Support Strategies for Breastfeeding

Support Strategies for Breastfeeding

A new study has found negative attitudes to breastfeeding may have contributed to an increase in chronic disease in Australia.

The research by Australian National University's Dr Julia Smith - which mapped the public health impact of premature weaning over the past five decades - suggests more should be done to promote breastfeeding past the age of six months to combat the risk of chronic disease in future.

Interview with Dr. Jennifer James

RMIT University's Dr Jennifer James is an expert on breastfeeding and human lactation.

Dr. Jennifer James is the Director of Lactation Consultants of Australia and New Zealand (LCANZ) and has also acted as the consumer representative on the Advisory Panel on the Marketing in Australia of Infant Formula (APMAIF). Please see: www.lcanz.org for more information.

What negative attitudes are we seeing in terms of breastfeeding?

Dr. Jennifer James: I think there are a lot of reasons woman stop breastfeeding before they want too. For the majority of woman they expect to breastfeed their babies when they're having their first baby; they know that it is the best thing for them and their baby and most women try really, really hard. Women don't receive good education, growing up, in terms of not seeing babies around them, being breastfed. So, they go into their first pregnancy, I am talking about the Dads as well, and if they don't see breastfeeding as a normal part of life, they don't understand that 'of course babies are breastfed, how else do you feed babies?'

Then, when women are having their first babies they are suddenly bombarded with this huge amount of information about parenting; from the $300 jogging pusher to the clothes and a huge array of merchandise.

Women that have baby showers now, instead of getting clothes, they are given things like breast pumps and feeding type products. All of a sudden breastfeeding becomes a really technical thing to work out how to do it.


How have negative attitudes to breastfeeding contributed to an increase in chronic disease in Australia?

Dr. Jennifer James: We know that babies are designed to have breast milk exclusively for the first six months, they don't need anything else, breast milk is designed to meet everything a baby needs, for the first six months.

For the second six months the introduction of appropriate solids is about education; taste, texture, smell and socialising to the family table. Breast milk is still the stable nutrition for that second six months.


How long should woman breastfeed for?

Dr. Jennifer James: It is interesting that women are hearing this message of only breastfeeding to six months. The reality is that no, it's not the time to stop, keep going. We have a very high drop out rate from about six weeks.

Breast milk continues to be important for the coming years.

Exclusive breastfeeding, the ones that do manage to breastfeed to six months are introducing other things like artificial formula, quite early, so the babies gut and body are being subjected to artificial formula and solids are often started too early, before the babies are ready. All of these things impact on the ongoing health of a growing child.


Can you talk about the advantages of breast milk over formula?

Dr. Jennifer James: It is best to talk about the disadvantages and risks of not breastfeeding. We know that breast milk is the normal way to feed babies and anything else you give is abnormal. The risk, particularly in the early period, can damage a very vulnerable gut lining; colostrum is a very thick sticky substance and it is designed to clear the baby's bowel and put a thick protective layer down. We are beginning to suspect that in terms of long term chronic disease, damage to that very fragile gut lining is implicated by artificial formula.


When we say chronic disease are we referring to obesity and diabetes?

Dr. Jennifer James: Yes, those that cost huge amounts of money in direct and indirect health costs, they also cost hugely to the health and wellbeing of our population.


What strategies do we need to put into place to support breastfeeding in Australia?

Dr. Jennifer James: The first thing we need to be doing is to make breastfeeding the norm. We need children to be growing up and seeing breastfeeding as being the way to feed a baby so by the time young couples are having their first baby, they don't think twice about anything else, they just breastfeed.

We need to be educating our health professionals because one of the biggest problems that woman face when they are having their first baby is contradictory advice. Mothers get given all of this different advice. A lot of health professionals stay current, a lot don't. Women go to GP's and some are fabulous and know exactly what to do; other's do things like advise woman to stop breastfeeding because they are on antibiotics, for example.


Can woman who are taking antibiotics still breastfeed?

Dr. Jennifer James: Absolutely! There are very few drugs that breastfeeding woman take that are contraindicated in breastfeeding, very, very few.


Can you talk a little bit about how the Australian health system fails new mothers who want to breastfeed; is this because of lack of education?

Dr. Jennifer James: Unfortunately, in a lot of times that is true. The next thing is that our maternity wards are understaffed which means woman are in hospital for a very short space of time. Midwives aren't able to sit and spend the time, which women need, in that short space of time. Then, women go home to Dad and if they're lucky their Mum, but there is a good chance that Mum was a bottle feeder, so she doesn't know anything about breastfed babies either.

There is not a great deal of support for women in the community; when we brought in short hospital stays, there was this great promise of all of this community support that would be available- that isn't there. Woman who are having problems in the early post-natal period can ring their hospital and make an appointment to see a lactation consultant but it may be two or even four weeks before they can see someone and that's too long.

If women can access support and expert care from a lactation consultant, in those early weeks they will go on and continue to breastfeed.


How have strategies encouraged breastfeeding in Australia and overseas?

Dr. Jennifer James: There are lots of strategies. The Australian Breastfeeding Association (ABA) has the workplace program where workplaces are accredited for supporting their employees when they are breastfeeding. Strategies include returning to work slowly in short bursts, working from home, being able to express their breast milk in a private area that is clean and that they have somewhere to store their breast milk. The ABA has a very good program, Australia wide. I am unsure on the exact figure of how many companies are accredited now, but it must be well over 50.

There have been a number of trials, around the world, where woman are visited by lactation consultants in the home, in the early weeks, after discharge- that has shown to be very helpful to continuing breastfeeding.

Peer support groups and breastfeeding friendly groups such as the ABA work very well for a lot of woman and are important.

Educating the whole family, not just the woman, is beneficial because often Dad goes back to work and suddenly it is all Mum. It can be very isolating being at home with the young baby. Looking at ways to support woman, once they go home, is crucial.

We certainly have the law behind us when we breastfeed wherever. If woman feel that they can't breastfeed their baby whenever and wherever then they are a lot less likely to either go out, which means they are stuck at home or trying to organise their day around a babies feeds, which is very tricky with a breastfeed baby or they stop breastfeeding.