Breastfeeding Intentions and Shaking up the System

At my first antenatal Appointment I was asked, “are you planning on breastfeeding?” After an emphatic “yes” the midwife began informing me of the benefits of breastfeeding. I basically said “yeah, yeah I know. Don’t worry I will be breastfeeding. I know the research”

Content with my response, she ticked the box and moved on.

When I birthed my first daughter she latched on easily during that first golden hour. Breastfeeding over the first 24 hours was a cinch. During the obstetrician visit before discharge he told us she had a mild tongue tie. The panicked eyes of my husband stared at me across the hospital bassinet. “What the eff is a tongue tie?!” we both thought, “and why has our perfect little no complications angel of a baby been cursed with it?”

The doctor told us it was mild but with just a little snip it would be taken care of. “A little snip?? As in CUT our brand new baby?!” So naturally, we sought the second, third, fourth, fifth opinion from every consecutive health professional we spoke to. My god, the understanding about tongue ties was abysmal, evident by the fact that everyone we spoke to had a different idea about them, each of them very confident in their opinion. None of them, however, referred us on to see an IBCLC (International Board Certified Lactation Consultant).

My daughter cluster-fed all night during her first and second night at home. By day three my nipples were on fire. I felt this was probably normal. If pain wasn’t to be expected, I wasn’t sure why they would sell nipple gel pads and ice packs and lanolin cream at every chemist. But the pain wasn’t easing. In fact, it may have been getting worse (my memory is hazy). Some reading I had done on tongue ties talked about the lipstick shape a nipple took after breastfeeding with a poor latch. My stinging cracked nipples had that new lipstick shape after every feed.

The child health nurses gave me the old, “the latch looks good” talk. My GP told me it’s normal for nipples to hurt for six weeks. One of our health professionals even talked about tongue ties being the new “it” procedure and it was probably nothing to worry about as baby was gaining weight well. I kept wanting to say, “she’s gaining weight because I feed her every single time she smacks her lips together or sticks her tongue out or makes the faintest sound of discontent.” But I never said it. I don’t know why.

Knowing what I know now, we might have made a different choice. But with such contradictory evidence and opinions coming in from all angles there was no way we were subjecting our baby to a medical procedure. It felt risky and irresponsible. And yet with my pain and my cracked nipples and a threat of snipping the tie, still no one referred us to an IBCLC.

Breastfeeding became easier and the pain eventually eased. I weaned my daughter at 16months and moved on, not thinking too much about my breastfeeding journey after that. My baby boy a few years later had a similar-looking latch to my daughter. It was a little stingy, which I wasn’t expecting for the second child. But it did ease much faster, and I was pain-free after a few weeks. I’m still breastfeeding him now and he’s just turned 18 months.

Today I’m a postpartum doula. I’ve just finished a breastfeeding support course with the Newborn Mothers Collective. I’m learning all about tongue ties and the process of diagnosing and treating them. I’m learning about the history of tongue ties and that they are not, in fact, a new diagnostic fad. I’m learning that my experience could have been very different. And while I don’t pretend to have experienced any kind of profoundly difficult or traumatic event, studying breastfeeding has definitely brought up some big feelings for me.

Thinking back, there are moments all over my pregnancy, birth and breastfeeding journeys that could have been tweaked to achieve better outcomes. Breastfeeding, my mental health, my husband’s mental health, and both babies’ sleep. Perhaps if I had hired a doula or a private midwife things would have been quite different. But that didn’t happen, and so things slipped through the cracks and went undiagnosed or unnoticed.

I can’t go back in time. But I can try to change things up for mothers of the future - starting with the antenatal conversations. Where the breastfeeding conversation with the hospital midwife ended, I think it should have been just the beginning. I know the public health system is stretched as it is, but we’re talking prevention, people! Prevention is cheaper than ‘cure.’

I envision midwives and obstetricians working with a flow chart (look, maybe there is one and I don’t know about it because I don’t work for QLD health, but it seems to me there’s a one size fits all approach and it needs to change). A flow chart = protocol. It would assume the person walking through the office doors knows nothing about the benefits of breastfeeding. But as they move down the flowchart, the information shared would become more detailed, as the patient reveals more understanding.

The idea would be that women don’t leave the office feeling overwhelmed with information they can’t handle. But that they do leave the office with more information than they had upon arrival - information that is constructive for their individual breastfeeding intentions. Perhaps women leave with their own flow chart. Like their birth map, but a breastfeeding map - ‘If this, then…’

I have built a breastfeeding intentions worksheet for my clients. I learned from Julia Jones (Newborn Mothers Collective) that by establishing some intentions, based on up-to-date evidence-based information, women can build their breastfeeding self-efficacy or ‘confident commitment’. Research indicates that breastfeeding self-efficacy improves breastfeeding outcomes¹ and the ability to withstand common breastfeeding challenges². The intentions and confidence need to be established prior to birth; before any challenges are faced.

Unfortunately, I am but one postpartum doula. Women who hire me are already at an advantage, having attached themselves to a source of breastfeeding information and support. For most, we don’t know what we don’t know. I was a confident first-time mother back in 2017 and I thought I had all the answers. I had a confident commitment to breastfeeding and was quite determined. But I wish I had access to better information before I started so that I wasn’t scrambling for answers once faced with challenges. Already under the immense pressure of motherhood and sleep deprivation, I wasn’t in a position to critically analyse the research.

“Are you planning on breastfeeding?”
“yes”
“that’s great news. So you’re aware of the wonderful benefits of breastfeeding, to you and your baby?”
“absolutely”
“what about the possible challenges you may face and the protective factors? Are you aware of these?”
“oh, I don’t think so”
“let’s have a chat then”

¹Blyth, R., Creedy, D.K., Dennis, C.-L., Moyle, W., Pratt, J. and De Vries, S.M. (2002), Effect of Maternal Confidence on Breastfeeding Duration: An Application of Breastfeeding Self-Efficacy Theory. Birth, 29: 278-284. https://doi-org.ezproxy.une.edu.au/10.1046/j.1523-536X.2002.00202.x

²Avery, A., Zimmermann, K., Underwood, P.W. and Magnus, J.H. (2009), Confident Commitment Is a Key Factor for Sustained Breastfeeding. Birth, 36: 141-148. https://doi-org.ezproxy.une.edu.au/10.1111/j.1523-536X.2009.00312.x