Health: more funding is needed for breastfeeding specialists

Taking place from October 1-7, the theme for National Breastfeeding Week this year is ‘Supporting you from bump to baby and beyond’.

However, Irish breastfeeding rates are still amongst the lowest worldwide.

We’re stuck at number 20 out of 22 EU countries, with 63% of Irish newborns receiving breastmilk at birth. In Sweden, 94% of babies are breastfed at birth and that figure is 83% in the US.

Beyond that, 40% of Irish babies are still being breastfed at three months and this drops to less than 15% being exclusively breastfed at six months.

In 2023, a group of academics, healthcare professionals and representatives of breastfeeding support groups came together to prepare a World Breastfeeding Trends Initiative (WBTi) report for the Republic of Ireland. It was led by Dr Liz O’Sullivan, lecturer in nutrition at the Technological University Dublin.

It found that while good policies are in place, we’ve only seen modest increases in breastfeeding rates relevant to HSE targets. Dr Liz O’Sullivan called the results ‘mediocre’.

There isn’t enough training being provided for staff, the research found. Furthermore, the quantity and quality of active breastfeeding support for mothers via the HSE also varies, depending on locality. That’s despite a lot of investment.

Getting mothers to actually engage with services in the antenatal and post-natal period is a challenge, the report stated. It also highlighted the serious need for more support in hospitals.

More funding is being sought, therefore, to increase the availability of lactation consultants in hospitals and in the community.

Research by campaign group Bainne Beathe in 2022 also backs this up. They pointed to a lack of expert help in the first week of a baby’s life as a key barrier to breastfeeding, with formula often offered as a solution to breastfeeding problems rather than support.

Anecdotally, cost may also be an issue, with mothers having to pay a private lactation consultant approximately €150 for help, for example, if HSE help is not available

Historically, reasons for women not continuing with breastfeeding include challenges like tongue-tie, mastitis, blocked ducts and latch-on difficulties.

Practical issues related to going back to work may also feature, along with social challenges – like the fact that breastfeeding is not always easy in public spaces.

Anecdotally, cost may also be an issue, with mothers having to pay a private lactation consultant approximately €150 for help, for example, if HSE help is not available.

Currently, the number of public lactation consultants in the country stands at 59, which averages out as just over two per county.

National Breastfeeding Awareness Week dwells on the positive, however, pointing out that the number of specialist infant feeding and lactation consultant positions in the health service has doubled to 59 since 2021.

HSE staff are getting more education around this now too, they say, with a new training programme implemented. There has also been an 18.6% increase since 2015 in the percentage of babies breastfed at the three months developmental check-up. While Laura McHugh, HSE National Breastfeeding coordinator, is glad to see the progress she is aware of the challenges.

“We know that there is a lot more work to be done to ensure every family is supported to have the best possible infant feeding journey, every step of the way.”

One reader’s story

Mum-of-three Lianna Reidy’s experience in relation to breastfeeding and getting HSE help via the public health system has been positive. Experiencing mastitis on her first baby, she was referred by her public health nurse to a HSE lactation consultation.

Lianna is from Kilmihil, Co Clare and breastfed her three children – Zoe (4) for a year, Oisín (2) for six months and she continues to feed her youngest child, Culainn, who is five months.

She is currently on maternity leave from her job as a quality manager with CupPrint in Ennis, a company that makes recyclable cups, and originally is from a beef farm in Monaghan.

“When I became pregnant I knew that I wanted to feed the baby myself, if I could,” says Lianna. “Living on a dairy farm, our first child was due in January – calving season – so I knew my husband wouldn’t be able to help with bottles at night so breastfeeding also seemed the natural option.

"I could stay in bed and feed my baby and I wouldn’t have to be measuring formula and sterilising equipment. Every family needs to make the right decision for them and their baby, and this felt right for us.”

Feeding her first child did mean overcoming some difficulties, however. As well as general tiredness, she developed mastitis a week after Zoe’s birth.

You want the freedom of giving the baby to someone else to feed, but at the same time you want to be there, to be their nurturer

“I was feverish and had no energy along with breast soreness and redness so it wasn’t pleasant.”

It was at this point that Lianna contacted her public health nurse for support.

“She put me in touch with our area lactation nurse, Gobnait, straight away. I didn’t know lactation nurses existed before that. She helped me to keep feeding and the problem eventually resolved after a couple of days.”

Lianna advises any mother to reach out for help if they are experiencing difficulties and would like to continue breastfeeding.

“When you’re in the thick of it (a breastfeeding problem) you don’t think you are going to come out of it,” she says, “but you can, and help is there.”

Lianna went on to feed Zoe successfully for a year.

Her second child, Oisín had tongue tie as well as colic and a reflux issue so she needed extra support.

“Again, Gobnait was able to help and advise me about the tongue tie. He had surgery at six weeks to sort that out. Because of the tongue tie, he hadn’t been feeding properly. His suction wasn’t good enough so he wasn’t getting the good milk, the hind milk. He was getting enough to keep him growing but not all he needed.”

She fed Oisín for six months but then got Covid. “I lost my milk overnight really,” she says, “but he settled well on the bottle.”

Having to give up so quickly was a bittersweet experience for her, however.

“I didn’t have the pressure down the line of ‘how do I wean him off’,” she says, “but there is an emotional side to it when you have to finish. You want the freedom of giving the baby to someone else to feed, but at the same time you want to be there, to be their nurturer, to be there for them the whole time.”

Culainn, her third child was born last April and all is going well.

“Some people might say you’re crazy to be breastfeeding when you’ve two other children to look after,” she says, “but I find it’s the easier option.”

There was a glitch related to her own health when Culainn was eight weeks old. Lianna developed gall stone pain and had to spend five days in hospital.

“The pain was worse than childbirth. Being in hospital was awful, with three children at home and me still feeding Culainn. Niall, my husband and my parents and mother-in-law minded the children and I expressed milk and stored it in the hospital fridge. It was brought home to him and he took it from a bottle.

"Again, Gobnait, the lactation nurse, helped me, organising things like a good pump so that I could express easily.” Lianna is now waiting to have a gall bladder/gallstone operation.

As well as getting lactation help, Lianna attended a breastfeeding support group in nearby Kilrush when she was pregnant.

“I found the support groups in the community great. You get tips from other mothers as well as advice from the feeding specialists.”

To sum up, she says that breastfeeding is a journey.

“Yes, it’s not easy at times, but for our family, it has been a positive experience.”

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