Don't be too keen to wean
Long-term breastfeeding is considered an oddity here, but statistics suggest it is best for baby, writes SHEILA WAYMAN
IF SOMEBODY had told Maria Moulton five years ago that in 2012 she would be breastfeeding two children simultaneously and one of them would be old enough to talk about it, “I am not sure I would have even started”, she says, jokingly.
“You don’t start out breastfeeding a three year old or a four year old – you start with a tiny little baby and they grow every day and you don’t really notice.”
Having seen her eldest child, Lily, self-wean at three years and 10 months, she is now tandem feeding three-year-old Anna and baby Maggie who was born last January.
Toddlers still get plenty of nutritional value from breast milk, she points out, as well as enjoying the closeness with their mothers, and it is particularly useful if they are sick and off their food.
But the nursing of toddlers is not something that is much talked about in Ireland and rarely seen. Many breastfeeding mothers who have no problem feeding their small babies when out and about become much more circumspect as they grow bigger.
“You don’t see somebody nursing a two or three year old very often,” points out Canadian-born Moulton, who lives in Cork and is author of The Mammy Diaries. Even she, who campaigns for support for women who choose to breastfeed, thinks twice about feeding Anna in public.
“I would love to be able to say I’d whip it out no problem. But [at that age] they are old enough to know if people are thinking ‘that is kind of odd’. They pick up on things. I don’t want them to get uncomfortable with it.”
However, on the positive side, when she was in a play centre recently, a member of staff came up and told her she was “amazing” and Moulton wondered what she was talking about.
“I didn’t even realise it, but Anna had come over for a quick nurse; the baby was in the sling and she was latched on too. Generally we do not tandem nurse in public.”
Without tapping into a network of mothers also nursing into toddlerhood and beyond, Moulton says she would feel a lot more isolated.
It is a point echoed by all the women interviewed for this article. And a closed group on Facebook, “Extended breastfeeding in Ireland”, that was set up earlier this year, now has nearly 500 members.
Describing itself as a “parent-to-parent support group”, it says it has intentionally left the nursing age limit for joining the group completely open but that all its members agree that breastfeeding for “quite a while” is a good idea.
Áine O’Sullivan, a mother-of-one living in Rathmines, Dublin, has always taken breastfeeding one day a time and continues to feed her son Mathew, who is now two and a half. She found the first two weeks “the biggest hump” and settled into it after that.
But when he hit six months she began to feel a bit isolated. Most of her breastfeeding friends had stopped by four months and he was the oldest baby in the breastfeeding support group she was attending.
O’Sullivan, a primary teacher but currently at home full-time, started a blog, titled andmybaby, for other mothers who feel like her and want to take a similar approach to parenting.
“I am an advocate of breastfeeding for people who want to do it,” she stresses. “I am not trying to convert people.”
The feeding of infants is a curiously divisive topic among mothers in Ireland, where the rate of breastfeeding is one of the lowest in the world. Some women who breastfeed complain about the lack of support and others who choose to feed their babies formula say they are made to feel like bad mothers by proponents of breastfeeding.
Statistics show that just over half of mothers here start off breastfeeding (compared with 99 per cent in Norway) and that number drops off sharply. It is down to a quarter by three months and only about 3 per cent follow the World Health Organisation’s recommendation of exclusive breastfeeding for the first six months.
Although there has clearly been an increase in awareness of the health benefits of breastfeeding for both mother and baby, the message that, after the introduction of solids, continued breastfeeding is recommended until age two or older may come as a surprise to many.
While anything beyond six weeks might be seen as “extended” breastfeeding in Ireland, says lactation consultant Sue Jameson, the average duration across the world is 4.2 years.
Toddlers only have the odd feed during the day, she explains, but they will still be getting about 35 per cent of their protein requirements from breast milk “so it is very good for the fussy eater”. It is also helpful for the “needy baby” who wants a lot of emotional contact.
Once breastfeeding passes the 18-month mark, mothers tend to let their children self-wean, says Jameson, which usually happens between the ages of three and four.
“It can happen at any time out of the blue, or it can happen gradually. Some babies just wake up one morning and say no; others are content to keep dipping back once a day or once every couple of days.”
The effect of breastfeeding on fertility varies from woman to woman. During the full-time feeding of a baby up to six months, provided there is feeding during the night and no spoon feeding or drinking from a bottle, it is about “97 per cent effective” as contraception, says Jameson.
On the first baby, it is usually seven to nine months before the mother’s period returns. Continued breastfeeding reduces fertility, so older mothers who are keen to get pregnant again quickly may curtail their feeding.
However, plenty of breastfeeding women have no problem getting pregnant again and the milk will only stop in the latter days of the pregnancy, shortly before labour. “It suddenly drops and more colostrum comes in for the new baby.”
The only rule around tandem feeding is to feed the younger child first, says Jameson. Sometimes the older one will choose to wean naturally at this stage – maybe triggered by the drop-off in supply, or change in taste.
Vicky Blair, a mother of three who lives in Swords, Co Dublin, also never planned to be breastfeeding two of her children at the same time – “it just happened”. Her first child, Sam, now aged five, self-weaned at two years, seven months, when she was four months pregnant with her second child, TJ. But TJ was just 17 months old when she became pregnant again and he continued to feed throughout the pregnancy.
“Sometimes he may not have been getting anything – it might have been just for closeness,” says Blair, who was a bit worried that the colostrum would not come back. But it did and her third son, Jake, got all of that.
When she and Jake came home from hospital, “TJ upped his feeds quite a bit”, she says. “But he did understand that the baby got it first. Sometimes they fed at the same time and for the first while they kept to one side each, which seemed to work best for us.”
