I’m sometimes asked by mums-to-be or their family with chequebook poised, what do people need to breastfeed?

When you’re pregnant, what do you need to add to your list and what can you usefully do to get ready?

A lot of people are desperately keen to breastfeed and are determined to make it work but most of their commitment to breastfeeding in pregnancy is buying a super expensive breast pump, a bunch of bottles and a steriliser.

Hold your horses.

That might all prove to be useful and especially useful if you are intending to be one of the many women who provide breast milk to their child once they return to work - but there are other things to prioritise in the beginning. 

If something goes wrong, a breast pump might be your salvation but companies like Ardo can dispatch you a breast pump to arrive the next day and it will be hospital-grade and fully serviced and you won’t be stuck trying to patch through with the breast pump you probably bought for a completely different purpose. www.ardobreastpumps.co.uk/

The most useful thing you can do in pregnancy is get information.

That’s better than getting anything else.

Because unless you live in Alaska, most other things can be sourced efficiently and effectively should the need arise and having a house full of them may not send the best message to your psyche.

That might sound trite, but your belief in your own potential and your belief that breastfeeding is going to work and your faith that it probably will is part of your arsenal. Those who start with a ‘hmmmm, well, I’m going to give it a go and just see what happens. If it doesn’t work, at least I gave it a shot’ might be missing a piece of the puzzle. Your commitment and your understanding that you are a big piece of why this is going to work is pretty crucial.

Of course, for some people it might not work out. But the truth is that for the vast majority of people who really want it to work, it does. If you are prepared, if you know where to get help and when help is needed and you get help soon enough – the chances are you WILL be OK.

Those who give up early on and are unhappy about it, didn’t recognise when problems were occurring, didn’t realise what was normal breastfeeding behaviour for a newborn and struggled to find help when they needed it.

So what pieces do you need for your puzzle?

1.       Read about breastfeeding. 

 This can start early. Do you really need to read a lot about the benefits of breastfeeding? Possibly not, but you might still not have an understanding of why exclusive breastfeeding is recommended.

Read some studies – not just a couple of pages in a jolly leaflet. This stuff matters.

You may well spend hours carrying around a book of baby names.  Devote hours to this as well. Take some time to really understand what breastfeeding does for your baby and what NOT breastfeeding may do. There are links to many many studies here:  www.unicef.org.uk/babyfriendly/what-is-baby-friendly/the-benefits-of-breastfeeding/

But read some books too. Books like ‘The Food of Love’ by Kate Evans or ‘The Womanly Art of Breastfeeding’ published by the La Leche League or Dr. Jack Newman’s ‘Guide to Breastfeeding’ or his ‘Ultimate Book of Answers’.

Make sure you have an understanding of the relationship between ‘supply’ and ‘demand’ in breastfeeding, what a good latch and body position looks like and what is a normal pattern for the first few days.

2.       Think about how breastfeeding might link with your other parenting choices. 

 Research tells us that the majority of mothers who breastfeed sleep in the same bed as their baby for all or at least part of the night for at least some of their breastfeeding experience.

They might start out believing strongly that this won’t happen to them but somehow along the way, it seems to end up feeling like the best choice.

It’s important it doesn’t happen accidently but happens with careful thought.

Bed-sharing isn’t safe for all families but with the right precautions it can aid breastfeeding and make a family safer as a result.

You can read some important guidelines in the UNICEF ‘Caring for your baby at night’ leaflet: www.unicef.org.uk/babyfriendly/baby-friendly-resources/leaflets-and-posters/caring-for-your-baby-at-night/

If you want to look at this issue even further, take a look at some of the work of Dr Helen Ball (http://www.dur.ac.uk/sleep.lab/projects/bedding-in/). Her study on where infants sleep in the post-natal ward and how this impacts on breastfeeding is a real eye-opener.  A key resource for anything on infant sleep is the infant sleep infant source website: www.isisonline.org.uk/ Also have a look at the work of Dr James McKenna: (http://www.naturalchild.org/james_mckenna/)

Using a sling - not a structured upright baby carrier where the baby’s weight is compressed onto their lower spine, but a wrap or sling that allows your baby to rest in their natural position and with their baby weight evenly distributed – is something that also seems to fit naturally into the breastfeeding relationship. You can read more about this exciting world of shopping possibilities on www.thebabywearer.com and how the decision to ‘wear’ your baby is about so much more than shopping or ease of travel on the bus.

