Hospital support for breastfeeding is only the start. It is what happens in the home and the community that is likely to determine if mother and baby can strike up a really happy feeding routine.
Research shows that the attitudes of a woman’s mother and partner are very influential on whether she attempts, and then continues, to breastfeed.
However, no two babies are the same so it is not just first-time mothers who may encounter initial challenges. But at least experienced breastfeeders know it will get easier and all the advantages it brings.
For those looking for guidance, the public health nurse is a first port of call.
But few of them will be International Board Certified Lactation Consultants (IBCLCs).
Some of the country’s 197 certified lactation consultants work in private practice. Others – such as midwives, medical practitioners, nurses and nutritionists – have studied for the standalone qualification to enhance their own roles.
Nicola O’Byrne is president of the Association of Lactation Consultants in Ireland (ALCI), which has 123 certified members, as well as associate members in training or who have a particular interest in the area.
Operating a private practice based in Sandyford, Co Dublin, she outlines the rules that govern the work of all lactation consultants:
Feed the baby: "First, we try to increase or maximise intake at the breast," she explains. "If this isn't possible – maybe the baby is too weak – we give expressed milk, then donor milk, then formula as the last option."
So, there are times when lactation consultants will recommend formula, with a view to it being a temporary measure.
Sometimes it will have to be used long-term but it is entirely feasible to keep breastfeeding as well if the baby is supplemented correctly, she says, such as with the use of a tube at breast or paced bottle feeding.
Protect the supply: "If the baby isn't feeding well enough or not frequently at the breast, then we will get the mother to hand express and pump her milk." This increases the supply and means more breastmilk for supplemental feeds.
Sort the problems: This may include recommending seeking treatment for muscle restrictions following birth, frenotomy for tongue tie, antibiotics for mastitis, healing the mother's nipples, and emotional support.
The mother gets to decide: The mother is the one to choose the most appropriate plan of action for herself and her baby, says O'Byrne. "She is the one who is doing it and there are always many ways to achieve this."
Fiona Ring, from Killester in Dublin, contacted O'Byrne after she had struggled for more than six weeks to nurse her second child, Maia.
There had been no such issues with her first daughter Aisling, now aged five, who had fed “like a dream – I loved breastfeeding”, says Ring.
But Maia was spending “every waking moment crying”, never seemed satisfied and was being fed at very frequent intervals.
“I felt she had a very shallow latch,” says Ring, who was determined to push through the pain it was causing her breasts in the hope of reaching the blissful state she had achieved with Aisling.
When O’Byrne first saw Ring and her baby, she didn’t know which of them to be more worried about.
All the signs were that Maia had tongue tie and she was referred to Dr Siún Murphy, a plastic surgeon in Blackrock Clinic who also takes a particular interest in breastfeeding.
She cut the tongue tie and, when O’Byrne rang a couple of days later to check on their progress, a very relieved Ring was able to say: “We have a new baby”.
At last, Maia was contentedly feeding and sleeping.
In talking about lactation consultants, it is important to stress that they are most likely to see cases where there are issues – the majority of breastfeeding mothers won’t need their services.
But at the same time, O’Byrne – who struggled herself with feeding the fourth of her five children – says parents need to be prepared for the odd bump in the road.
During pregnancy. it is a good idea to line-up support with a voluntary group in your area, such as the La Leche League, Cuidiú and Friends of Breastfeeding.
Also, check out the HSE’s breastfeeding.ie website, which has been interactive since October, with online queries being answered by a lactation consultant.
For more information on lactation consultants, see: aclireland.ie. See also lalecheleagueireland.com; cuidiu.ie; friendsofbreastfeeding.ie