How the NHS fails new mothers on breast-feeding

So much distress could be spared if a breast-feeding counselling service could be available universally and on demand

14 June 2014

8:00 AM

14 June 2014

8:00 AM

There is really no question about whether it is best for babies to be breast-fed, at least for the first few weeks of life. Plenty of research from around the world has proved conclusively that breast-fed babies, who receive all the mother’s antibodies from the colostrum (produced during the first few days) and then the milk, have a better resistance to infections and viruses, and get them more mildly if they do succumb. They have fewer allergies, have a 20 per cent lower risk than formula-fed babies of dying between the ages of 28 days and one year, and may be protected against some diseases that strike later. Breast-feeding also creates a bond between mother and baby, helps the mother to reduce her weight back to pre-pregnancy levels, and reduces maternal stress levels and the incidence of serious post-partum depression. None of this is now a matter for debate.

So, given the massive benefits, why do some mothers in the developed world never start breast-feeding or, which is even more common, give it up in despair after a few days or weeks? It is certainly not for want of information about the benefits.

Not many issues are so affected by the issue of social class as that of breast-feeding. Of those who never start, far more mothers come from social groups C2, D and E than A, B and C1. It is a commonplace that working–class mothers rarely breast-feed. From the time when I had my first child, when I was 35, until now, I have known and known well a dozen women from C2, D and E who have not attempted breast-feeding. Their reasons were various but only one was too ill to do so. I asked the others, tactfully, why they had not considered breast-feeding, because I wondered why anyone would not. After all, if for no other reason, women consider the economic one. It is far more expensive to bottle-feed — formula milk, bottles, teats, sterilisers and their chemicals are expensive. Breast-feeding is free, and it is a myth that it costs a lot because the mother has to eat extra quantities of costly food. A good balanced diet and a lot of water are all that is required; and even women with poor diets manage to breast-feed successfully, simply because nature takes what it needs for manufacturing milk first. The mother’s own nutrition takes second place. (That is one of the biggest problems in the third world.)

The reasons I heard ranged from ‘I just don’t fancy it’ to ‘It’s disgusting’ and often included, ‘He says he isn’t having it, those belong to him.’ No one gave the halfway reasonable answer: ‘So that he can take his turn doing the night-feeds.’

But it is a little more complicated than I have made it sound, for two main reasons. A lot of working-class women have felt patronised by the breast-feeding fascists, who go on marches, display banners on their cars and take part in flash breast-feeding sessions in public places. Oh yes. When I lived in north Oxford, I felt sorry for any woman who dared to buy formula in the local chemist, because she risked running the gauntlet of these females, who would accost them and tell them aggressively why they should be breast-feeding, and list the harms they were doing to their child by not doing so. No wonder these self-appointed breast-feeding police were sworn at or even physically assaulted. How dare they? They have the facts on their side, not the right to bully.

But set aside the women who do not attempt to breast-feed, and look at the many others who decide to do it, want to do it, start doing it, but give up after a week or two. They are the ones who have a problem and need advice and assistance. In the last year alone, I have known four young women who have been in this situation. Two gave up breast-feeding and two struggled on painfully, eventually getting the help they needed.

It is a long time since I was a nursing mother, but given that I had my last baby when I was 44, not so long as it might be. I remember all too vividly the first days of trying to feed my daughter, and being in physical and emotional distress because I did not seem to be succeeding and had absolutely no idea why. The midwives in the hospital had been helpful, and when we were there apparently all was well, but once we got home, everything went downhill. My health visitor was worse than useless. She suggested I try both bottle and breast-feeding, which is not easy because the mechanism for delivering milk from breast and bottle teat is quite different and the baby becomes confused. I was hysterical, my child was hungry and cried non-stop — my world began to fall apart.

And then a neighbour called with a misdelivered letter. She had four children and had been a midwife. Within an hour she had checked the baby for tongue-tie and me for any breast problems, and discovered nothing wrong, but she showed me that my daughter was not latching on to the breast correctly. It does not always come instinctively to a baby, but once the whole little hungry mouth had been guided to take in a larger circumference of breast than merely the nipple, deep, satisfactory sucking commenced. We never looked back. My last baby fed easily from the start, perhaps because I had full confidence that I knew how to do it, perhaps I was more relaxed, or perhaps she was a better feeder. Whatever the reason, there was never a moment’s problem, she fed hugely and slept deeply, and so did we.

But what about those young mothers I know who have abandoned breast-feeding in despair — or come close to doing so? They include my own elder daughter, who, after a couple of weeks of misery with a hungry, crying baby, and at first no help and then conflicting advice, was given the name of a private breast-feeding counsellor and paid for two sessions with her. It was, she says, the best money she ever spent. The same happened more recently, with two friends. One paid; the other was extricated from her unhappy mess of being desperate to feed, not succeeding, and having a ravenous and hysterical baby, by someone who voluntarily visits such mothers and gives them an hour or two of advice and guidance. Bingo. And that, unless there is some other, possibly more serious problem — is all it takes. But those unhappy early days are very common — they probably happen to most first-time mothers who breast-feed.

