‘We want breastfeeding to be the easiest choice to make’

Prof Patricia Leahy-Warren, head of school of nursing and midwifery at University College Cork (UCC), shares a story that a breastfeeding mother told researchers.

One day while breastfeeding her infant, her mother-in-law visited and commented to her son on how thin he looked, adding that he mustn’t be getting fed at all. Her son replied that his wife was doing the most important job of breastfeeding their baby and that his mother should bring lasagne the next time she visits.

“His mother was upset initially but then embraced what she could do to help which led to a better relationship between her and her daughter-in-law,” explains Prof Leahy-Warren who is the lead researcher on a major new €2.5 million Health Research Board-funded study to prioritise breastfeeding as a public health issue.

She says that the right support from partners is one of the most crucial supports for breastfeeding mothers. “There is a lot of research which found that partners felt breastfeeding mothers under severe emotional and physical pressure should consider other options, but we want partners – mothers and mothers-in-law too – to have better awareness and knowledge about how best to support breastfeeding mothers.”

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A recent opinion column in The Irish Times by Dr Clare Moriarty, Irish Research Council postdoctoral fellow at Trinity College Dublin (TCD), questioned the recommendation from World Health Organisation (WHO) that infants should be exclusively breastfed on demand for the first six months of a baby’s life.

Dr Moriarty argued that this approach didn’t allow couples to share feeding and meant that a breastfeeding mother couldn’t be apart from her baby for the first six months. With a colleague, Dr Moriarty published a paper making the case that the WHO guidance was “ethically unsupportable as a piece of public-health advice”.

Her column prompted a raft of letters to the editor from breastfeeding mothers and public health advocates alike. One mother, who exclusively breastfed five children, explained how she never removed herself from company, but “tucked her baby in for a feed as she continued to read a book, sit at the park, watch a dance recital or a football match”.

“Older children will naturally share maternal attention, developing the aptitude to nurture through the closeness and intimate family dynamics of being included rather than feel excluded,” she wrote. She added that the “portable nature, perfect temperature, uniquely designed formulation of each mother’s breast milk means it is easy to be present in family and community life (including attending weddings, a concern raised by Dr Moriarty) without need to prep, pack, tote or worry.”

Another letter writer, Vivienne Parry, head of advocacy at Unicef Ireland explained that both Unicef and the WHO recommend exclusive breastfeeding for the first six months of life, because evidence shows it significantly reduces the risks of infectious diseases and provides a strong foundation for long-term health for both mother and child.

Breastfeeding is a learned skill

—  Prof Leahy-Warren

Prof Leahy-Warren says that the scientific evidence of the health benefits of breastfeeding for mothers and babies over formula feeding is incontrovertible.

And while debating the issues around breastfeeding is important – everyone has an opinion about breastfeeding, she quips – what is more important is that the debate moves away from breastfeeding being the mother’s sole responsibility to society’s collective responsibility. “We need to shift the focus away from pressure on individual women and towards addressing Government policy, legal protections, health systems, communities and workplaces,” says Prof Leahy-Warren.

The UCC researchers, who will work with national women, infant and children’s health programmes, will explore the social and cultural attitudes, familial support, health professional education and skilled breastfeeding support needed for women. “Breastfeeding is a learned skill,” says Prof Leahy-Warren. “We have the notion that babies just latch on and instinctively feed and it will be fine. But I breastfed three children – including twins. It was horribly difficult, yet fantastic at the same time. I was often told to give it up because I looked exhausted.”

The UCC study aims to investigate and influence a cultural shift towards valuing breastfeeding as one of the most effective ways to ensure child and maternal health. Ireland has a low breastfeeding initiation rate. Just 62 per cent of babies in Ireland are breastfed just after birth, compared to 95 per cent in Australia. In Ireland, only 37 per cent of infants are exclusively breastfed by the time they go home from hospital.

Prof Leahy-Warren is well aware of the historical legacy of two generations of mothers, the majority of whom didn’t breastfeed their babies. The medicalisation of childbirth (and past availability of free baby formula in hospitals) and the rise of nuclear families geographically removed from practical support from extended families haven’t helped either.

[ It’s time for a little more realism and empathy on breastfeeding ]

[ Why are Ireland’s breastfeeding rates stubbornly low? ]

She is also cognisant of the coy marketing of infant formula at pregnant women through social media channels and so-called influencers. “The marketing of follow-on milk from six months onwards – which is completely unnecessary – undermines women’s confidence in starting and continuing to breastfeed,” she explains.

Dr Louise Gallagher, assistant professor of midwifery at the School of Nursing and Midwifery at TCD has studied breastfeeding rates in Ireland, Australia and Sweden. “Undoubtedly, when more mothers are breastfeeding, it becomes more visible and seeing other women breastfeeding in public frequently can help to normalise it within a society,” she says.

One of the biggest issues that the UCC research hopes to address is education and skills training (and assessment of these skills) to all the health professionals and health workers that pregnant women come into contact with. According to Prof Leahy-Warren, currently, there is very little assessment of breastfeeding skills training among midwives and public health nurses, not to mention assessing such training for GPs, hospital doctors, occupational therapists, speech and languages therapists and other healthcare professionals. Better awareness of breastfeeding among catering staff and hospital porters would also help transform attitudes to breastfeeding.

“We don’t want to push breastfeeding,” says Prof Leahy-Warren. “We don’t want to put pressure on women. We want breastfeeding to be the easiest choice to make.”

Researchers will go into hospitals, community health centres, primary care centres and GP practices and ask women what they need to support them to breastfeed their babies. Researchers will also hold ‘townhall’ style meetings in Tallaght and rural Kerry and ask civil servants, shopping centre managers, school teachers how they can contribute to making breastfeeding easier for women to do.

“We want the infrastructure around women to allow them to make breastfeeding the initial choice. Parents’ decisions are based on informed choice so we want women to be surrounded by mothers, mothers-in-law, neighbours and friends who are informed about the value of breastfeeding,” she adds.

This work will ideally complement ongoing work in Ireland to try to reverse the abysmally low breastfeeding rates. Since 2021, more Department of Health funding has seen a significant increase in lactation consultants employed in maternity units and primary care centres. The HSE National Breastfeeding Implementation Group is also currently reviewing the National Breastfeeding Action Plan which expired in 2023.

Prof Leahy-Warren also wants to know what the young women in Ireland today think about breastfeeding. “I recently asked a mother of a young pregnant woman whether her daughter would consider breastfeeding. The woman replied, “ah sure, she’ll try anyway”. I told her that her daughter had no reason not to breastfeed as there was a very small per cent of women who couldn’t breastfeed. Her daughter went on to breastfeed her baby for seven or eight months.”

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