“Paid” to breastfeed – crazy or cost-effective?

It’s been a while since I wrote a post on breastfeeding. I’ve been thinking about writing one now that we’ve somehow got to a point where I’m tandem nursing 2 toddlers, but with everything going on, it’s not actually happened yet. However, something in the news this week has prompted me to write because I’d like to note and share my thoughts on this.

According to the BBC news article that I read at first, a trial scheme is being run in deprived areas of South Yorkshire and Derbyshire which will offer new mums £200 in shopping vouchers if they breastfeed their baby for 6 months; this is being funded through both government and medical research money. My first thought when I read this was “are they crazy?! is this a joke?!” The very fact that breastfeeding saves you more than £200 in formula milk per baby should be a financial incentive in itself.

And then I thought about it some more, in an attempt to understand it some more, and still came to the conclusion that it was a bad idea. Of course if money was no object to the government, then why not encourage mums to breastfeed with a sum of money, but as funds are limited, I believe this money would be far better spent on NHS resources to support breast-feeding mums in a useful way.

When we had issues breastfeeding, the best help that we got in the local community was from volunteer peer supporters – mums at our local La Leche League (LLL) group who give all their time and energy to help out struggling mums for free, out of the desire to help each mum reach their own breastfeeding goal, whatever that might be. If we’d have relied on overworked midwife and health visitor advice, I am convinced that I would not be sitting here writing this, despite my own determination, because we were given at best no and at worst factually inaccurate advice from health professionals whom we thought we could rely on. If money is to be spent trying to improve breastfeeding rates, this, in my opinion, is where it needs to go – providing more up-to-date and evidence-based training for (and just more!) midwives and health visitors who see these new mums on a regular basis before and after the birth of their baby.

What good will it do to get more mums to start out breastfeeding if there is little means of supporting them if they hit issues? I can imagine a scenario where a mum is encouraged by the financial incentive to give breastfeeding a go when her baby is born, but who then faces a problem which ultimately leads her to give up, because she is not given any support, or is told something that is not helpful, or worse not true, by people that she trusts (maybe a health professional, maybe a family member). The fact that she would then miss out on the £200 could lead to even more of a feeling of failure and guilt that many mums, in my experience, describe when they feel they have had no option but to give up breastfeeding even though they really wanted to.

Having said all this, as I thought about this trial more, and read more commentaries on it, I realised that I am of course looking at it through my middle class eyes. I grew up knowing that breastfeeding is the ‘normal’ way that a human infant is born to be nourished, though I also knew that formula is an option which many mums choose for whatever reason to use instead. I was breastfed, my brother was breastfed (not that I can remember either of those cases!), and my younger cousins were breastfed – I saw them and remember this.  I also did well in a good school, went to university and got 3 degrees, and through this education and my own reading because I’m interested in finding out more, I have understood why breastfeeding is important.

If I had grown up in a family whose babies were all bottle fed by default, hung out with friends whose families all bottle fed their babies, and left school with few qualifications or general interest in reading, then things could well have turned out very differently. This is the situation in the more deprived areas of the UK, where breastfeeding uptake rates are much lower than in better off areas, because new mums just don’t know about the importance of it, and why would they if bottle feeding is the norm where they live? It is in some of these more deprived areas that the trial is taking place, specifically because for mums to succeed in breastfeeding, they’ve got to know that it is even an option in the first place. If these vouchers address the uptake issue then that can’t be a bad thing, although I would still be concerned about the lack of support once they’ve started. According to the Lonely Scribe blog, Derbyshire, one county in which this trial is taking place, already has a strong network of good breastfeeding support available to new mums, so this should not be a concern here.

This blog also points out that the media reporting of this trial hasn’t exactly been to clear – it’s NOT a government  policy that is definitely going to be brought in across the country, rather it is a scientific study by researchers who are trying to assess how a financial incentive might impact public health and therefore whether it would be something the government could consider as they are ultimately in charge of the public health budget in this country. As breastfeeding has significant benefits to child and adult health, breastfeeding rates affect how much money will be needed later in babies’ lives in terms of their health.

As a researcher myself I understand the importance of setting up a study which will provide evidence for or against a certain hypothesis, and waiting for the results of the study before jumping to any conclusions. So that is what I should do with this trial too – wait and see whether it provides any evidence for or against the hypothesis that offering mums money to breastfeed increases breastfeeding rates in specific areas. I’m still not convinced that, even if evidence for this case is shown in the results, it could be generalised to other areas where breastfeeding uptake rates are higher.

A similar point of view of “wait and see” was expressed in the statement from Anna Burbidge, Chair of LLL Great Britain, on this study. She notes that LLL GB “will be looking with interest at this scheme to see if offering vouchers to mothers who breastfeed as a way of acknowledging the value of breastfeeding to babies, mothers and society, will increase the numbers of babies being breastfed.” If more mums breastfeed, then this would help make breastfeeding the norm, and help create a culture that encourages breastfeeding because it is the norm. So if this study shows that money can help in the areas where increasing numbers of breastfeeding mums is most needed, then great.

