Why can’t we latch on?

It's breastfeeding awareness week, and surely everyone knows that breast is best. So why do so many UK mothers bottle feed their babies? Joanna Moorhead asked 10 experts what we're doing wrong - and what we should do to improve thin.
  
  


Sheila Kitzinger Campaigner for intervention-free childbirth and mothers' and babies' rights

We need a law, like the one in Scotland, that would make it a criminal offence to harass or stop any mother from breastfeeding her child in public. We know many mothers feel embarrassed or self-conscious about breastfeeding when they're out and about - they think they'll be seen as immodest or exhibitionist, which is ridiculous as all they want to do is give their babies the best food possible.

A law like this would make it absolutely clear that women do not have to breastfeed surreptitiously, and that all babies have the right to breast milk - it removes the need for women to feel anxious about what they're doing, which is why it's such an important step. The Scottish bill was passed last November and became law in March, and there's now a campaign to pass a similar measure for England and Wales, which I'm supporting - the website is at www.thewaynatureintended.org.

Miriam Stoppard Author of more than 20 childcare books

What would change everything is a proper, big-budget, well-thought-through marketing campaign to really push breastfeeding. If a company like L'Oreal or Cadbury's had a new product to launch, it would put a fortune into market research and then formulate a strategy and work out what it needed to do before going out there and doing it: and that just hasn't happened with breastfeeding, although it really ought to. The government gives relatively tiny amounts of money to initiatives like breastfeeding week - it would have to invest properly in the sort of campaign I'm talking about. But it's been done before, with the five-a-day message, and the health and long-term economic results of higher breastfeeding rates are at least as good as the results of more consumption of fruit and vegetables. What we've got to think is: if a company came out with a great new health drink that can do what breast milk can do, how would they market it?

· Conception, Pregnancy and Birth by Miriam Stoppard is published by Dorling Kindersley.

Clare Byam-Cook Former midwife, baby-feeding consultant and author

Well, I'd end breastfeeding week for a start. You get all these breastfeeding mothers trotted out, but how does that help? It's like having an infertility week and putting up pictures of parents showing off babies. What we need to do is stop all this endless talk of "support" - if I hear that word again in relation to breastfeeding, I'm going to scream - and start looking at ways to show women properly how to latch on.

The simple fact is, most mothers don't understand the practical knack of getting a baby to fix on to a nipple and feed, and what they need is a midwife or health visitor who will show them how to do it. It's not rocket science: what you need to do is shape the breast so it's doughnut-shaped rather than apple-shaped, and when the baby's mouth opens you shove her on and she starts feeding happily away.

The other thing I'd like to see is a bit of honesty: you get these counsellors who bully women into carrying on breastfeeding when they feel their milk supply isn't good enough, and the fact is not all women can do it and there comes a stage when it's right to call it a day. To say every woman is physically capable is to say every human being has perfect eyesight: it just isn't true. · What To Expect When You're Breastfeeding and What If You Can't by Clare Byam-Cook is published by Vermilion.

Andrew Radford Director of the Unicef UK Breastfeeding Initiative

Breastfeeding is still being undermined at the time when mothers and their babies are most vulnerable to interference, which is in the first few days in hospital. Too many babies are given bottles of formula milk or water while they're in hospital and that interferes with demand feeding and changes the baby's feeding pattern. We know that 90% of all mothers who give up breastfeeding in the early weeks wish they'd continued, so the will is there on their part. But midwives and health visitors aren't trained to support them to breastfeed successfully, and some of their practices - like giving bottles - actually undermine breastfeeding.

The problem is historical, in that for many years in the west there was this feeling that breastfeeding was not very important - it's only since around 1990 that research started to show clearly that, even in a developed country, breastfeeding has huge health benefits.

Julia Drown Ex-MP for South Swindon who chaired the all-party parliamentary group on maternity services

What we need to change is the culture on breastfeeding. Look around you and everywhere you see images of babies being bottle-fed. On the telly, in books, in films - where there's a baby, there's usually a bottle. In shopping centres, ludicrously, you even find that the symbol for a breastfeeding room is ... a bottle. What we need to do is turn things around so that breastfeeding becomes seen, as bottle-feeding is now, as the normal, the usual, the accepted way to feed a baby. There are huge double standards about breasts in our society: you get people who have no objections to page-three girls in the tabloids who then make a fuss when they get a glimpse of nipple when a woman is discreetly breastfeeding her baby - and that's what breasts are for, for heaven's sake!

Heather Welford Breastfeeding counsellor with the National Childbirth Trust

We need to stop clockwatching: it has no part in successful breastfeeding. In the past few years there's been a spate of popular authors such as Gina Ford who have advocated scheduled feeding, and more and more women are being pulled into this myth that it's possible to feed a baby by limiting feeds to certain amounts of time. But the truth is, if you're interested in establishing good and happy breastfeeding, then clockwatching has no place: you need to give the baby unlimited time at the breast in the early weeks to satisfy his hunger and to establish the milk supply.

