Breastfeeding – ongoing support for parents is the key to success..
The full reference for this draft article is: Trotter S (2011). Breastfeeding – ongoing support for parents is the key to success. Nursing in Practice (Sept/Oct), Number 62: . It is also online at: http://www.nursinginpractice.com/article/breastfeeding-%E2%80%93-ongoing-support-parents-key-success
Click on the links below to read sections of the article:
Sharon Trotter RM BSc (Adv Studies in Midwifery), Independent Mother & Baby Consultant.
Sharon Trotter is a UK practising midwife and independent Mother & Baby Consultant. Sharon works independently to advise and promote best practice in breastfeeding and baby skincare, her special areas of interest. Following publication of her articles in a number of peer-reviewed journals, Sharon has implemented a new policy for baby skincare within her local NHS organisation. Maternity units all over the UK and beyond are updating their policies in line with this simplified approach, now recommended by the DoH and in line with the Postnatal Care Guidelines (July 2006) published by NICE, where Sharon is a stakeholder (www.nice.org.uk).
She is also author of the bestselling book, Breastfeeding: the essential guide. Details of this and her peer-reviewed articles can be found on her websites at www.tipslimited.com and www.sharontrotter.org.uk
In 2007 Sharon launched the unique TIPS Award Scheme. Through this scheme parents test products on a strictly volunteer basis. This means that the TIPS Award Scheme is the most respected and impartial testing programme in the baby and toddler market sector.
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Not a month goes by without a media splash about breastfeeding (often negative and misleading) which leads to anxious parents flooding breastfeeding forums in the UK and beyond with queries. So incensed was I about a recent article on early weaning that I wrote a short article about the media coverage of infant feeding (Trotter 2011). By spreading inaccurate advice, these sensationalist articles risk upsetting the often fragile self-confidence of new parents (fathers must be included here) which is vital to the successful establishment of breastfeeding. This article will consider the reasons why breastfeeding rates are so poor and what healthcare professionals (HCPs) can do to improve this.
Being a passionate advocate of breastfeeding, my overwhelming aims are to:
- promote breastfeeding, and
- support new parents as they make the transition to parenthood.
I hope parents can benefit from my expertise, acquired through personal and professional experience.
Parents need and deserve accurate, evidence-based advice from experts (not necessarily HCPs) who really understand how breastfeeding works. It is not enough to just promote the advantages of breastfeeding, we have to provide parents with the practical help and support they need, when they need it.
The World Health Organization (WHO 2009) recommends that mothers breastfeed exclusively for six months. Once mixed feeding is introduced, breastfeeding should be encouraged for up to two years and beyond. Like breastfeeding, mixed feeding should always be baby-led. Sadly only one percent of UK mothers still exclusively breastfeed their infant by six months of age - this is a shocking statistic (NHS 2005).The results of the 2011 Infant Feeding Survey are still being collated, but early reports show little change in present rates.
Fashions in healthcare influence how women choose to birth their babies and also whether they decide to breastfeed. In the UK, cultural trends have lead to the disappearance of the traditional extended family. Living away from close family can lead to isolation. Additionally, new parents may not have been around babies or around breastfeeding Mums. This could put them at a disadvantage when trying to learn this new skill. It is therefore not surprising that the early drop off rate for breastfeeding is so steep.
In the absence of a national breastfeeding advice 24/7 helpline funded and run by the NHS, it may be difficult for parents to get expert advice when they need it most. Such a helpline should be set up as a priority for UK breastfeeding rates to increase. A number of websites provide excellent breastfeeding advice (for example NHS Scotland's www.feedgoodfactor.org.uk, www.breastfeedingnetwork.org.uk and www.abm.me.uk) but not everyone has access to the internet or the necessary skills to source the advice they need online.
My grandmother had eight children, all of whom were breastfed for two or three years, until the next baby appeared! This is natural family spacing in practice, and was the norm in the 1940s. My mother had four children and although attitudes to breastfeeding had started to change then, with bottle feeding becoming more fashionable, breastfeeding was still her natural choice. Feeding on demand was not encouraged at that time so mothers tended to breastfeed only for a short time. As my youngest brother was born when I was seventeen years old, I was lucky to have the opportunity to see breastfeeding at first hand.
As a midwife and mother of five children, I have been involved closely with breastfeeding for over twenty six years. I have personally breastfed my own children for more than seven years in total! My youngest son self weaned just before his third birthday.
