Fill a room with 100 expectant parents and you can count on about 85-90 of those parents wanting to breastfeeding their baby. They know it's something they want to do and they fully intend to provide their baby with their own breastmilk straight from the source. However, by 6 months, only 1 of those babies will still be exclusively breastfeeding. It's quite a staggering statistic, only 1% of babies is England will be following the UNICEF and WHO recommendations to be exclusively breastfed to six months. You have better odds of getting pregnant from sex whilst using a condom or winning at a game of roulette than you have of exclusive breastfeeding your baby to 6 months of age.
So what determines the lucky 1%? A case can be made for several contributing factors, but for the sake of this article and staying focused on factors that can be managed on a personal level , those things that you can do as a parent to try and increase your chances of a successful breastfeeding journey, lets narrow it down to these two issues: 1) overcoming common obstacles and 2) knowing who to contact for support to overcome said obstacles. As I tell every expectant family I speak to, there is no way of knowing what issues you may face in those early days, but there are a few issues that parents seem to come up against fairly frequently, and if you can rule those things out quickly through being informed, then you may well be on your way to achieving your goal to breastfeed your baby.
Here are three of the most common hurdles parents experience in the first few days of their baby's life:
1. Painful Feeding
How many of us have had this conversation?
breastfeeding parent: "It hurts too much when I feed."
health professional (taking a quick peek over your shoulder): "latch looks good!"
breastfeeding parent: "Okay, so everything is okay?"
health professional: "Yes. It may just take a while for the pain to go."
And so you plod on through gritted teeth and constant toe curling and breath holding until...until you just can't plod on anymore and the pain becomes too unbearable to continue. Should feeding be painful? Sometimes it can be sore to start with while you get to grips with technique, this is a new skill for you both and it can generally take some time to master it, however you'll also want to work with someone who is capable of helping you to tweak the positioning and attachment so that you might be able to achieve that pain-free latch as soon as possible. Just plodding along through gritted teeth and hoping it gets better means you're likely to see an early end to your breastfeeding journey. How does that saying go? "The definition of insanity is doing the same thing over and over again, but expecting different results."
2. Perceived Insufficient Milk Supply
We are often let down by society on this one, because we are completely blind-sided by the length of time that we spend with a baby on our breast. Where do we ever see this portrayed in accuracy? Remember Friends couple Ross and Rachel and that little Emma that hung around for about 2 or 3 episodes and then we never saw her again and Rachel was back to hanging with friends at Central Perk. What about The Big Bang Theory's Howard and Bernadette and their little Halley who we never even get to lay eyes on. It's rare we ever get to see a baby breastfeed, usually it's often just alluded to; we definitely aren't ever shown the extent a baby will be on the breast feeding. Most parents expect to feed their baby and then put them down, getting a bit of a break of about 2-3 hours before they need to feed again, but after a bit of a sleepy start, most babies will stay firmly attached to mum's breast, which can cause many parents concern over whether baby is getting enough milk, or whether mum has low supply. What happens more often than not is that parents begin to offer supplemental milk which can compromise mother's supply. Where it wasn't initially a problem, it now becomes one. Baby can also begin to develop nipple confusion or bottle preference and it can cause difficulties with keeping them happy at the breast.
One of the best indicators of whether baby is actually getting enough milk at your breast is whether enough poo is coming out. What goes in must come out! If you're seeing lots of poos, then you know baby is getting the colostrum and milk to push this out.
Of course, there are times when a baby that is always on the breast may actually be a cause for concern and it may be the case that they are not getting enough milk and require supplemental milk. Seeking knowledgeable support to work this out for your particular family can help you troubleshoot what might be going on and how you might be able to supplement baby, if it's needed, in a way that is supportive of the breastfeeding relationship. You may also be able to develop a plan back to exclusive breastfeeding, where that is your goal.
3. Quick Weight Loss Post Birth
In my experience, this seems to be on the rise. Perhaps it's due to an increase in birth interventions, or various maternal conditions that affect fetal weight, like diabetes or obesity, but we are beginning to see a lot of babies lose a lot of weight quite quickly post birth. It's within the range of normal for a baby to lose up to 10% of their birth weight in the first few days of life, however sometimes they can lose more. Working with someone who has knowledge and experience around breastfeeding, can help you to determine whether there are other risk factors to make this sudden weight loss a concern, or whether all things look normal and baby is likely just finding their appropriate centile on their weight chart.
