Sunday 17 December 2017

Is breast best when done for longer?

Only 10pc of mothers are still breastfeeding at six months, despite recommendations

Claire Ui Shuileabhain, Clonmany, Co Donegal, with her daughter Aine (left) and Fionnuala
Claire Ui Shuileabhain, Clonmany, Co Donegal, with her daughter Aine (left) and Fionnuala

Penny Gray

BREAST is best, proclaim the billboards, and many of our maternity hospitals proudly display the Baby-Friendly Initiative plaque, which aims to promote breastfeeding throughout the pregnancy and birth experience.

But although initiation figures are growing – according to the latest figures from the HSE, about 47pc of mothers are breastfeeding upon discharge from hospital, up from 32pc in 1991 – duration remains worrying low, with research studies indicating that less than 10pc of babies are still breastfeeding at six months of age.

The current recommend-ations are that babies are exclusively breastfed until they are six months old, at which age solids are introduced to the diet. Many mothers assume that this is the right time to wean their babies on to a bottle – but breastfeeding for an extended time has many benefits for both mother and baby.

Caz Koopman, who is breastfeeding her 19-month-old daughter, Liobhan, was only made aware that she could feed past six months at a lactation course she attended prior to the birth of her daughter.

"I didn't realise there were any benefits in feeding past six months/a year – I thought the people who fed beyond this were a bit weird – but I read somewhere that breastmilk is 90pc stimulation, brain development and so on, and 10pc food."

Claire Ui Shuileabhain tandem fed her sons until they were both five years old (they are now 20 and 17) and is now tandem feeding her two daughters, who are six and three years old.

"Babies nurse when they are upset, they nurse when they are happy, they nurse when they are sad, or hurt, or any emotion they might have," she says. "I have found with my sons that the love and sense of security they get with breastfeeding has actually made them more independent and secure individuals as they grow into adults."

Claire's experience of tandem feeding shows that breastfeeding has many different faces. "Tandem feeding wasn't something I planned, but I believe in the child weaning naturally, and my three-year-old son wasn't ready when I got pregnant.

"When I was about seven months' pregnant, he complained that my milk tasted a bit "off" but he carried on regardless and I ended up feeding them both. I also tandem feed my two daughters, but my elder daughter has just recently self-weaned at the age of six.

"I think of it as a selfless act, there are times when you have to turn down a social invitation because you have to stay and feed the babies, but it's a conscious decision that I have made, and in the grand scheme of things, it's not very much time in their lives."

We've all heard the jokes – "if he's old enough to ask for it or if he can chew steak, he's too old" – but is this really the attitude we have as a country? "I have had people say to me that she was too old for it now," says Caz. "Or that I'll never have another baby while I'm still breastfeeding – but that's not necessarily true. I don't want to wean Liobhan early on the off chance that I might not get pregnant again. And who's to say what will happen?"

Remmi Rabidoux, who is feeding her son George, who is four-and-a-half, was heckled by a comedian at a gig for breastfeeding her son.

"Before I had a child, when I lived in the States, I would approach a mother who was breastfeeding in public and thank them for doing it, as little girls who don't see it as normal will not grow up to do it.

"I've never felt funny about breastfeeding in public because I don't think people usually know what you're doing. But I was at a comedy gig and the support comedian heckled me from the stage. He just wouldn't let it go, and I remember feeling a bit sorry for him. At the intermission, about half a dozen people came up to support me."

Claire had her sons in the UK, but moved to Ireland before she had her daughters – did she notice any difference in the attitudes to breastfeeding between the two countries? "I have to say I did," she says.

"There was more of a presumption that you wouldn't breastfeed, a lot more self-consciousness, and a lot more negative comments made about nursing. But I was very fortunate to have a La Leche League group close to me, and although it didn't change what I was intending to do, it did lessen the sense of isolation."

