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
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: Web Developer - Junior / Middleweight

    Negotiable: Recruitment Genius: One of the South East's fastest growing full s...

    Guru Careers: Marketing Manager / Marketing Communications Manager

    £35-40k (DOE) + Benefits: Guru Careers: We are seeking a Marketing Communicati...

    Recruitment Genius: Commercial Engineer

    £30000 - £32000 per annum: Recruitment Genius: Estimating, preparation of tech...

    Recruitment Genius: IT Support Technician

    £14000 - £17000 per annum: Recruitment Genius: You will work as part of a smal...

    Day In a Page

    Blundering Tony Blair quits as Middle East peace envoy – only Israel will miss him

    Blundering Blair quits as Middle East peace envoy – only Israel will miss him

    For Arabs – and for Britons who lost their loved ones in his shambolic war in Iraq – his appointment was an insult, says Robert Fisk
    Fifa corruption arrests: All hail the Feds for riding to football's rescue

    Fifa corruption arrests

    All hail the Feds for riding to football's rescue, says Ian Herbert
    Isis in Syria: The Kurdish enclave still resisting the tyranny of President Assad and militant fighters

    The Kurdish enclave still resisting the tyranny of Assad and Isis

    In Syrian Kurdish cantons along the Turkish border, the progressive aims of the 2011 uprising are being enacted despite the war. Patrick Cockburn returns to Amuda
    How I survived Cambodia's Killing Fields: Acclaimed surgeon SreyRam Kuy celebrates her mother's determination to escape the US

    How I survived Cambodia's Killing Fields

    Acclaimed surgeon SreyRam Kuy celebrates her mother's determination to escape to the US
    Stephen Mangan interview: From posh buffoon to pregnant dad, the actor has quite a range

    How Stephen Mangan got his range

    Posh buffoon, hapless writer, pregnant dad - Mangan is certainly a versatile actor
    The ZX Spectrum has been crowd-funded back into play - with some 21st-century tweaks

    The ZX Spectrum is back

    The ZX Spectrum was the original - and for some players, still the best. David Crookes meets the fans who've kept the games' flames lit
    Grace of Monaco film panned: even the screenwriter pours scorn on biopic starring Nicole Kidman

    Even the screenwriter pours scorn on Grace of Monaco biopic

    The critics had a field day after last year's premiere, but the savaging goes on
    Menstrual Hygiene Day: The strange ideas people used to believe about periods

    Menstrual Hygiene Day: The strange ideas people once had about periods

    If one was missed, vomiting blood was seen as a viable alternative
    The best work perks: From free travel cards to making dreams come true (really)

    The quirks of work perks

    From free travel cards to making dreams come true (really)
    Is bridge the latest twee pastime to get hip?

    Is bridge becoming hip?

    The number of young players has trebled in the past year. Gillian Orr discovers if this old game has new tricks
    Long author-lists on research papers are threatening the academic work system

    The rise of 'hyperauthorship'

    Now that academic papers are written by thousands (yes, thousands) of contributors, it's getting hard to tell workers from shirkers
    The rise of Lego Clubs: How toys are helping children struggling with social interaction to build better relationships

    The rise of Lego Clubs

    How toys are helping children struggling with social interaction to build better relationships
    5 best running glasses

    On your marks: 5 best running glasses

    Whether you’re pounding pavements, parks or hill passes, keep your eyes protected in all weathers
    Joe Root: 'Ben Stokes gives everything – he’s rubbing off on us all'

    'Ben Stokes gives everything – he’s rubbing off on us all'

    Joe Root says the England dressing room is a happy place again – and Stokes is the catalyst
    Raif Badawi: Wife pleads for fresh EU help as Saudi blogger's health worsens

    Please save my husband

    As the health of blogger Raif Badawi worsens in prison, his wife urges EU governments to put pressure on the Saudi Arabian royal family to allow her husband to join his family in Canada