Health: Breast is best

When I was pregnant for the first time a "breastfeeding counsellor" came to our antenatal class to tell us that "breast is best". Given that a friend of mine had just told me breastfeeding was more agonising than giving birth, I felt compelled to ask: "Will it hurt?" "Of course not," laughed the counsellor. "It's what your boobs are designed for." She admitted there might be a little "discomfort" if the baby did not "latch on". But, she added, "Many women even find it erotic."

Sadly, according to Department of Health statistics, most new mothers do not agree. Each year in Britain 75,000 of us stop breastfeeding in the first week after our baby is born. This is not necessarily through choice.

According to Robert Finch of the Department of Health's Infant Feeding Initiative (a scheme aiming to encourage women to breastfeed), "Of those who give up in the first week, only 1% do so because they have breastfed for as long as they wanted."

In the weeks following childbirth, breastfeeders continue to drop like flies: less than half of those who breastfeed immediately after their baby is born are sticking to it by the time the child is six weeks old. And no, this is not what we want. The vast majority (80%) who give up before their baby is four months old say they would have liked to continue for longer.

So why do we stop? Most of us probably know that breastfeeding is good for babies: studies have shown that a breastfed baby is likely to be brighter, healthier and less prone to allergies than a formula-fed one.

Women are less likely to get breast, ovarian and cervical cancers if they breastfeed and can (we are told) lose the pregnancy flab quicker that way. And if the thought of a stomach like Madonna's won't persuade us all to whip out our boobs, the message that breastfeeding is convenient and "easy" (nothing to sterilise, buy or remember) surely should.

But it is not that simple. "There are," says Finch, "wide and varied reasons why women stop breastfeeding." One that will ring a bell for many new mothers is that breastfeeding is not always as easy as it looks. "It may be natural," says Finch, "but it's not instinctive." This seems to go against the antenatal message. Listen to any group of new mothers, and some will be saying how breastfeeding was not the idyll they had expected. We are, it seems, simply not prepared - psychologically as much as physically - for the difficulties that can arise when we try to do the "natural" thing.

This was certainly my experience. I was told by midwives that on day three postpartum my boobs would swell to the size of watermelons and start gushing real milk instead of the gloopy colostrum that feeds the baby in its first few days. They showed me various positions. They gave me a breast pump. I waited with a growing sense of hysteria and inadequacy for the engorgement to happen. It never did. This did not mean that I could not breastfeed. It just caused unnecessary angst.

Most of us learn something of the physiology of breastfeeding before we give birth. It goes roughly like this: when the baby is born, a hormone, prolactin, tells the cells in the breasts to start making milk; the baby's sucking then sends messages to the pituitary gland in the brain, which triggers the release of another hormone, oxytocin, which in turn makes the muscular walls of the milk-producing cells contract; this ejects the milk down the duct and out through the nipple. It is what they call "supply and demand".

But it does not always work so smoothly. My friend Rachel gave birth to twins recently. Like me, she was reassured that her milk would "come in" (they said on day five). It didn't. "I was distraught," she says. "I spent several days in hospital with hungry and upset babies." When her milk supply still hadn't come in a few days later (like mine, it took a fortnight to become properly established), she had to start "supplementary feeding": that is, to breastfeed, then give her twins a bottle of formula. "I was absolutely devastated," she says. "I felt like a bad mother. I felt like I was feeding them junk. I cried for a week."

This may sound extreme, but according to Eleanor Jackson, a breastfeeding counsellor, it is incredibly common: "So many women feel like failures when breastfeeding goes wrong, and so often it's just a matter of confidence. Breastfeeding," she stresses, "is a learned art."

Government statistics bear this out. The chief reason we give up (48% of us) in those early months is "insufficient milk supply". We either believe or are told that our breasts are failing to produce enough milk. In reality, says Jackson, it is extremely rare for women to be physiologically unable to breastfeed (reasons for this may include breast reduction surgery that has damaged the glands or a retained placenta in the first week or so after birth).

The problem is that breasts do not always look or feel like they are producing milk, and breastfed babies can guzzle frequently and voraciously. This can be alarming if you were expecting to gush milk and have a baby that takes efficient four-hourly feeds. Breastfed babies do not always gain weight in the same way as bottlefed babies, either. According to Jackson, "There is a huge 'normal' weight range for breastfed babies." The health visitor's growth chart, then, can be worrying reading for a breastfeeding mother. When - as happened to me - a health visitor informs you that your baby has not gained enough weight and that you should "top up" with a bottle after each feed, it is easy to panic. My health visitor did not discuss my diet, my rest or how often I was feeding my three-month-old baby. Nor did she suggest places I could go for support. Instead, I was sent to the chemist, feeling I had failed when, with support, I could have taken measures to increase my milk supply.

OK, so there are worse things in life than feeding your baby from a bottle. But if you are expecting your body to do it all automatically then setbacks can be profoundly undermining. "I asked the midwife in my antenatal group whether I'd have enough milk for two," says Rachel. "She told me, 'Nature's a marvellous thing - of course you will.' " It was after the problems set in that a health visitor admitted to Rachel that: "In all her time she'd only met one person with twins who'd been able to breastfeed exclusively. And she had two nannies."

Of course, childbirth educators and health professionals do not want to put us off. But surely it would help if we were told beforehand that our breasts might not do what is expected of them; that it is common for boobs or ache, or block up, or get engorged, or nipples to crack; that our babies may not gain weight exactly as the chart says; and that in the first six weeks they may feed up to 12 times in 24 hours. To present us instead with a picture of erotic mother-infant bliss is, surely, setting us up for a fall?

Janet Fyle, a midwifery policy adviser to the Royal College of Midwives, says midwives are not to blame: "Midwives aren't raising expectations," she says. "The expectations women have come from within. Midwives don't set women up; they give them information and, when difficulties arise, offer support, listening and reassurance."

Wherever our expectations come from, it is clear that the support is not always there afterwards. Another friend of mine, Tracy, experienced severe, burning pain each time she fed her newborn. She was told by midwives, health visitors, breastfeeding counsellors and her GP that nothing was wrong. "You're just the kind of person who wants things to be perfect," said one breastfeeding counsellor. Two months later, Tracy was diagnosed with thrush in her nipples. It cleared up with some cream, and she had no problems from then on.

So yes, of course we need to be encouraged; and yes, we need to be told how valuable breastfeeding is. But we also need to know - in advance - how "normal" problems are. Antenatal realism might not solve the whole breastfeeding issue - it is too complicated for that. But it might help countless women feel better about themselves, whether they choose to continue or not. And that cannot be a bad thing, can it?

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