This post was most recently updated on March 15th, 2019
What does support mean? When it comes to breastfeeding your baby, the dictionary definition may, or may not be too helpful:
1. bear all or part of the weight of; hold up.
2. give assistance to, especially financially.
1. a thing that bears the weight of something or keeps it upright.
2. material assistance.
While the dictionary definitions may give us some clues, at first glance it can be difficult to work out what ‘breastfeeding support’ actually IS. I mean, what does it LOOK like? What do we DO? I remember wondering if I could be bothered to haul my child and my aching boobs off the sofa just for a patronising smile and a pat on the shoulder. I couldn’t have been more wrong. So let’s get out a magnifying glass and examine this stuff a bit more closely.
OK here goes. It’s clear that ineffectual, hurried, myth-based, judgemental, clumsy, incompetent or non-existent breastfeeding ‘support’ is being routinely mistaken for skilled, experienced, competent, compassionate, evidence-based, non-judgemental breastfeeding support. So I’m going to attempt to give you an insight into some of the differences, starting from the minute your baby is born. I’m sure loads of you reading this will be able to come up with more examples. (The following scenarios are all based on you having a healthy, term baby and designed to give you just a taster of some of the more common situations we encounter)
This Might Not Get You Where You Want To Go
& This Might Help You Get Where You Want To Go
You have no antenatal education about breastfeeding
You go to a small, friendly class with an experienced infant feeding specialist. You feel able to ask questions and come away feeling like whatever happens, you’ll have someone non-judgemental to turn to for help and information.
Or, your antenatal education focuses mainly on persuading you to breastfeed, listing the ‘benefits’ of breastmilk.
She doesn’t try to sell you the benefits, but talks about feeding in a down to earth, realistic manner, not whitewashing the truth that sometimes it can be tough. She talks about some of the road humps that can present themselves along the way and gives you some simple, practical tips on how to avoid them or deal with them if necessary. You come away feeling prepared, understanding that whilst it might be natural, for humans it’s a learned skill, like riding a bike, so you might need some support in the early days.
Your antenatal education consists of a list of things you ‘should’ expect to happen in hospital. You are not given choices of told about any of the pros and cons of birth interventions.
You receive good quality, extensive, non-judgemental antenatal education that not only results in you feeling prepared for the birth, but the postpartum period too. You are aware of how some birth interventions can impact on breastfeeding and know that, should you require or choose those interventions, you can get extra help afterwards to get breastfeeding off to a good start.
Your baby is born and is wrapped in a towel and handed to you to cradle in the crook of your elbow. You wonder if you should feed him and look up to someone for help or ask what you should do.
Your baby (with your consent of course) is placed on your belly/chest or on the floor/bed for your to pick up yourself. You are not aware of anything else in the room other than your baby (and your partner). Your baby and you just seem to fit together like a perfect jigsaw. Everything is warm, and dark and quiet (to steal a client’s beautiful description “like a mossy cave”). You and your baby just seem to ‘know’ what to do.
A midwife controls the first feed, grasping a large handful of your breast with one hand, and the back of your baby’s head with the other and kind of ‘schmooshing them together.
You and your baby are skin to skin. Your baby is given the freedom to crawl his way and bob his head, with little rests between his efforts, til he eventually finds your breast and latches on.
You are transferred to the postnatal ward and your baby is put firmly in a separate cot. You are sternly told not to hold your baby except when you feed and change her and definitely not to fall asleep.
A friendly midwife with a warm smile welcomes you to the ward. She encourages you to cuddle and hold your baby skin to skin and shows you how to lie on your side with your head on a pillow and feed and sleep that way. The hospital bed has a side car cot so that there is no chance of the baby falling out. If you’ve had a particularly tiring birth experience, she encourages your companion to cuddle the baby for a while until you’ve had a nap. You are brought food and drink and your companion(s) unpack your bag and place everything you need within reach. You’re shown the call bell and encouraged to use it.
You are not told how often to feed her. You are not told what to look out for when changing her nappy. If there is a laminated sheet with pictures and information about what to look for in her nappy, it is not pointed out to you.
