persevere but the pressure to try a formula top-up was strong.

P: A small number of people mentioned giving my baby 'top-up' feeds when she was going through growth spurts and also to fill her up for the night, but I was never influenced by their comments. I just smiled and said nothing.

Q: Does you partner help with feeding? Did they receive enough advice or information to support you to breastfeed?

C: My husband was told by the antenatal class leader that supporting me to breastfeed was crucial. The HV didn't advise him on breastfeeding, but she did ask him if he had all the information he needed and asked me if he was giving me the support I wanted. I think if I had asked for help she would have advised me, but I was feeding well by the time she came to visit.

S: Yes, he does. The only support I am aware of for dads is a pamphlet, which no matter how much I waved in front of him, he never read! I think feeding is something the mother takes the lead on and instructs the father as all babies are different.

N: My husband was extremely supportive and helped me as much as he could, advising on latch and positions and researching on the internet for information and advice. My husband never met our HV and he doesn't feel that he was provided with any help or advice in relation to breastfeeding by the midwives he did meet, he had to do his own research on the internet.

L: Yes, but I think we could have received more information, perhaps at antenatal classes, about cluster feeding, establishing supply and what the variations of normal are.

P: My husband was totally supportive of my breastfeeding, especially in the early days when it seemed to be non-stop. I did tell him I couldn't carry on with it when it got really hard, but he advised me to sleep on it and not rush to go and buy some formula! On occasion he spoke to the midwives and HV alone as I was asleep and they all asked how it was going and answered any questions that he had.

Q: Did your HV recommend any breastfeeding support groups in your area?

C: I found the support group I went to on a list that was given to me by the community midwives. The group was really helpful, I was pleasantly surprised. The lady I saw was a HV and she was brilliant. She knew exactly what she was talking about and she made me feel much better and really put me at ease.

S: Yes, although I feel that by the time I went (about five weeks) I already had the majority of information they provided. Support groups are worthwhile but the real value in them is gained if visited in the first couple of weeks.

N: The HV didn't, but one of the midwives told me to go to a breastfeeding cafe.

L: Yes, when my daughter was two weeks old I went to a breastfeeding cafe staffed by local midwives and HVs. They reassured me that my round-the-clock feeding was a variation of normal and to do whatever I needed to do to cope with it (co-sleeping, breastfeeding lying down, etc).

P: Yes she mentioned a breastfeeding cafe. I heard it was very helpful but I very luckily did not need to attend at any point.

Q: Was there a particularly helpful piece of advice you received from your HV about breastfeeding?

C: I don't think I was given any advice. I told her it was going OK and that was that.

S: After we had got through the first 15 weeks I was having trouble filling up my baby. She was thrashing around and displaying various traits that could have been colic. I explained the situation to the HV and she suggested my baby wasn't getting enough at each feed and that compression would help, which it did. I saw a doctor who suggested I give formula at the end of each feed, which I felt was the opposite of what I needed to achieve. I found doctors unhelpful when it came to breastfeeding and their opinion and advice largely varied.

P: My community midwife told me not to hunch over but to sit in a relaxed position and to be relaxed when feeding, which would make the milk flow faster. She also told me to practise lots of skin-to-skin contact to ensure production. She told me that there would be pain at the start as my nipples would be sore and I was glad of her honesty, as I didn't worry about the initial pain and it soon eased.

Q: Did you experience any problems with breastfeeding?

C: It was very painful. I struggled to get over the agony I was in for the first two weeks. The nipples hurt, the breast hurt and every time the baby latched on it hurt. I overcame the problems by using nipple shields, going to a breastfeeding cafe support group, and using cabbage leaves and linoleum cream. Persistence was important.

S: I had problems latching on originally. I asked two different HVs for help and after the second visit felt I had a better idea and technique.

N: I found it excruciatingly painful. My baby would thrash around, bobbing on and off, chomping on my nipple and taking hours to feed. The midwives said it was normal to hurt and that I would get used to it. I was told that the latch was perfect and that perhaps my baby just had a strong suck. I attended a breastfeeding cafe where I was told my baby had wind. At the six-week check the GP diagnosed acid reflux and I had very bad thrush in my breasts. She also felt it was likely that he had a posterior tongue tie.

L: The constant feeding even after 10 weeks was incredibly tiring. I contacted the national helpline, attended the cafe and read anything and everything I could get hold of online.

P: I was very lucky not to have any problems with breastfeeding, apart from the initial pain, which I have since discovered is totally normal but was not mentioned in any of the literature I read.

Q: If you decided not to continue with breastfeeding, when was this and why?

C: I was adamant that I didn't want to give up.

