Doctors need to hammer home breast message

The State’s first national breastfeeding co-ordinator stresses the importance of breast milk to babies as she marks her retirement

DOCTORS NEED TO give a clearer message of support for breastfeeding, according to the State’s first national breastfeeding co-ordinator, who retired last week.

In other countries the medical profession is unequivocal about it, Maureen Fallon tells The Irish Times. But in the Republic, which has the lowest rate of breastfeeding in the world, doctors send out a qualified message.

“They’ll say, ‘Breastfeeding is great, but if it’s not for you that’s okay’. There is always a ‘but’ there – implied if nothing else.”

The difference that medical advocacy could make is evident in premature baby units where nearly all mothers provide expressed breast milk “because the doctor has said this is going to be a significant part of the baby’s treatment”, she says.

With evidence emerging of ways in which formula-feeding changes the biology of babies – “their body fat is different, their electrolytes are different” – maybe it is time, she suggests, to look at the risks of the decision not to breastfeed, as opposed to saying breast milk has “add-on” advantages.

When Fallon took up the post, initially in the Department of Health, in 2001, just under 42 per cent of mothers started breastfeeding. By 2008, the latest year for which figures are available, the rate was marginally over 50 per cent.

That compares to an initiation rate of almost 100 per cent in Denmark, Norway and Sweden. There is also a rapid fall-off here, with only about 3 per cent of mothers reaching the recommended six-month milestone of exclusive breastfeeding.

“Duration rates are still quite low, but the trends are towards longer breastfeeding, which is very encouraging,” she says. “For our society in general, that is what is going to change our culture around breastfeeding.”

Various factors contribute to the low rates – not least of which is the loss of expertise and confidence in breastfeeding as the majority of mothers in the last two generations opted to bottle feed.

What upsets Fallon more than anything else is where mothers who are committed to breastfeeding find the early stages too difficult – “although natural, it is a learned art” – and decide to stop before even establishing it.

“They haven’t even experienced breastfeeding, to my mind, because they have just seen the downside of it.

“I was never somebody who wanted to promote a cause as such, but for mothers to see it was achievable for them and that they didn’t need to doubt their abilities to breastfeed. We also need to ask society to value it and to make it easier.”

All babies and mothers are programmed to breastfeed, and breast milk is the “ultimate bespoke” product, designed to ensure your baby survives and thrives.

“It is not made for any other than your own individual baby. Why would you go out and buy an inferior product?”

It is also about more than delivering milk – the intimacy and body contact involved strengthens the mother-baby bond.

A first-time mother usually looks for support from her own mother who, if she did not breastfeed, will almost certainly advocate a bottle if there are “problems”.

Frequent feeding, which is normal for very young babies, can be seen as a problem when breastfeeding is judged on the pattern of bottle-feeding, she says.

“Because the bottle-fed baby is given a feed which is difficult to digest, it is more likely to be quieter for longer because the food stays in the gut longer. But that isn’t the norm.”

Health services need to provide better support, but she believes the breastfeeding training that has been organised by the HSE, mainly for midwives and public health nurses, has improved the quality of the service in recent years. “I see midwives and public-health nurses really going the extra mile for breastfeeding.”

There is also much closer co-operation with voluntary organisations, such as Cuidiú and La Leche League, who, she says “play a blinder” in building the confidence of mothers through peer support.

Her biggest frustration as national breastfeeding co-ordinator was not being able to progress strategies promised in the five-year action plan, Breastfeeding in Ireland was devised in 2005.

“Nevertheless,” she adds, “it is still there and the HSE has made it a priority to continue its implementation, so I am heartened by that.”