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'Unrealistic' breastfeeding advice criticised

New mothers can feel set up to fail by “unhelpful” advice telling them to breastfeed for six months, researchers have said.

Recommendations that babies are breastfed for six months, without introducing solid food or other liquids, is considered “unrealistic and unachievable” by many families, they argued.

Promoting this ideal - as set out by the World Health Organization and the Department of Health - is “perceived as setting parents up to fail”.

Experts from the University of Aberdeen and the University of Stirling based their findings on 220 interviews with 36 women, 26 partners, eight of the women’s mothers, one sister and two health professionals.

They said their findings also showed that health services were not providing the right help to women following birth to enable them to breastfeed.

“By promoting six months exclusive breastfeeding, policymakers are encouraging idealistic expectations and goals in pregnancy, but health services are not providing the skilled help required to establish breastfeeding after birth.”

The experts found the “mismatch between idealism and realism” could mean mothers feel pressurised into breastfeeding.

All the women in the study intended to breastfeed and were keen to “give it a go” but the researchers found a range of views emerged, including the fact that families saw sharing the responsibility of feeding as an opportunity for fathers and grandparents to bond with the baby.

Some found expressing milk difficult, time-consuming and distasteful, while others said breastfeeding in public was difficult.

Some families felt that delaying giving the baby solids went against their intuition.

Antenatal care was also found to paint an “unrealistic picture” of breastfeeding, whilst NHS staff were not always available to help with feeding in the early stages.

Care of women who want to breastfeed was seen as “highly variable and determined to some extent by luck”.

The authors, writing in the journal BMJ Open, concluded: “Adopting idealistic global policy goals like exclusive breastfeeding until six months as individual goals for women is unhelpful.

“More achievable incremental goals are recommended.

“Unanimously, families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at three to four months when solids are being considered.”

Readers' comments (3)

  • I certainly think we should be encouraging mothers to breast feed for ANY length of time as it is better than NO time at all. I also agree that mothers need to know that midwives are flexible in their approach and not slavishly following the same guidelines for all. It is our duty to adapt our help and advice to the lifestyle and expectations of the mother, if we truly want breast feeding rates to rise. However this is not usually prossible as the guidelines are strictly enforced in most maternity units and midwives must follow them.

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  • This is an excellent study and full of common sense.

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  • Surely the main point of this study is that if all we do is encourage mums to breastfeed and talk about DH recommendations, they are going to feel badgered and set up to fail. We have to listen to mums and understand the competing pressures they face. Before and after birth we also need to be presenting a realistic picture of breastfeeding, including that there may be initial hurdles to cross even if breastfeeding is "natural", and then providing adequate skilled, sensitive support at birth and in the early weeks (and again around 4 months) in terms of practical help and clear information, but also encouragement and emotional support, setting achievable goals. Many mothers may be able, in the midst of difficulties, to manage to breastfeed until the next day...and then the next day...and then the next....but would find "keep going till 6 months" at that time insensitive.
    A piece of insight work we did in our area showed similarly that mums often feel they get little information and support on HOW to do it and would have liked more specific reasons as to why it is worth trying for their and their baby's sake, other than "it's best" or "good for immunity". They also need support that is proactive in reaching out to them in acceptable ways - otherwise, when they encounter difficulties, they may think it is only them who have problems and just give up.

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