To find out about parents' experiences of breastfeeding, we ask Testers who register on the TIPS website to list their three top breastfeeding problems. We have been collecting this data for four years (see figure 1). Of all the problems mothers have told us about, the most concerning relate to: positioning, attachment, sore nipples and conflicting advice. Other problems include frequent feeding, tiredness, mastitis, blocked duct, engorgement, over supply, under supply, slow feeders and thrush. Interestingly, only a few mothers told us they were concerned about their milk supply or the baby's weight gain.
If a new mother experiences one or more of these concerns, this can lead her to switch to formula feeding in the early days and weeks. Research shows (Healthcare Commission 2007) that many of these mothers bitterly regret having to give up breastfeeding, especially when they realise they could have continued feeding with a little help. In fact our statistics show that over 92 per cent of the problems mentioned could have been addressed, and probably resolved, with the right support and encouragement at a time when these mothers needed it most.
This is why commonsense advice and support is vital. With this in mind, I developed a breastfeeding toolkit (Trotter 2008). This aims to provide mothers and professionals with a quick reference guide.
Here are my top ten breastfeeding tips, in no particular order:
- stay close to your baby: this increases natural hormones which stimulate milk supply – using a baby sling is really good for this
- get help with positioning and attachment if breastfeeding becomes painful
- dads often need help too – successful breastfeeding is almost impossible without support from the mother’s partner
- listen to your baby: baby-led feeding on demand is vital – avoid clock watching; a breastfeeding routine will develop in time
- don't worry too much about weight gain: this will vary between babies. As long as your baby is waking for feeds, taking feeds well, having wet and dirty nappies,you can be reassured they are getting enough milk and will in time gain a satisfactory amount of weight
- find a local peer support group: these are great for increasing self-confidence – contact Lactation Consultants of Great Britain, The Breastfeeding Network (BfN), The International La Leche League International, The National Childbirth Trust or The Association of Breastfeeding Mothers (ABM)
- get breastfeeding advice on the phone: call the national breastfeeding helpline on 0300 100 0212 to speak to the nearest ABM or BfN volunteer (lines are open between 9.30 am and 9.30pm). Private organisations such as Greatvine (2011) also provide one-to-one advice lines
- remember that breastfeeding is much more than just a way of feeding your baby. It provides the emotional and psychological stability a baby needs to a become a confident, relaxed, and independent individual
- Breastfeeding is a joy – with each feed mothers get a rush of endorphins, which are basically 'happy hormones'. By helping mother and baby feel good, this natural stress-buster reduces the risk of postnatal depression
- above all be POSITIVE!
This information and advice are based on my book Breastfeeding: the essential guide (Trotter 2004) and the article ‘Breastfeeding basics – advice for new mums’ (Trotter 2008). Additional advice can be found in the TIPS® Toolkit for Breastfeeding (2010): a one page factsheet for parents. HCPs, including midwives, health visitors and breastfeeding peer supporters who need to update their skills will also find it useful.
You can download the breastfeeding toolkit free on www.tipslimited.com and you can read 'Breastfeeding basics – advice for new mums' on www.sharontrotter.org.uk
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Greatvine (2011) – The UKs leading experts just a phonecall away. Accessible at: https://www.greatvine.com/
Healthcare Commission. Women’s experiences of maternity care in the NHS in England. Key findings from a survey of NHS trusts carried out in 2007. Available from: http://www.healthcarecommission.org.uk/_db/_documents/Maternity_services_survey_report.pdf
Trotter S (2004). Breastfeeding: the essential guide. ISBN: 0954838106. TIPS Ltd, Scotland
NHS 2005 - http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/infant-feeding-survey/infant-feeding-survey-2005
Trotter S (2008). Breastfeeding basics: advice for new mums. Nursing in Practice (September/October 2008) Number 44 – (Children’s health): 23-5.
Trotter (2010). TIPS Toolkit for Breastfeeding. TIPS Ltd, Scotland
Trotter S (2011). Media coverage of infant feeding studies: informed choice or promotional opportunity? Midirs Midwifery Digest 2011 vol 21, number 2, page 233-4.Trotter S (2008). Breastfeeding basics: advice for new mums. Nursing in Practice (September/October 2008) Number 44 – (Children’s health): 23-5
World Health Organization. Child and adolescent health and development (2009). Available from: http://www.who.int/child_adolescent_health/documents/9789241597494/en/index.html
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