Breastfeeding seems to be one of those topics that reveals some very strong feelings in many mums – whether they did or didn’t do it. I’m sure that in the discussion of this voucher trial this week there have been many emotive comments from people’s experiences of breastfeeding, good or bad. My personal conclusion on what I’ve read about the trial is that it sounds ridiculous and far removed from how I myself see and experience breastfeeding, but I look forward to hearing about the results and whether this financial incentive could benefit mums in social circumstances different from mine. I’d be interested to hear what you think too.

Breastfeeding support: accurate info, practical help, listening ears

I am absolutely convinced that every mum needs support if she is going to reach her breastfeeding goals. Breastfeeding involves many factors (physical, hormonal, emotional, social, psychological etc.) that come together to create the unique journey of a breastfeeding pair comprised of mum and baby; the same mum can even have a completely different experience with two (or more) different children. Sometimes these factors create a very favourable situation, making the breastfeeding journey relatively straightforward, but in other cases these factors cause issues that make the journey a very difficult one.

The mums who do have a difficult time obviously need support, and I’ll come on to where you can find this in a moment. But even those who have no major issues need a certain amount of (perhaps subtle, in the background) support in the form of, for example, a helpful partner and/or family who understand why breastfeeding is important and how it works. As a society, we can all give moral support to all breastfeeding mums by making them feel welcome and normal in public places, not making them feel self-conscious and like they have to hide away. This is one of the most fundamental ways of supporting breastfeeding mums in general.

But on an individual level, what if you do encounter problems? What can you do about it, and where can you go to get support? The first thing to remember is that you are not alone – many mums experience issues ranging from relatively minor/temporary/easily fixable problems to more overwhelming/long term/unbearable problems. The second thing to remember is that there are sources of support out there, even though you might have to be quite pro-active in searching them out at a time when you’re already feeling exhausted. Our experience of breastfeeding could have been a lot worse and a lot shorter if we had not been lucky enough to find the right support at (more or less) the right time. I see breastfeeding support as encompassing three different aspects: accurate information, practical help, and listening to emotions.

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The obvious place you might think to look for support would be your midwife and/or health visitor. In our experience they were mixed in how helpful they were, and I know that this very much depends on the individuals and how much breastfeeding-specific training they have had and how recently they completed it. I gave birth in a midwife-led birth centre, and it was a very positive and empowering (as is currently the buzz word in birthing) experience. I cannot fault the support of the midwives there to get breastfeeding off to a good start: they allowed me to have a completely natural birth with no pain relief except a pool; Andrew was delivered straight onto my tummy and breastfed almost straight away by latching on of his own accord; we were not hurried onto the post-natal bay and were allowed lots of skin-to-skin time; they checked on us a lot during the night after he was born, constantly asking if I needed help with feeding, and even suggested I wake him after he’d slept so long without a feed – this was really important to stimulate my milk supply.

But we were only in hospital for about 12 hours after the birth. The problems came when I went home and we were in the care of my community midwife. She was (unfortunately) on annual leave during Andrew’s first week. Of course everyone needs a holiday and I’m not complaining about that, but when we rang her team because we were concerned that feeding wasn’t going well, we did not get the support we needed. Later that week he was admitted to hospital with dehydration and significant weight loss, and I felt let down by the community midwife team care.

When we came out of hospital the second time, and I was trying my hardest to give breastfeeding a go as well as continuing the formula supplements that the paediatricians had started, my community midwife told me that I should only keep him on the breast for 20 minutes at a time every three hours and then top-up with a bottle, to give my breasts time to ‘fill up’ again. At the time I believed her, but having read more about how breastfeeding works from La Leche League (LLL) resources, I know that this is rubbish! Breast milk is constantly being produced as soon as some leaves the breast – it’s more like a continuous stream than a bucket you have to fill, then empty, and then wait for it to fill again before taking any more out. Our health visitor wasn’t much better – with her it wasn’t so much the inaccuracy of her advice rather the lack of her visits. She came a couple of times, checked I was in a fit state to look after my baby, and then left us to get on with it. I could have made the effort to ring her, but by that time I had started to get support from my local LLL group and thought that was much more worthwhile than keeping in touch with a busy health visitor – these mums had time for me whenever I wanted advice (more on this in a moment).

However, the most crucial support we received in the first week was from the infant feeding specialist midwife at the hospital when we were on the paediatric ward. Looking back, it was, ironically, good that we went back into hospital. She introduced us to the SNS (at-breast supplementer that I talked about in my last post). Without this way of supplementing, with Andrew still getting as much breast milk as I was able to produce, I don’t think we’d still be breastfeeding today. This midwife’s support was helpful and, most importantly, she gave us accurate information.

So the moral of the story with health professionals is, in our experience, don’t be afraid to question their authority and seek a second opinion – in many cases their training on breastfeeding is very basic and often out-dated because it does not feature prominently in current training (even for midwives and health visitors). If you’re anything other than a perfect textbook case, you might find they give, out of ignorance, inaccurate or downright misleading information.

