Mothers want and need professional breastfeeding support, argues lactation consultant Justine Van Der Watt.
Any health professional who provides services to mothers and infants should be aware of the World Health Organization guidelines regarding infant feeding.
Infants under six months should be exclusively breastfed, with family food being introduced at six months and breastfeeding continuing until two years or beyond if the mother and child desire.
The health benefits for infants, mothers and the community are well-reported.
However, according to the latest Australian Bureau of Statistics (2021), only 35.4% of Australian infants are currently exclusively breastfed for up to six months, which is well below the WHO’s target of 70% and the current world average of 44%.
Although breastfeeding is a biological norm and most mothers desire to breastfeed, the act of breastfeeding is a learnt behaviour. Mothers require support from well-trained and knowledgeable professionals to learn how to attach their baby and understand their baby’s cues.
Since the late 1990s, hospital length of stay following birth has greatly reduced, sometimes less than 24 hours but more commonly one to two nights. However, intervention rates are increasing and more than 37% of Australian mothers currently give birth by caesarean, 12% by vacuum or forceps. Approximately 43% of first-time mothers are being induced, with only 40% of women presenting to maternity services in spontaneous labour.
In the first few days following birth, newborns receive colostrum, with mothers’ milk volumes starting to increase by day three to four. Interventions such as caesareans can delay this by 5-7 days. Similarly, increased interventions can decrease a baby’s desire to feed in the early days after birth. This means many mothers and babies are potentially being discharged before milk volumes start to increase and when babies are not yet feeding efficiently.
For healthcare professionals who see new mothers and babies immediately following birth, it is important to understand that early, uninterrupted skin-to-skin and 24-hour rooming-in can positively influence the duration of breastfeeding.
Although, medical interventions can impact a woman’s ability to experience skin-to-skin immediately and care for her baby without physical support. Those who have had caesareans and epidurals may also struggle to care for their babies immediately following birth, which in turn can decrease women’s ability to be involved in their baby’s care and decrease opportunities for early milk removal.
A literature review by James, Sweet, and Donnellan-Ferandez (2016) reported that breastfeeding success can be impacted by length of stay (LOS) in hospital, advocating for individually tailored LOS to the mother’s needs and desires.
The authors found some mothers benefited from longer hospital stays, while others benefited from being in their own home environment. The authors also reported that a lack of practical advice regarding breastfeeding can negatively impact a mother’s confidence, which may decrease the duration and exclusivity of breastfeeding.
Yet, research currently being conducted through Edith Cowan University confirms that conflicting advice and lack of practical breastfeeding support is still an issue for new mothers while in hospital.
According to Swerts et al (2016), the first two weeks post-birth are crucial for breastfeeding support. After discharge, Australian mothers are generally seen at home by visiting midwives provided by the hospital of birth, with the majority receiving support only once or twice in the first week.
Following that, care is transferred to the child health nurse, who traditionally visits the woman and her infant once in the second week following discharge. New parents can then be left on their own until a GP or follow-up obstetric appointment at six weeks post-partum, which may leave new mothers lacking breastfeeding support during the crucial first few weeks.
A Cochrane Review by McFadden et al (2017) reported “when breastfeeding support is offered to women, the duration and exclusivity increases.” The authors of this review reported that maternal breastfeeding support is best offered by trained professionals or peer support counsellors, with the most benefit seen with the support being delivered face-to-face and tailored to the individual needs to the mother and baby.
A schedule of at least 4-8 postnatal visits has also shown to have a positive impact on breastfeeding duration.
To optimise Australian breastfeeding rates, health professionals and policy makers need to advocate for more time with women at the bedside prior to discharge, provide consistent and practical breastfeeding support in hospital and once discharged, and increase accessibility to regular breastfeeding support in the first few weeks, even months, after birth.
ED: Justine is a registered nurse, midwife and International Board-Certified Lactation Consultant, and a Master of Midwifery (Research) candidate at Edith Cowan University.