Many women think that breastfeeding is something that comes naturally to some women, but that others have problems and "can't" breastfeed. Yet research would indicate that unless there's a medical reason why a women can't breastfeed, eg medication, the vast majority of women can breastfeed and can work through any problems they encounter.

Both Caz and Remmi encountered extensive problems after the birth of their babies but managed to work through them.

"Liobhan had a fairly tight posterior tongue tie that wasn't diagnosed for some weeks," says Caz. "It looked as though someone had taken a cheese grater to me. I had to top up with formula (but she usually refused it). But luckily I had done a lactation course before birth so I knew who to turn to."

Remmi encountered problems too, and supplemented with breastmilk from Ireland's only milk bank in Co Fermanagh – as well as milk from a good friend. "George was born quite ill, he had aspirational meconium and was in special care for almost three weeks. I was pumping milk, but when he came home, he was exclusively at the breast and I had a low supply.

"At the time, between the fog of new motherhood and the stress of having a sick baby, I didn't realise that the problem was not me, it was him.

"For the first month he was sucking on the tube and I think that messed up his suck. He eventually worked through it and my milk supply rebounded.

"He was probably three months old by the time I stopped supplementing. I probably could have increased supply by pumping, but I literally couldn't fit in the pumping around his feeding, which was constant.

"So a friend who had a four-month-old pumped some milk for me. She thought it was no big deal but I think that if I live to 140 years old nobody would ever do anything as lovely and generous for me. It meant the world to me that I didn't have to give him formula."

So while it's clear from Remmi and Caz's stories that breastfeeding is something that needs to be learned through experience, for both mother and baby, is there any merit in education for the mother in, say, antenatal classes? "I don't think anyone can learn to breastfeed by sitting in a class – it's like learning to ride a bike in a classroom," says Remmi.

"I don't think it's something you can learn in a step-by-step format. But I think you can educate a person about what's normal – that it's normal for a new baby to feed constantly for the first few days until the milk comes in, but that it does change.

"I feel that culturally we've moved from a place where people would sincerely believe that formula was no different from breastmilk, that it really didn't matter, to a place where people know that this isn't the case," Remmi continues. "I think people now feel they should breastfeed and put pressure on themselves, but I think a lot of women don't want to breastfeed.

"My fear is for the next generation; not that they don't think that breastfeeding isn't important, but that they think it's incredibly difficult, that their sister or their colleague or their friend had tried to breastfeed but failed. And as it's fairly unheard of for women not to produce sufficient breastmilk, I think the women who give up very early on are maybe uncomfortable with saying they wanted to give up. Women say they are going to "try" to breastfeed – but you don't say that about learning to drive a car."

'If women don't have experience of babies being breastfed, they mightn't know that babies are supposed to feed constantly for the first few days and that they're going to be up all night, and that if they don't position them carefully they're going to get sore. I think it's important to convey to women who haven't got to that stage in their lives that it can be difficult and often it doesn't work, but that women who are motivated to continue can get through such problems.

"I don't mean that as a judgment on anyone's decision, but it's a danger lurking around the corner for the next generation."

The media would have you believe that formula feeders think that long-term breastfeeders are hippy types with an unnatural obsession with their children, while breastfeeders think that formula feeders are willfully poisoning their babies out of sheer laziness. Most mothers would say that in their experience this is not the case, so where did this attitude spring from?

"I think there's a lot of hype," says Caz. "[Lactation consultant] Clare Boylan was the one who told me to go to La Leche League and I was a bit skeptical, I thought they might be all a bit mad. I had to top up around the time of Liobhan's tongue tie and I thought I'd be given a lecture about how bad a mother I was, but they couldn't have been more supportive.

"But with the knowledge I have now, I would never formula feed my child. I feel strongly about it for my child, but I don't have the right to make that decision for anyone else's child and I wouldn't judge someone either. I think the only person who has a right to judge me as a parent is my child."

For more on La Leche League, log on to www.lalecheleagueireland.com; to contact lactation consultant Clare Boylan, see www.breastfeedingconsultant.ie

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