Women need Foundations, not just Scaffolding!

A report on a talk given by Sharon Breward, RGN RM RHV IBCLC BFC (ABM)

Sharon works as a health visitor in North Wales and as part of that role, she runs antenatal breastfeeding workshops for pregnant women in the community. The first question Sharon posed during her talk at the ABM Conference was: Why is antenatal preparation for breastfeeding necessary?

Well, we all know that breastfeeding is "normal", but it seems that our society views breastfeeding initiation as an “optional extra”. The NHS seems to have abdicated its responsibilities for clinical breastfeeding care to the voluntary agencies and therefore such skills are not viewed as necessary for health professionals. No other area of clinical care gives the option to "opt out" of best practice. Achieving Baby Friendly Initiative status may be optional but it is the only evidence- based framework of benchmarked clinical care standards for breastfeeding care and as such its standards should not be viewed as optional. The breastfeeding rates in Australia and Norway are far better than the UK. If other countries in the West can achieve good breastfeeding rates, why can't we?

Sharon then took a look at the language used when discussing breastfeeding: "benefits", "problems", "support". Maybe we need to change the way we talk about breastfeeding? There are no benefits of breastfeeding. There are risks of artificial feeding. We should be giving honest information to women. We need to empower women, and preparation is the key. Knowledge is power. Women need foundations. What is meant by that? Foundation: an underlying basis; load bearing part of a structure. The definitions of the word, "support" (as opposed to "foundation") are: bear all or part of weight; assist, encourage, approve. Is "support" enough?

Breastfeeding women need more than just support, they sometimes need skilled help; expertise. When a women experiences complex breastfeeding problems there should be a referral pathway to a specialist, just as there are referrals for other clinical issues. So, a new dawn?

  • Present the problems of not breastfeeding
  • Offer women "foundations" not just "support"
  • Provide care pathways and specialist resolution
  • All women deserve practical preparation.

In the community where Sharon works, all women receive:

  • Leaflet from GP which details some of the evidence of the potential problems associated with artificial feeding.
  • Feeding Your New Baby leaflet is given at midwife booking.
  • A personal invitation to a Breastfeeding Workshop is given to all women once they are over about 30 weeks of pregnancy.

If women choose not to attend the workshop they receive one to one preparation for breastfeeding. This is a potted version of the workshop covering the basics of breastfeeding and a review of the main issues. A video is loaned and a doll is used to show the positioning and “plugging in” process.

Breastfeeding Workshop

The workshop is a two-and-a-half hour session for mothers-to-be and their partners: small group of participants; emphasis on practical skills; and information. Vocal, visual and 'hands on':

  • I hear it and forget it,
  • I see it and remember it,
  • I do it and I know it

The sessions are held in the evening so that partners have an opportunity to attend. Humour is used a lot— when they're laughing, they're listening!

Content of the Workshop

The attendees are asked what they already know about feeding a baby, and where they got this information from. Influences will be: parents, the media, relatives, society in general, friends. Are we a breastfeeding society? The attendees are shown a graph showing the breastfeeding statistics in Wales and Australia (at this point, the dads often comment that they now realise “why the Welsh rugby team is crap!”). Wales has a national strategy to improve breast-feeding rates. Breastfeeding is important. The attendees are given a handout explaining the risks of artificial feeding. The information includes some more statistics as below.

If you choose to bottle-feed your baby, in one year you will

  • make up 2000 bottles
  • use 200 hours to do this
  • spend eight or nine whole days in the kitchen
  • spend around £600

The attendees are asked to consider, "what is a mammal?". Sharon showed us pictures of adult animals, and baby animals. She put a picture of a baby animal with the wrong adult picture. Would we expect a sheep to feed a kitten, for example? Would a dog feed a baby goat? A picture of a cow was placed next to a picture of a human baby. "Why do we choose to feed a baby human another species milk?" Other animals' milk is closer to human milk than cow's milk, so why do we use modified cow's milk? At this point, Sharon picked up a tin of formula milk with a picture of a cow on it. Much more relevant than the usual pictures of fluffy ducks!

