There is no way for me to sugar-coat this so I’ll just come out and say it. The infant feeding support available to women, whatever side of the camp they are, sucks major ass. It’s not just a shambles, it’s an omnishambles.
So now that I’ve said it, let me quickly define what I mean by that, especially for those that work in infant feeding support and may now be thinking, “Hang on a minute, Love…what the bleeding nipples you on about?”
There is an argument that, it is breastfeeding promotion that needs to change. That it’s thin veil of ironical informed choice currently puts tremendous pressure on new mothers and leads to guilt overload and feelings of failure if things don’t turn out how the WHO prescribe. There is another train of thought that thinks there isn’t enough pressure to breastfeed and the promotion needs to be ramped up with the inclusion of stricter controls being put on the availability of formula and the obliteration of blatant formula marketing campaigns cleverly using follow-on milks.
I’m not sure that either of these things will change in the short term – the fight is against two equally powerful Goliaths. Breastfeeding propaganda has been around for centuries. Formula has a very valid place in the first world and the anger evoked in fighting against either of these things is like drinking poison in the hope it will kill the enemy. Although there is hope.
I, personally, have a gripe against the upper echelons of policy makers, health ministers and treasurers who act upon an assumption that they know what the problems are by discussing statistics in a focus group. Those responsible for deeming infant feeding only important enough for an afternoon’s lecture for medical students leading to GP’s prescribing possibly unnecessary treatments for both breast and bottle fed babies. The lack of support available to those finding themselves unable to breastfeed due to the misinterpretation of the Unicef document that highlights the importance of eradicating formula promotion, but not the eradication of support for those using formula. The struggling labour wards with ridiculous turn around times and tick boxes to complete in order to sate the statisticians. The lack of continuity of advice for breastfeeding mothers. The lack of any advice for bottle feeding mothers. The lack of funding for those desperately trying to support breastfeeding women. The postcode lottery that is associated with anything to do with the NHS and whether the hospital you find yourself birthing in has a milk bank associated with it. In fact, the milk banking system full stop. That is why I believe infant feeding support is an omnishambles.
Back in November, I created an Infant Feeding Survey, with the purpose of finding out from hearing real women’s stories and views, what their infant feeding experiences were and how they felt it could have been improved. I had in mind, to use this information as a way to build on the already brilliant foundations of support in the local area but also to highlight other areas that may be lacking, and if there was a way to address some of the above, without having to drink any poison.
Now, I’m not silly. I know that isn’t enough responses to substantiate my hypotheses that that the WHOLE support system is shambolic and out of the 563, roughly 30% of the answers are UK-based (the rest are women from Australia, New Zealand, Canada, USA, Romania, Saudi Arabia and South Africa.) However, despite the different localities on a world map, the answers are all surprisingly (or not so surprisingly) similar and echo the same message throughout – a lack of support, or perhaps more importantly, lack of THE RIGHT support.
There are two things that I think came across loud and clear from the results of the survey which are as follows:
#1: Informed choice is not that well informed when it comes to mixed feeding or formula feeding. For those women who know they will have a short maternity leave, that have lost both breasts to cancer, that have survived sexual abuse, for those that adopt, have surrogate children, that foster, that have a high risk of PND, that are on medications that are necessary and incompatible with breastfeeding, for those with multiples that are keeping their options open and for those that just do not want to breastfeed – advice is not forthcoming and sometimes detrimental to their maternal mental health. 5-17% received advice from health care professionals when they found themselves needing formula, whereas 31% researched guidance on the internet and 75% of those that ended up using formula just followed the instructions on the box (out of 325 respondents).
However a baby is fed, there will be risks associated with it. Breastfed babies are readmitted to hospital because of low weight gain and dehydration. Formula fed babies are five times more likely to be readmitted due to gastroenteritis, according to a 2009 article in the Telegraph, which also reports on bottle babies being put at higher risk due to lack of information since bottle feeding was removed from antenatal teachings. Hospital readmissions from incorrectly made up formula is not really formula’s fault, but the lack of education that surrounds the correct use of formula. This NHS Change for Life leaflet is available with good information on sterilising and correct use of powdered formula and follow on milks. However, it is not freely available to purchase unless you ask for it. I can’t imagine many first time mums having the balls to request a copy.
