This week is World Breastfeeding Week – a celebration of breastfeeding and a chance to discuss what’s important to breastfeeding parents – as well as understanding what barriers face us when we decide we’d like to breastfeed our child. The theme for this week is “protecting breastfeeding” and the four objectives that make up the theme are:
- Inform people about the importance of protecting breastfeeding
- Anchor breastfeeding support as a vital public health responsibility
- Engage with individuals and organisations for greater impact
- Galvanise action on protecting breastfeeding to improve public health
One of the biggest challenges facing anyone who chooses to breastfeed is the information received during pregnancy and in the earliest days. Many families find themselves confused and discouraged by different advice received from friends, family and even the healthcare professionals they rely on to give the most up-to-date and reliable information.
You didn’t fail if you had to stop breastfeeding before you were ready. You were failed.
The issue is that breastfeeding is rarely focused on within healthcare and is mostly ignored within the training of the majority of healthcare professionals. One would assume that paediatricians, midwives and health visitors had a glut of training in the subject of infant feeding, but unless they have taken a special interest in it and taken it upon themselves to expand their knowledge, that simply isn’t the case.
Where then should families get their information? Thankfully, there are organisations and qualified people out there who can help, but first time parents often find it difficult to understand where to find it.
The value of properly trained assistance
An IBCLC (International Board Certified Lactation Consultant) is the most qualified person when it comes to infant feeding. Yet few people have even heard of an IBCLC and even fewer know how rigorous the training is. To even sit the exam, an IBCLC must have at least 1,000 hours of proven clinical experience and they have to re-certify every 5 years to ensure their knowledge, practice and advice is as evidence-based and up to date as possible.
Whilst I’m lucky that I was able to access the best breastfeeding support – in part due to my geography and socioeconomic background – I didn’t find feeding any of my three children easy. It was only after a lot of tears, sore nipples, a struggle with milk supply, a pigheaded attitude and a lot of frantic googling at 3am that I found the support I so badly needed. It was a kind breastfeeding peer supporter, back in 2016, who brought me the answers I so desperately needed.
Despite all the pumping, herbs and even mantras I recited in desperation, why couldn’t I do as nature intended? Why couldn’t I breastfeed my baby?
Even now, I tear up thinking about how determined I was to continue breastfeeding yet, whatever I tried, I could not manage to get that “perfect latch”. Difficulties in breastfeeding my daughter presented right from the outset and I was encouraged to give her formula within just a few hours of her birth. We continued to mixed feed her right up until she was firmly established on solids, whereupon I just breastfed her until she self-weaned when I was pregnant with my second child. However, in those early days, I spent hours upon hours reading about how to get the right latch and just could not understand why, despite all the pumping, herbs and mantas I recited, I just couldn’t do what – apparently – nature intended?
Finally, some answers came…
Partial answers eventually came in the form of a feeding assessment from a lovely IBCLC called Vanessa. After the breastfeeding peer supporter had listened to my tales of woe and been there when my daughter burst a blood blister on my nipple – she recommended Vanessa take a look inside her mouth. Missed by the midwife, health visitor and GP, my daughter had what’s known as a tongue tie: a thick band of skin under the tongue that was tethering her tongue in a way that made it hard for her to latch on properly.
In the end, all three of my children have had tongue ties and so I know the experts within the county of Kent very well – I have seen most of them in the pursuit of breastfeeding each child, despite the difficulties all three babies presented me with. But why is it so difficult to get help and why isn’t the government prioritising breastfeeding support, given we all know the importance and health benefits of supporting those who wish to breastfeed their children?
The crucial role of an IBCLC
To find out more about the importance and role of an IBCLC in helping protect breastfeeding, I spoke to two Kent-based IBCLCs; Anna Le Grange and Hannah Croft. These two women are not just experts in their field, but compassionate and passionate champions of helping people like me to meet their breastfeeding goals.
Anna Le Grange has 20 years’ experience as a Registered Children’s Nurse and is based in Faversham. She recently published “The Mindful Breastfeeding Book: Preparing you for calm and connected feeding”, available on Amazon.
Hannah Croft, who is based in Canterbury, is a trained and qualified Norland Nanny and became an IBCLC in 2018 after 4 years working as a Voluntary Breastfeeding Counsellor with La Leche League.