You remember your antenatal class and you have a really good leaflet about getting off to a good start to prompt your memory and a fun, evidence-based phone app that helps too. Plus every midwife you meet gently and cheerfully checks how things are going and double checks that you’re happy with the way he is feeding. They ask you open questions and really listen to your replies. You never feel hurried or that any of your questions or worries are silly. You are assertively told that you are the expert in your own baby and reminded that YOU are your baby’s natural habitat. If they notice that your baby doesn’t seem to be feeding as often or as well as is ideal, they sit with you longer, or fetch a breastfeeding specialist member of staff who comes quickly. As a team, you work out what might be going on, and what can be done to get things back on track.
You believe that good babies sleep a lot. No one disabuses you of this notion.
A friendly midwife or a volunteer peer supporter or maternity care assistant or your mother and sister and friends, or ALL of the above, take the time to explain that healthy, normal babies need to wake and feed frequently. Most days it’s AT LEAST 8 to 10 times and usually more. Some days it might feel they never want to leave the safety and comfort of your warm bosom (the velcro baby). They help you see what a big, scary place the world must seem to your baby and how safe she feels when he tastes your sweet milk. They patiently explain that frequent feeding in the early days helps build your milk supply to match the needs of your growing baby. They tell you what to look out for and how to recognise when things might not be going OK
You are told to fill in a feeding chart which includes recording how many minutes the baby is at the breast. No one tells you that timing feeds will tell you nothing about how much milk a baby gets. No one tells you a baby can do a very good job of pretending to breastfeed. Conversely, a copious milk supply and a strong, efficient feeder can get lots of milk in a very short time. No one tells you this, either.
Someone checks that you understand how to recognise your baby’s feeding cues and reminds you that if you keep him close you’ll notice when he wants to feed a little more easily. You’re given a simple chart to note down when your baby feeds just so you have a memory jogger in case she sleeps a little too long. It gives you some tips on waking a sleepy baby, like stripping off some clothes or changing a nappy. During your first day, someone sits with you and teaches you how to recognise when your baby is drinking and gives your tools, like breast compressions, to keep him drinking when he blisses out and forgets what he’s doing. You have a useful conversation about your unique storage capacity and the infinite variety in the ways babies feed, reassuring you not to expect your baby to feed for the same amount of time as other babies, or more or less frequently, either.
You ring the bell each time you want to pick the baby up. You need help because you had a cesarean, or because you’re finding it hard to latch her on, or you’re not feeling confident. No one comes. Or no one comes for a long time. Or when someone comes they seem irritated or in a hurry. Or when someone comes they don’t introduce themselves and you don’t know who they are. Or you don’t want to bother them – they seem so busy – so you don’t ring the bell at all.
You ring the bell and a smiling midwife pops her head round your curtain. If you had your baby at home, you get 2 visits from unhurried midwives in the first 24 hours. If you’re in hospital your partner or doula is with you at all times if you need them. They help by holding the baby if you need a nap or a shower, handing you the baby back for feeds, bringing you everything you need while you cuddle him and rest and recover from the birth. Every member of staff introduces themselves, sits at your level to talk to you, doesn’t touch your breasts or your baby without your consent and has easy access to a little baby and knitted breast to show you some tips for getting a comfy latch.
When someone comes to help you, they stand at the bottom of the bed, glance in the general direction of your breast and baby and declare the ‘the latch looks fine’.
It feels a bit ouchy, or even very ouchy so when you call for help, someone comes and asks you lots of open questions to find out as much as they can about what is happening. They ask you what YOU think might be going on. Then when you latch him on, they come (with your permission) very close and watch how you are bringing your baby to the breast and what happens when he latches on. They tell you, categorically, that the only ways to assess if a latch is fine is if the mother is comfy and the baby is getting lots of milk.
Your helper looks at your posture and makes sure you can find a comfortable and sustainable way to sit or lie. They look at your baby’s position too and may suggest some little tweaks that mean the whole of his body is in contact with yours and he comes to the breast chin first. She makes sure he feels safe, with his bottom drawn in snuggly to your body, and checks that nothing is impeding the back of his head, so he can tip it back, open his throat and reach the nipple. She demonstrates with her doll and knitted breast. She shows you pictures or videos, maybe. She has a repertoire of different positions to try if one doesn’t seem to suit you. She watches a WHOLE feed, because she knows that there are clues to be had by watching you and the baby for the duration of a whole feed.
