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Do we need to rethink our ‘breast is best’ attitude?
This thought came to mind while watching the ﬁnal episode of Girls season six (‘Latching’), which was the end of a journey for the main character Hannah. The series documented her life as a single writer in her 20s trying to survive in New York – relationship breakups, career challenges, self-identity crises and an unplanned pregnancy after a one-night stand with a surf instructor, which culminated in her facing up to life as a single parent and attending her family doctor, exasperated at her baby’s perceived rejection of her as a result of difﬁculties getting him to latch-on and breastfeed.
There was Hannah – committed to breastfeeding because she knew it’s good for her son, and wanting what is best for him, yet the mother-to-son connection had yet to take hold. This was despite reading the manuals, having the necessary equipment (including a quite intimidating-looking breast pump backpack) and a supportive best friend and mother.
Everything she seemed to do was ‘wrong’ and her baby’s failure to latch-on just appeared to be a summation of all her ‘failures’ as a new mother. At one of her baby checks, when she asked for advice on whether it was better that baby feeds from breast versus bottle for bonding purposes, she was tersely told that “breastfeeding is mysterious, sometimes it’s a piece of cake, sometimes there’s something about the chemistry, it’s just off”.
Now, whilst I would doubt that any trained medical professional would give the same ambivalent response to a new mother, it did make me wonder what women really think about the advice we give to them on leaving hospital, baby in arms, and when they come to us for their two- and six-week checks, when the weighing scales are brought out and we nod approvingly when baby has gained the appropriate amount of weight or furrow our brow when they don’t quite get there and enquire as to how “mum is doing”.
Unquestionably, our national breastfeeding rates compare pretty poorly internationally with initiation rates here rating amongst the lowest globally. According to most recent data, Ireland has a rate of 46.3 per cent exclusive breastfeeding on discharge from a maternity hospital, compared with 81 per cent in the UK, 79 per cent in the US and 90 per cent in Australia.
The World Health Organisation (WHO) has set a target of 50 per cent for exclusive breastfeeding in the ﬁrst six months by 2025. Ireland currently has a rate of 15 per cent at six months, compared with the global average of 38 per cent and WHO European average of 25 per cent.
There is also a strong correlation between breastfeeding rates and socio-economic class and maternal education. The Growing Up in Ireland study found that 79 per cent of mothers who breastfed had a third-level degree compared to 29 per cent who had left school at Junior Cert level.
The beneﬁts of breastfeeding for both mum and baby are well-established; nutritional benefits, lower incidence of childhood respiratory tract infections, otitis media, gastroenteritis, diabetes, and of course, potential for bonding. So what explains the exceptionally low rates here in Ireland? Are we possibly at risk of communicating these beneﬁts to women in such a way that they feel they are under pressure versus empowered to fulﬁl all of their obligations at a time of extraordinary change and emotional upheaval? Is the message they hear through the ‘breast is best’ mantra one of ‘it’s this, or failure’.
Even the most highly-motivated women ﬁnd their progress halted by wary looks in cafes, waiting rooms or restaurants when they breastfeed in public. When, at times, it can feel that the whole world is judging one’s efforts as a mother, a suspicious look in the IKEA cafe, augmented by weeks of sleep deprivation, may just be the straw that breaks the camel’s back.
Education and supports for women who chose to breastfeed should not be a delayed reactionary effort, it must be taken seriously and provided at each step along her pregnancy and during her post-natal care. Barriers to breastfeeding should be explored individually and practical supports offered. There should be wider access to dedicated lactation consultants both in hospital and in the community and women should routinely be provided with information about accessing local breastfeeding support groups.
Of course, at a societal level, there needs to be wider availability of dedicated breastfeeding areas in public and in healthcare facilities for women who understandably may not feel fully comfortable feeding their babies in public until they reach a time when they do feel fully conﬁdent.
Ultimately, women need to hear ‘it’s okay, you can do this’ and not potentially negative encouragements such as ‘you must, this is better for your baby’. Breastfeeding is deﬁnitely not a ‘piece of cake’, nor should it be a mysterious art form only for the enlightened and dedicated ‘earth mother’. It is normal, women should feel comfortable talking about it and we as healthcare professionals should feel conﬁdent about supporting them every step of the way.