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Protect Breastfeeding: a shared responsibility

Updated: Feb 22, 2022

It's World Breastfeeding Week! This year's theme is: "Protect breastfeeding: a shared responsibility". The theme highlights the importance of support - right from a nuclear level through to a more structural level, to enable women to achieve their breastfeeding goals, so that babies and infants can reach their optimal health.

Because it's not just about nutrition. Breastfeeding is so much more than that. Of coarse it's the perfect food for your baby, it has everything your baby needs (we all known that). But it also changes to meet their needs throughout the day and as they grown. It's immune boosting. It helps to fight illness. It's "alive". It's protective against many health issues. In third world nations, it's a matter of survival. It's connection. It's filled with oxytocin and other feel good hormones. It's their pain relief, their play and their safe space. And it needs to be protected.

Did you know that approximately 96% of Australian women initiate breastfeeding at birth?! Did you also know that the WHO recommends for babies to be exclusively breastfed until approximately 6 months of age, and for breastfeeding to then continue alongside solid food for up to 2 years or beyond? In Australia, however, by one month of age, our exclusive breastfeeding rates fall to just 61%, and by 5 months, only 15% of women are exclusively breastfeeding.

What does that tell us? With such high initiation rates, women WANT to breastfeed. Yet something is happening here that causes our breastfeeding rates to fall so rapidly. It's not physiology. And it's definitely not that our breasts don't work, as made evident by breastfeeding statistics in many other areas of the world. This has got to do with our social, cultural and structural scaffolding that fails women. Our lack of education, our birthing practices, our postnatal care, our extended postpartum support, the lack of evidence based advice, the unrealistic expectations of babies and our social/cultural norms. Women and babies deserve better. They need greater support.

I posed a question on my socials this week - "What have you found the most challenging about breastfeeding?". Some common themes emerged: lack of support in navigating breastfeeding challenges, poor advice, and the unwanted opinions of others.

Breastfeeding IS natural. It's beautiful. But it's a LEARNED skill. And it really does take a village. This got me thinking about my own breastfeeding timeline. The ups, the downs, the challenges and the triumphs. So I wanted to share my stories, and share my gratitude for the village I've had around me.

Breastfeeding my first got off to a VERY rocky start. A physiological birth at home somehow resulted in my little one being born with a cephalhematoma (a big bruise on the side of her head). She struggled to latch well at birth. A sore head and a tongue tie (which we had released on day 5) resulted in severe nipple damage, which then led to countless bouts of mastitis. The first hit saw me dealing with a raging infection which spread to my rib cage and back. The support I had around me was amazing. My midwives visited daily for the first week, a number of times in the 2nd (with further visits at 4 and 6 weeks at home) with endless support via phone. My husband took care of everything so my only focus was feeding. We were also so held by our family and friends; with meal drops, practical and emotional support.

I managed the mastitis with usual conservative measures alongside homeopathics, therapeutic ultrasound and lymphatic massage and eventually with the first bout, I took antibiotics - unfortunately resulting in a 3 month battle of breast and nipple thrush.

The damaged nipples and poor latch were the first priority. A wound that just wasn't healing. I didn't want to introduce a bottle without the establishment of breastfeeding and so we battled with nipple shields, syringe feeding, hydrogel discs, and ongoing pain. My little one had chiropractic and osteo treatments to improve her intense suck and to release the tension in her jaw caused by the cephalhematoma.

Being a midwife I had a cloud of pressure over my head. Completely self inflicted! But there was that expectation I had put on myself, that I should know what I was doing. I really needed to take that midwife hat off and step into the role of 'new mum' that needed so much support.

By 6 weeks postpartum the nipples still hadn't healed and breastfeeding was as painful as at the beginning. It was then when I broke. I always tell women to go easy and take one day at a time, as it takes 6 weeks to establish feeding and a milk supply. We'd reached 6 weeks, and I was nowhere near that milestone. Feeding was so unenjoyable. I watched the clock dreading the next feed. I just wanted to enjoy my baby and not have my pure focus on feeding. I knew my husband was going back to work the next week and so was also feeling the pressure of the loss of his constant support. I had envisioned we'd be in a rhythm by now, and I couldn't see past the clouds.

I then happened to stumble across Gabi at a lactation support clinic who became my saving grace. 3 laser treatments later and my nipples were completely healed. She suggested I may have thrush which I then sought assessment and treatment for, and by 2 months we had found that rhythm. By 3 months I was finally feeding pain free, enjoying breastfeeding and enjoying my baby!

We navigated a few more bumps and hurdles along the way - more mastitis and a cow's milk protein intolerance, but were able to manage these quite easily with the right support.

I decided to wean at 18 months as I was pregnant with our second, and had no desire to tandem feed them both. She wasn't ready. I still hold some guilt around the decision as it was not a smooth process, however I had thought it was much kinder to stop then vs. when our next baby arrived. I was so scared of breastfeeding again. There was a lot of anxiety around what it would look like. I couldn't repeat what happened last time. Another physiological birth at home, but this time she latched straight on! Things were looking up from the start. Having missed out on just enjoying my baby the first time, I think I literally spent about a week in bed with her, soaking up the skin to skin contact I had longed for, but missed out on last time.