During the workshop, attendees are told how to get breastfeeding off to a flying start:

  • lots of skin to skin after the birth - it's the baby's first cuddle until he is ready for his first meal.
  • video - "Self Attachment" which shows the effects of medication (during labour) on the baby's ability to breastfeed.
  • discuss medication in labour and the effects of separation immediately after the birth.

How is milk made?

They discuss:

  • how mum's milk protects baby from illnesses
  • colostrum is the baby's first precious gift from mum
  • colostrum is the baby's first immunisation - a package of protection
  • hormones used to make milk: Prolactin is the Delia Smith, Oxytocin is the waiter
  • a breastfeed consists of starter, main course, and pudding.

A young Indian doctor of Sharon's acquaintance found the idea of mother and baby sleeping separately very strange. Back home in India there were no cots on the maternity ward.

How do you do it?

Most of have learned to ride a bike, perhaps to drive a car...... when learning to breastfeed consider the midwife and health visitor as your “stabilisers”! Stops you wobbling too much and keeps you on the straight and narrow!

  • Forget about positioning and attachment - learn to "plug in" properly!
  • When latching the baby onto the breast remember s/he needs a wide open mouth - think BIG MAC rather than spaghetti.
  • Breastfeeding video - "A guide to successful positioning".
  • Get out dolls, cushions, telephone directory (foot rest) and practice.
  • Discuss co-sleeping as an aid to breastfeeding - how to do it safely.

What to expect

  • How often to feed the baby - watch the baby not the clock
  • A breastfeed is like a Mars bar - helps baby work, rest and play!
  • Breastfeeding is about more than just transferring food.

DANGER PERIOD—THE BIG THREE!

Three days: Tearful mum, frantic baby!

Third week: Growth spurt and mum possibly coming down to earth after euphoria of birth, and too many visitors. Mum is running on adrenaline.

Three months: Growth spurts and general development of baby. Babies seem to go a bit barmy just as you think you've got the hang of it!

  • No need to panic - help is always at hand
  • Mother and baby anxiety cycle - dad to the rescue
  • Food myths - discuss eating while breastfeeding - how to ignore the old wives tales
  • There is a weekly drop in - Baby Club” to discuss any breastfeeding worries
  • When out and about with baby, look for the "welcome to breastfeed here" sign

Mums are often keen to know about expressing so that they can go out and dad can be involved. Sharon advises them to wait three or four weeks if possible. She shows them the technique of hand-expressing on a breast model but doesn't go into great detail about pumps at this point but each woman is given the UNICEF leaflet which explains expressing. After the baby is born, expressing is discussed as and when mum feels necessary. Towards the end of the workshop, mums who have recently given birth come along to share breastfeeding experiences.

Sharon recounted a story about a mum of twins who had attended an antenatal workshop. When Sharon visited them at 11 days postnatally, the twins were being bottle-fed and mum was in tears. She had wanted to breastfeed but it just hadn't worked out. Sharon suggested that it wasn't too late, and how about trying them at the breast now? Mum went from tears to smiles in five minutes. The babies fed well and mum was eventually able to fully breastfeed.

The workshop ends with a light hearted look at pictures of celebrity breastfeeding parents - to help make breastfeeding “cool”! Catherine Zeta Jones, Victoria Beckham, Claudia Schiffer, Emma Thompson, Sadie Frost, Fiona Phillips, Fern Britten and more - "James Bond" actor, Pierce Brosnan is a breast-feeding dad and is a particular favourite of the mums! Sharon pointed out that she has to spend hours “researching” this information in such academic journals as Hello magazine!

Finally, does this approach to preparation for breastfeeding work? YES! In Sharon’s practice the continuation of breastfeeding at eight weeks improved by 20% in the first year of the new approach to preparing for breastfeeding. In the second year the continuation rate rose by another 16%. Preparation it seems…. is a launch pad for success!

This workshop is now available for appropriately trained ABM members to use throughout the UK under license to the ABM. More details can be found here