Your nipples start getting sore. When you call for help, someone else comes and tells you ‘the latch looks fine’. Someone else tells you ‘pain is not normal, you’re doing it wrong’. Another midwife tells you to ‘just carry on, it’s always sore at first’. Your aunt visits and tells you your ‘nipples need to toughen up’. Your mother comes. You cry on her shoulder and she tells you that ‘you had formula because I didn’t have enough milk, and you’re fine’.
You have continuity of care from a midwife you have had the opportunity to get to know throughout pregnancy. Ideally she supported you through the birth too. You trust her. She may be part of a small team and you’ve got to know all of them. When different people come to see you, they are careful to ask you what their colleagues have already suggested. If you complain about the conflicting advice you’re getting, they are able to explain that breastfeeding knowledge was different a generation ago, that we now know a little more about how breastfeeding works and your mother and aunt are just trying to help. The midwives have good skills that help them help you find a comfy position to feed in. They give you time to talk through how to cope with any undermining advice you might be getting and, if they can’t get you feeding comfortably, they call in someone like an International Board Certified Lactation Consultant to try to work out what is going on. They encourage you to hang out with the local peer supporters because they understand that breastfeeding is more than just mechanics – emotional and practical support from other mums is important too.
Your baby is very sleepy. It’s hard to wake her up to feed. You worry she hasn’t poo’d. Someone tells you not to worry, it’s normal for breastfed babies not to poo every day.
You get good support so that you have easy access to information about waking your baby. Your midwives check his jaundice levels regularly. All your worries are always validated and you never feel dismissed or ignored. You’re able to refer to the leaflet about nappies and what to expect in the early days and discuss your concerns. You feel heard and together, you put a plan in place to get a little more milk into your baby.
Your baby wakes up and feeds for 45 minutes once every hour and a half. You literally can’t put your baby down without her screaming blue murder. It’s day 3 and you feel so exhausted you’re hallucinating. Either, you are convinced you have no milk, OR someone tells you that you have no milk, OR someone suggests taking the baby away and to give her a bottle to ‘give you a break’ OR you are completely ignored and left to figure it out on your own.
Someone comes and sits with you. They might even give you a hug. They bring you and your partner a cup of tea and suggests the partner hold and comfort the baby for a few minutes while you talk. They listen and get a full picture of the situation. They explain that the baby is beginning to want more milk and is working hard to tell your body to bring in the copious milk volume they want. You are told that today and tomorrow are typically tough days, not just because the baby is waking up and wanting you intensely, but because your hormones might be all over the place as your body gets ready to lactate in earnest and because by now, you might be bone-achingly knackered. In an ideal world, you’d be surrounded by loving helpers, to run you bath, give you a massage, facilitate your naps, sit with you through feeds and to pop out and buy a savoy cabbage for tomorrow (and some chocolate).
You wake up the next morning to boulders on your chest. They are rock hard, hot and pulsating. Your baby tries to latch over and over, bobbing around on your chest like a maniac woodpecker, screaming til her face goes purple. No one tells you how to deal with this engorgement OR someone hands you a pump. You try the pump, nothing comes out and you are confirmed in your fear that you have no milk OR you try the pump and loads comes out and you feed the baby with a bottle and feel like this might be your solution OR you feed the baby with a bottle and cry OR you feed your baby with formula and your breasts start feeling really painful.
You are well prepared and know to expect some engorgement in the early days. You have cold compresses, a savoy cabbage in the fridge and understand that engorgement is swelling and copious amounts of milk. You understand that the swelling can make it difficult for your milk to flow and hard for your baby to get a large mouthful of breast. Someone reminds you that you can press some of the swelling away from the front of the breast to quickly help baby latch on. This ‘reverse pressure softening‘ works really well and baby latches on and drinks loads! You use the cold flannels between feeds and then swap to warm ones to help the milk flow. You are encouraged to have a warm bath or shower and the milk flows then, too, relieving some of the pressure. You’re emotionally held during this day, nurtured and loved if you have an emotional breakdown and reminded things will start feeling easier soon.
