If I had a pound for every time I heard someone ask “Can every mother breastfeed her baby?” I would be a wealthy woman. Certainly, if the horror stories, tabloid articles and certain books and websites are to be believed, the odds of an individual mother succeeding at breastfeeding are pretty dismal. Is breastfeeding success a matter of luck then? Is it something of a relic – what we did hundreds of years ago and we might as well resign ourselves to low expectations? Or is there a more complicated, yet more complete answer? Well, if you’re still interested to find out the truth, read on…..
All the following statements in bold are true. There are a few ‘ifs’ and ‘buts’ though!
Nearly everyone can breastfeed
Ok, don’t roll your eyes at me! This really is true. But it would be a short blog if there wasn’t more to the story!
Nearly everyone can breastfeed if they are prepared
Ah, I hear you say! Yes, not every family is prepared for the realities of breastfeeding in the first few days. Babies should be feeding a LOT. This essentially ‘calibrates’ the milk supply for the long term. Frequent, effective feeding in the very early days (especially the first 2 weeks) sets a mother’s milk supply for the duration of her breastfeeding experience. See this video for a more thorough explanation.
Nearly everyone can breastfeed if they are prepared, and well supported
Ok, let’s say you were prepared antenatally for a feeding marathon for the first week. Let’s assume that you are ok with that, maybe even embrace it because you understand the necessity of it. Still not easy if you don’t have a back-up crew on hand. So often, friends and family can be a little unimaginative when they offer to help a family with a new baby – frequently suggesting that they feed the baby with a bottle ‘so the mother can rest’. If only everyone knew how potentially damaging this can be for a fragile and yet-to-be established milk supply, they would think more creatively! There are SO many ways to support a new mother so she can focus her efforts and resources on feeding her baby – bathing, winding, changing, settling, dressing and singing to babies. Caring for older siblings, doing the shopping, cleaning, and cooking. Encouraging the new family, being the visitor gatekeeper, providing company and a listening ear. That’s what a new family needs!
Nearly everyone can breastfeed if they are prepared, well supported and nothing major interferes with the process of establishing milk supply
When I’m training others, I explain milk supply by using an analogy. Don’t get hung up on the analogy – you’ll see what I mean!
Let’s say the average ladies shoe size in the UK is size 6. That means that tiny little size 3 feet exist, and so do size 10 feet. But size 6 feet are waaaay more common. Look at the graph below:
Most women have a totally normal milk supply, provided nothing major goes wrong (size 5-7 feet)
Some women’s milk supply is vulnerable. They can tolerate problems less. They may also have a medical condition (size 2 feet)
Some women have a natural tendency to oversupply. They can probably get away with more, and still have no problems with milk supply (size 9 feet)
Size 2 Size 6 Size 10
Now, I appreciate that this is a silly example, but both size 2 and size 9 feet are normal. Unusual, yes, but normal. However, unlike feet, you cannot tell whether a mother has a natural tendency to struggle with milk supply before she gets going. So, my recommendation to everyone is to assume she has size 2 feet. Let’s try to make sure we have all eventualities covered, make as few mistakes as possible, and do the best we can.
So – to have the best chance possible:
- Breastfeed early (within the first 30-60 minutes)
- Breastfeed often (at least 8-12 times in 24 hours)
- Expect and plan for night feeds – long gaps with no breastfeeding at night are seriously risky in the first few weeks
- Make sure breastfeeding is effective (see this video, and my earlier blog)
And I know some of you are now wondering what medical conditions I’m referring to. Well, none of these guarantee problems, but they are known risk factors. You may have every condition in this list but still have oversupply, or you may have none of them and really struggle. Everyone is different, but in general, these conditions may make breastfeeding a little more of a challenge:
- Polycystic ovary syndrome
- Female factor infertility
- Breast reduction surgery
- Insufficient glandular tissue/breast hypoplasia
- Under-active thyroid
- Previous breast cancer requiring mastectomy or radiotherapy
More often, to be honest with you, the problems are less serious in origin, and relate to infrequent, ineffective or scheduled feeding, or separation of mothers and babies. Read my earlier blogs on what to do if your breastfed baby is admitted to hospital, and how to rescue breastfeeding from disaster.
Nearly everyone can breastfeed if they are prepared, well supported and nothing major interferes with the process of establishing milk supply, or they have swift access to skilled support to resolve problems
Ok, now, there are no two ways about it, we are becoming a more complex population! We are older when we have our babies, we have more health problems, and we have more complicated pregnancies and births. However, even with all this, most women can still breastfeed. But they certainly do need prompt support. Support from someone who is skilled and knowledgeable, calm in a crisis, and able to help the family to 1) Feed the baby, 2) Protect the milk supply, and 3) Figure out the underlying problem and make a plan. That person could be a midwife, health visitor, peer supporter, breastfeeding counselor, or IBCLC. But remember, just because the problem you have hasn’t been solved yet, doesn’t necessarily mean it cannot be solved. Keep asking for help!
Nearly everyone can breastfeed if they are prepared, well supported and nothing major interferes with the process of establishing milk supply, or they have swift access to skilled support to resolve problems that are resolvable and the woman wishes to persevere
Now we’re in the eye of the storm! This is where I get into the real bit of my job. Most women encounter a roadblock in their breastfeeding journey. Whether they get over the roadblock or not depends on:
- Their motivation to breastfeed (no judgment here!)
- What the problem is
- How old their baby is
If the problem is resolvable, and the mother has the support and internal resources to get over the bump in the road, then yes, she can still breastfeed. I’m not going to lie and say that all problems can be fixed. Unresolvable problems cannot be resolved. That would be doing a great disservice to the wonderful, motivated and committed mothers who have had absolutely enormous problems to overcome and no matter what we tried, it didn’t work out. However, most of the time, problems are not fundamentally unresolvable.
What’s the takeaway?
Well, the simple question, ‘can every mother breastfeed her baby’, has a simple answer on the face of it. But we need to stop tiptoeing around the potential problems. For too long, breastfeeding advocates have insisted that nearly everyone can breastfeed. My takeaway message is ‘nearly everyone can breastfeed, if they are prepared, well supported and nothing major interferes with the process of establishing milk supply, or they have swift access to skilled support to resolve problems that are resolvable and the woman wishes to persevere’. This isn’t another way of saying ‘you’ve got to get a bit lucky to succeed with breastfeeding’, or ‘it’s common to not have enough milk’. This is about being realistic with women, so they know what to expect. This is about empowering women so that they have solutions up their sleeves when they hit roadblocks. This is about not dumbing down or sanitising breastfeeding information so we ‘don’t put women off’. We have high breastfeeding initiation rates in this country. The reason they fall away so spectacularly is that roadblocks happen. Period. We need to stop pretending there are no roadblocks and give women a map to show them the diversion instead.
Lyndsey Hookway is a paediatric nurse, health visitor, IBCLC and holistic sleep and behaviour coach. She works privately at www.feedsleepbond.com as well as for the NHS and as an independent lecturer and trainer. She offers webinars and bespoke training for health professionals, childcare, sleep and maternity carers and parents. Her first book will be published at the end of 2017.