Breast is best? Try telling the midwife

Hospitals give up too easily when mothers run into problems

"The tears were running down my face and falling on to my baby's tiny nose and into his mouth because he was screaming. The milk was dripping from my breast. Even when he managed to get the nipple in, it hurt like hell. The midwife sat on the bed, and said very firmly, 'What you both need, dear, is a bottle.' "

Patricia Wilson's memories of her first week as a mother are marred by the distress she felt every time she tried to breastfeed. "What made it worse was that most people around me - midwives, the woman in the next bed who was bottlefeeding, even my own mother - made it clear they thought there was no point in struggling on. 'Just put him on the bottle.' Well I didn't and I'm glad. But I needed all my strength and determination to get through that first week."

It seems that we British aren't good at breastfeeding. It's not that we don't try. Patricia Wilson, whose baby was born in a major London hospital, is in the majority - 63 per cent of UK mothers start off breastfeeding. But by two weeks, a fifth have switched to the bottle - regretfully, yes, but often mightily relieved as well to wave goodbye to an unrewarding and sometimes painful experience. Four weeks later, only 39 per cent of babies are receiving any breast milk at all, according to government statistics.

Health education agencies and birth gurus alike never tire of stressing the benefits of breastfeeding. Mothers who have done it enjoyably for some time testify to the sense of self worth and satisfaction that it brings. But many mothers never reach that stage. They never get beyond the first days, beset by problems that leave them, and their babies, in tears of desperation.

The fastest fall-off in the British breastfeeding rates occurs when mothers are still in hospital. Because, for all the emphasis on its benefits, both hospital practices and staff attitudes often discourage breastfeeding, making it more difficult for women to succeed at a skill that everyone acknowledges has to be learnt and encouraged. Research shows, for example, that early bottles and breastfed babies don't mix. The bottle undermines a mother's confidence, hinders milk production and takes the edge off the baby's interest in the breast. A breastfed baby who has any formula while still in hospital is three times more likely to be fully bottlefed by two weeks than the baby who has had no formula at all. Yet in hospital, 45 per cent of breastfed babies are given bottles in those crucial first days.

"Health professionals like quiet babies, and they'll suggest a bottle to deal with crying," says Dr Tony Waterson, a consultant community paediatrician in Newcastle who has made a study of breastfeeding in hospital. "They have the suspicion that breast milk can't be enough." Institutional routines are difficult to change, he adds. "We know keeping mothers and babies together is good for breastfeeding - yet some units still insist on putting the baby in the nursery."

Getting a baby correctly attached and positioned at the breast - called latching on - is essential for effective breastfeeding, and for avoiding soreness. Breastfeeding is no longer learnt through a lifetime of watching other females do it, so skilled professional help is critical. Yet poor, often conflicting advice means almost a third of breastfeeding women suffer sore or cracked nipples while in hospital. In fact, 30 per cent of women who quit in the first week give soreness as their main reason.

Dr Waterson says that formula milk manufacturers have so heavily promoted their products to hospital staff that they now feel more knowledgeable about formula than they do about breastfeeding. Pati Rundall of Baby Milk Action agrees. "In the past decade and a half, healthcare facilities have allowed themselves to be inundated with materials, money and sponsorship from the milk companies. The result has been complete confusion about the benefits of breastfeeding."

The lack of confidence among health professionals when it comes to supporting breastfeeding is caused by poor training. "All we had on breastfeeding was one or two lectures plus whatever we could gather when we were with the qualified midwives," recalls Geraldine Dowling, a former midwifery student who is now a breastfeeding counsellor for the National Childbirth Trust. And learning by "sitting next to Nelly" can perpetuate bad practice rather than passing on wisdom. "When I was a student I heard experienced midwives give mothers very poor advice and saw them position babies on the breast in ways which were certain to cause problems."

The Royal College of Midwives and the Health Visitors Association are beginning to tackle the training issue: a new course, Invest in Breast Together, offers in-depth, post-qualification training and looks at staff attitudes as well as techniques and skills. Meanwhile, hospitals themselves are being challenged to adopt pro-breastfeeding policies by the World Health Organisation and Unicef, through their worldwide Baby Friendly Hospital Initiative (BFHI). The Jessop Hospital for Women in Sheffield is only the second British maternity unit to win BFHI status, after detailed appraisal by a team of assessors earlier this year.

The midwife Sue Ashmore is infant feeding adviser at the Jessop. "Our main problems were the same as everywhere else - women were getting conflicting advice from different professionals, and not getting enough support."

A new pro-breastfeeding policy has been implemented at the Jessop, using the WHO/Unicef programme's "10 steps" plan. It includes compulsory training in breastfeeding support for all staff, including doctors, and the outlawing of certain practices - breastfed babies are never given a bottle unless it is medically indicated.

Formula milk promotion is also outlawed on hospital premises. "We don't object to factual information, but we refuse logo-ed pens, diaries, sponsored events and leaflets," says Sue Ashmore.

Can all this go too far? After all, women can feel failures when they hit problems with breastfeeding, and guilty for months or even years if they quit. There is an argument that professionals should be neutral about feeding, to minimise upset and to protect the feelings of women who don't want to breastfeed.

Sue Ashmore is unrepentant. "We live in a bottlefeeding culture, and mothers may not get breastfeeding information from anyone but us. All women need to know that breast milk is the healthiest option. Then we'll support them whatever choice they make, and help them feed happily."

For more information on NCT breastfeeding counsellors call 0181-992 8637. A directory of more than 5,000 breastfeeding-friendly stores is published this week by the NCT. They include Asda, Boots, Debenhams, Principles, Safeway and Sainsbury's. Available from the NCT, price pounds 2.