Your baby is weighed on day 5 and has lost 10% of his birth weight. You are told you MUST supplement with formula. No one tries to figure out the reason for the large weight loss. No one suggests you top up with your own milk or donor milk. No one asks you what you want to do and what your goals are.
After weighing your baby someone assesses the whole picture, looks at your journey so far and pieces the puzzle together. An early slow start might have set you back a bit, but now your milk has come in and baby is feeding well and often and not making you sore, you may decide to weigh again in a day or two, especially if nappy output is good. If there are other things that are worrying after watching a whole feed, you may decide together to supplement the baby. You are given choices, including pumping or using donor milk or formula. You are given good guidance on how much extra milk to give your baby and given choices about how to give that milk to him – bottles, finger-feeding, cups or tube at the breast.
You find a lump in your breast and a red patch. You start feeling really ill and go to the GP. S/he tells you to stop feeding on that side OR gives you antibiotics and tells you to formula feed until you have finished the medication.
You call a breastfeeding helpline or pop to your local support group or go directly to the GP. Everyone you speak to says the same thing and supports you to get your milk flowing in whatever way seems easiest for you. Your GP gives you a course of antibiotics that are safe to take while breastfeeding. You spend a day feeding lots and using cold compresses to bring down the inflammation and warm water to help the milk flow. You do some expressing too and concentrate on trying to feed the baby with his chin pointing towards the lump. Everyone around treats you as if you are ill – because you are! You are ordered to bed with your baby and brought food and drinks and painkillers if you need them.
You go to the doctors because you have a burning pain during and after a feed. Your nipple is white after a feed. Your doctor tells you that you have thrush and gives you medication that is designed for athlete’s foot OR gives you medication that is designed for the baby’s mouth and tells you to put it on your nipple OR gives you medication for your nipple and none for the baby OR gives you medication that is designed to go in your vagina. The doctor does not ask you any other questions about feeding.
You go to the doctors and ask about the burning feeling in your nipples. The doctor asks if you have spoken to a breastfeeding counsellor or lactation consultant and tells you that it’s hard to tell if a woman has thrush on the nipple without taking a swab. You ask the GP to take a swab and then pop by the breastfeeding drop in where you experiment with feeding in a different position and it feels much better!
OR the counsellor asks you lots of questions, rules out lots of other reasons for the pain and agrees that it might be thrush. The swab results come back positive and the GP prescribes the correct medication for both you and your baby.
At a Health Visitor clinic when your baby is weighed, the dot on the centile chart is a little under the line. The Health Visitor suggests putting another ounce in his bottle. When you say you are breastfeeding, she seems surprised and suggests topping up with formula.
When your baby is weighed, your Health Visitor has the time to chat informally with you. She takes the time while you undress your baby to ask you how everything is going. She knows you quite well by now and remembers you are breastfeeding. She takes your baby’s weight and plots it carefully on the chart and points out the explanatory notes in your baby’s red book. You are reassured to see that you don’t need to worry about your baby dipping a little under the line he has been on for a few weeks. The Health Visitor points out lots of other ways she can see your baby is thriving and you leave feeling proud at how well your baby is developing.
No one seems able to tell you why breastfeeding hurts so much, or why your baby isn’t putting on weight fast enough, or why your baby is so colicky or refluxy. You work on your positioning and attachment over and over again with many different people but your nipple is always compressed after a feed.
Your overwhelming feeling you are left with, is that the implication is that it is your fault, that you are doing it wrong, or that these things just sometimes happen (no explanation, no curiosity to find a cause). You cannot continue in this way and take the advice everyone gives you, to switch to formula.
You don’t understand what people mean when they say a happy mum equals a happy baby, because you don’t feel very happy!
OR, someone says your baby might have a tongue tie, but that it doesn’t affect breastfeeding. OR someone says your baby might have a tongue tie (and then says nothing else). OR someone says your baby might have a tongue tie and that the wait for an NHS appointment is 6+ weeks. OR you wonder if your baby is tongue tied, ask someone to look and are told there is no restrictive frenulum. After you stop breastfeeding, you accidentally find out your child actually is tongue tied. OR you are told your baby is tongue tied and have to wait for division and are not offered any other support while you wait for the appointment. After the appointment to divide the tie, you are not given any information on what to expect or any support as your baby re-learns how to latch deeply.
