The Government wants to promote a breastfeeding culture, but is it providing enough support for new mothers? Kate Holmquist reports

The nanny State may have failed to provide a comprehensive childcare policy, but that hasn't stopped it from telling new mothers how to feed their babies. Without lengthening paid maternity leave or providing sufficient support where it most matters - mothers' first few weeks at home with their new babies - the Government is trying to change the predominant baby-rearing culture from bottle to breast.

During National Breastfeeding Week recently, it launched an attractive ad campaign aimed at educating the majority of mothers who don't breastfeed that breast is best. The Government hopes to raise Irish mothers' low breastfeeding rates of 40 per cent to European levels - which range from 70 per cent in France to 99 per cent in Norway.

Some mothers are rebelling because they feel that the pressure to breastfeed is unreasonable. "Breastfeeding is not what I want to do. It doesn't suit me; I was too ill after my first baby to breastfeed for longer than a week and with my second I will try to breastfeed for the first week or two, but that's it. With a bottle, the baby's father can help me out," says Aoife*, a well-educated working mother in her early 30s. "I don't care what the Government says. Nobody's going to make me feel guilty about it."

She refuses to accept and even resents the view that a mother who does not breastfeed is making a decision that is detrimental to her baby's health. Breastfed babies have lower cot death rates, for example, and higher IQs. As Aoife tells it, she is living in the real world and after a difficult birth, she had a duty to her baby to care for her own health rather than sacrificing it. "I realised my baby would suffer if I ran my health into the ground," she says.

Other mothers do feel guilty, even when they have tried their best. Jane* soldiered on breastfeeding despite agonising pain for three months, but still wishes she'd been able to continue for longer. "You are so isolated, alone all day in the suburbs. I felt anxious and guilty, wanting to do the best for my baby." Her husband comments: "If a man had to put up with what my wife did, he'd stop trying after three minutes."

Only one per cent of new mothers are unable to breastfeed for physical reasons and after an initial transition period of a few weeks, breastfeeding should not only be painless, but enjoyable too. So why do so many Irishwomen find it so difficult?

The Government and the nursing profession have shown commitment to supporting breastfeeding. Midwives and public health nurses are trained to offer support and guidance. Maternity hospitals now have lactation consultants and the HSE even has a national breastfeeding adviser, Maureen Fallon, who travels the country nurturing these efforts. Voluntary groups such as Cuidiú and La Leche League offer mother-to-mother support - all a new mother has to do is ask. But the experiences of Aoife and Jane show that there is still a gap between public policy and the reality of new mothers' lives.

Jane, who genuinely wanted to breastfeed, did all the right things. Before the birth, she contacted a voluntary breastfeeding support group so that she would know who to call when she needed help. In hospital, she asked the midwives for advice even to the point of feeling she was hassling them, but was troubled by the fact that the midwives were rushed and gave conflicting advice. When she asked to see the lactation consultant, a midwife replied: "What do you want one of those for? Midwives are trained to do the same thing." And while the lactation consultant she eventually got to see was helpful, Jane believes just one lesson in hospital is insufficient.

Conflicting advice was probably her worst problem. She had been warned pre-birth by the voluntary group not to let the nurses give her baby a bottle because it would prevent the baby learning to suckle the breast. This is actually outdated advice. Jane's baby lost too much weight in the early days due to feeding problems and Jane eventually had to give in to a bottle, which made her feel guilty.

She also had flat nipples, and the remedy for that was to use a breast pump in the early days to express a little milk and pull the nipples out. Simple. But before the birth, an adviser from a voluntary group told her not to use a breastpump for at least six weeks as it would be harmful otherwise. This advice is medically incorrect, but Jane didn't know this, so when a hospital midwife advised her to use a breast pump, she was initially reluctant.

In fact, all new mothers should be shown how to use a breast pump and express milk while still in hospital. A little pumping can help relieve painful engorgement of the breasts; and if the mother returns to work outside the home she will know how to express milk to leave with the childminder during the day, while continuing to breastfeed in the evening.

