Most mothers want to breastfeed and they should be supported in their wishes
I have wanted to write a piece on breastfeeding for a while. But I had to accept that I couldn’t cover everything in one piece and that I would need to focus on one aspect if I had any chance of developing any level of depth or nuance.
I was keen to discuss the lifelong health benefits of breastfeeding for the nursing dyad, along with the potential health and economic benefits for our society and our health system. For obesity alone the health benefits and the fiscal impact of obesity prevention are profound. We know that Irish babies who are breastfed are less likely to be admitted to hospital, to get asthma, respiratory and ear infections, and common colds (Murphy S, et al, MC Public Health, January 2023). We also know that breastfeeding mothers are less likely to develop type 2 diabetes, cardiovascular disease, and breast and ovarian cancer ( Pérez-Escamilla R, et al, The Lancet, February 2023). This, however, is not that article.
I had also wanted to explore the systemic inequalities faced by Traveller families. According to Pavee Point, the Traveller infant mortality rate is estimated at 14.1 per 1,000 live births, which is over three times that of the general population (3.9 per 1,000 live births). The organisation has also highlighted that Travellers have the lowest breastfeeding rates in Ireland at 2 per cent. Addressing this is one of many important steps to tackle the many health inequalities they experience.
I had hoped to explore the impact of underhanded marketing practices of commercial milk formula and how that undermines breastfeeding dyads. This is not that article. However, if you haven’t read the recent Lancet paper on this topic, it is open access and well worth it (Rollins N, et al, The Lancet, February 2023).
The impact on the planet cannot be ignored. I had wanted to explore the importance of breastfeeding from a planetary health perspective, delving into the carbon footprint of breastmilk substitutes and the impact improved breastfeeding support could have on our carbon emission reduction targets. The waste produced during the manufacturing of commercial milk formula (CMF), bottles, and sterilisers, has a massive global impact. I am not for a second blaming individual families for the climate crisis. I am, however, blaming poor policy and inadequate support, coupled with exploitative marketing practices.
I hoped to highlight the work of the organisation Breastfeeding for Doctors, founded by my good friend and Emergency Medicine Consultant Dr Robyn Powell, and how supporting doctors with their own breastfeeding journeys has ripple effects for their future practice. But the article I’ve chosen to write today is broader than this and centres on the importance of peer support and centring on maternal autonomy.
I’ve chosen to focus on the importance of peer support for breastfeeding because so many mothers stop breastfeeding earlier than they want because of poor support or bad advice that causes early weaning. I’m going to briefly share part of one of my breastfeeding journeys to illustrate why breastfeeding support matters.
When my first baby was two weeks old I collapsed in the bathroom. I had acute cholecystitis and choledocholithiasis and after a week in hospital I left with an empty common bile duct and I was post-cholecystectomy. During this week my resolve to breastfeed was really tested. My baby was at home being breastfed my expressed milk. I was setting alarms to pump, washing my pump parts in microwavable steriliser bags, and storing my pots of mama milk in a tiny fridge my big sister sourced for me. I knew how often to pump and how to store because one of my sister-in-law’s best friends happened to be a La Leche League Leader. She had gifted me a book called The Womanly Art of Breastfeeding, which I had thrown into my bag, along with my unopened pump, on the way to the hospital. When I got home, my baby had developed a bottle preference. Every time she latched, it was toe-curling agony for me.
When I was struggling with breastfeeding, at this point, well-meaning family, friends, and healthcare professionals kept telling me I had done enough and it was fine to bottle-feed CMF. Even writing this now brings back strong emotions for me. What women want matters. How women want to feed their babies matters. I did not need anyone’s permission to formula feed. I was not looking for that. I was looking for the support to help me do what I wanted to do, which was breastfeed my baby. I wanted this for my baby. I also wanted this for myself, to decrease my diabetes risk (having had gestational diabetes I had been advised my 10-year risk of type 2 diabetes was 50 per cent, but this could be reduced to 25 per cent with two years of breastfeeding).
I think the lack of appreciation of the impact on mothers when breastfeeding is taken from us by inadequate support is at the core of some of the strong emotions associated with discussions about infant feeding. Some 63.8 per cent of Irish babies are breastfed at their first feed (HSE National Women and Infants Health Programme, 2019 statistics). But by hospital discharge, this has already fallen to 45.7 per cent and to 31.2 per cent by the three-month public health nurse baby check. I believe this really matters because I think what mothers want matters. In my circle of friends, the women who chose to breastfeed and for whom it worked out are happy with their feeding choices and so are the women who made an informed choice to formula feed. There is, however, a large group of women who start breastfeeding in hospital but, in the first few weeks, get poor support or bad advice when they encounter the common early issues. This results in them being forced to formula feed. That is not choice. Choice is having the support to do what you chose and being facilitated and supported to do so. I think all mothers and babies deserve this informed choice (Prof Amy Brown’s book, Why Breastfeeding Grief and Trauma Matter, is an excellent deep dive into this topic).
How can we improve breastfeeding rates in Ireland? It takes more than policy and it takes more than funding (though these are critical). Fundamentally, we need to shift to a position where as healthcare professionals our default position is to value and protect breastfeeding. Is it all about more specialist support? The recruitment of 20 new lactation consultant posts in the past two years is welcome progress. However, we must not forget that breastfeeding, like mothering, takes place in the community. A wise mother once said to me, ‘breastfeeding is caught not taught.’
On an individual level it starts with supporting women with evidence-based information so they can breastfeed for as long (or short) as they want. Directing women antenatally to the HSE’s ‘my child’ website so they can link in with their local support group before their baby arrives is key to giving mothers who want to breastfeed every chance to achieve their own personal goals (www2.hse.ie/services/breastfeeding-support-search/).
Where did I find this support? When my daughter was six-weeks-old, on a cold wet evening, I dressed us both up and drove to the house of a woman I had never met for my first La Leche League meeting. I was nervous outside. A friend had said to me that they were “very into breastfeeding” in a tone that intimated there was something quite dubious about this. But at this point I was desperate. Latching was agony and I needed help. I can still remember the colour of the walls and the couch and the carpet, which I looked at as I told my story, as I cried. And I remember what the woman leading the meeting said to me: “Gabrielle, what do you want?”
“I want to breastfeed my baby until she’s a year old.”
“Well if that’s what you want, we’ll help you find a way to do that.”
And they did. Within three weeks she was fully feeding at the breast and gaining weight well. I attended every meeting for the rest of my maternity leave. I found my tribe of women, the village it takes to raise a mother. I listened, I learned, I found a safe space to learn not just about breastfeeding, but about mothering.
When the time came for me to move continents and go back to work for my Fellowship, that same village lent me books on working and breastfeeding and helped me plan for managing night shifts with a breastfed six-month-old. The La Leche League, Cuidiú, and Friends of Breastfeeding are doing incredible work in our communities supporting nursing dyads.
When I think back to the young woman I was 10 years ago, on the cusp of being a mother, I marvel at all I have learned. I am grateful for all the wisdom I have been fortunate to receive to help guide me. My hope is that, going forward, all women and babies have access to that same support so that all Irish women breastfeed for as long as is right for them with the support to make those informed choices. I’m enthused by recent developments, including the revised galactosemia policies, which open the door to targeted action to support breastfeeding in the Travelling community.
Most women want to breastfeed. We need to protect breastfeeding. Is bainne beatha é bainne cíche.
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