There were still a few hurdles. Some nipple damage - which I got on top of straight away with Alicia and the laser treatment. Eve also had chiropractic and osteo treatments to improve her latch. We dealt with a few bouts of mastitis down the track in our breastfeeding relationship, and had to navigate the cow's milk protein intolerance again, but this time I knew what to do. I fondly reflect on this moment; at 12 days postpartum. It was Valentine's Day and we decided to get out of the house for take away burgers. We took them down to the beach and found a park bench. I was breastfeeding Eve in the ring sling whilst eating my burger, with Rose running circles around us. I stood there and literally burst into tears. My husband rushed to my side thinking something was wrong. I had to explain through my sobs that these weren't tears of sadness, but rather of happiness and relief. Such a contrast to our last experience - I couldn't believe at 12 days post birth I was actually out of the house, enjoying my baby, our family, and breastfeeding relatively easily.

Our breastfeeding relationship ended at about two years. I was ready. I was touched out, but she was also ready. It was such an easy, smooth and effortless transition. I can't even remember how it ended, or our last feed. I just remember thinking back "Oh, she hasn't fed for a few days now" - and that was that.

This time around, our start was smoother again. Another physiological birth at home - he latched straight away and fed regularly from birth. I had some nipple damage, but no more than a graze. He couldn't quite open his mouth widely at first, and wasn't giving that big wide gape that babies are meant to before they latch - but a few chiropractic adjustments resolved that very quickly. Lisa helped me navigate a bit of an oversupply, and by 3 weeks postpartum we were set. No mastitis this time (thank goodness!). We're currently 16 months in, with no end in sight. At the moment I'm just enjoying him. I know he's our last, and so I'm just enjoying our special "milky drink" time. When it feels right for us both, we'll eventually stop.

And so my advice to anyone reading this and wanting to breastfeed is: ARM yourself!

- Get informed. Seek out antenatal breastfeeding education so you know how to recognise when your baby is latched well, and you are aware of normal infant feeding behaviours. It can come as quite a shock to the system not knowing how often they need to feed and that it is completely normal.

- Do not let ANYONE interrupt that initial skin to skin contact with your baby following birth. Your baby should remain in skin to skin contact with you for at least an hour following birth until after they have had that first breastfeed. These are the Golden Hours and have been shown to impact breastfeeding duration postnatally. If skin to skin at birth in not possible, due to unforeseen circumstances - have baby placed skin to skin with you as soon as practical after birth.

- It's a good idea to allow baby to seek the breast on their own initially, to imprint that instinctive behaviour babies are born with to seek the breast.

- Spend as much time as possible in skin to skin contact with babe in the hours, days, and weeks post birth (there's a reason why many cultures have 40 days of confinement). This allows "free access" to the breast, which lays down prolactin receptor sites at the breast - becoming the driving force of your long term milk production.

- Ask for help on the postnatal ward! Have your midwife watch you breastfeed to ensure a correct latch and to troubleshoot any issues that may arise.

- If you are having any difficulties, get help. Seek the advice of a IBCLC to ensure you are getting sound, evidence based advice. They are the experts in breastfeeding and can help you navigate any hurdles along the way.

- Watch your baby - not the clock! Babies aren't robots. They need to eat/drink when they are hungry or thirsty -just like we do as adults. Routine feeds can be damaging to milk supply. Did you know that how often your baby feeds is actually dependent on your breasts milk storage capacity? Over a 24 hour period, all breastfeeding women make a similar volume of milk. How often your baby feeds however is based on your storage capacity. Small storage capacity = frequent feeding. Large storage capacity = more spaced out feeding. Hint: it has NOTHING to do with breast size! - Sleep when your baby sleeps. The reality is, you're going to be up at night feeding. Babies are programmed to wake at night for feeds. This is completely normal. They don't start to develop a circadian rhythm until around 6 months of age, and even then - many babies continue to wake throughout the night for 12 months or more. It's completely normal. So really - SLEEP when your baby sleeps, as this is your time to catch up. - Remember - "it takes a village". Arm yourself with yours. Communicate your breastfeeding goals to your family and friends and prompt them on how they can support you best (no unsolicited advice, practical support, time to rest and sleep, meals, helping with older children). - Nourish your body. Ensure you are eating a well balanced nutritious diet and drinking plenty of water. - And lastly, go easy. Rest and don't put too much pressure on yourself. Remember it takes 6 weeks to establish breastfeeding and to establish a milk supply. Take one day at a time, as you find your feet in this new role. There's no rush to 'get back to normal' as this is your new normal.

Despite the initial struggle and the hurdles along the way, I have really loved breastfeeding my 3 little ones. However I couldn't have reached my breastfeeding goals without my village. And so in celebrating World Breastfeeding Week; this year I'm celebrating the circle of support I have had, and continue to have around me - because it really is a shared responsibility. A shared responsibility to support mothers and to protect breastfeeding.

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