Last weekend we were at a christening, and Elphie spent the entire day asleep apart from the service which she screamed though – hence I missed most of it and instead got a nice self-guided tour of the graveyard. Anyway, I digress; the point was that there were a ton of kids around, one of whom was 15 weeks and, like all new parents, we bored the childless couple also on the table by comparing war stories (they wanted kids one day, they should have been taking notes!). It transpired that they were formula feeding, seemingly because their son had lost too much weight initially and had been readmitted to hospital and faced with that trauma and the difficulties they were having with breastfeeding, they moved to the bottle. In fact of the eight mothers in her NCT group, six had moved to formula feeding and one was about to.
Now I have no intention of going all sanctimummy about formula feeding, Elphie was probably virtually entirely formula fed for her first week after all, and for some mixed feeding is a choice – replacing an evening feed with formula when supply is at its lowest for example or adding formula to expressed milk – and if that’s what you want to do and what’s right for you then go right ahead! But the thing that is making me uncomfortable is that these are often not mothers who have chosen to formula feed, they are ones who prior to birth were committed to breastfeeding, who really wanted to, and yet a few weeks in they have moved entirely to formula feeding and have gone through emotional turmoil and guilt about that decision. It’s that that upsets me, maybe because I was a hair’s breath away from ending up on the same path.
In 1-5% of cases women cannot or shouldn’t breastfeed because they experience low milk supply in the absence of a latching or feeding issue, e.g. due to insufficient glandular tissue, breast cancer, hypoplastic breast syndrome, breast reduction or other extensive breast surgery, galactosemia, pitituary or thyroid imbalances; or who shouldn’t breastfeed, e.g. those with HIV, undergoing chemotherapy, those with drug or alcohol addiction – Breastfeeding Basics provides a good summary.
Department of Health statistics show that in 2012/13, 73.9% of mothers were initiating breastfeeding at birth, but by the 6-8 week check only 47.2% were still breastfeeding.
The UK Infant Feeding Survey 2005 (Bolling et al. 2007) showed similar figures with 78% of women in England breastfeeding their babies after birth but, by 6 weeks, the number had dropped to 50% and only 26% of babies were breastfed at 6 months.
As NICE states: “Three quarters of British mothers who stopped breastfeeding at any point in the first 6 months (and 90% of those who stopped in the first 2 weeks) would have liked to have continued for longer. This suggests that much more could be done to support them. The British figures also contrast with data from Norway, where over 80% of mothers breastfeed for the first 6 months (Lande et al. 2003).”
There is support out there – but in some cases it’s a matter of persevering till you find the support that works. The lady at the Christening had said she’d had plenty of support from Lactation Consultants provided by her Local Authority, but was it the right support if she moved to formula within a fortnight when she had previously been committed to breastfeeding? Or if 75% of her group had moved by 15 weeks?
Given the pre-eminence of the maternity hospital I gave birth at, I expected the breastfeeding support to be top notch. But other than ten minutes from a midwife in the delivery suite, none was forthcoming, despite premature babies having a greater likelihood of latching issues and despite Elphie’s blood sugar levels dropping to the extent that I was told to supplement with formula. In retrospect I should have asked to see a breastfeeding specialist not have expected it to be offered if they thought I needed it – use of formula should have been a pretty good sign that I needed it!
“The Baby Friendly Initiative is a worldwide programme of the World Health Organization and UNICEF. It was established in 1992 to encourage maternity hospitals to implement the Ten Steps to Successful Breastfeeding and to practise in accordance with the International Code of Marketing of Breastmilk Substitutes. In the UK, we also work to implement the Seven Point Plan for Sustaining Breastfeeding in the Community and run a University Standards programme for midwifery and health visiting courses.”
This list provides an overview of which hospitals have reached which level of accreditation – shockingly from my perspective, mine has only registered an intent to be accredited (Cath’s is fully accredited) so it’s not surprising that the support just wasn’t there.
In the community there are breastfeeding specialists available alongside the midwives via referral in the early days, as well as drop-in clinics organised both by the local authorities and by private practitioners. I have gone a bit Fight Club on the whole drop-in session thing and aim to go to as many as I can until Elphie is off the shields, just sitting with breastfeeding mums seems to help (although it is not especially useful when she latches perfectly at these when the specialists are available and not at home!).
There’s also the local La Leche League which will likely have monthly meet-ups with local breastfeeding mothers and whose Leader may provide support for any issues that come up or provide you with a referral to someone who can! And Eco Crazy Mom can point you to a few other support group sources. Indeed she’d recommend going to the meetings from your second trimester, which is a great idea as you’d actually get to see breastfeeding happening, in real life and have a license to stare (well, not look away anyway).
There are also helplines you can call:
And there is professional help you can seek via a Lactation Consultant who can provide one on one advice and support in the privacy of your own home. This is at a cost but if you consider what a year’s worth of formula would cost you then it’s worth the investment!
The thing is, you need to shop around for the help that is right for you – if you want a breastfeeding evangelist who would try everything and anything to get your baby breastfeeding then someone who recommends mixed feeding likely wouldn’t be for you as you want breastfeeding support to focus on the breasts not the alternatives, and you should keep on looking (probably someone recommended by La Leche League would work better as they tend to be more breast focussed). However, if what you want is someone to say it’s ok to mixed feed but give you options for moving off it, then that is probably someone completely different.
The Analytical Armadillo has written a great post about formula not being the end of breastfeeding. You can come back from it to more breastfeeding or full breastfeeding from mixed feeding – a time of trouble when you step back from breastfeeding does not need to be the make or break that starts 100% formula.
I have been reading a rather evangelical LLL book, The Womanly Art of Breastfeeding, and would say this is recommended reading for anyone planning to breastfeed – ideally to be read before the birth as a lot of it is about the immediate period after the birth. Something I read, especially the bit in bold, has stayed with me:
“There’s a reason your baby isn’t breastfeeding, and a good helper will keep looking as long as you want her to… or until, as often happens, that magic “something” happens and your baby starts nursing. We’ve seen babies who suddenly “got it” at two weeks, four weeks, six weeks, three months, six months, and so on. When La Leche League Leaders work with mothers, we don’t worry that the baby will never latch. We worry that the mother won’t be able to “keep the faith” until it happens. It will work, and in the meantime there are ways to keep your milk supply strong. Babies are built to breastfeed. Early babies, small babies, sick babies – they’re all designed to feed themselves at breast.”