Niamh Mullen reports on the need to encourage women to breastfeed after a Dublin study reveals the extent of our poor breastfeeding rates.
More support and better information is needed from GPs and maternity hospitals to encourage women to breastfeed after another survey has shown abysmal rates of breastfeeding in Ireland.
A study of the feeding practices of 450 women who gave birth at the Coombe Hospital found only one woman exclusively breastfed her baby for six months as advised by the World Health Organization (WHO).
The study, ‘The prevalence and determinants of breastfeeding initiation and duration in a sample of women in Ireland’, will be published in the journal Public Health Nutrition later this year. It found 47 per cent of Irish women and 79.6 per cent of non-national women started breastfeeding their baby. At four weeks the percentage of Irish women still breastfeeding had dropped to 28 per cent, while 75 per cent of non-nationals were still breastfeeding. At six months some women were still partially breastfeeding – 9.6 per cent of Irish women and 50 per cent of non-national women. The study also found 94 per cent of women had decided whether they were going to breastfeed before they gave birth.
Dr Siun Murphy — a doctor who has set up a special website to encourage breast-feeding says there is not enough encouragement for mothers to breastfeed, and many are not aware of the health benefits.
“Some GPs are great – often breastfeeding mums themselves. But for the most part they just do not know about breastfeeding. It is through no fault of their own. It is not taught at medical school,” said Dr Murphy, who is a specialist registrar in plastic surgery at the Mater Hospital.
h4. Not enough midwives
She added there were not enough lactation midwives and no lactation consultants in the public hospital system to help women who wanted to breastfeed. When she had her own children, she said, nobody in the hospital asked her if she wanted to breastfeed, never mind offered her support.
Her website – www.thebreastway.ie – was set up last year and has more than 400 registered members. It was a response to concerns of mothers and doctors that not enough was being done to increase Irish breastfeeding rates.
Dr Murphy said one of the problems was that women were often discharged from hospital before their milk came in, or was on the brink of coming in. “Before then you are not running into problems. But in the first week or two there can be latch problems, you can get a cut on the nipple, which can lead to an infection. You go to your GP, you are given antibiotics, you are told to stop and that is the end of it. But loads of antibiotics are compatible with breastfeeding,” she said.
Dr Naadia Ibrahim, an Irish GP working in the UK, is also involved with Dr Murphy’s website. She is breastfeeding her second daughter who is three weeks old. She said she treated many women who thought they could not take any antibiotics, painkillers or anti-depressants while breastfeeding – all of which was untrue. “GPs need to talk about it antenatally and there should be training for GPs who are interested,” she said.
Another common reason a woman will stop is if she is advised to pump before six-weeks. “It can cause nipple confusion and the baby gets lazy using the bottle. It is easier for them to feed from a plastic teat,” Dr Murphy explained.
Flat nipples are another obstacle to feeding some women encounter. However, many women can overcome this, according to Dr Murphy.
Another issue she identified was the centile chart used for weighing babies. It is common for all babies to lose weight initially. However, formula fed babies gain weight more quickly than breastfed babies. This can make it seem like breastfed babies are not thriving, according to Dr Murphy.
She said WHO charts introduced in 2006, specifically for plotting the weight of breastfed babies, were not being used in all hospitals and led to some mothers being advised to switch to formula because their baby was not gaining enough weight. She added that she was aware of mothers being offered free formula in maternity hospitals – a breach of WHO guidelines.
In countries where there is little or no formula advertising and hospitals support mothers who want to breastfeed, rates are much higher. Sweden has a breast-feeding rate of 97 per cent. In Norway it is 99 per cent and in Denmark 98 per cent of women breastfeed.
h4. Embarrassment
Dr Roslyn Tarrant — a dietician who authored the Coombe research — found embarrassment was a significant cultural reason women chose not to breastfeed – an obstacle also identified by Dr Murphy. “People are out and about and they do not see it,” she said. “If none of your friends are doing it, and you are, you can think you are a freak.
“It is a societal thing. In Sweden, for example, women are breastfeeding in coffee shops. You get on the train and there is a woman breastfeeding. They are much more open about it,” said Dr Murphy.
She suggested a TV advertising campaign would be a good way to improve the image of breastfeeding. In Marin County, California, an effective ad featuring young, attractive women breastfeeding has been televised.
About Gary Culliton
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