These three issues seem to make up the majority of the concerns that plague parents in the early days of their baby's life. Each of these things can spell out an early end to our breastfeeding journeys or they can be overcome when we are supported by knowledgeable breastfeeding professionals. Which brings me to my next point, who do we ask for help?
The majority of parents will access support from the NHS staff in hospital or from their routine postnatal home visits. Very few parents even realise they can access breastfeeding support via other channels. You may find that you achieve successful breastfeeding without needing to seek out further help, or you may find that you'd like to build a network of professionals and get second, third, fourth,etc.opinions on your breastfeeding struggles. Knowing that you have options and what your options are are key to getting that support that is unique to your family unit and your breastfeeding dyad.
The following is a very brief description of who's who in the world of breastfeeding support. Lactation Consultants of Great Britain have a more detailed chart if you'd like more information. The Baby Friendly Accredited Health Professional
Prerequisites: None required in addition to already being the necessary health professional.
Training/Qualification: Ideally 18 hours of BF education, annual update of 1-6 hours to meet BFI audits.
Scope: Should be able to recognise newborn norms and (in)effective feeding, various risk situations like hypoglycemia, jaundice, NEC, etc. and challenges like mastitis, tongue-tie, weight loss/slow-gain. Knowledge varies according to situations where HPs work specifically. Those working with high risk premature babies, would have knowledge surrounding those specific issues. Those working with older babies/children in community would have knowledge specific to those issues. Work within the scope of their existing employment.
Prerequisites: Varies drastically across organisations and regions, but usually need to have breastfed for 3-6 months, and a passion for supporting mums with breastfeeding on a volunteer basis.
Training/Qualification: 16-36 hours of BF education. Continuing education should be provided, not necessary.
Scope: Encourage parents to breastfeed and support basic breastfeeding issues, painful latching, cluster feeding, using a pump, hand expressing. Should be able to recognise and explain newborn norms. Should employ listening skills when speaking with the mother and provide her with information and assurance relevant to her concerns. Complex issues (e.g. weight gain issues, jaundice, tongue-tie assessment, etc) referred to a specialist. Work under supervision and to organisation’s procedures.
(inc. NCT, ABM, BfN, LLL)
Prerequisites: Fed their own baby for 6-12 months (depending on organisation).
Training/Qualification: Varies across organisations, the average is a 2 year programme of education. Continuing education should be provided, not necessary to maintain role.
Scope: Extensive counselling skills; employ listening and reflection to explore mothers’ concerns and meet with appropriate information to make decisions on how to move forward. Can provide resources to parents, can not do any physical assessments or diagnosis of mother or baby. Refer complex issues of a medical nature. BFCs can work in either a paid or volunteer capacity, varies by organisation. Adhere to the individual organisation’s policies and procedures.
International Board Certified Lactation Consultant
(this DOES NOT include unregulated lactation consultants)
Prerequisites: a mother who is a breastfeeding counsellor with one of the recognised organisations, a health professional working in breastfeeding support capacity, or an IBCLC mentored applicant.
Training/Qualification: Various listed medical and science courses that include, but not limited to, Anatomy/Physiology, Child Development, Nutrition; a health professional would have gathered this through their qualification, a BFC would complete these courses individually. A 90 hour Lactation Course, 1000 hours of lactation specific clinical practice. Must recertify every 5 years and must retake exam every 10 years.
Scope: Any breastfeeding issues, in addition to common norms. They would manage complex situations, high-risk babies, oral assessment, physical assessment of mother, medications (but not prescribing), relactation, extensive knowledge of infant feeding. Some IBCLCs may also have counselling skills as a result of previous qualifications. They adhere to the Code of Professional Conduct for IBCLCs.
It may be that you don't encounter any issues with regards to breastfeeding, but statistics show that the majority of parents do encounter them, and knowing who can help you overcome those obstacles is paramount to continuing to feed your baby. Having this knowledge and support is what will eventually get parents on the path to reaching their breastfeeding goals and what will also eventually see that 1% statistic grow to more!
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