3.       Write a feeding plan.

 Got your birth plan? Write a feeding plan too. One sheet of A4 that explains to everyone around you what you consider important:  your priorities for skin-to-skin and that early feed, what you want to happen in the event of a c-section or your birth going in an unexpected direction. On that sheet have phone numbers of helplines and local support and some key phrases to help you focus on what early latching and positioning will look like.

4.       Find that local support

 Don’t leave this until you are sitting there in a dressing gown with sore nipples, wondering what happened to the last couple of days.

While you are pregnant, do your research. You want 3 types of support – someone on the end of a phone, someone who can come to your home, and local groups where other mothers meet and you can develop a network of peer support and coffee friends.

Your midwife might be able to point you in the direction of all three.  But if not, get hassling.

In the UK, there are FOUR charities that support breastfeeding: The Association of Breastfeeding Mothers (ABM), The NCT, the Breastfeeding network (BfN) and the La Leche League. Their contact details can be found on my links page. There are FIVE breastfeeding helplines. One for each of the charities and a fifth – the National Breastfeeding Helpline – funded by the Department of Health and staffed by the ABM and BfN.

In different parts of the UK, different charities are more active than others. You might have an active La Leche League group round the corner from you – with a dedicated La Leche League Leader and a network of supportive mentors. Or an NCT or ABM counsellor who does home visits and is a devoted volunteer. Or a Breastfeeding Network supporter who runs some local drop-ins and is a star. You might have to phone the charities to find out who is in your area.

Find who they are, talk to them WHILE you are pregnant and even better, if you can, go to a group and see some people breastfeeding. This might sound a bit weird but it really isn’t. It makes a huge difference to see some good latching and different positions and talk to others about their early days. You will be welcomed.

If someone asks you what lovely present they can buy you -  the babywipe warmer or the cashmere booties? – ask for a session with a qualified lactation consultant (IBCLC). Get one round to check your latch and positioning in the first few days and answer a thousand different questions about breastfeeding and check to see you are on the right path. You can find who is your local LC by checking www.lcgb.org listings. Ask them to show you their IBCLC badge and check they have professional indemnity insurance.

You should also find some of your antenatal education focuses on breastfeeding. This will vary enormously depending on the type of class you are able to find. It’s a good place to find out who is active locally and start to build up the network of peers who may see you through some tough times.

5.       Tell the people you love why breastfeeding matters.

 Buy your mum ‘The Food of Love’.

Get your partner to read the UNICEF page which links to relevant studies.

Make sure people know how important this is to you and what a normal breastfed baby does in the first few weeks and what growth spurts are and what cluster feeding is. Tell people to spend an hour on www.kellymom.com and they’ll learn some things that will help them to become members of your team.

For many of us, the first time we see breastfeeding up close is when we will do it ourselves. That’s not always going to end well.
 
We don’t live in a culture where we’ve absorbed latching and positioning and normal breastfeeding behaviour since we were little girls. We live in a culture where bottle-feeding has been the norm for decades and as infants, fewer of us were breastfed than at any time in history.

If we want to change that, it's down to us.

Pregnancy is a great time to learn more and take responsibility.

It’s exciting and scary all at the same time – as are most things that are important in life.

And one little warning - once you start reading, it’s not always easy to stop!

I’m hoping it’s a myth that the term ‘Breastfeeding Nazi’ is thrown around willy-nilly. Usually I’ve seen it being talked about in the context of what a bloody stupid phrase it is and how could anyone possibly use it and be so dismissive of concepts like genocide, fascism and racism.