The number of health visitors has been cut back so far that now the service barely exists. Midwives are not breast-feeding counsellors — they receive only an hour or two of tuition when they are training, and do not come out to see mothers beyond the first few days. There are voluntary advisers who work out of hospitals, but you cannot guarantee there will be one in your own area when you have problems. Where they do exist, they are very overstretched.

So much distress could be spared new mothers, and fathers, and babies, if a breast-feeding counselling service could be available universally and on demand. Perhaps those who could afford it might pay to subsidise those who could not. How many mothers would not gladly hand over hundreds of pounds to be got out of the awful cycle of hunger-crying-failure-to-feed-distress that goes round and round, causing untold pain, feeling of failure, rejection of the baby, sleep deprivation, strain on partnerships?

It is no use expecting the NHS to provide teams of free feeding counsellors as of this moment, but perhaps a start could be made by women who have fed their own babies successfully, and who have some spare time, volunteering to visit and help new mothers to feed successfully. Others might train and have a part-time job as paid breast-feeding counsellors. The time given up to a mother and baby is minimal by comparison with the rewards of setting them on the road to confident, successful, enjoyable, calm feeding. Those months during which I breast-fed my own babies were among the most fulfilled, contented and delightful of my life. I only wish I were not too old to volunteer myself.

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Show comments
  • The NHS should inform all women that if they want their children to be healthy and brighter then the rest then they should all breast feed (This is a proven fact)

    • Susan Hill

      Indeed. But they cannot force them and some simply will not for the reasons given above.

      • I believe the reason why some women don’t breast feed is because they are told the wrong information such as the manufacturers of bottle milk (This is because they want to sell their product)

    • I couldn’t stand the thought of a baby sucking my nutrients — what I needed for my life — out of my body. I’ve always guarded my body as my own. One of the reasons why motherhood really wasn’t on the cards for me.

      • In your own words not on the cards for ME.(But how about your child?) Love is giving and when you give. you will get it back, Trust me that’s true love

  • Kitty MLB

    Yes indeed breastfeeding is best.
    Its why bosoms were created, and the healthiest babies are
    always breastfed.
    Admittedly it can be uncomfortble, as they are like little
    sink plungers and some stop quite late when babies have
    teeth appearing. And then the issue of feeding in public.
    Yet mothers can use their own milk in bottles.
    There really is no other substitute.

  • Mrs Josephine Hyde-Hartley

    Breastfeeding is free and easy , but you have to singularly want to do it on demand, unconditionally because there are no half measures – Happy or unhappy, babies don’t do anything half heartedly.

    And It’s wonderful telling people you ” don’t know” how much milk the baby has taken – there’s none of that bottle half-full or bottle half-empty dithering.

    • Susan Hill

      You do get a good sense of how much they’re drinking though.. my first one faffed about and never took much at one time.. the last just sucked very vigorously I could practically watch the foam on the pint going down the glass.

  • Liberty

    What is absent from all MSM discussions concerning class is the fact that WC people cope with life worse – on average – than MC people. It is obvious why; bright people with better adapted characters do better in school, get better jobs, marry people similar and have children that inherit their characteristics, money, lifestyle, etc. Those children of WC parents who are more able, do better in school, get better jobs, become middle class, marry MC people, etc and pass their characteristics on to their children just like those who were born MC. So, the MC will ALWAYS do better [on average] on any variable you care to mention than the WC. It has always been so and always will. What defines the MC are being better educated, having better jobs with better pay, etc so if they weren’t like this they would not be MC, they would be WC.

    This does not mean that we should not help WC people who are not coping so well of course and there are many exceptions either way, it is just that the things that make people members of a social class are the the things that make them more or less successful. It cannot be otherwise.

    • manonthebus

      Unless, of course, you are WC and become a top class footballer or a rap star or just a good-looking celebrity, or you win the lottery (I nearly forgot that).

  • shellgirl

    Why are you too old to volunteer? We breastfeeding peer supporters give what time we can, I’ve never heard age come into it? Join us- it’s fabulous 🙂

  • Peer Supporter

    Dd a lot of research for this post did we? There are hundreds, if not thousands, of volunteer Peer Supporters up and down the country doing exactly what you have asked for. We help in hospitals and children’s centres, have websites, Facebook pages, telephone helplines, etc. The only thing we cannot do is a home visit but most areas will have local children’s centres. Mums also need to reach out for the help that is available instead of just assuming it’s not there. We’re trying but it’s hard with little more to work with than enthusiasm and passion. As for too old to volunteer? Never.