La Leche League, an international charity with branches all over the UK, provided me with much of the support I needed, as well as the IBCLCs I saw with all three of my children, so they’re worth checking out if you need help.
What are most people’s goals when they start their feeding journey?
Hannah: The majority of people that I see go into it thinking “I’ll see what happens, I’m not going to put too much pressure on myself” because there is this overall view that breastfeeding is always going to be hard and people go into it expecting it not to work. I spend a lot of time helping people manage their emotions around it, because it’s not embedded into our culture.
Anna: They vary a lot. The parents that I see are rarely thinking beyond the first six months and when things go wrong often it’s a bit of a surprise how emotional it is; it’s an instinct to breastfeed our children and that isn’t recognised until that biological imperative kicks in and it becomes quite an emotional thing when there’s disappointment. There’s often a feeling of being let down by one’s body. I don’t have an agenda about what I talk to people about, I just reflect back what they have been saying and use counselling skills to really listen. I focus on the pair of them together – the feeding dyad – rather than just the mum or just the baby. Sometimes what they really want is acknowledgement and validation that they have tried really hard.
What kind of support do you need to offer most? Is it practical or emotional?
Hannah: It’s really a balance between the two – without the emotional support, the practical support isn’t as useful.
Anna: There’s often an expectation that what an IBCLC will offer will be the practical support but that’s often not the most powerful help we can offer. Often these families have been through a lot of different people – different health care professionals before us and – before Covid times – they may have been to breastfeeding groups. Then they end up at our door and they’re usually looking for that magic bullet to solve all their breastfeeding difficulties. I’m a big fan of using relaxation tools – no matter what you’re going through, counselling tools will help whatever the breastfeeding outcome.
What are the biggest barriers to breastfeeding success?
Hannah: Misinformation! There’s a lack of timely support. We need better antenatal information as there’s a huge emphasis on preparing for birth but not enough on preparing for parenthood and the realisation of what feeding a baby really means in terms of that frequency especially in the early days.
Anna: Really it’s a lack of education in healthcare professionals and a lack of funding and prioritisation of the right of a baby to receive human breast milk. The help from HCPs is really variable. Those HCPs who are educated in breastfeeding support are usually only the ones who have taken it upon themselves to learn more to support the parents they see.
What steps could the government take to better protect breastfeeding?
Hannah: We are in a really sad position right now – the message that comes through loud and clear is that we should breastfeed our babies but it’s a cruel message without adequate support. The practical message is to breastfeed but the government always needs and wants a quick result. Breastfeeding support isn’t simply a quick fix because changing culture is huge and a long term aspiration.
Anna: As always, it’s about giving over additional funding for support and prioritise that funding, We know the stats on things like childhood cancers and the link between breastmilk and preventing other illnesses, so it’s really backward thinking to cut breastfeeding support. It simply costs more in the long run. There are so many known, long-term health outcomes in terms of both adult and child health.
How do we move away from the formula vs breastfeeding debate?
Whenever World Breastfeeding Week comes around, or even just any conversation about breastfeeding, it sparks a conversation around “fed is best” vs “breast is best”. Is it always impossible to discuss breastfeeding without also prompting discussions about the merits of formula vs breastmilk?
Hannah: It is usually the formula companies who stir up that rivalry and we need to really hold them to task. We need to challenge them to comply with the WHO code but also recognise the value and importance of formula which of course has a valuable part to play in feeding our babies when people need it. There should also be more recognition of the challenges and successes behind mixed feeding and support around how to best achieve that. Breastfeeding does not have to be all or nothing.
Anna: I’m actually really thrilled that Lucy Ruddle IBCLC has recently published a book on mixed feeding (Mixed Up: Combination Feeding by Choice or Necessity). Online things are really polarised but in real life it’s rarely like that. Most of my clients are mixed feeding in some way and I think breastfeeding education needs to recognise that breastfeeding really doesn’t have to be all or nothing. We must celebrate what every parent is doing – everyone should have more support. A lot of the time when people are displaying negative emotions around celebration of breastfeeding it’s because they’re really hurting. I think acknowledging that pain really makes a difference and we should view those expressions with empathy.