But I have to assume it’s been spoken in anger a few times genuinely. I’ve heard a minor celebrity chuck around the phrase ‘breastapo’. I imagine it can’t simply be restricted to a tabloid column.

It seems to refer to the idea that there are a group of breastfeeding supporters (who might call themselves ‘lactivists’) who are focused on demeaning mothers who use formula milk with their babies and see the role of breastfeeding promotion and protection as synonymous with making formula-feeding mothers feel rubbish.

I don’t know where these people are. I’ve been to conferences, breastfeeding picnics, training days, informal get-togethers, committee meetings with Breastfeeding Counsellors and professionals and Lactivists and I’ve yet to meet someone who would fit this description.

Oh, how I wish I would meet one because it would be a joyous moment to be able to sit one down and have a conversation with one of them and ask them what the hell they are playing at.

And if I ever met a mother who had met one of these people (haven’t had that experience either), I would ask them to write a letter to whatever organisation they were from and complain just as I urge people to complain about poor experiences at the hands of health professionals.

 I know enough about the training offered by the NCT, Breastfeeding Network, Association of Breastfeeding Mothers and the La Leche League to find it highly unlikely anyone who has completed that 2 years+  training focusing on listening and empathy and helping an individual woman to reach their goals could ever be blatantly unkind to a mother who is not breastfeeding.

If someone gets through the training of any one of those organisations and can fit the criteria of a ‘breastfeeding Nazi’, those organisations would definitely want to hear about it.

I have to imagine the real ‘breastfeeding Nazis’ are the untrained or the sketchily trained: Women who don’t understand why breastfeeding might fail and are unable to empathise with why a mother might choose to use formula; Women who have their own personal issues that they have yet to come to terms with and lack any delicacy in their ability to deal with fellow human beings in many areas.

This is why I believe I am not one of these people:  I have spent countless hours with families who struggle to breastfeed for a host of complex reasons. I absolutely know how hard it can be for some people and how painful it can be – physically and emotionally. I know it doesn’t work out for everyone despite their best efforts. And I spent a lot of time trying very hard not to upset people.

I often meet people who have already chosen to use formula by the time they seek professional support with breastfeeding. This is true of a lot of IBCLCs.

What on Earth would be the point of alienating these families on the first meeting?

What a breathtaking lack of intelligence and skill that would represent on my part.

90% of the time when a parent tells me they have given their baby formula, it is a fragment of a long story and not the focus of anything useful. It was something they chose to do in that moment based on a series of complex factors. In many many cases, it was the right thing to do at that time. In some cases, it was a decision based on desperation or a misunderstanding (like not knowing young babies might cluster feed for a period of 24 hours) but it was still a decision based on the best knowledge they had at that time.

Of course, I meet the people who desperately want to make breastfeeding work.

I rarely meet the people who don’t even want to try.

But don’t assume those of us qualified in breastfeeding are intent on treating those women with disrespect either.

We reflect on why families may not choose to breastfeed in our training and we get that a mother using formula in a cafe may have a background that includes issues such as insufficient glandular tissue, hormonal abnormalities, a history of breast cancer, breast surgery, significant childhood burns or sexual abuse.

We WILL NOT be the people raising our eyebrows at the mother mixing her formula bottle. Lactation Consultants and qualified breastfeeding counsellors should be the LAST people to do that because even if you weren’t one of those people and you simply didn’t fancy breastfeeding, we will still go out of our way to offer a smile.

We want you to walk away and remember our face as a friendly person.

You might want to give breastfeeding a go next time. You might need us in the future.

You might have a friend who is struggling with breastfeeding, perhaps a friend who is mixed feeding, and we want you to feel we are a person you can trust. We hope that we are.

