Offering advice on breastfeeding

Practical advice can support and reassure breastfeeding mothers.

Breastfeeding
Breastfeeding

You may be wondering why a man is writing about breastfeeding, a subject that generally sits firmly in the domain of pregnant women or those in the puerperium. When I finished my GP training I found that I knew very little about breastfeeding and felt unable to give any worthwhile advice to patients who presented with problems.

Then, as a father of two small children I went to National Childbirth Trust (NCT) classes, and watched my two daughters being breastfed. I realised just how important breastfeeding is to health, and how poorly it is promoted.

UK government advice is to breastfeed babies exclusively for six months and then provide solid food in addition to breastfeeding. However, the UK has one of the lowest breastfeeding rates in the world, especially in low socio-economic groups and disadvantaged families.

GPs can ensure patients know the benefits, help them take advantage of support organisations and encourage mothers to give their baby the best possible start in life.

Advantage of breastfeeding
Breastfeeding has advantages for both mother and child.

Advantages to the mother are:

  • Increased bonding between mother and the baby.
  • No need for sterilisation of bottles.
  • No problems with milk temperature.
  • Weight loss and contraction of the womb after delivery.
  • It is free.
  • Protection against pre-menopausal breast and ovarian cancer.

Advantages to the baby are:

  • Immune boost thanks to antibodies in breast milk.
  • Reduced likelihood of allergy compared with cow's milk.
  • Protection against childhood illnesses including respiratory tract infections, otitis media, atopy, type-1 diabetes and necrotising enterocolitis.
  • Reduced risk of constipation because the milk is rapidly absorbed and often very little waste is produced.

High drop-out rate
Recent data show that 69 per cent of babies in the UK are breastfed, but that breastfeeding is stopped after just two weeks in a fifth of these, and after six weeks in a further third. Only 10 per cent of mothers breastfeed for as long as they intended.

There are many reasons why mothers give up breastfeeding. These include:

  • Concern that their baby is not latching on to the breast properly.
  • Painful breasts or nipples.
  • A perceived lack of milk production.
  • Concern over baby's growth.
  • Uncertainty as to how much the baby has fed off a breast.
  • Mastitis.

Longer amount of time taken to breastfeed compared with bottle-feeding.

Inconvenience
Anecdotal evidence would suggest that one of the main reasons women do not breastfeed is that it is inconvenient.

An exclusively breastfed baby is tied to its mother in a way that a bottlefed baby is not. Good advice about expressing breast milk and combination feeding may help improve the continuation rates.

Lack of guidance
Breastfeeding is rarely taught at medical school, so many GPs have only their own personal experiences to guide them in advising their patients.

There is often a gap in GPs' knowledge that results in patients being poorly informed.

If a mother presents struggling to breastfeed her baby, or if the baby has gained insufficient weight through breastfeeding, it is easy to advise her to try bottle-feeding. If the mother is sent to the health visitor, she may be given conflicting advice. There are no set guidelines.

Support groups
Organisations such as the NCT and La Leche League provide peer support from women with personal experience of breastfeeding who have had some form of training. They sometimes see patients in clinics run jointly with a health visitor clinic and offer telephone advice.

The Baby Friendly Initiative is a global programme run by UNICEF and the WHO that works with health services to help parents make informed choices about how they feed and care for their babies.

Growth charts
Current UK growth charts are based on data from predominantly bottle-fed babies. But bottle-fed babies gain weight more quickly than breastfed babies.

New growth charts have been drawn up by the WHO to reflect the growth of babies who are exclusively breastfed. These charts have been backed by the Royal College of Paediatrics and Child Health.

Adopting these new charts should help to promote breastfeeding in the UK by reducing the number of mothers concerned by the slower growth of a breastfed baby. According to these charts, up to 25 per cent of UK babies are heavier than normal. There is increasing evidence to suggest that the growth pattern characteristic of a breastfed baby is associated with reduced risk of childhood and adult obesity and associated morbidity.

Dr Gowrie is a salaried GP in Maidenhead, Berkshire

This topic falls under Section 8 of the GP curriculum, 'Care of Children and Young People': www.rcgp-curriculum.org.uk .

Learning points
Support for breastfeeding mothers:

1. Give information about the physical and psychological benefits to both mother and baby of breastfeeding.

2. Encourage mothers to contact peer-support groups, such as the NCT and La Leche League.

3. Advise mothers considering switching to bottle-feeding about expressing milk and combination feeding.

4. Reassure mothers concerned about slower growth of breastfed babies that this is normal and associated with improved health outcomes in later life.

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