How can families support those with issues to carry on?
Hannah: Antenatal conversations are really important and getting the whole family on board with those hopes and goals are crucial. Just telling someone to stop breastfeeding isn’t really helpful – you don’t necessarily want to stop, so family members and friends should think about how they can help. So, what practical support can you give? Can you wash pump parts, hold the baby so parents can have a shower or a sleep – what ways can you assist so they can carry on breastfeeding. With other things that people find hard, we look at ways to support them to continue, we don’t just say to stop. It’s also a feminist issue, with breastfeeding we often just encourage giving up and leave it at that, but if men were struggling with something their body wasn’t doing as it should, they would be referred to a specialist.
Also, there is a conversation to be had about finding the right support for your family, and seeking help from an IBCLC. Parents spend a lot of money on prams and perhaps even newborn photoshoots but will baulk at paying for healthcare outside of what is provided by the NHS.
How can people heal from breastfeeding grief if they haven’t reached their goals?
Anna: Acknowledging how you feel about it is really the first step. There isn’t a lot of space to say how we feel about breastfeeding and if we are honest with ourselves, when we say we were “made to feel” something, like guilt or shame or too much pressure, those feelings are internal. And there is a reason for that – it is a biological instinct set off by hormonal changes that drive us to want to feed our babies and the grief felt when it doesn’t go to plan is a physiological thing. People feel angry at themselves and their bodies. Be honest with yourself and give yourself unconditional space to think and feel. There’s a great book called Why Breastfeeding Grief and Trauma Matters which covers all that that stuff and why it feels so hard to stop. There’s a big hormonal change when you stop feeding and there is always an overemphasis on just how the baby is. There’s that “as long as baby is fed” which ignores the feelings and goals you have. Seek some help if it’s on your mind and if you’ve had problems feeding your first, be prepared for some big emotions to emerge when you have future children. It’s always helpful to debrief.
That final point from Anna about debriefing and breastfeeding grief is such a poignant one.
In between my first and my second child, I volunteered for some time as a breastfeeding peer supporter, to pay back my dues from that peer supporter I saw when my first was so tiny. Peer supporters have experience in feeding babies and undergo training to help with simple breastfeeding troubleshooting. They also listen and reflect back some of the emotional difficulties that accompany recovering from birth, sleep deprivation and the hormonal whirlwind of becoming a new parent, especially when feeding is difficult.
One story stands out for me still so vividly it feels like it just happened.
I was listening to a new mother talking about her experience feeding her tiny baby of just three weeks. She had come to a breastfeeding group to seek help as her baby wasn’t gaining weight and she was experiencing pain at every feed. Just like me, she was grateful to have been able to see a specialist – back in those days in Kent, it was quite easy to see an IBCLC for free, before cuts and changes made that a more difficult endeavour. The IBCLC had diagnosed a tongue tie in her son and suddenly, so much made sense. But her story was not much different to many I had supported before – except for the woman who accompanied her. The new mother told me that she had brought her grandmother along because they were incredibly close and her grandmother was really keen on supporting her to breastfeed. I had watched this kind older lady gently caress her great grandson’s head while her granddaughter readied herself for a feed. The lady kissed her on the head as she handed over the baby and then sat, listening carefully to everything said in the conversations. It was only after I had given some basic information about tongue ties – somewhat based on my own experience – that I noticed the grandmother’s tears.
“I think that’s why I couldn’t feed your mum,” she said, her voice wavering. “Part of the reason I want to help you with feeding him was because I failed with your mum. I wanted so much to feed her and there wasn’t anyone to help me. It was so painful and I just couldn’t do it” she said. Now in her 70s or early 80s, this woman was still experiencing the grief and sense that she had failed her precious daughter. The grief had endured through the years.
Breastfeeding really matters. It matters to parents and their babies. It matters for Public Health. It matters to our environment. It matters to the countless people let down by our inability to support families to meet their goals and allowing ourselves to become distracted by petty arguments that obfuscate the real arguments that breastfeeding is what a baby needs. It’s the biological norm and it’s a health issue for the breastfeeding dyad.
Let’s do all we can to protect it and insist that everyone takes it seriously. It is a shared responsibility.
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