Many women, after the birth of their first child, ask why no-one told them what childbirth would really be like. Actually, most couples have no filter when it comes to recounting their birth stories to expectant mothers, but like all profound experiences – war, love, bereavement – until you experience it yourself, it’s just words. Breastfeeding though, compared to childbirth, should be easy right? Otherwise the human race wouldn’t have overrun the planet. Why then do so many women report that they stopped breastfeeding long before they wanted to? Why are initiation rates so high but, six weeks later, breastfeeding rates so low? How can it be that at a time when women are enfranchised, waged, vocal and assertive, the ability to feed our babies with our bodies is eluding so many of us, and worse, causing so much anguish and guilt? How do we put breastfeeding back in its place as a normal, unremarkable part of a woman’s experience as she moves from girlhood, to womanhood, to motherhood and on?
After long months anticipating the birth, attending ante-natal classes, buying nappies and baby clothes and going on maternity leave, the big day comes and you retreat with your partner and midwife to give birth to your baby in a physical and emotional trial the like of which you have never experienced. It is different for every woman but, transformative or terrifying, empowering or just plain excruciating, there is nothing like the awe and emotion of holding your newborn baby.
The midwife will probably encourage you to breastfeed your baby in that first hour, then, if you’re in hospital, you may be transferred to the post-natal ward. If your baby wakes, and the ward is not too busy, someone may come to help you breastfeed again. Or maybe not. And within 24 hours you’ll probably be back at home waiting for the community midwife to come in and see you and your baby.
Suddenly, you as new parents realise that, exhausted and disorientated, there is no recovery time and you’re on-call 24 hours a day. And yet the support structure of regular ante-natal appointments and classes is gone replaced by sporadic midwife visits and a six-week check-up that seems a lifetime off. In this vacuum, mothers and babies are left to work out breastfeeding for themselves. You will know that “breast is best” because a lot of money has been spent telling you so but you may not be able to remember much, if anything, from the breastfeeding class you went to before the baby was born, or replicate what the midwife did to get the baby to breastfeed in hospital. You will have the community midwife’s number but may feel reluctant to call; you’ve probably been given a list of breastfeeding drop-in groups but are unsure if that would be any help. You may know other people who have breastfed, or you may not but by the third or fourth day at home you and many other women will have damaged nipples, engorged breasts and feel everything is out of control.
How then, if breastfeeding is natural and the biological norm, can this be? Well, there are two reasons; the first is the disparity in care pre and post birth. All the money is spent ensuring a safe birth and there is nothing left to mother the mother while she establishes breastfeeding. The second is a lack of candour about the early weeks of breastfeeding.
If we want to promote breastfeeding because we know about the health benefits but we really don’t want to spend any money supporting women in the early stages, it seems sensible to draw a veil over the fact that, truthfully, it’s a skill that takes mother and baby a couple of weeks (or even five or six) to master. Best too to ignore the fact that the majority of women would benefit from regular skilled help from breastfeeding peers, supporters, counsellors or lactation consultants. And to ignore the uncomfortable fact that older, highly-educated women are much more likely to access this support than younger, less wealthy women. It’s possibly also best to let women go on believing that the Midwives tasked with helping them on a busy postnatal ward have hours of specialist breastfeeding training – well, they may not. If we don’t want to spend money on breastfeeding, best too to go on insisting that breastfeeding doesn’t hurt rather than accepting that in the early days, sometimes it just does, but that with plenty of help and support, that will pass.
But this dissembling is as detrimental to breastfeeding as the lack of support and information. Pregnant women know that labour will be painful and a good midwife knows how to mitigate that. Her strategy would not be to deny the existence of the pain. Much better to acknowledge that breastfeeding can be uncomfortable at first as your breasts start to produce milk and your baby learns to suckle: it can be demanding as tiny babies need to feed every couple of hours and want to be close to you. But those months pass very quickly. If society is frank about it, new parents will work through it without tormenting themselves that they’re DOING IT ALL WRONG.
We know that good care during labour results in better outcomes for mother and baby and we wouldn’t expect a woman to give birth alone – why have we allowed a hiatus to appear at the moment of birth that cuts a woman adrift with her new child? Medically, the four weeks after birth are included in the perinatal period which spans the last 12 weeks of pregnancy, the birth and the baby’s first 28 days of life. For millennia, different cultures have afforded women up to 40 days after birth to be with their new child, their cooking and cleaning done for them, so they can rest and feed the newborn.
There is an enormous pressure now to return to ‘normal’ as quickly as possible. Everything about breastfeeding works directly against that. It is irregular, frequent, time-consuming and unpredictable. At best, mothers will have one hand free to hold a book, TV remote or phone, and only after a bit of practice. If mothers are allowed to extend the pregnancy and birth into the whole perinatal period, to take the 40-day babymoon to adjust to motherhood, most find that, after six weeks, while life is not ‘normal’ in the pre-birth sense, they have adjusted to their new normal. Simply by being. Simply by allowing time to pass.
This is the special place that grandmothers, aunts and older sisters have always inhabited, normalising the new experiences for the mother, giving love, food, comfort and offering up the benefits of their own experiences and knowledge. When these older, wiser women are absent, breastfeeding can be an uphill battle. I have volunteered as a Peer Helper for the Breastfeeding Network for four years and feel privileged to spend time with women and their babies at this very special and intimate time. Peers fill a gap in modern life where new mothers often live far away from their families, have little experience with babies and only a tentative sense of belonging in their new home town. Peer Helpers all have children of their own, and have all breastfed so we have plenty of information to pass on and good listening skills, but our real purpose is as ancient as midwifery. We adjust the baby at the breast, talk about how to make more milk or less milk, explain how milk is made, empathise about how full-on it all is, sort out cracked nipples and mastitis, signpost complicated cases to lactation consultants, look and listen, get stools, cushions and drinks of water, we laugh with them and get tissues out when they cry. We’re there to mother the mother, to listen and affirm, to rejoice and console, to reflect the rightness of her as a mother and the loveliness of her child. We listen and listen and listen. We do very little. As we listen and make space for the mother to be a mother she works out exactly what she and her baby need.
Because that’s how you get breastfeeding to work.