N: I gave up breastfeeding when my baby was 10 weeks old. I couldn't cope with the pain in my breasts any longer and I couldn't get out and about as breastfeeding was so difficult. I wasn't sleeping (it often took over an hour to feed and he was feeding every three hours) and my baby wasn't getting enough nutrition (he had dropped from the 50th to 9th percentile). It took me quite a few weeks to decide to give up breastfeeding, despite all the difficulties. I felt emotional and guilty as all the midwives I had seen had been so adamant that I must carry on and that it was the very best thing for my baby. Once I stopped it took me about two weeks to get used to it--but it became clear that it was the best decision for me and my baby. He very quickly started putting on weight and sleeping better and it lifted the physical and mental burden I had been carrying about breastfeeding. When I look back now I regret not having given up sooner.

L: I stopped breastfeeding at 12 weeks. I wanted to monitor how much my daughter was taking at each feed so that I could ensure she was going to bed at night and for naps as full as possible. To begin with I expressed and gave her the expressed milk in bottles but the time spent expressing combined with the amount of time it would take her to finish a bottle was too much for me so I switched to formula. Initially, I felt an enormous sense of relief as I saw her sleep improve but I did have a crisis of confidence over the next few weeks that I had quit too soon, that she was missing out and that people would think me a bad mother for it ... the list goes on.

Q: Is there anything your HV could have done more of to help you breastfeed?

C: The HV came a little too late to advise me on breastfeeding. I struggled in the first two weeks and the HV came later than that. But she was very nice and probably had other priorities to address. It is nice to know that she believed me when I said feeding was going well and I did feel I could go to her if I had any problems. If I had been struggling with breastfeeding specifically I think I would have called the midwives rather than the HV and she did stop visiting me after a few weeks without any communication.

S: I think there needs to be much more focus on breastfeeding at the beginning, in hospital and at home.

N: If the HV or any of the midwives had suggested that something was wrong I would have seen my GP before the six-week check and my son would have started acid reflux medication sooner, which might have allowed me to continue breastfeeding.

L: Perhaps more information would help, but also some pragmatism. It's fine being told that waking at night every 1-1.5 hours is normal, but no alternatives were presented.

P: All the advice and help I received from the various sources was great.

Q: Do you breastfeed in public places? How have you found the experience?

C: I do but I find it embarrassing. I worry people are looking at me. I'm not bothered what people think, I am more bothered about people seeing my actual breast or my nipple, particularly men. I don't mind breastfeeding in a venue that seems relaxed but I'm not so comfortable in a busy place.

S: Yes, all the time! I thought I would be embarrassed, but it's something you have to do. My partner and I are quite active and if I didn't we either wouldn't go out or my baby would starve. I've found it better during winter with several layers on. I've also found people really don't stare I've done it everywhere!

N: I did on a few occasions. It was difficult because of our circumstances but I didn't ever feel embarrassed--nor did I feel that breastfeeding was unwelcome or frowned upon.

L: I used to. I was fine with it and never felt in any way awkward.

P: I started very early as I wanted to be able to breastfeed in public with confidence. I have since breastfed in all sorts of places with no trouble. I am quite thick skinned but I have not really found the experience to be a problem. Apart from a few curious stares now and again the experience has been positive.

Q: How do you think breastfeeding rates in the UK could be improved?

C: I think people find breastfeeding uncomfortable so don't persevere. There is so much discussion about getting your baby to latch that some women have an automatic excuse; they say 'my baby wouldn't latch on so I couldn't carry on'. Some women feel like breasts are too personal for a baby to suck on and some think formula feeding is easier. People don't understand the health benefits clearly enough--they think formula has the same benefits as breast milk.

S: I think when something becomes more accessible (formula in handy individual bottles, for example) it becomes more popular. I also feel there isn't enough support in hospital and women leave without knowing what to do properly, and then give up a couple of weeks later as they've been on the wrong path. I know for some people breasts are overly sexualised and they think their purpose is not to sustain and feed a baby--the most natural thing ever --but instead to pop out of low-cut tops.

N: Given the pressure new mothers are put under I find it surprising that we have low breastfeeding rates in the UK. Of the mothers I know all have breastfed, most for at least three months. I feel I was put under inappropriate pressure to continue breastfeeding.

L: It's so accepted where I live, I think it is still a bit of a class issue.

P: People are embarrassed about natural bodily functions and scared of 'offending' people. The emphasis should be on making sure that your baby has the best possible start in life by breastfeeding and new mums shouldn't feel they have to be trapped in the house, but able to get out and about and feed their baby on demand. Perhaps if breastfeeding was more apparent in popular culture, in TV soaps or dramas for example, it would become more normalised. I strongly believe that not telling women that there is going to be some level of pain and discomfort in the early days discourages them to continue when it hurts as they assume it will always hurt or that something is wrong. All the literature I received said it should not hurt at all--but the midwives and HV admitted there would be some level of pain that would ease with time. I think health professionals should be honest about it being pretty hard at the beginning but that it will eventually become one of the most rewarding and wonderful parts of being a mother.
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Publication:Community Practitioner
Geographic Code:4EUUK
Date:May 1, 2014
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