You doula suggests your baby might be displaying some of the signs of tongue tie. Your breastfeeding counsellor talks about tongue tie as a possible cause of your problems early on, and explains what it is and how it can sometimes effect breastfeeding. Your Lactation Consultant performs an oral assessment of your baby’s tongue function and carefully and clearly explains what she has found. Everyone points you to NHS or private tongue tie division services that are qualified, highly skilled, safe, effective and fit for purpose without a long wait time for an appointment. There is frequent, accessible, skilled breastfeeding support so that you can talk it all through in a safe space with a compassionate person who can help you decide what you want to do. Everyone supports you to weigh up all the information you have, including how you are feeling. No one tries to persuade you to have the tongue tie divided and no one tries to persuade you not to. You are treated like an individual who can make their own mind up. If you decide to have the tie divided, you have great follow up breastfeeding support as your baby re-learns how to latch deeply.
You ask everyone you meet if breastfeeding should hurt. Everyone – your friends, neighbours, doctor, midwife, health visitor, uncle Tom Cobbly and all say YES, it’s normal for it to be painful. You can’t continue with it being so painful so, seeing no option, you stop breastfeeding and buy some formula.
Everyone you talk to about breastfeeding is really kind and takes you seriously when you say it hurts. Everyone agrees that pain is your body’s way of telling you something isn’t quite right and asks you if you’ve been to see a breastfeeding counsellor but you feel a bit shy asking for help. You meet a peer supporter in the playground who has her baby in a sling. You end up telling her about your pain and she shows you some ways of holding your baby that might help. She tells you she volunteers at the breastfeeding clinic and you resolve to go, feeling less shy now you know her.
You go to the group that week and have a wonderful conversation with the counsellor. You pain disappears within days. You go to the group every week and see dozens of mothers coming in looking worried or even in tears and see them leaving with smiles on their faces. When you baby is a year old you decide to train as a Peer Supporter yourself. Surrounded by a family of like-minded women you feel such unstinting positive regard and lack of judgement that you continue breastfeeding for as long as you and your child enjoy it. The feelings of companionship and community means that comments about feeding a toddler and the odd weird look when you feed in public don’t upset you at all.
You begin to notice women who remind you of the woman you were when you gave birth everywhere you go. You become determined to be that woman in the park for as many mothers as you can.
The scenarios above are, of course fictional. So I decided to include some real quotes, from real mothers. I asked them to explain what breastfeeding support did for them and how they felt about it, or what happened when they didn’t get the help they now know they should have received.
“…she just suggested a few things I could try, and also said she’d make her way to me if I needed her. The next day my daughter had put on 40g.”
“…I had a lot of support with shallow latch, flipple technique and general reassurance. From you and others at breastfeeding specific groups. Helped with positioning, latching, all sorts. Feeding cues, telling me what was normal etc…”
“…I’ve had so much help, from qualified IBCLCs to peer supporters to women who have been there and done that. Even as a trained PS I needed help and not one of them has ever begrudged it.”
“These women saved my journey without a shadow of a doubt, I am getting goosebumps and watery eyes thinking about it. This silent army of women, making cake late on a Sunday night, juggling their lives to come and sit with you and help you, calming anxious mothers and distressed partners, unravelling the tales we have told ourselves and the pickles we have got into both emotionally and mentally. And they do it for no recognition.”
“After two unsuccessful breastfeeding journeys…the only thing that healed this and allowed me to move on to have a successful breastfeeding journey with my third was someone that listened to my story and helped me understand what had caused my problems and that I was failed by the system!”
“…I’d come to my local group (thank goodness it was in my home town) and you have shown me so many positions, comforted my cluster feeding frenzy, pain and distress, telling me it was all normal, and just like that it was over. Most of all it’s the education you’ve given me. I’ve educated my mother who grinned and beared it for 2 weeks – just. I’ve educated women who hadn’t thought about breastfeeding. But mostly you’ve kept me sane!”