Most risks can be very easily avoided if women are given the correct information and support, prior to birth and in those early days rather than both breast and bottle feeding mums being left to their own devices. Which leads me to…
#2: The criticality of those first few days in receiving the RIGHT support enabling more women to achieve their breastfeeding goals. Nearly 94% of respondents (529 out of 565) had an intention to breastfeed. But many of these women seem to have been failed at the first point of contact. This is for many anecdotal reasons about conflicting advice, lack of any advice or detrimental advice. Mainly though, because this is where the ‘one size fits all’ support seems to come into play which seems to be paralysing the healthcare professionals. 72% of the 523 who responded to the question about breastfeeding complications experienced ‘sore nipples’ with the second most popular answer being ‘baby wouldn’t latch’ (35%). When issues arose which required intervention in the form of supplementation, 82% used a bottle (302 out of 364) with the majority using expressed breast milk, ready to feed or powdered formula. The vast majority of these mothers felt completely unprepared for the complications experienced which had a harmful effect on their breastfeeding experience and/or their maternal mental health. It really isn’t any wonder there is such a dramatic drop off from breastfeeding in those early weeks.
Supplementary nursing systems, which are very effective at supplementing when a baby is latching but not gaining weight, was used by 10% of the 364 respondents and screened donor milk was used by 3 out of 383 respondents. That is less than 1%.
Cup feeding which can be useful for supplementing without causing nipple confusion was used by 16%. Cup feeding can be tricky and is usually carried out by the partner whilst the mother can express. How many women and their partners are taught the techniques needed for cup feeding prior to birth? How many are taught the reasons why cup feeding might be necessary? Not that many, I’d guess.
It also seems very strange to me that so much is done to promote the health benefits of breast milk, and yet the availability of donor breast milk is so dire when it could be so beneficial to those many women finding themselves facing complications that are only being resolved with limited options. The following video I have blogged about before, describes how the use of screened donor breast milk has a significant positive psychological impact on new mothers facing challenges to their own health or the health of their newborn infants, which in turn has a positive effect on milk production, sometimes several weeks down the line. It is mainly anecdotal but perhaps more research should be carried out on the maternal mental health benefits and breast milk production when screened donor breast milk is routinely offered as a choice.
Screened donor breast milk costs £120 per litre compared to £5, which goes a long way to show why it isn’t routinely offered as an alternative when breastfeeding isn’t going to plan. However, if the research and statistics are correct in assuming formula is costing the NHS millions, surely it is a worthy investment? It’s all very well preaching what we should all be doing with guilt-inducing poster campaigns (which probably cost a fair bit), but why don’t government invest more where it could really make a difference.
A pilot scheme that involves a telephone service to new mothers who have been discharged from hospital, enquiring about how they’re getting on and whether they require further assistance with infant feeding, costs £6000. No money in the pot to try it though apparently. The cost of women being trained as volunteer peer supporters? Approximately £100 per person. Are these volunteers able to access mothers who cannot leave their homes due to post operative issues or multiple children? No. Would they? In a heart beat, and would also happily volunteer their time in hospital should they be able to untangle themselves enough from the red tape to be able to step foot in the hospital. Would the midwives be grateful for volunteer peer supporters in hospital? I should imagine so. That will leave them enough time for the piles of bureaucracy they are currently disappearing under.
I know, from my own personal experience, after my pubic bone and vagina was left in tatters following the arrival of baby #1, I was unable to leave the house. I also had postnatal anxiety due to the complications I was having with breastfeeding. When asked how I was feeding my baby, I replied “bottle with expressed breast milk”. A box was ticked and no further comment was made. If I was offered a volunteer peer supporter to pop round for a chat, I would have jumped at the chance. If someone had phoned me to ask how infant feeding was going, I may have asked for help sooner.
Perhaps there are a few simple changes that could be made easily and cheaply that might make a difference:
GPs and other healthcare professionals having a referral pathway to enable them to quickly identify local resources which are better placed to help with feeding problems, on top of keeping regularly up to date with infant feeding evidence. This will mainly consist of every arrow pointing towards the local infant feeding support group. Supplementary nursing systems being routinely offered as an option in hospitals when a baby is latching but milk production is delayed – apparently they are freely available in hospitals but few midwives are au fait with their correct application. Educating prenatally on the symptoms of tongue/lip tie and the conditions which may contribute to low milk supply such as polycystic ovary syndrome. Educating prenatally on the most common complications associated with breastfeeding and how they are resolved. Having tongue/lip ties routinely checked in hospital and not just presuming that 2nd,3rd,4th time mums will not experience breastfeeding issues.
If you wish to read through the infant feeding results and share your own interpretation of the results, you can read the full survey results here. It certainly makes for some very interesting reading.