A tired father or a worried grandmother asking for ‘just one small bottle of formula’, or scripts for mother and baby for topical antifungals are both red flags for me. How many of us would recognise that both of these families are likely to require breastfeeding support? It is only when I went on my own breastfeeding journey that I started to notice them.
The widely-known benefit of breastmilk is the reduction of common childhood illnesses. To ensure babies receive these ongoing benefits, the World Health Organisation (WHO) states that babies should be exclusively breastfed until six months of age, after which food should be introduced into their diet.
Yet, eight out of 10 women in the UK stop breastfeeding before they would like to. In 2010, the number of babies exclusively receiving breastmilk at 6 months of age in the UK was only 1 per cent, despite 81 per cent of mothers initiating breastfeeding. This is staggeringly low compared with the USA where 25 per cent of 6-month-olds are exclusively receiving breastmilk, and 73 per cent in Cambodia. Mothers in the USA are legally entitled to 12 weeks of unpaid maternity leave compared with the UK where mothers are entitled to 39 weeks paid statutory leave. So, why are our figures so low?
Breastfeeding knowledge being lost
Breastfeeding is often considered an art, and in areas where breastfeeding is widespread, experience is often shared amongst mothers. Sadly, the low numbers of women breastfeeding in the UK has led to a decline in the sharing of this knowledge. A reduction in the public health budget has led to fewer health visiting services, access to infant feeding specialists and closure of children’s centres.
With little to no breastfeeding training in pharmacy and medical degree courses, it is not unusual for health care professionals to only understand the difficulties of breastfeeding when they experience it themselves.
A recent Welsh study found that 30 per cent of mothers stopped breastfeeding prematurely due to the lack of services and support during lockdown. The added challenges of Covid-19 has meant fewer opportunities to visit parent and baby groups or have visitors and this has made what should have been a supported experience for many, to a more stressful journey. In all aspects of society, it seems that the odds are stacked against educating families on the benefits of breastfeeding or supporting women in meeting their breastfeeding goals.
I believe that, in order for there to be an uptake in the number of mothers achieving their breastfeeding goals, it’s time for healthcare professionals to tackle the relevant issues head-on. How can community pharmacists provide support?
Pharmacists are well placed for opportunistic conversations, ranging from informal chats with pregnant women to experienced mothers. It may be as simple as a kind word, offering a mother the consultation room to breastfeed in (although mothers are legally allowed to breastfeed anywhere) or engaging with an older child while mum deals with her baby for mothers to feel supported. These opportunities give us the chance to discuss the benefits of breastfeeding, identify any problems breastfeeding mothers may be experiencing and to signpost to local and national breastfeeding support or organisations.
Pharmacists can also develop their own skills to deliver knowledgeable breastfeeding advice. This includes an understanding of lactation physiology, components of breastmilk, positioning and attachment, recognising the benefits of skin to skin contact, the ability to interpret growth charts, identifying how partners can be supportive and familiarising oneself with the drugs suitable for breastfeeding mothers. Useful resources include the Breastfeeding Network and the LactMed database (also see the list of resources below).
Common medical issues that can occur include mastitis, thrush, engorged breasts, reflux, tongue-tie and cow’s milk protein allergy. It is important to recognise their symptoms and evidence-based management. Further knowledge of breastfeeding and infant behaviour includes an understanding of colostrum and how long it takes for breastmilk to “come in”, feeding cues, typical breastfeeding patterns and the associated risks of interval feeding, recognising if a baby is getting enough milk (e.g. quantity of wet and dirty nappies), understanding the “top-up trap”, paced bottle feeding for mixed fed babies and realistic expectations of sleep. A registered lactation consultant (IBCLC) would be the suggested professional for signposting.
Benefits of supporting breastfeeding
If we are to increase the uptake of breastfeeding in numbers and duration, there’s clearly a wide variety of knowledge for parents and pharmacists to develop. Furthermore, reflectively speaking, as healthcare professionals we need to be mindful of any negative personal experiences of breastfeeding and offer non-judgemental, evidence-based advice.
The WHO advises that children should be breastfed beyond the age of two years old, and many mothers aim for their children to self-wean (average age: four years old). Meeting the needs of these mothers is likely to improve the healthcare of their babies, reduce the risk of sudden infant death syndrome (SIDS), as well as reducing the mother’s risk of postnatal anxiety and depression and ovarian and breast cancer, while also saving millions of pounds for the NHS.