"Political, social, cultural, and personal factors contribute to a woman’s individual capability to breastfeed." Photo: Getty
Niles Newton’s studies of breastfeeding problems in new mothers back in the 1950s found that 80 percent of women experienced sore nipples, which doesn’t seem surprising when it was common practice to rub alcohol on nipples.
Sixty years later and we are less liberal with alcohol, but it seems there has been little progress for women initiating breastfeeding. In a brand new, baby-friendly, public hospital and an equally well-equipped private hospital in Melbourne, a recent study conducted by La Trobe University found that almost 80 percent of first time mothers experienced nipple pain and 58 percent suffered from nipple damage.
Previous studies have found that although the most common reason given by women for stopping breastfeeding before they had planned was ‘not enough milk’, nipple pain was frequently a contributing factor. Some women refuse to even begin to breastfeed because of the fear and expectation of pain.
For our own research we recruited 360 first time mothers, asking them about breastfeeding practices and problems after birth. The group was tracked until eight weeks postpartum.
The mothers in our study were well placed to achieve optimal breastfeeding. Many were recruited in the breastfeeding classes the hospital offers to pregnant women. They were educated, motivated and supported to breastfeed. All of the women intended to do so for at least eight weeks; most for six months or a year.
Baby-friendly hospitals, such as the one where our study took place, facilitate practices that support women to successfully begin breastfeeding: early skin-to-skin contact, initiating breastfeeding within an hour of birth and rooming babies in with their mothers rather than in a nursery.
An important part of the baby-friendly accreditation is ensuring that specific policies have been put in place to promote and protect breastfeeding, which includes comprehensive training of staff to support women to breastfeed.
Despite being well placed to embark on breastfeeding, the challenges faced by the women in our study were significant. Of the nearly 80 percent who had experienced nipple pain in the first week after birth, 20 percent still experienced significant nipple pain after eight weeks.
Almost one in ten women suffered nipple damage for up to two months after giving birth.
Despite this, our results show the women’s clear commitment to breastfeeding. The women in our study persevered with breastfeeding despite the challenges and 94 percent continued to breastfeed at the end of the study, eight weeks postpartum.
Only 6 percent of the babies in the study were completely formula fed and 13 percent had their breastmilk feeds supplemented with formula.
Australian women, generally, want to breastfeed their babies; 96 percent of new mothers begin breastfeeding but only 30 percent of infants are breastfed for a full year. Fewer than 3 percent of infants reach the optimal breastfeeding goal of two years, which would ensure the strongest start for babies and the least risk for mothers’ long-term health.
So – what is a way forward to assist the next generation of new mothers?
There are many barriers to breastfeeding, and the factors influencing women’s decisions on how they will feed their newborn go beyond the physical ability to lactate.
Newborn babies are hard-wired to breastfeed, but sometimes they are prevented from using their skills and instincts to seek out and latch on to the breast correctly because we misinterpret their cues. Baby care books, while appearing to offer expert advice, sometimes prescribe routines and rules that undermine breastfeeding.
Political, social, cultural, and personal factors contribute to a woman’s individual capability to breastfeed. Support is a key factor in women’s successful initiation and continuation of breastfeeding – from family, health professionals (like The Australian Breastfeeding Association), and the community.
Breastfeeding success shouldn’t come down to the sheer luck of having a neighbour who breastfed or stumbling across a great video on the internet.
We ought to be able to reassure women that it is possible to achieve comfortable, successful breastfeeding in a timeframe that also allows them to enjoy early motherhood.
Miranda Buck, is a neonatal nurse, lactation consultant and PhD Candidate at La Trobe University. Her research interests include breastfeeding problems, the transition to parenthood and social media use by parents.
Associate Professor Lisa Amir, is a general practitioner and lactation consultant. She works in breastfeeding medicine at The Royal Women's Hospital in Melbourne and in private practice. She is a Principal Research Fellow at Mother & Child Health Research at La Trobe University, and is the Editor-in-Chief of International Breastfeeding Journal.