Got (Breast) Milk?
As the world marks Global Breastfeeding Week, breastfeeding experts say Canada’s health care system is failing women who may have problems nursing their newborns.
The theme for this year’s breastfeeding week, which runs from August 1–7, is “Breastfeeding Support: Close to Mothers,” highlighting the crucial part health care and community support systems play in sustained breastfeeding success.
Dr. Jack Newman, known as Canada’s breastfeeding guru, established the country’s first hospital breastfeeding clinic in 1984 and has educated women on proper feeding practices for over 30 years.
One could “fill a book” with the misconceptions that circulate about breastfeeding, he says, and much more needs to be done to support and guide new mothers.
“Mothers realize more and more that most doctors don’t really know much about the practical aspects of breastfeeding,” says Newman, author of several breastfeeding publications including a help guide for both professionals and mothers.
The problem comes down to a lack of proper training, he says.
“It is true that more doctors believe in the importance of breastfeeding, but very few have had any training in how to prevent problems or help the mothers if they do have problems.”
Much has been written about the advantages of breastfeeding, such as its ability to reduce infection and disease, boost the baby’s immune system, and prevent obesity, as well as its links to increased performance on intelligence tests.
Nursing is also known to benefit mothers, lowering their risk for diabetes and certain cancers while reducing high blood pressure and cardiovascular disease as they age.
The World Health Organization, the Canadian Pediatric Society, and Health Canada all recommend exclusive breastfeeding for at least the first six months of a baby’s life to achieve these benefits.
However, breastfeeding rates in Canada have not increased significantly in the past decade, and only 25.9 percent of Canadian mothers breastfeed exclusively for the first six months of their baby’s life, according to a 2009/10 Statistics Canada report.
A University of Alberta study released this month also found that over half of the 402 women they surveyed started out breastfeeding exclusively but quit after three months. That number dropped to 15 percent by six months.
The majority of women said they stopped early because they didn’t produce enough milk.
Most Problems Preventable
Newman says problems with milk production and other common issues such as difficulty latching on and nipple pain are almost always preventable, and if women were given sufficient guidance on proper methods before they left the hospital, breastfeeding success rates would be much higher.
“What is striking is not that so many mothers have difficulty with breastfeeding but that so many actually manage to succeed,” he says.
“What we do to mothers during labour and birth in hospital interferes with breastfeeding in many ways—hospital practices around breastfeeding are appallingly bad.”
The problems often start before the baby is born, says Newman, because many doctors don’t discuss the importance of breastfeeding with pregnant women in order to avoid making them feel guilty if they have difficulty or decide to bottle-feed.
After the baby is born, mothers who have a struggle nursing are often instructed by doctors to switch to formula, instead of investigating the issue and receiving help and referral, he says. In addition, training is not consistent and some public health nurses may not know how to help mothers.
Dr. Verity Livingstone, medical director for the Vancouver Breastfeeding Centre, notes an additional obstacle for breastfeeding mothers.
“Conflicting advice amongst health care providers is the most pressing issue confronting mothers trying to solve their breastfeeding problems,” she says.
“Almost all breastfeeding problems have a simple explanation. Once a correct diagnosis has been made, then appropriate management can be offered.”
But identifying the right diagnosis takes time and experience, she adds, saying breastfeeding and lactation is one of the most neglected areas of medicine today.
“The lack of education in breastfeeding medicine within the health care system has played a major negative role in the support of ongoing breastfeeding.”
But perhaps equally discouraging for new mothers, says Newman, is that breastfeeding is nearly “invisible” in society. By contrast, formula is readily available, convenient, and heavily advertised in parenting magazines and on television.
“Often we still view the bottle as the symbol of babyhood,” he says. “Children grow up never having seen a baby at the breast, but they see lots of babies bottle-feeding. In school, nothing is taught about breastfeeding, not even in sex education classes.”
WHO to the Rescue
But a World Health Organization initiative may be helping to change that.
Currently 15 Canadian health facilities, primarily in Ontario, are members of WHO’s Baby Friendly Initiative (BFI). Launched in Canada in 1998, the program is part of a global effort to enable mothers to breastfeed successfully.
The criteria for a health centre’s BFI accreditation include standards such as staff training, helping mothers breastfeed within the first hour of birth, allowing infants and mothers to remain together 24 hours per day, and giving newborns no food or drink other than breast milk unless medically indicated.
According to the Breastfeeding Committee for Canada, more hospitals across Canada are currently working toward BFI accreditation and other initiatives to improve breastfeeding support.
“Over the last decade there has been a major shift to include breastfeeding medicine into the undergraduate and postgraduate training of medical students, family practice residents, midwives and nurses,” says Livingstone.
“Despite this, many mothers experience challenges with breastfeeding and they still do not receive the standard of care that they should.”
In a statement to mark Global Breastfeeding Week, WHO said it aims to have 50 percent of mothers breastfeeding exclusively for their baby’s first six months of life by 2025. Globally, 38 percent of infants under six months are currently breastfed exclusively.