While Blair never expected to be feeding two, she wasn’t going to suddenly stop with TJ when his little brother arrived.
“It would have done him more harm than keeping going, we would have been denying him. They hold hands when they are feeding now. I think it helped ease Jake into the family.”
Jake is now six months old and she expects TJ, who will be three in July, will self-wean shortly, as he has gone back to just two feeds a day.
Blair returned to work in the public service six months after each of her pregnancies. In general, employees are only entitled to take breaks for breastfeeding or expressing milk until the baby is six months old, but as a civil servant Blair is entitled to an hour’s breastfeeding break each day until her child is two. You can use that hour, she explains, to express in the office or to reduce the working day by an hour in the morning or the evening.
Friends of Breastfeeding, of which Blair is a committee member, is campaigning to extend the rights of all working mothers to breastfeeding breaks, pumping rooms and storage facilities, up to two years.
MILKING IT: BREASTFEEDING AND AVOIDING CHILDHOOD OBESITY
The finding that children who are breastfed and weaned onto solid foods later have a lower risk of obesity at age nine, as announced last week, may be explained by nutritional and/or behaviour factors in those early months.
Parental BMI – one of the strongest determinants of childhood obesity – is among a wide range of variables controlled for in the research, which is based on data collected by Growing Up In Ireland.
The study, published in the journal Social Science and Medicine, finds that children who have been breastfed for three to six months are 38 per cent less likely to be obese at nine years of age than exclusively formula-fed children, with those breastfed for six months or more 51 per cent less likely to become obese.
Its authors, Dr Cathal McCrory and Prof Richard Layte of the ESRI, look to other international studies in speculating on the reasons for this finding. A key explanation may be the slower weight gain of breastfed babies: rapid weight gain may predispose babies to metabolic risk later in life. Formula milk has a higher density of energy and protein than breast milk.
When it comes to behaviour, breastfed babies consume a large feed in the morning followed by smaller feeds during the day. Bottle-fed infants take the same amount at regular intervals – suggesting that parental control rather than hunger cues might drive infant feeding, which could have a lasting effect on regulating appetite.
SUPPORT FOR LONG-TERM BREASTFEEDING
“Are you still breastfeeding?” is a question that every mother who continues to breastfeed in Ireland becomes very familiar with. Sometimes it is asked in admiration, more often with an increasing sense of concern, or even disgust, as the months turn into years. It is no wonder some longer-term breastfeeders begin to question themselves and look around for others doing the same.
“You need a different kind of support when you are just beginning to breastfeed and when you are continuing to breastfeed,” says Vivienne Bwalya, who attends a Cuidiú group in Dublin southwest for mothers with older babies that meets weekly in different houses. It evolved from an early breastfeeding group: as it happens, nearly all of them are continuing to feed well past the first year.
On a recent Friday morning, the mothers sit on chairs that ring the front room of Hannah Smolenska’s redbrick terraced home in Rathmines, while their toddlers play with toys on the bright blue rug in the centre of the wooden floor.
“When you come here you find out lots of things are ‘normal’ and you can come up with your own prescription for living,” says Bwalya, a mother of two whose younger child, Naoise (18 months), is with her this morning. “I didn’t have this kind of support with my first child.”
An administrative assistant, she went back to part-time work when Naoise was 10 months. “I was going to express but she didn’t need it. So when I’m there she feeds and when I’m not she doesn’t.”
Sarah Coss has come with Maebh (19 months) and Ruairí (five months). She had hoped to feed them in tandem and was quite upset when Maebh, who was only five months when she got pregnant again, stopped breastfeeding as her milk supply dropped. “I had fed my older son until 15 months,” she explains. “It was very hard, because Maebh was so little, to end that relationship.”
When Maebh moved on to formula, she had problems digesting it and had other health problems. So, after Ruairí was born, they decided to give her one bottle of expressed milk a day, which she drinks more enthusiastically than any of her other bottles. “I was really open to her going back to the breast,” adds Coss, “but she didn’t know what to do.”
Self-confidence is a huge thing in breastfeeding, says Caoimhe Whelan, co-ordinator of this branch of Cuidiú, who stopped when her eldest boy, Ruairí, was 19 months. “For the last six months of that, I was thinking ‘I should wean him’.” Now continuing to feed her second son, Lorcan (20 months), she feels it is regarded as an “inconvenience” by medical staff because he has type 1 diabetes. The attitude has been “we are not suggesting you give up but how do we measure what he is getting”, she explains. “I feel quite undermined.”
Sacha Johnston, who is feeding Odin (16 months), says breastfeeding is most often questioned over the issue of sleep. There is also an obsession with independence and mothers “getting their life back”.
By continuing to breastfeed, “I am clearly not prioritising myself and my relationship”, she says ironically.
When Donna Reid became pregnant at the age of 18 with her first child, it was presumed she would not be breastfeeding, that she would be handing over her child to her mother and going “out partying”.
“I desperately wanted to breastfeed and I did breastfeed him. I was a student nurse and I knew it was best and knew it was something I wanted to try.”
She stopped at six months with her son but now, nine years later, she is continuing to feed 14-month-old Saoirse.
Singapore-born Jeanne Collins, who is breastfeeding Cian (16 months), says it was a struggle in the early months, until his tongue-tie was fixed at four and a half months. “It was so easy then, I wasn’t going to stop.”
As the women discuss attitudes to breastfeeding, the crumbs on the floor multiply and the noise level increases among the tiring toddlers – only abating when one or two retreat to their mother’s breast for comfort.
If we were all living in another country where breastfeeding is unquestionably the norm, says Johnston, “we wouldn’t be having this conversation”.