As I just mentioned, I got amazing support from my local LLL group. This is an international organisation represented in many countries across the world. In Great Britain there are groups who meet in various cities, towns and villages across the country. The mission of LLL is ‘to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.’ This is exactly what I found when I went to my first coffee morning, after I was lucky enough to meet one of the volunteer leaders at a breastfeeding drop-in clinic who encouraged me to come along as she knew I was struggling.

A flyer for our local LLL group, with lists of meeting and coffee morning dates inside, hanging on our notice board so I know where to meet each week 🙂

From what I’ve heard said by others, breastfeeding support organisations like this and others (e.g. NCT) in the UK can be seen as an exclusive group of well-off ladies who bang on about ‘breast is best’ and look down on those who feed their babies formula without persevering through difficulties. In my experience, nothing is further from the truth! I took formula (in the SNS) to meetings and was not shunned; I’ve seen mums take bottles to meetings and were not shunned. In fact it is mums like me that are made to feel particularly welcome, because mums at LLL meetings who have overcome problems themselves know exactly how it feels to be under all the different pressures and prejudices associated with how you feed your baby. All these mums wanted to do was help me in how I chose to feed my baby, by giving me accurate information, practical help and a genuinely interested listening ear when I was in floods of tears. At no point did I think that I would have been thought less of in that group for bottle feeding Andrew. Now they are some of my most respected mummy friends. I always look forward to seeing them once a week for continued support now that we’ve overcome our initial breastfeeding struggles and are into the toddler feeding stage, which comes with its own difficulties, such as the judgement from others that it’s not normal (it is normal – I’ll write more about this next week).

So the moral of the story with breastfeeding support groups is don’t be afraid to go – whatever your circumstances, your age, your income, your background, your breastfeeding journey (or lack of) so far, there will be other mums who would feel privileged to be able to help you in the way you need it most to meet your breastfeeding goals. It’s not just LLL groups (that’s what I had access to here in Cambridge); there are all sorts of other local groups run by mums for mums. Other organisations with such groups are the NCT and the ABM. Children’s Centres are a good place to look for these groups, as many of them meet there, or have links with the centres who put their leaflets/posters out. A google search would probably bring up a few hits in your local area. Or your midwife or health visitor might be only too pleased to pass on information about such groups if they are rushed off their feet with a huge caseload!

Last, but not least, I could not write a post about breastfeeding support without giving pride of place to Daddy and grandparents. I definitely could not have got through the hard times without Tom, my amazing husband. He has done everything possible to support me whilst breastfeeding, including practical help like making sure I had drink and food in the early weeks when I was constantly feeding, and emotional support by being my person to cry on at any time of day or night (he got very wet in the early weeks!) and making it clear to me every step of the way that he would be behind me 110% with whatever decision I made about feeding, whether I chose to persevere with breastfeeding or switch to bottle feeding. He never pressurised me either way, and has found many ways to help me and bond with Andrew without doing the feeding, for example bath time has always been Daddy and Andrew time. He understands how breastfeeding works (mainly from how much I rabbit on about what I’ve read about breastfeeding!) and is happy that I still feed Andrew now at 16 months – he knows it’s a natural thing because he sees on a daily basis how much Andrew and I get out of it. He also knows that I am now very passionate about sharing our experience of breastfeeding and supporting others, and doesn’t complain when I talk at him about it in the evening after a hard day at work 😉 Basically, Daddy is the best! He’s the most important source of support that I had and still have for breastfeeding.

Daddy with Andrew (aged 6 months)

But if your baby’s dad isn’t around for whatever reason, there’s no reason why you can’t have another person, for example your mum or another family member or close friend, to be that rock of support. I am also blessed to have very supportive parents who have been behind my decision to breastfeed despite tough struggles every step of the way. I guess they know me so well that they know there’s no point getting in the way when I’m determined to do something. In the early days and weeks they helped by doing lots of practical stuff for us, like housework, shopping and cooking, and they still do these things when they come to visit every few weeks on average. They too understand how breastfeeding works – it helps that my mum breastfed my brother and me at a time when there was much less support for it than there is now. This was particularly important in the early days: they weren’t the kind of family members who would come round and insist on constantly cuddling baby and questioning when I knew he wanted feeding; instead they of course enjoyed cuddles, but respected that I was the primary person who Andrew needed access to, to stimulate my milk supply and feed him as much as necessary. They knew that doing the housework themselves was more helpful than taking Andrew off my hands so that I could do it. Having people around you who understand these things is very important. Support is only helpful if it’s the right kind of support.

Granny and Grandad with Andrew (aged 14 months)

I hope that this post based on our experience of support for breastfeeding has been informative. Why not hop over to some other blogs and read about other sources of support that mums have found helpful? There are some links below, and more on the main website, where you can also find out more about the Keep Britain Breastfeeding Scavenger Hunt 2012. Don’t forget to enter the competition below to have a chance of winning the grand prize.

Breastfeeding in England – Breastfeeding support groups

Mama Geek – Breastfeeding Support – Why it’s important and where to find it!

My gorgeous boys – Breastfeeding: Where to get support

Breast 4 babies – Ten Things My Midwife or Health Visitor Never Told Me About Breastfeeding

Diary of the Milkshake Mummy –  Together everyone achieves more

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