Friday, October 16, 2009

Are we making breast feeding too complicated?

In August I did some rural midwifery locum for a month - this is after a break from clinical practice of nearly three years. It seemed to me that at every post natal visit I did, mothers complained of a breastfeeding problem - baby was crying too much, baby wasn't crying enough, baby was too thin, baby was too fat. The trendy breastfeeding 'problem' these days appears to be milk allergies - every time a baby cries it's because it has a milk allergy. So we get onto a roundabout of special diets, herbal teas, medications and so on and so forth.

I know breastfeeding has its challenges and I do not wish to denigrate the problems that women have. But what happened to sticking the baby on the boob, feeding when she wants and for as long as she wants, accepting that babies need a lot of attention for weeks and even months and just getting on with it?

Image: 'Yummy milk' PhylB


serendipitynz said...

Totally agree Sarah, I was a mother of 3 under 4 yrs, I'm now a grandmother of 7, but as an inexperienced mother in a rural area without any support, I just "got on with it", fed the babies when their cry sounded "hungry" and never doubted my ability to sustain them. My children were all different, one was a lazy feeder, one was ravenous and the third demanded feeding every two hours but slept through the night from birth. I just went with the flow and the breast feeding experience for me was a joyful one, which probably explains why my last child was breast fed for 13 months, I just didn't want to relinquish that joy.

Pamela Harnden said...

I am so with you on this one! It is actually not breastfeeding problems its that mums are unprepared for a crying baby who needs frequent feeding.
Someone complained about me because she had to wait 6 wks after I had discharged her for her baby to sleep during the night which she said was thanks to her plunket nurse!

Phyl said...

I think these are the excuses we often hear when mums realize the huge commitment involved in the first 6-12 weeks of feeding. It isn't getting back in your jeans and out shopping, it is sitting for hours on end with a feeding baby and no one who can do it for you... but when you put the first few weeks in a perspective compared to the child's lifetime, and just accept that life is on hold for a bit, then you just do it.
I started with my first baby in 1997 intending to try breastfeeding to see if I could do it - I stopped feeding him at 2 when I got pregnant with his sister, who fed to 2.5, the next one fed till 20 months, and I recently stopped feeding my 18 month old (Anna in your picture) because I am pregnant with number 5.
I manage to look after all my kids, run a linguistics business from home and stay sane, though things at home are never the most neatly organised!
Just do it and enjoy it :-)
(PS thanks for using my photo!)
(Re- Pam's comment - 6 weeks for a night's sleep!? I have considered myself lucky when each of mine has slept through from around 1 year old!)

Pauline said...

Thanks for your post Sarah. Although still a student midwife, the mismatch between expectations and the realities of a new baby is something I have seen a lot of - both with clients and friends. For these women I wonder how much attention has been paid to exploring parenting during the antenatal period, how much support they have from those around them and whether the professionals caring for them are 'meeting them where they are' instead of trying to fix the 'problem' of the day.

Sarah Stewart said...

Thank you all for your comments - it's great to have this conversation

There's no doubt about it, some babies are easier to feed than others, & the help mums require varies considerably. But I do wonder how many of the problems mothers have is caused by the way midwives approach breastfeeding.

When I started my midwifery training in the 1980s, we 'forced' mothers to do some terrible things that hugely inhibited breastfeeding - we've come a long way since. But it's almost as if we've come full circle. Instead of making women feed 10 minutes per side every 4 hours like we did years ago, it's 'you must feed frequently or else we'll have to cup feed'. Now, I'm not saying that is wrong, it just feels to me that midwives have replaced one mantra for another.....this is just my opinion and I'm not even very sure I am articulating my thoughts very well.

I agree with you all that a huge issue is the unrealistic expectations women have about breastfeeding, and Polly is right that one answer is informing women in the ante natal period. But I'm still left with the question: with all the research that has gone on and emphasis on things like BFHI have we done the midwifery equivalent of 'medicalising' breastfeeding?

Merrolee said...

Hi Sarah

This is probably too late for your discussion but.... my daughters are now 23 and 20 - and both had in hospital (one midwife delivered because the GP didn't get there in time, the other GP delivered!).

In those days (and now I feel my age).. we were encouraged to be in hospital for between 5 and 6 days. I know it goes against practice now.. but I think those days were so essential for getting breastfeeding well established in what we would now call a 'community of learning! of mums, nurses etc all on the ward.

Both of my children have low tone, so the learning to 'latch on'as newborns was not easy for either of them (and I only had pethidine/gas for pain relief so they weren't dopey babies)...and when my milk 'came in', they had to get the hang of it all over again - and I needed nurse assistance! In that time of sharing a room with up to three other women you also got to see that it wasn't easy, that the baby would cry, that it wasn't always feeding it needed etc etc etc.. We weren't at home with just partners and the midwife popping in - you had lots of different nursing staff with different ideas, plus the other mums and their babies - you got to see different ways of holding the baby etc.. I think that this 'community of learning' is potentially really missing when mum's birth at home, or go home within 6 hours (you have got to be kidding me - I would be hanging onto that delivery bed for dear life if I was having kids now).

The first time the mum goes to feed the baby and it doesn't go quite right, and the midwife isn't there to quickly deal with the issues I think an emotional rollercoaster starts - which leads very quickly to the issues you are describing in your posting - ie the difficulty with feeding is seen to happen for a number of reasons... instead of the mum's learning from their 'community of learning' that breastfeeding is actually hardwork and takes learning on the part of the mum and the baby and therefore takes perseverance!!!!!

Oh.. successfully breastfed daughter no 2, while no 1 daughter made her preferences very clear within 2 months not helped by an unhelpful Child Health Nurse who got her knickers in a twist about a very slight weight loss one week and so strongly said I must supplement no 1 daughters feeds with bottle! Low toned child figured out very quickly this was much easier and started to refuse breast!

No 2 child also had same weight loss about the same time - young (and different Child Health Nurse) suggested supplementing feed but I told her that I wasn't going down that track again and I'd persevere for another week or two -child was happy, sleeping well, and a very tiny weight loss was not something I was going to worry about just yet! Decision to persevere was vindicated - no 2 gained weight and continued to feed well until 18 months!

M-H said...

Sarah, I agree so much with this - like Robyn I had three kids under four, and breastfeeding was the only time I got to sit down for days on end, so I was highly motivated to 'get on with it'. La Leche League (first in the form of a book by Karen Pryor and later through live meetings) was an important source of confidence for me. I also agree with Merrolee - those first days in hospital were very important in getting to know the baby and establishing the feeding relationship without all the demands of home. But sometimes it feels as if women are trying to insert the new baby into their lives, rather than acknowledging that not only does this new little person have to fit into the household, the household will be forever changed by their arrival and you can't predict or control how.

Sarah Stewart said...

Thanks to both Merrolee and M-H for your stories. Getting a balance is very difficult and in the end , the support women need and receive has to be individually assessed.

When I started as a student midwife first time mums stayed in hospital for 8 days. They hated that because they missed their family so much, and the problem of in consistent advice was rife. Now I encourage women to go home from hospital (or have home birth) as early as they can and have just a couple of community midwives as support, but that has its issues too.

I do think societal attitudes to parenting and breastfeeding have a huge influence on midwives have to carefully consider how they deal with this issue in a way that supports women yet doesn't buy into things that undermine breastfeeding.