    • Susan Hill

      I know about those and I did a lot of research but 4 young women I know failed to get any NHS help… one in Norwich, one in Bristol, one in High Wycombe – and my daughter could get none so paid – not a huge amount and it was best money ever spent but in spite of asking at clinics and hospital, the others could get no one … home visits are actually of the essence when this is the problem – Why be so snide to me ? The ones I knew tried hard to find help I can assure you.

      • Peer Supporter

        It was not my intention to be snide and for that I apologise but, similarly, I felt that you were dismissive of the work being carried out.

        I would question how hard your four young ladies tried to find help as a quick google search has revealed numerous sources of free help and support in all of those areas (Peer Support, Breastfeeding Groups, NCT groups, local NHS helplines, etc.) As I said, the help isn’t going to come to them, they have to seek it out. Having said that, our area is soon to start a telephone service where the volunteers will telephone new mums in the first few weeks but, even then, how many mums will tell us what we want to hear because they are scared to admit they might be ‘failing’?

        I agree that home visits are essential but in my area we have a paid NHS Breastfeeding Support Team so the volunteers are not required to do any (I am not sure if it would be allowed in any event for safety/insurance reasons).

        Hard work is being done and change will happen but it is a two-way street and we rely on mums being brave enough to tell us when they are having problems and that’s not always an easy task!

        If you really feel as passionate as you seem to, please consider volunteering as a Peer Supporter. You know the old saying, if you’re not part of the solution then you’re part of the problem!

        • Susan Hill

          Apology accepted but I have had a deluge of mail from people saying they couldn’t get help .. many went to private breast feeding counsellors, several said they had tried volunteers who didn’t help, even though they were very nice…it worries me that you suggest I might help because it is so long since I breast-fed, I wouldn’t be remotely qualified, even with training and I might give all sorts of incorrect guidance. I am not in any way suggesting volunteers etc don’t exist but WHY do new mothers find it so hard to find you ? WHY don’t GPs and midwives etc pass on details ? One or two got someone on the end of a phone but you need a person there beside you. The private counsellors must have insurance and health and safety checks obviously – one young Mum (Bristol) had a private counsellor come out at 10 pm. and stay for 4 hours, helping her.

          • Peer Supporter

            The role of a peer supporter is to inform, support and empower, not to advise. We have regular training to keep up to date and a team of professionals we can call on for help, if necessary. We can check that a baby is attaching correctly (which is usually the problem) and help with other minor issues but, if there is a medical need, we guide mums towards the relevant help.

            I can only speak for our local area but the volunteers are providing the midwives with our details to pass on during antenatal appointments and we attend antenatal classes. We also ‘advertise’ our Facebook page wherever possible and get involved in community events. GPs are trained but are not really the best people to visit initially with a breastfeeding issue.

            I can’t agree that help is hard to find but only because that’s not my experience. I do believe, however, that many women choose not to access it through embarrassment at ‘failing’ at something that allegedly should be second nature. There is no shame in asking for help but, unfortunately, for some, it’s easier to reach for the formula.

            Interestingly, out of our 110 page ‘likers’ on Facebook, only one person responded to a request for feedback on the breastfeeding support in our area so either we’re getting it completely right (unlikely) or mums are short-changing themselves by not speaking up about what they need until it’s too late.

            Maybe you should find out whether there is a maternity liaison service at your local hospital and go along to a meeting to ask them why there isn’t more help? They need this sort of feedback.

            I agree the NHS should do more, particularly considering the significant cost savings it could see through increased breastfeeding rates but the service is so disjointed that, like everything else, it’s a postcode lottery.

  • Jayne Joyce

    I am very sorry that you heard of such difficult experiences in North Oxford, Susan! I am surprised; I’ve never come across this, or heard of anything like it since I have been working in this area. Jayne Joyce IBCLC, Facilitator, North Oxford Baby Cafe, and Leader, La Leche League North Oxford

  • Neilgadhok

    I agree wholeheartedly with the writer. My wife recently came out of hospital having relied on them to give breast feeding support. They singularly failed to ensure my daughter was latching on and feeding. Very distressing for Mum and baby and the only option was to hire a private lactation consultant in the middle of the night. Best money we have spent. She a) diagnosed tongue tie which the NHS had failed to look at and b) ensured we saw her hp again free if charge at a local breast feeding counsellor. There is no point in the NHS saying breast is best when it fails to follow up with the correct professional advice. This is a specialist subject and sadly training seems to be lacking.

    • Susan Hill

      It is very worrying that so many doctors and midwives fail to diagnose tongue tie. Friend had both babies with it, both double checked, and found to be ‘fine’ thugh tongue-tie runs in the family. Both babies couldn’t feed, distress all round until in each case GP and then district nurse found the tongue-tie at once.

  • Guest