'I felt a failure. No wonder so many women give up'

Four years after giving birth to Tabitha, Anabel Hands (left) still remembers every detail of her struggle to breastfeed while in hospital.

"I couldn't get Tabitha latched on. Some of the midwives were kind, but short of time; others didn't seem interested. Just hours after the birth I was told to give a bottle, as breastfeeding wasn't working. A nursing auxiliary said I had such small nipples I couldn't hope to feed properly, and suggested nipple shields. Someone else advised offering water. Everyone said something different."

To Anabel's distress, Tabitha was eventually given a bottle. "I felt devastated - a failure. Eventually. a midwife came and got Tabitha on the nipple, but she sort of did it for me. I felt like an idiot.

"There was no real support for breastfeeding in the hospital. I never had the impression that anyone there was really bothered about it. No wonder so many women give up."

Life and Style
ebookNow available in paperback
ebooks
ebookPart of The Independent’s new eBook series The Great Composers
Life and Style
Baroness Lane-Fox warned that large companies such as have become so powerful that governments and regulators are left behind
techTech giants have left governments and regulators behind
News
Keith Fraser says we should give Isis sympathises free flights to join Isis (AFP)
news
Life and Style
'Prison Architect' players decide the fate of inmates
tech
Life and Style
A picture taken on February 11, 2014 at people walking at sunrise on the Trocadero Esplanade, also known as the Parvis des droits de l'homme (Parvis of Human Rights), in front of the Eiffel Tower in Paris.
techGoogle celebrates Paris's iconic landmark, which opened to the public 126 years ago today
News
Cleopatra the tortoise suffers from a painful disease that causes her shell to disintegrate; her new prosthetic one has been custom-made for her using 3D printing technology
newsCleopatra had been suffering from 'pyramiding'
News
people
Arts and Entertainment
Coachella and Lollapalooza festivals have both listed the selfie stick devices as “prohibited items”
music
Sport
Nigel Owens was targeted on Twitter because of his sexuality during the Six Nations finale between England and France earlier this month
rugbyReferee Nigel Owens on coming out, and homophobic Twitter abuse
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Senior Web Designer / Front End Developer

    £28000 - £32000 per annum: Recruitment Genius: This fast expanding web managem...

    Ashdown Group: Trainee Consultant - Surrey / South West London

    £22000 per annum + pension,bonus,career progression: Ashdown Group: An establi...

    Ashdown Group: Trainee Consultant - Surrey/ South West London

    £22000 per annum + pension,bonus,career progression: Ashdown Group: An establi...

    Ashdown Group: Recruitment Consultant / Account Manager - Surrey / SW London

    £40000 per annum + realistic targets: Ashdown Group: A thriving recruitment co...

    Day In a Page

    No postcode? No vote

    Floating voters

    How living on a houseboat meant I didn't officially 'exist'
    Louis Theroux's affable Englishman routine begins to wear thin

    By Reason of Insanity

    Louis Theroux's affable Englishman routine begins to wear thin
    Power dressing is back – but no shoulderpads!

    Power dressing is back

    But banish all thoughts of Eighties shoulderpads
    Spanish stone-age cave paintings 'under threat' after being re-opened to the public

    Spanish stone-age cave paintings in Altamira 'under threat'

    Caves were re-opened to the public
    'I was the bookies’ favourite to be first to leave the Cabinet'

    Vince Cable interview

    'I was the bookies’ favourite to be first to leave the Cabinet'
    Election 2015: How many of the Government's coalition agreement promises have been kept?

    Promises, promises

    But how many coalition agreement pledges have been kept?
    The Gaza fisherman who built his own reef - and was shot dead there by an Israeli gunboat

    The death of a Gaza fisherman

    He built his own reef, and was fatally shot there by an Israeli gunboat
    Saudi Arabia's airstrikes in Yemen are fuelling the Gulf's fire

    Saudi airstrikes are fuelling the Gulf's fire

    Arab intervention in Yemen risks entrenching Sunni-Shia divide and handing a victory to Isis, says Patrick Cockburn
    Zayn Malik's departure from One Direction shows the perils of fame in the age of social media

    The only direction Zayn could go

    We wince at the anguish of One Direction's fans, but Malik's departure shows the perils of fame in the age of social media
    Young Magician of the Year 2015: Meet the schoolgirl from Newcastle who has her heart set on being the competition's first female winner

    Spells like teen spirit

    A 16-year-old from Newcastle has set her heart on being the first female to win Young Magician of the Year. Jonathan Owen meets her
    Jonathan Anderson: If fashion is a cycle, this young man knows just how to ride it

    If fashion is a cycle, this young man knows just how to ride it

    British designer Jonathan Anderson is putting his stamp on venerable house Loewe
    Number plates scheme could provide a licence to offend in the land of the free

    Licence to offend in the land of the free

    Cash-strapped states have hit on a way of making money out of drivers that may be in collision with the First Amendment, says Rupert Cornwell
    From farm to fork: Meet the Cornish fishermen, vegetable-growers and butchers causing a stir in London's top restaurants

    From farm to fork in Cornwall

    One man is bringing together Cornwall's most accomplished growers, fishermen and butchers with London's best chefs to put the finest, freshest produce on the plates of some of the country’s best restaurants
    Robert Parker interview: The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes

    Robert Parker interview

    The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes
    Don't believe the stereotype - or should you?

    Don't believe the stereotype - or should you?

    We exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor