Breastfeeding is [insert word here]

Breastfeeding isn’t just something to discuss alongside chats about the day’s nappy contents (korma-coloured or mustard?). It’s a topic that really gets some people going.

Wading through inflammatory headlines (‘breast is best’, ‘mammary mafia’), conflicting research and mixed professional advice is challenging. Doing so after 6 feeds, 12 nappy changes and a grand total of 4 hours’ sleep is a million times harder.

So this post is for all expectant parents and every 3 a.m. breast/bottle/combi-feeder struggling for straight answers on breastfeeding.

(Disclaimers: Tired mum of 3 under 4. Doctor of 10 years and GP.)

BF-ing is recommended

Good infant nutrition is important, and we all want what’s best for our little ones. Despite this, the way we choose to feed our mini people varies massively and often causes controversy.

The World Health Organisation’s recommendation to breastfeed exclusively for 6 months¹ is based on evidence, but many amongst the general public seem to question whether the benefits are exaggerated, or if the advice is even relevant to us in the UK. So, here is a quick summary of the research.

BF-ing is good for the immune system

There’s no denying it - breastfeeding saves young lives that would otherwise be lost to diarrhoeal diseases in countries where contaminated water is used to hydrate infants or make up formula.²

You’d be forgiven for thinking that this doesn’t apply in the UK, with our excellent water supply and sanitation. And yes, we’re incredibly fortunate to have a low infant mortality rate in this country. But studies show that, in the UK, breastfed babies have fewer episodes of gastroenteritis than those not breastfed.³

Breastfeeding reduces the risk of ear and chest infections too. This is seen across a variety of populations of different wealth and stages of development. The benefits also extend beyond infancy and into childhood. ^{2, 4}

Brainy babies

Breastfed babies do better in intellectual and motor development assessments, even when the mother’s IQ, socioeconomic status and other potential confounding factors are taken into account.⁵ The average IQ difference is in the region of 3 points.

Is breast really best?

Does breastfeeding protect a child from obesity, cancer, hypertension, diabetes and allergies? Some studies suggest yes, but more research is needed there.^{4, 6} Does breastfeeding reduce a mother’s risk of breast cancer? Yes.⁶

So, on balance, based on the evidence available, it is better to opt to breastfeed (3 key words coming next) if you can, as there are definitely plenty of reasons to do so.

We may not like to hear this, especially those of us who haven’t breastfed as much as we’d have liked, but it’s important to know the facts. Not to beat ourselves up with, but to help expectant mums in making an informed choice.

Why does the UK have one of the lowest breastfeeding rates in the world?

The 2010 UK-wide Infant Feeding Survey found that just 1% of mothers are still exclusively breastfeeding at 6 months. In fact, most women will have stopped long before 6 months, with 24% of English mothers exclusively breastfeeding at 6 weeks.⁷

We also know that 80% of new mums initiate breastfeeding, and of those 8 out of 10 will stop breastfeeding sooner than they wanted to.⁷

This suggests that the desire to breastfeed is there for many, but for those 80% who would have liked to breastfeed for longer - something got in the way.

But BF-ing is so natural and easy

[huge eye roll]

If you want to get the mum-guilt going nice and early, when your super extra maxi pad and jumbo underpant combo are still in situ, that old chestnut is sure to do it. Add a 36 hour-long labour or recovery from an emergency c-section and it’s likely you already feel as if you’ve failed at the whole Mother Earth thing (*putting my hand up here*).

Few feel they’ve sailed through conception, pregnancy or birth. Some will have experienced birth trauma or have mental health problems related to the pregnancy. So, when the time to breastfeed comes along and for whatever reason it isn’t working out, your Lansinoh-clad nipples sting like your perineum and you don’t resemble the perky smiling nursing ladies in the pictures, it’s yet another (pardon the pun) let-down.

A great breastfeeding consultant is worth their weight in gold and I can tell you that from both personal and professional experience. Unfortunately, there isn’t consistent access soon enough after birth for many women, and expectations of what breastfeeding is and feels like are often poorly set by antenatal classes and social media. Breastfeeding is hard and only the owner of the breasts can shoulder the load.

If you do make it through the early newborn days to established breastfeeding, the story doesn’t end there. Because that day will come when you venture out of the house in search of caffeine. And then, the general public gets involved.

BF-ing is embarrassing

There is legislation to protect your right to breastfeed in a public place. But that doesn’t stop ill-informed and often insulting opinions being proffered by passers-by. The most absurdly offensive thing I ever heard was, ‘it’s like masturbating in public’. It is not a surprise, therefore, that women feel awkward or ashamed to breastfeed out and about.

Nursing covers are a blessing for some, but a hindrance to others - there are so many limbs and layers of clothing under there that it’s easy to get tangled or lost, plus your baby will play peek-a-boob at the least appropriate moment.

Then there are all sorts of social etiquette dilemmas. To breastfeed or not to breastfeed around your father...or your father-in-law? On public transport? In a restaurant?

According to research by Swansea University and revealed by Dispatches, 40% of women who stop breastfeeding by 6 weeks cite being judged, discouraged and shamed in public as a main reason.⁸ This isn’t a surprise to me and unlikely to be a surprise to you if you’ve ever been in this situation.

There are still many women being turned away from cafes and restaurants or being asked to nurse in toilets. I recently heard a woman on the radio suggesting that new mums ‘should just stay at home’. Sounds like a jolly great idea, eh? Certain to work wonders for those mothers already experiencing loneliness and isolation.

BF-ing is a personal choice

Yes, breastfeeding is a controversial topic. A few years back, Tamara Eccleston’s ‘brelfie’ (that’s a breastfeeding selfie, for the non-Instagrammers amongst us) was met with mixed opinion. Journalists coined terms such as ‘mammary mafia’ and ‘nipple nazis’ to suggest the image would shame women who chose not to breastfeed. And others berated Tamara for daring to bare at all.

Ultimately, at the heart of it, we’re all trying to do what we think is best for our little ones and ourselves.

We need to be mindful that many women do want to breastfeed. We must also be supportive and understanding of those who can’t or do not wish to, and much (MUCH) more accepting of the fact that breastfeeding is a personal choice.

It isn’t always easy or painless, every baby is different, and every family has their own personal circumstances. That’s not to say we shouldn’t be pro breastfeeding - we know it has plenty of proven benefits - but instead of judging one another’s decisions, we’re better off putting our efforts into pushing for more accessible breastfeeding support and continuing to shift society’s rather bonkers opinion of nursing mothers.

References

1. World Health Organization (2019). Breastfeeding. [online] Available at: https://www.who.int/nutrition/... [Accessed 25 Jul. 2019].
2. PAHO (2002). Quantyfing the benefits of breastfeeding: A summary of the evidence. [online] Available at: https://www.paho.org/hq/dmdocu... [Accessed 26 Jul. 2019].
3. Renfrew, M., Pokhre, S., Quigley, M. and McCormick, F. (2012). Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. [online] Unicef.org.uk. Available at: https://www.unicef.org.uk/wp-c... [Accessed 26 Jul. 2019].
4. Hörnell, A., Lagström, H., Lande, B. and Thorsdottir, I. (2013). Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food & Nutrition Research, 57(1), p.20823.
5. Strøm, M., Mortensen, E., Kesmodel, U., Halldorsson, T., Olsen, J. and Olsen, S. (2019). Is breastfeeding associated with offspring IQ at age 5? Findings from prospective cohort: Lifestyle During Pregnancy Study. BMJ Open, 9(5), p.e023134.
6. Victora, C., Bahl, R., Barros, A., França, G., Horton, S., Krasevec, J., Murch, S., Sankar, M., Walker, N. and Rollins, N. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), pp.475-490.
7. McAndrew, F., Thompson,, J., Fellows, L., Large, A., Speed, M. and Renfrew, M. (2010). Infant Feeding Survey 2010. [online] Sp.ukdataservice.ac.uk. Available at: https://sp.ukdataservice.ac.uk... [Accessed 26 Jul. 2019].
8. Hosie, R. (2018). Why Britain has some of the lowest breastfeeding rates in the world. [online] The Independent. Available at: https://www.independent.co.uk/... [Accessed 26 Jul. 2019].