Health: Is breastfeeding really best?

Always accessible, always at the right temperature, the risk of illness reduced (in baby and mother) and it costs a lot less than formula feeding: the benefits of breastfeeding certainly inspire (if we didn’t always know it was the tailor-made food for babies).

However, Irish breastfeeding rates are still too low, despite all the good reasons for doing so. Currently 58% of Irish mothers start off breastfeeding, according to Rebecca O’Donovan, assistant national breastfeeding coordinator with the HSE.

Thirty years ago that figure was less than 30%, so it’s a big improvement. “At the moment, the 58% figure drops to 55.5% after four days and then to 38% by the three-month public-health nurse check-up stage,” she says.

The research shows that the numbers drops to 2% by the time babies are a year old. Only the UK has lower levels than us at this point, with only 1% of mothers there breastfeeding by the time their child is one year old.

But what reasons have mothers given for the reluctance to breastfeed in the past? The drawbacks mentioned in the 2016 National Maternity Strategy were lack of support in maternity hospitals, not enough access to lactation consultants and poor quality and sometimes contradictory information.

Tips at the click of a mouse

The HSE spokesperson says this has much improved since then, and the HSE’s revamped website www.breastfeeding.ie, in existence since 2007, is part of that improvement. It began to provide online lactation consultant advice via its Ask Our Expert facility in 2015 and also provides tips on any aspect of breastfeeding at the tap of a screen or click of a mouse.

It’s a whole new world. Older mothers probably wish that such easily accessible information was out there when they were new mums! Irish Country Living would give the website a 10/10 rating. Not only does it mention what supports the HSE provides but also lists the support groups of all the other breastfeeding support organisations as well, making it comprehensive and inclusive.

Voluntary groups lead the way

Rebecca acknowledges that it was the voluntary support groups like La Leche League and Cuidiu that led the way in getting more State support for breastfeeding mothers.

“The voluntary groups have played a huge role really in Ireland,” she says. “It is a lot different than years ago. You just have to look at the websites to see the number of support groups around now: 300. There are over 100 lactation consultants trained now also, and these include midwives, practice nurses, GPs and public health nurses. The first clinical midwife specialists took up posts in the early 2000, so there is more help out there. We are getting there.”

She says that it is a skill that may have skipped a generation. “Bottle feeding became the norm for a while, but nowadays the resources are there to encourage mothers to choose breast over bottle,” she states.

As a lactation consultant herself in Cork University Hospital for many years, she was delighted to help mothers get started. “I saw so many mothers begin their breastfeeding journey and see it established and coming back then with their second and third baby. The job satisfaction was huge.”

Evidence for breast is best

The evidence is stronger than ever that breastfeeding is best, she says. “Every breastfeed makes a difference – that’s our slogan – and breastfeeding is important for the health of children and mothers,” Rebecca says.

The Lancet published an article in 2016, for example, she says, looking at the importance of breastfeeding in terms of reducing illnesses – such as chest, ear and tummy infections along with reducing the risk of diabetes and sudden infant death.

“It also has health benefits for the mother in terms of reducing the incidence of pre-menopausal breast and ovarian cancer.” The financial gain shouldn’t be forgotten either. “There is an economic benefit for the family as well, as it is free.”

Because we missed out on a generation of mothers who didn’t breastfeed, the knowledge wasn’t handed on to daughters as it would have been in the past – but it’s different now, she believes.

“Mothers who have breastfed in the last 30 years are now able to help their daughters as they become mothers, passing on their knowledge and tips.”

Ideal length of time to breastfeedI

But what is the ideal length of time to breastfeed your child? “The World Health Organisation (WHO) says that breastfeeding should be done exclusively for six months and combined with solid foods until baby is two years of age. That’s the global recommendation,” she explains.

So what turns mothers off breastfeeding and how can they overcome those challenges? Rebecca responds not by listing disadvantages, but by focusing on the fact that breastfeeding is a skill that takes practice and patience.

“Most importantly you need family and professional support. In the early days and weeks, your supply is getting established and the baby needs to feed really frequently to build on the supply so it can require some time.

“If mothers have been to a preparation for breastfeeding class when they were pregnant, however, they will have learned a lot even before their baby is born that will help them settle into breastfeeding when the time comes,” Rebecca explains.

“That’s probably one of the most important aspects – getting comfortable yourself and having the baby comfortable. If the baby is properly positioned and attached to the breast the mother is less likely to get sore and the breastfeeding journey and experience, therefore, gets off to a really good start.”

Confidence is key

But what about embarrassment? How does a mother get over a disinclination to feed in public? “Learning the skill initially takes time and practice. Sometimes what mothers wear makes a difference as well. Some use a strategically placed scarf as they feed, and nursing bras are very handy nowadays. Feeding can be done so discreetly that other people would be unaware of it,” she says.

Attending a breastfeeding support group initially can help in building up confidence to feed when out socially. “The mothers will be breastfeeding in the company of other mothers and then they might go for coffee afterwards. Little by little your confidence grows, and as you get more efficient at feeding it gets easier and you just find it so convenient: the milk is at the correct temperature and is readily available.”

Entitled to feed in any public place

The recent news story about a woman not being encouraged to breastfeed in a particular location at a Kildare GAA match highlighted the legislation that is there to support mothers now, she says.

“It’s important that mothers know that by law they are entitled to feed in any public place they wish. She can be offered a private space but that’s her choice if she wishes to use it.

“In terms of legislation and support, the situation has improved a lot. Mothers need that support in society so that they will feed as long as possible.”

More support from employers too

Employers are obliged to be helpful to nursing mothers too. “It is important that employers and business owners are aware that mothers are entitled to breastfeed,” she says.

“Mothers are protected by law. They have to get their maternity leave and when they return to work, by law they are entitled to a space to use if they want to have their baby brought in for feeding or to express milk to store it for another time.

“When mothers return to work they need to consult with their line manager about this. Probably when many return to work (usually when their baby is six months old and they are on solids) they would have reduced a certain number of breast feeds because it’s complimented by solids at that stage.

“Usually mothers back at work would breastfeed in the morning then pump at lunchtime, store it in a fridge and bring that breast milk home for the baby to have the next day at lunchtime, when they are not with them.

“Generally they need a room, a wash-hand basin and access to a fridge. A lot of the contact online is from mothers asking how to continue to breastfeed when going back to work. It is really great when the employers can work with the employees to make a return to work possible,” she says.

“It is good to see how young fathers are so supportive nowadays also. Everyone needs support and encouragement.”

See www.breastfeeding.ie for access to an online lactation consultant. There are also webchat facilities available and video tips about a range of topics and links to support groups in your area also.