The other thing I think should be done is to re-educate health visitors: they have a big role to play in supporting breastfeeding mothers: even if they understand the mechanism, they don't know how to help mothers to breastfeed exclusively for six months, which is what the government now recommends.

· Breastfeeding Your Baby by Heather Welford is published by Marshall Editions.

Deborah Jackson Author

We need to stop nagging mothers with "breast is best" messages and to re-educate the rest of society. Advertising campaigns should target dads and mothers-in-law, doctors and strangers-in-the-street. The nursing mother deserves praise, not negativity ("Getting your boobs out again, are you?"). She wants to feed without having to hide - and she desperately wants positive and practical support when there are problems, not the common reflex reaction of, "Well, put him on the bottle then!"

In 1970, breastfeeding rates in Norway were as low as those in Britain today. Then Norway banned all advertising of artificial formula milk completely. They offered a year's maternity leave on 80% of pay and, on the mothers' return to work, an hour's breastfeeding break every day. Today 98% of Norwegian women start out breastfeeding, and 90% are still nursing four months later.

· Deborah Jackson's When Your Baby Cries is published by Hodder Mobius, and A Gift for New Mothers is published by Duncan Baird.

Michel Odent Author and obstetrician who pioneered water birth

Everyone knows breast is best - ask your taxi driver, ask your hairdresser! Everyone knows it, but the rates aren't improving. And why is that? It's because the problem isn't with breastfeeding, it's with the birth process itself. The physiology of breastfeeding is closely linked with the physiology of childbirth, and if you mess with the delicate hormonal process of birth, you inevitably mess with the delicate hormonal process of breastfeeding.

There are lots of elements of this - to take just one, when a woman is in labour she releases a substance called endorphin. This, in turn, helps release prolactin which initiates milk production. The problem is that where birth is heavily interfered with by the use of drugs, the natural process isn't allowed to happen. Look at any country in the world and you'll find that where there are high levels of intervention in birth and a high caesarean section rate, there's a low breastfeeding rate. Tackle those problems, and you'll get to the root of the breastfeeding problem too.

· Michel Odent's Birth and Breastfeeding is published by Clairview.

Sally Inch Infant feeding specialist at the Oxford Radcliffe Hospital Trust

Astonishingly, there's no requirement for midwives to be taught about breastfeeding as part of their pre-registration training. It seems such a basic thing to do, and of course many people assume midwives are experts in breastfeeding. But breastfeeding is a learned skill - I trained as a midwife, but it wasn't during my training that I learned about it, it was by watching women and learning from them, as well as from other skilled experts and feeding specialists.

What figures show is that the biggest fall-off in breastfeeding rates is between birth and two weeks, and that's precisely the time when they're in the care of midwives. So what I say is, give them a clear and uniform training so they all know what they need to know. We wouldn't let a midwife qualify if she hadn't been taught how to deliver a baby, and she shouldn't be allowed to qualify if she hasn't been taught how to help a woman breastfeed.

Rosie Dodds National Childbirth Trust policy research officer on baby feeding and nutrition

What we need is a proper, joined-up strategy on breastfeeding for England. It's true that breastfeeding rates overall in the UK haven't altered very much, but there are signs that they are improving in Scotland and in Northern Ireland, where there are good strategies in place. Now we need one for England that will pull together all the important things we need - better training for health professionals, breastfeeding breaks at work for women, peer support schemes.

Another very important move I'd like to see is a complete ban on the advertising of formula and follow-on milk: at the moment companies aren't allowed to advertise formula designed for babies of under six months, but they are allowed to advertise formula for older babies. It undermines mothers' confidence: the advertising says things like "contains iron and vitamins" or "helps babies with reflux problems" - but it omits to mention that breastmilk contains iron and vitamins, and that breastfeeding is best for babies with reflux.

Bottom of the league

Despite campaigns such as Breastfeeding Awareness Week, breastfeeding rates in the UK are among the lowest not only in Europe, but throughout the world. The government undertakes a major infant feeding survey every five years - its last figures, published in 2002, relate to 2000 and show little significant difference from the previous survey in 1995.

Across the UK as a whole, 69% of mothers breastfeed at birth, compared with 66% in 1995. At one week only 55% are still feeding (56% in 1995); by six weeks the figure is down to 42% (the same proportion as in 1995). By six months, the age until which exclusive breastfeeding is now recommended by the Department of Health, only 21% of mothers are still breastfeeding at all, unchanged from 1995.

The survey also shows that many mothers who give up breastfeeding do so reluctantly. Ninety per cent of those who stopped at one week or less wished they could have continued; so did 87% of those who stopped before six weeks. Even among those who stopped at between four and six months, 48% said they would have liked to have carried on.

 

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