“Something was not right. I asked about tongue tie – the HV barely looked inside his mouth (from what I know now she did not check properly at all). The problem was that I thought that all those people were there to help me – no one at any point suggested I could seek out a lactation consultant. I did not know they existed! I wanted to breastfeed but I was exhausted and my baby was so unsettled. I tried expressing and feeding from the bottle – he loved it! So the health visitor said – you see? Just do that! Sadly my milk dried up VERY quickly when expressing (in a few weeks) and I switched to formula. It felt like the right decision at the time but I can now see how badly I was let down. If I knew then what I know now… I needed support – but I thought I was getting it! I thought I was the problem.”
“I didn’t know how to hold him to feed. I didn’t know anything about feeding. I thought pain was normal. At six weeks old feeding was horrifically painful. My nipples were bleeding and ripped. I cried every time he latched. I was desperate. My sister suggested I call her friend and LLL leader. She helped calm me over the phone and found me my nearest immediate drop in. She came to see me the next day herself at my home. She helped me find a comfortable position, she listened to me, she asked if I knew about tongue ties (I didn’t) and gently suggested I might see a lactation consultant. She held my hand. She knew.”
“When I crawled down the stairs to use the phone, I was too feverish to walk, the breastfeeding counsellor I spoke with was kind and listened to my garbled talk. She explained how to get my milk flowing so the mastitis eased a bit (using a deep basin of hot water and flannels to aid hand expression) and she encouraged me to call the GP. Later, she invited me to gatherings of breastfeeding mothers where I learned how to avoid getting so ill with mastitis.”
“I would never of got this far without the amazing breastfeeding support I received from the specialist at my local maternity department, and the wonderful peer supporters at our breastfeeding group. They helped me adjust my positioning to allow my daughter to latch properly, which meant she could gain weight and I didn’t experience pain while feeding.”
“First BF journey cut short at 3 weeks due to thinking I wasn’t producing, baby was agitated and I could no longer express. Failed by my Health Visitor and GP for telling me I’d dried up because I was too young so needed to formula feed. Twins, lasted a week of combi feeding, 1 because I was told by everyone I came into contact with at birth that it was impossible to feed twins and 2 because they were prem.”
“…8 months in with my first baby and first breastfeeding experience and would not have got this far if it wasn’t for the help of breastfeeding supporters helping me with new positions to use, latching techniques and boob and nipple care. And on my very worst day where I was 99% sure i was giving up and turning to formula she saved our journey letting me use a pump for a day which in turn made me realise how much I hated not feeding my little lady! She also got me in touch with someone who diagnosed a posterior tongue tie and referred us to have it snipped! Forever grateful!!! Breastfeeding support is essential these days with so much incorrect information out there!”
“I had various midwives and health visitors help me adjust our latch with both my boys. My first I fed for 4months. And my second for a full 13 months. Without guidance and advise from those in the know I’d have given up a whole lot earlier!!!”
“…the midwife finally said ‘Have you seen the breastfeeding counsellor?’ No. I hadn’t. Because I didn’t know that such a thing existed. So that’s when I met the wonderful Debbie. The first person I’d ever met who knew anything about breastfeeding, in 5 weeks of a really traumatic journey. She was amazing and gave us some wonderful support, but unfortunately the damage to our breastfeeding relationship, both physically and mentally, had already been done. I stopped at 8 weeks after a night of cluster feeding and a panic attack that she wasn’t getting enough. All I could think was if only I’d met Debbie sooner. And I vowed that next time I would seek her out before I’d even had baby.”
There were many, many, many more quotes than this – it was an outpouring. I hope, if you’ve never had any breastfeeding support or the ‘support’ you got was a read traffic light instead of a green one, that this article has been a little helpful. I love hearing people’s stories, please feel free to comment below and tell me how it was for you.
Have you had great breastfeeding support or wish you had? I am a trustee of an amazing little charity called Cambridge Breastfeeding Alliance. We provide ‘green traffic light’ support to hundreds of families every year and rely on donations to keep running our groups and out-reach work. Please consider donating – one small kindness that could make a massive difference!