Wednesday, 9 August 2017

Breastfeeding and the NHS: are you tough enough?

A friend came round for coffee yesterday. She's heavily pregnant and had just been to a breastfeeding workshop run by the NHS.

"How was it?"

"Useless. They showed us some films, and told us how good it was for the baby. And then they told us the stats..."

Yep, the stats. You've probably seen them.

Breastfeeding rates at birth - 80ish per cent. At six weeks, about 20 per cent. At six months?

One per cent.

In the Q&A at the end, my friend raised her hand and asked:

"If it's so great, and everything you say is true, it's a no brainer. So what happens between birth and six weeks? Why does hardly anyone carry on?"

Good question.


You know it's the best thing to do.

You know you should do it, you have to do it, it's the best thing for the baby. It's good for you; makes them clever, keeps them well.

You know there's a friend or two who is sailing through it with just a smear of Lansinoh twice a day, and pumping gallons.

But for a huge number of women, it's really, really, really fucking hard.

Physically difficult, painful, draining. Emotionally loaded with guilt, shame and the hormonal intensity, sometimes physical pain of new motherhood. And: no sleep.

Difficulty is not a reason not to do something. But it is a reason why you cannot do it alone.

But what support is there?

You have midwives - who are AMAZING at getting babies out safely and making sure they stay safe. But in many cases, are not able to support breastfeeding. Either because they can't spot the problems (don't know how to diagnose types of tongue tie, for example) or because they are so overworked.

(The lovely midwives who helped me in so many ways were only able to peer at my boobs and tell me the latch "looked fine". Only for me to cry: "but my nipples are bleeding" I was told more than once that my nipples "just needed to toughen up". I don't blame midwives.)

Would women feel better, perhaps, if they knew all this was weighted against them from the start?

That as the result of political decisions made, it is easier to lay the guilt on thick and then suggest women are too easily swayed, too weak-willed, too stupid to continue? Because they succumbed to 'societal pressures' to please their partners and get back into their jeans? A petition has been launched this week calling on the government to just stop cutting breastfeeding services. (Sign it here.)

Yes, the government provides some help. If you are able to leave the house in the first week and get to a breastfeeding group in the library, maybe someone will help you.

If you are lucky enough to have a good midwife, maybe. One of the rare visits from the mythical government funded peer support worker (rarer than unicorns), you could get help.

Or maybe if you have a tongue tie diagnosed (nine out of 12 pregnant friends had a baby with tongue tie), and you can bear to wait the six weeks for the treatment then you're in luck.

(The city I live in has ONE person trained to do this procedure, hence the waiting list.)

I was lucky in another way. Through NCT, I managed to access a saintly volunteer who turned up at my house with nipple shields, tissues and a shoulder to cry one one night, when following a traumatic birth, I was feeling like a failure in so many ways. I was lucky enough to be able to afford the £190 for the NCT course in the first place.

Maybe a friend will tell you about the existence of nipple shields (because the NHS won't).

Maybe you'll work out how to make up a bottle so that in your darkest hours, 3am, in pain, crying, you can just get through the night.

Maybe you'll read some unbiased stats on bottle feeding, and feel better (newsflash: bottle feeding is also fine).

Maybe you'll be fine, sail through. I hope so.

Maybe, maybe.

The fact is, the government could provide better training in tongue tie. It could provide midwives with more time. It could train up more support workers. It could prioritise it.

But it's easier to place the responsibility at a personal level, keeping women badly supported and under-informed about the realities of their situation. And to make them feel they personally have failed when they find it hard. Rather than being able to see that the system has failed them.

The NHS has limited money. I get it. You can't spend on everything. In which case: perhaps they can just stop with the pressure and the guilt. Accept the support isn't there, and so on two hours of broken sleep, in pain, with no help, many women simply cannot do it. And also, all the medical evidence that says bottle feeding is fine.

And you know what? Some women hate it. Also an excellent reason not to do it. Who wants to resent their kid? Your body is your own.

You might think from reading the above that I hated breastfeeding. That I tried, and I gave up.

I didn't. Within 48 hours days of arriving home with our daughter, (an extended stay due to an emergency C section), we were readmitted to hospital because of she had lost too much weight.

We had gone in first, because movement stopped - and it turned out her heart rate was not recovering fast enough.

Just writing these words, even now, makes me go cold all over. I still can barely think about it.

Did I mention I had shingles too? I got it three days before she arrived, and had active shingles through labour and readmittance - so I was kept in isolation the whole time. Nurses refused to come into my room to help because they were pregnant themselves and too scared. I get that.

Once, after being ignored for hours, on a busy ward where I wasn't allowed to leave my room and had to use antiviral hand rub every time I touched my own child, I begged them for some formula so I could feed her, fatten her up, and we could just go.

The ward was too busy to help us. The resources were too stretched. I cried at them to let me just leave. Finally, some help came. The ward called the NCT peer volunteer into the hospital, and her, the head neonatologist and the midwife put a plan together. Within 12 hours we were home.

I was put on a regime of feeding, topping up (formula and breast) and expressing every three hours. I was given a hospital grade pump, sent home with a box of tiny formula bottles, expressing kit and plastic teats and told to wake up the baby every three hours, if she hadn't woken up herself.

I did everything I was supposed to do, while feeling mentally pretty fucked up. I fought and fought to try and do at least one thing 'right'. I could never express more than an ounce. Not with the hospital pump; with foul-tasting 'mothers' milk' herbal tea, warm compresses, looking at photos of the baby.

Every day, for six weeks, I fantasised about putting her onto formula.

But I was so tired, exhausted, handling the mental load that saw me referred to the hospital psychologist for a 'traumatic birth'. So I fed, because of apathy. I didn't have it in me to try and learn another thing.

Six weeks in, it clicked. It stopped hurting. I felt reassured that she was gaining weight.

I went to the GP for the six week check. She said nonchalantly: "No one ever tells new mums that it really just takes six to eight weeks to sort out breastfeeding, if everything is going right. People think it's going wrong, so they give up. But it just takes that long." No shit.

And in the end, Rose fed until 15 months. Nothing but breast milk until six months. I fell into the vanishingly small percentage of women (less than 0.5%) that fed until over a year.

Whatever sort of feminist I thought I was before she came along, I am 1000x that now.

The shame I felt at 'failing' at birth; the terror that something could have happened to my baby before she was even born - and on top of that, the pressure to breastfeed, because I was terrified that something else bad would happen if I didn't. Well. It wasn't time or mental energy well-spent, to put it mildly.

So what is the upshot of all of this?

These breastfeeding rates are not the fault of women. They are not the fault of the people in the system. It is the system they work in, and the way it is built.

It's designed to use your guilt to help its own targets.

It can help you, but you have to fight for it and seek it out.

And perhaps, inherently, the system accepts the high rate of bottle feeding (which is remember, totally fine) as the price for not investing where it needs to.

Your guilt, your body, your baby should not be a political pawn.

Next time someone tells you breast is best, and shows you the stats. Just ask the same question.


Then perhaps we can have a real conversation around breastfeeding rates.

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