Her experience is typical of the battle many mothers who want to breastfeed face, despite the best intentions of hospital staff and voluntary groups.

When she returned home from hospital, Jane joined a mother-and-baby group, and found that the other mothers were having difficulties too. Jane's own sister had successfully breastfed, but lives a long distance a way and could offer support only by telephone.

Eventually, about two months in, she paid for a private lactation consultant to visit her home for two hours. This made a difference, but by that point Jane was so exhausted that she still found breastfeeding difficult. Because of the pain she found it difficult to breastfeed in public, which meant that she was probably more isolated than she needed to be.

Initially Jane felt that other new mothers were out and about with their babies, while she was still stuck in a chair, alone at home, with a glass of water, a hungry breastfeeding baby and the TV remote control. Things gradually improved, until at 15 weeks she began to wean her baby on to the bottle.

Told about Jane, Maureen Fallon expresses empathy and understanding. She explains that breastfeeding is a learned art passed on from one generation to the next. In European countries with high breastfeeding rates, mothers pass this knowledge on to their daughters. There's no need to cart your baby many miles to a breastfeeding clinic.

Fallon agrees that staffing shortages in maternity hospitals make it difficult for midwives to sit and observe a mother and baby's entire feed and without this it's impossible to sort out the problem, she says. In a breastfeeding culture such as Norway, this sort of observation happens naturally at home between women. Mothers get 13 months' paid maternity leave to focus on the baby, learning meanwhile the wisdom passed on by other mothers.

In Ireland, a new mother's own mother is unlikely to have breastfed herself and is more likely to be telling her daughter to wean the baby, start a routine and become active again.

Fallon believes that the best way to challenge the prevailing culture, which has 41 per cent of new mothers breastfeeding in hospital, with many of these giving up within a few weeks, is to try to provide a surrogate version of Norwegian support.

She thinks that this can be done through voluntary mother-to-mother groups, but again there's a problem.

Maureen McDermott Quinn founded the Mayo Breastfeeding Group on her own initiative and with her own resources. Voluntarily, she assists new mothers up and down the county and her network now has groups in Westport, Castlebar and Ballina.

However, last week when McDermott launched what she and Fallon consider to be the State's first national breastfeeding website (www.breastfeeding.ie), she had to do it entirely out of her own pocket. She's hoping that advertisers will come on board to support the website.

She also points out that breastfeeding advisers need to be properly trained in communication skills, but when she applied for grants to the HSE she was refused. Jane found that the voluntary group adviser she contacted before hiring the professional consultant merely preached at her down the telephone line for half an hour, reinforcing Jane's belief that the "breastfeeding mafia" think mothers with difficulties have an attitude problem.

There may be a few diehards out there, but Fallon says that this "mafia" myth is untrue. Voluntary groups want to support mothers, not undermine them. "You can have all the information in the world, but unless you have self-belief, and someone imparting self-belief to you, it won't work."

There are cultural challenges, too. A breastfed baby suckles little and often, wakes up more at night and is generally more in need of physical closeness. The natural way for new mothers to cope with this is to regard breastfeeding as an extension of the pregnancy and to surrender themselves to lying around breastfeeding and letting other things go. But increasingly the Irish view of new motherhood, where a mother has a mere 18 weeks' paid maternity leave, is to dispense with lying around within a couple of months, then re-enter the workplace fit and well with the baby's daytime care delegated to someone else.

Irish women are legally entitled to breastfeeding breaks at work, when they can express milk or have their baby brought to them (which isn't practical in most cases). Irish women are also legally entitled to time off work before the birth to attend breastfeeding classes.

Aspirations and real life have never been so conflicting, which is why Jane wishes that National Breastfeeding Week had never happened. She saw Caroline Corr on TV3, looking slim and beautiful and talking about how wonderful breastfeeding was. It made Jane seethe. "I don't need to see Caroline Corr glowing on TV. It only makes me feel more inadequate."

The Government's breastfeeding campaign may be well-meaning, but Jane thinks that for mothers in her situation, it has done more harm than good.

*Names have been changed