I’m reading a lot of research that considers the best ways to prepare and support women to breastfeed.
Truth is, we really don’t know for certain what’s the most effective way to do it.
One theme that seems to be coming through is that the what isn’t so much of an issue as the how.
When women are asked about what care was helpful to them, they talk about having their feelings acknowledged and being listened to.
Graffy and Taylor (2005) undertook a randomised controlled trial in the UK to measure the outcomes from a particular model of breastfeeding support. As well as this, they asked the women in the trial about what they thought constituted “Good Breastfeeding Support”.
The authors summarised it in 5 points:
1. women wanted good information about the benefits of breastfeeding. This was so they could defend their decision to breastfeed when they were questioned (as they expected to be) by their family and friends (!).*
2. women, as I mentioned above, wanted their feelings acknowledged and wanted to feel listened to.
3. women wanted practical tips for breastfeeding such as different positions for feeding.
4. they also wanted reassurance and encouragement to breastfeed.
5. Provision of resources for what to do if they were having trouble – someone to call or make contact with.
Not a bad list.
I would defy any midwife to not know how to provide the elements these women were after.
One of the big points here is that women aren’t expecting a huge amount from their caregivers. Mainly time, patience, a listening ear and some encouragement. You don’t need to solve all their problems….but hey, preventing some would be excellent.
As midwives, we can do this by helping them get to know their new baby – to read the baby’s cues, to offer the breast when the baby is quietly alert, to hold the baby close any time.
To believe them when they say they have tried to feed.
To stay with them when they are going to try.
You don’t need all the answers – you will have seen enough babies to know the range of what is normal – and be amazed by the immense variation in this!
Something I tried to mention to women in clinic when we were talking about breastfeeding at the 26 week visit (probably should have had a chat about it at every single visit…) was: “as midwives we know a lot about lots of different babies …but not so much specifically about yours – you will very quickly become the expert on your baby – you can use us midwives to help along the way with figuring it all out”.
My experience as a volunteer breastfeeding counsellor and then training to be a lactation consultant helped me realise there are more important things than “knowing all the answers” to breastfeeding problems when we are supporting women to breastfeed.
So much more is about walking beside them on the journey.
*just by the by…I think this issue needs unpacking (and highlighting) a bit more. Never mind criticism of the health message “breast is best” – when women are being judged on their decision to breastfeed by their own families!
4 thoughts on “Breastfeeding support – what makes it good.”
Great post Jen. I think good breastfeeding support is also about “when” and “where” – timeliness is crucial, both ante-natally and early post – natal.
Offering support in the home, on the mother’s turf, in those early days when mother and babe are recovering.
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I always thought I would breastfeed. I didn’t need convincing of the health benefits, I had already researched that. What I wasn’t prepared for was the reality of it and that it doesn’t always happen smoothly. Two days after giving birth I was home with my breasts so engorged my nipples inverted and my baby couldn’t latch on. All of us in tears and I felt so overwhelmingly underprepared for breastfeeding compared to all the research I’d put into the birth.
Ohhhh yeah. I hear you sister – and me a midwife at the time!! Determination is an amazing thing. And support, and the belief of others around you.
So true. Thanks for your comments Catina.
Cochrane also says that the care should be part of a schedule rather than initiated by women themselves.
Maternal and Child Health do this in Victoria with the first home visit, but timing? It’s everything.