NCT, NHS, breastfeeding promotion & support

The Telegraph reports that the National Childbirth Trust (NCT) are changing their policy from promoting breastfeeding to supporting it.

The reason the NCT state for the change is to widen their reach. They say their current clientele is 86% graduates 95% white, but they want to diversify enough to be in a position where their word of mouth advocates include “pregnant 15 year olds from Manchester”. To make myself sound like a prick for a minute, one reason I was initially attracted to the NCT classes over the free NHS ones is that I thought the attendees would be “more like me” than I’d expect at an inner city Bradford hospital NHS class. I find the realisation that this was my thought process a bit abhorrent. I didn’t go to NCT classes in the end, basically because I got round to it too late and there were no places left, so my opinions here are all based on the particular NHS class I attended. As it happened, the attendees were mostly white and overwhelmingly middle class, and about a third of us were hoping for homebirths (the actual homebirth rate in the UK is 2%). This, I think, says a lot about uptake of antenatal classes in general, and suggests that the NCT’s perceived diversity problem is not unique to them. The racial and apparent socio-economic diversity of the class in comparison to that of the people in the waiting rooms for antenatal appointments and ultrasounds was very different.

The antenatal class I attended definitely promoted the idea that “breast is best”, going through a patronising exercise of listing all the “reasons” why this is apparently the case. Rather than discussing the actual risk factors, it was very much presented as “if you formula feed, your kids will get asthma and diabetes, they will be obese, fail at school, and you will be broke.” Only with much more illnesses, complaints, diseases and causes of death included. In retrospect, it felt like fearmongering.

I don’t like the “breast is best” dogma. Breastfeeding is NORMAL, and formula is the best alternative. All parents want the best for their kids, and for the vast majority that indeed involves breastfeeding for as long as practicably possible. The demonisation of formula feeding led me to resist giving formula to my tired, struggling, low bloodsugar newborn in the first day of her life, despite the fact that the initial boost of energy, nutrition and hydration that it gave her when I finally gave in then enabled her to start breastfeeding better. (I’d been unable to feed her for the first ten+ hours of her life because I lost a lot of blood and had to be stabilised and taken to theatre, followed by being listless and useless for several hours, then physically struggling for another day with cannulae due to being on a drip and having a blood transfusion).

I struggled feeding for many other reasons over the next few weeks. The support I got from midwives and health visitors was, in my opinion, shit. I was baffled by the awfulness of the situation, and tearfully exclaimed on many occasions “something has to be wrong, because humans would never have evolved if feeding your kids is this painful!” It hurt so much I screamed in agony every time, and absolutely dreaded feeding her. There is an otherwise lovely video of Polly a few weeks old, gurgling in her daddy’s hands. Towards the end, I clearly say with resignation “she’s hungry again, isn’t she?” and sigh dejectedly. I was petrified that I would accidentally hurt her through the pain, crush her head or throw her across the room. It was awful. I got dismissive tripe from the midwives and health visitors, unhelpful hippy claptrap from LLL, and I was at the end of my tether.

In my experience, the NHS antenatal breastfeeding advice simply combined “Formula is bad for babies” with “Breastfeeding doesn’t hurt” – but both of these statements are patently false. In the immediate post natal period, all my struggles were met with a midwife, health visitor or lactation consultant looking at the latch and saying “great, that looks fine, keep at it, pain is normal.” It wasn’t though. Nobody noticed. Nobody listened. Nobody appeared concerned by the blatant contradiction in the ante- and post-natal advice. It got to the point where the lacerations in my nipples were so deep I feared that another day of feeding Polly would result in my nipple coming off in her mouth.

I tried everything. Not because any health professional suggested or recommended it (they didn’t), but because I was desperate. Nipple shields didn’t help me, but they have helped others with similar problems, despite being specifically advised against by our health visitor. Nipple shells, on the other hand, did help me a lot, I think by preventing the wounds from healing too closely and then being ripped open again at the next feed. Lasinoh nipple cream, despite my lanolin allergy, was also helpful.

I recall tearfully livetweeting chunks of What to Expect When You’re Breastfeeding… And What If You Can’t? by Clare Byam-Cook, it was the first time anything seemed to help. This was a turning point. I’m saddened it happened so late. Around this time, a research funding bod from the University of Huddersfield had noticed my desperation, and made me aware of her colleague, Abigail Locke, who was about to embark on some research into mothers’ experiences with attempting breastfeeding, whether they continued to do so or not. I got in touch and agreed to be involved in her research. Luckily for me, when she got to the interview stage I was finally quite comfortable, to the point that I actually fed Polly in the middle of our session. This meant I could mostly talk about it without crying. Her premise is around the contrast between ante- and post-natal breastfeeding advice from the NHS. Her experiences as a new mum led her to the same bewilderment I experienced, they lure you in to breastfeeding with the sales pitch, then abandon you with empty platitudes and gallons of guilt when it gets tough. The suspicion is that they fear that honesty about the difficulties you may experience would put people off initiating breastfeeding in the first place. I think she wanted to show that better, more honest advice could encourage more parents to keep on going though the tough bits, and get better, more timely support to get it right. I certainly think this is the case – I would have at least felt more normal, and felt a little hope that it would get better. I would at least have felt validated in my struggle, not dismissed.

In contrast to the antenatal sales pitch, at Polly’s “7-9 month check”, one of the questions on the form the health visitor completes is “When did breastfeeding stop?” How can they be so insistently pro-breastfeeding, and then appear to accept that nobody will be stupidly masochistic enough to continue that long? The World Health Organisation recommend that breastfeeding continue (along with other food) until AT LEAST two years.

I think the NCT are right to drop their evangelical approach to promotion of breastfeeding if one of the side effects of that is the demonisation of formula feeding. Parents feel enough guilt about every choice they make or don’t make as it is. The NHS should follow suit – however I definitely think reform is needed in their breastfeeding support. It took a book, a sympathetic prescription-happy doctor (who prescribed treatment for every possibility including antibiotics, antifungals and steroids), and ten days of rest (with pumping) to get anywhere near a semi-comfortable experience.

I’m glad I stuck it out. The key benefit of breastfeeding, to me, is instant, safe, clean food, drink and comfort for my baby. Not a reduced risk of allergies. Polly never had to cry while I made her a bottle up. Eventually, I barely even had to wake up at night to feed her, let alone get out of bed. It’s the perfect convenience food.

It’s also a perfect health food. When Polly had a horrible sickness virus recently, she was completely off her food, and even refusing her favourites. I struggled to get her to take a drink of water. I honestly think if it wasn’t for breastfeeding, she’d have been hospitalised for dehydration and exhaustion.

They never mentioned that in their silly “breast is best” guilt trip session.