A Lactation Consultant is professionally REQUIRED to support an individual mother to reach her goals. If a mother tells us she wishes to wean at 3 months, we support them to do that. If a mother wants to breastfeed once a day and formula feed the rest, we support them to do that.  We work with a lot of people who want to try and return to 100% breastfeeding after using some formula but we also work with a lot of people who simply don’t. They want to continue using some formula and THAT is their decision. We are professionally required to support them and we do so warmly and empathically.

A few times I’ve been in conversation with a new mum who is exclusively breastfeeding successfully and they ask a question about whether to introduce the odd bottle of formula.  Maybe they have a friend who does it and they don’t have to 'worry about pumping' or they’ve heard a rumour it might give longer blocks of sleep. They want to talk it through. These mums are asking for information and in those cases I do give it. I talk about why exclusive breastfeeding is recommended and how occasional formula use can change the Ph level of their baby’s gut. I discuss how this will then affect the bacterial colonisation of the baby’s gut and the symbiotic relationship between friendly bacteria and our human immune system and how these friendly bacteria help the breastmilk to protect the baby’s blood stream from allergens and pathogens. I talk about how giving formula might impact on a mother’s milk supply. I talk about the research surrounding formula feeding and sleep and how the digestion of an increased proportion of dairy casein proteins may have a negative impact on a baby’s sleep cycle and healthy sleep as well as a rumoured positive one.

I usually find that a mother asking this question has read a lot about the benefits of breastfeeding and has perhaps attended some antenatal breastfeeding education but is completely unaware of how formula use might change things. We might throw the term ‘exclusive breastfeeding’ around but it’s rather stunning how many people don’t understand what that actually means and even why it’s the recommendation.

Would I give all that information to a mother already formula-feeding? 

Extremely rarely.  Because it would be inappropriate and usually painfully unhelpful.

I give it to women who HAVE the choice about whether to exclusively breastfeed and are mulling that decision over. If a woman has the luxury of making that choice, they usually respect someone who gives them straight information appropriate for their situation. And if I meet that mum next week and she chose to use formula despite the information I gave, that was her choice. I want her to want to come next week.

So I don’t go up to the mother who is feeding formula to her premature baby and talk to her about risk of SIDS. That conversation may arise if a mother has opened a dialogue or if they are encouraged by the amount of breastmilk they are now able to express - if that information might be motivating or helpful. But there may be times when it would be the least helpful thing possible to say.

Lactation Consultants and Breastfeeding Counsellors tip-toe. We are careful. We know that we live in a society where not everyone gets the information we would like them to have about breastfeeding but  we also know that we are unable to look inside everyone’s heads and see if that information is there.

If we get it wrong, please call us on it. Because the requirement for professional reflection and self-improvement exists every day and after every interaction.

I want there to be exceptionally good quality antenatal education. I want every woman who wants to be able to breastfeed, receive the support to be able to do so. Because it’s often the women who don’t, who become the angriest.

They are so angry at the system failing them, the information they were not given, the helpline call that was never answered, the things their antenatal class did not tell them - that they understandably want to lash out on occasion. The Breastfeeding Counsellors might seem like the just the sort of smug bunch who deserve some of that lashing.  We are often in love with our own breastfeeding experience – perhaps nauseatingly so.  We talk about it being ‘the best experience of our lives’. We might wear little badges and T-shirts. It’s easy to see just how frakking annoying this all might be to the person for whom breastfeeding didn’t work out for.

However it’s too easy to perceive a raised eyebrow or imagine someone turning away from you in conversation when you are livid and sensitive and in pain.

It's true we may not always understand each other's motivations.

Accepting you do not understand someone’s decision (to breastfeed the 3 year old, to formula feed the 3 week old) does not mean that person should not be treated with kindness, care, consideration.

If anything we should try harder to be kinder to the people we do not understand. It's how dialogue happens, how we learn how to support fellow human beings, how the future gets better.

It’s in professional codes of conduct and it needs to be in every action, gesture, glance between every mother.