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Breastfeeding advice – too idealistic?

Is current advice to breastfeed exclusively for six months 'unhelpful' and too idealistic? A recent qualitative study has suggested 'yes'. What do you think?

Comments

Well, speaking as a midwife and a mother, I'd argue that idealism is what keeps us advocating breastfeeding - surely in an ideal world, every mother would breastfeed? So I can't see why idealism is something to be criticised!  On a personal level,I can totally see the difficulties in maintaining breastfeeding for this long. I fed each of my three for a year, and it was tough. And can I just say, I was self-employed when I had the first two, and a 3rd year student midwife when I had the third, and I had problems with mastitis and thrush with all of them, so I really do understand how tough it can be to live life with a baby at the breast! But ultimately, I kept going because I believed it was the best thing I could do for my babies.  If that makes me an idealist, then I have no problem with being seen that way!

i'm inclined to agree that bf advice is generally idealistic. having experienced breastfeeding now i will never again utter the words... 'if the attachment is good it shouldn't hurt'! breastfeeding can be painful & difficult, and nobody admits that. 

if i hadn't had the knowledge i have, then i could have easily convinced myself that it was going wrong. i kept going through two months of agony because i knew i had to do it for my son. i think success depends upon your motivation, not how easy or otherwise you find it.

now, 4 months down the line it's a joy to feed him myself, and such a small part of our day (but sadly not night!), i really look forward to our time together feeding. i look towards weaning with excitement & apprehension, but don't think it'll be a struggle to keep exclusively feeding him another two months.

one thing though, is that we ought to explain that the WHO guidance encompasses many countries where weaning carries many dangers not really applicable to the uk, so the 6 month thing should be interpreted individually with that in mind.

i've seen conversations on netmums where multips poo-poo the 6 month advice as they don't understand the rationale, and some are even weaning at 12 weeks because 'that's what they did last time'. i think explanation is key.

I don't think it is idealistic at all.  I have lived in Canada and Australia and it is not such a big deal! Women support each other, and as one of my Canadian friends said to me, people would glare at your there if you were not BF a newborn - the cultural perspective is different. I also worked with indigenous women in the Arctic and in central Australia who looked at me puzzled when I asked if they needed help with BF! They did not have the same issues starting BF. 

Yes, it can be uncomfortable for women, but I would maintain that if it is uncomfortable through a feed, then there is something not right.  I know you would disagree Melody, but I am convinced from having lots of BF training, working with LC's in Australia and from supporting mum's. If I could have a pound for the times women who have told me that they were told their positioning and attachment was ok by a midwife and BF is still painful, then after suggesting very simple P & A adjustment that BF is painfree!

I did doubt the painfree thing years ago until I went on a workshop in Australia with a session from Rebecca Glover - I was convinced after that, that BF should be painfree.

The WHO guidance is exclusive BF for 6 months and then up to 2 years! I think that is achievable as well. I have a few women coming back, pregnant again and still feeding. The 6 month exclusive guidance is to reduce the risk of food allergy and the guidance for feeding up to 2 years is to support immunity. Some babies might be developmentally ready a bit earlier than 6 months to start weaning

 and some later. Development of the immune system is thought to be in line with physical development.

I think we have to accept that, as with every other aspect of our practice, each woman is different, & some will experience painful feeding. i had lots of input, even help from a bf consultant, so my issue was not attachment, although i agree that this is generally the issue behind pain. i too would be rich with all those £s!

And i agree, we do make too much of an issue about feeding. our cultural perspective has a lot to do with women's lack of confidence in the process. but i do think that making them think it's going to be easy in the effort to convince them to try is setting them up for a fall. Perhaps if more women knew of others who had successfully fed their babies then expectations would be more realistic & women would face challenges with more confidence.

Yes, it is definitely difficult for some women and I agree that we shouldn't say it is going to be plain sailing. I wonder if midwives in general say this? I know when I talk to women antenatally, I do tell them it can be difficult for some women, but that I feel strongly that it is our job to support them through. For most women, it will be fine though, so there needs to be a happy median, as saying it is going to be really difficult wouldn't be appropriate either. 

I am a LC and a midwife and I would say we need appropriate support for women who have problems that are not resolved with usual measures (such as P & A).  Where I work, we only recently recieved funding for a 2 day per week post for an infant feeding coordinator, who's time is spent on BFI. I think time and money should also be spent on a specialised BF service, which I have seen work well in other units I have worked in. Women don't fail to BF, I think we fail to give them appropriate support.

For 12 years now I have been studying the psychology of breastfeeding....and the one thing that I have observed over and over again, is that as midwives we tend to base our thoughts about breastfeeding on our own experiences of it or if we haven't breastfed, on our educational experiences about breastfeeding, for example we go on a course. While all of these inputs into our lives play an important part in who we are and how we view breastfeeding, it is critical that we don't lose sight of the fact that women's experiences are not necessarily our experiences!

One paper that has the ability to bring us all back to reality is this one (see below) - it reports how a lactation consultant finally gets to experience breastfeeding for herself and things change! If you can get your hands on this paper - do - I think you will be as surprised as I was when I first read it! 

Fowler C, Lee A. (2007) Knowing How to Know: Questioning ‘Knowledge Transfer’ as a Model for Knowing and Learning in Health.  Studies in Continuing Education 29 (2): 181-193

Hi thanks for this! I am doing some research module; the paper is really helpful from a research perspective as well.

Perhaps we need to involve mother or service users in planning BF services.

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