Being a new parent can be one of the biggest, scariest responsibilities you will ever take on. Growing a whole new tiny person and keeping them alive can be anxiety inducing even for the most laid back. Am I holding them ok? Why are they crying? Am I doing any of this right?
Understanding and alleviating these concerns is a critical part of making sure new parents are supported and feel confident in their new role. Anxiety is not only uncomfortable at the best of times but can lead to relationship conflict, maternal identity issues and postnatal depression.
But as a society we have a major issue in supporting new mothers through this time, because many of us have lost sight of what new babies are really like. We have a habit of interpreting pretty normal baby behavior as something being wrong and needing fixing as it doesn't fit our societal norms about how we believe babies should behave.
Our culture pushes the idea of the mythical 'good baby'. Mythical good babies don't act like most babies. They feed at set spaced out time points, sleep through the night and need little interaction. I say mythical, as research shows that most babies tend to feed often, wake at night throughout their first year and being kept close is a basic human need. But we still persist with asking new parents whether their baby is good, and tutting when we hear about normal baby behavior as if this tiny person needs punishing.
But what's this got to do specifically with breastfeeding? How does this damage breastfeeding exactly? Because breastfed babies in particular do not act like mythical good babies and trying to encourage them to do so often ends in tears (both the baby's and yours) and ultimately formula use.
There are some basic differences between breast and formula milk that need to be understood for breastfeeding to work well. Breast milk is more easily digested than formula. Breastfed babies also tend to take smaller feeds as they are more in control of when they start and stop a feed whereas bottle fed babies are more at risk of overfeeding if they are persuaded to do so by a carer wanting to finish the bottle. This means that breastfed babies feed more often, quite easily every two hours or more, including throughout the night, whereas formula fed babies tend to go a little longer. Breastfed babies are also more likely to feed irregularly, as breast milk changes in energy density over the course of the day, whereas formula fed babies are more likely to be fed to a routine as it's a uniform product.
This frequent feeding is important for breastfeeding and does not mean that something is wrong, as long as your baby is alert, has a good colour and firm skin and is having wet and dirty nappies. Frequent feeding helps to build milk supply and trying to feed less often can lead to milk supply issues and eventually formula use. Feeding responsively, whenever the baby wants, may even promote healthy appetite control later on.
Loss of knowledge
But we have lost sight of this normal breastfed baby behavior. Some of the most common questions new parents ask are 'Is he feeding too much?', 'does this mean I don't have enough milk?' and 'Isn't he satisfied?'. We perceive normal, healthy feeding patterns as a sign of something being wrong. These are exacerbated by suggestions that back in the 60s and 70s, routines were normal and babies only fed every four hours and that anything else indicates a problem. This is true, babies were indeed often fed this way but breastfeeding failure rates were also very high and this was not a coincidence; spacing out the feeds too much led to insufficient milk being produced and babies being very 'unsettled' as they weren't being fed enough.
The UK has some of the lowest breastfeeding rates in the world and this cannot be explained purely by physical issues stopping women from breastfeeding. Women in other countries such as Sweden and Norway breastfeed for far longer suggesting that our issues with breastfeeding are at least in part, societal. This is not to say women are simply stopping breastfeeding because society does not like it, but because our society is not set up to support breastfeeding, and this can damage it.
Estimates of primary physiological inability to breastfeed are very low. However far more are having difficulty with breastfeeding. This is in part to do with a lack of good investment in maternity services, meaning that mothers are not receiving the practical help they need after the birth. But it's wider than that and another central reason is that we've simply lost track of what babies are really like. We expect them to act in a way that is physiologically incompatible with breastfeeding and then wonder why breastfeeding has gone wrong.
Because even though we might promote breastfeeding, in reality after the birth, whenever there is an issue, formula is often offered as the solution. Worried baby isn't getting enough? Use a formula top up. Wanting baby to sleep through the night? Offer formula before bed (a strategy that doesn't usually work by the way). Wanting to see how much they're drinking? Give a bottle. Formula is perceived by many as the answer to all problems and to achieving the mythical good baby (even though many mums will tell you changing to formula certainly didn't change their baby's behavior). Instead, what all these things typically do is decrease milk supply as formula is being used instead of breast milk and the body thinks the milk isn't needed.
Supporting new mothers
So if we want to stop topping the tables of poor breastfeeding rates, we need to look to the wider society in which we are trying to raise our babies. We need to support and care for our mothers to mother, rather than questioning how 'good' their baby is and pressurising them to care in a certain way. And most of all we just need to let our babies just do what babies are designed to do and not label them as doing something 'wrong' just because they are feeding, sleeping and seeking comfort in the way nature intended.
Dr Amy Brown explores this issue and others in more depth in her new book
Breastfeeding Uncovered: Who really decides how we feed our babies? published by Pinter & Martin