Supporting the Breastfeeding Mother

The first few days following birth offer precious opportunities to help new mothers establish confidence in breastfeeding.

Mothers who have physical and emotional support during this period are known to be more successful and experience fewer difficulties (Hunter and Cattelona 2014).

They are also more likely to reach the suggested goal of exclusive breastfeeding for six months, as suggested by WHO (World Health Organization).

Both WHO and UNICEF recommend:

• Initiation of breastfeeding within the first hour of life.
• Exclusive breastfeeding, without any additional food or drink.
• Breastfeeding on demand, as often as needed day and night.
• No use of bottles, teats or pacifiers.

(World Health Organization 2019)

However, these are stringent requirements for mothers to meet and failure to breastfeed can leave many mothers feeling inadequate, and leave midwives wondering what more they could have done.

So how can mothers be helped to breastfeed for as long as possible?

Providing Support is Key to Success

Current UK guidance recommends that all mothers attempt to breastfeed their babies for the first six months of life.

Yet a poll conducted by the Royal College of Midwives revealed that 43% of women surveyed did not feel as though they were given enough support and guidance to help them.

Meanwhile, a separate poll of 2,000 midwives revealed that:

• 57% ‘would like to do more’ to provide infant feeding support and help mothers.
• 25% felt that there was not enough time or resources to support new mothers with important aspects of breastfeeding such as latching-on and correct positioning.

(Nursing Times 2014)

In the view of the Baby Friendly Initiative (2019) support needs to be offered for the whole journey from pregnancy to new parenthood and not just for the first few days postnatally.

Sensitive conversations during pregnancy, skilled help after birth, ongoing guidance and social support are all needed to enable mothers to feel confident and breastfeed successfully.

For support to be effective it needs to be:

• Mother-centred;
• Face-to-face;
• Ongoing;
• Predictable; and
• Non-judgemental.

(Baby Friendly Initiative 2019)

Maycock et al. (2013) also raise an important point suggesting that although studies have identified numerous factors affecting breastfeeding including maternal education; mode of delivery; birth weight; and socioeconomic status, it’s support from the infant’s father that often plays a crucial role in the success of breastfeeding.

The Role of Fathers During Breastfeeding

Research shows that fathers can have a considerable influence on a mother’s decision to initiate and continue with breastfeeding.

Despite this, many midwives fail to engage with fathers in supporting breastfeeding.

First-time mothers who identified as having support from the infant’s father during the early post-partum period were more likely to initiate breastfeeding and had longer breastfeeding durations (Hunter and Cattelona 2014).

Although high-quality research remains relatively sparse in this area Sherriff, Hall and Panton (2014) suggest that there are five main factors that influence a father’s role in breastfeeding support.

• Knowledge about breastfeeding;
• Positive attitude to breastfeeding;
• Involvement in the decision-making process;
• Practical support; and
• Emotional support.

As Brown and Davies (2014) comment, the more the father feels included the better the outcome. It’s a view backed up by Sherriff and Hall (2011) who suggest that fathers are potentially the missing part of the jigsaw in terms of breastfeeding support.

That said, there is still relatively little research exploring the fathers' role and more importantly, the information and guidance he may need.

As Brown and Davies (2014) suggest, there is room for improvement here in the ways maternity staff embrace the father’s role, as many felt excluded from antenatal classes and breastfeeding education.

Key Messages for Improvements in Practice Include:

• Fathers want to be involved and support their partners in breastfeeding, but many felt left out and helpless.
• Fathers want specific and accessible information about the benefits of breastfeeding as well as strategies to encourage and support their partner.
• Fathers also need support during this time.
• Health professionals must involve, include and support fathers, recognising their importance in the breastfeeding relationship.

Practical Support, or Emotional Support - Which is Best?

Contrary to the idea that a fathers’ involvement in breastfeeding is always helpful, Emmott and Mace (2015) discovered that frequent grandmother contact, and father’s involvement are both associated with lower levels of breastfeeding, suggesting a negative relationship between practical support and long term breastfeeding.

In contrast, however, the father’s presence and emotional support is associated with more successful breastfeeding. This suggests that practical support and emotional support function differently, and that practical support may not always be as welcome or useful as previously thought.

Rempel et al. (2016) also report on two studies examining the relationships between fathers’ perceptions of their breastfeeding support and the mothers' perceptions of the support she received.

Interestingly, mothers' intended breastfeeding duration was shorter when fathers wanted them to continue for a long time and when they were more appreciative and knowledgeable about breastfeeding.

Likewise, when fathers reported being more appreciative and directly involved, mothers breastfed for a shorter duration.

In both these studies, mothers' perceptions of their partners' responsiveness and fathers' reports of their own responsiveness predicted that breastfeeding would continue for longer than it actually did in practice.

These findings suggest that the most effective breastfeeding support is provided using a sensitive, coordinated teamwork approach that is always responsive and adaptable to the mother's needs.

Technical Expert or Skilled Companion?

The theme of technical expert versus skilled companion also extends into the role of the midwife.

As Swerts et al. (2016) suggest, midwives value breastfeeding education and breastfeeding support as a significant part of their role. However, how a midwife approaches and supports the breast-feeding mother can be broadly classified into two distinct approaches:

• The midwife as a technical expert. Here the support is mainly breast centred, focuses on techniques, uses a ‘hands-on’ approach and sees a woman as a novice.
• The midwife as a skilled companion. Here the midwife is woman-centred, focuses on the mother-baby relationship and uses a ‘hands-off’ approach during breastfeeding support.

Most midwives seem to naturally favour the hands-off role of being a skilled companion but working in a busy hospital setting doesn’t always support this, leaving most limited to the role of technical expert (Swerts et al. 2016).

Perhaps then, in the light of these studies, there is room for both midwives and fathers to embrace the softer role of skilled companion, rather than a ‘hands-on’ expert.

Certainly, there is room for a more inclusive and innovative approach to a fathers’ influence, from early thoughts on breastfeeding through to established feeding and eventual weaning.

References

• Baby Friendly Initiative 2019, Blog: Supporting Breastfeeding: We Know What Works; Let's Make it Happen - Baby Friendly Initiative, Baby Friendly Initiative, viewed 29 December 2019, https://www.unicef.org.uk/babyfriendly/supporting-breastfeeding-make-it-happen/
• Brown, A and Davies, R 2014, ‘Fathers' Experiences of Supporting Breastfeeding: Challenges for Breastfeeding Promotion and Education’, Maternal & Child Nutrition, [online] 10(4), pp.510-526, viewed 29 December 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282396/
• Emmott, E and Mace, R 2015, ‘Practical Support from Fathers and Grandmothers Is Associated with Lower Levels of Breastfeeding in the UK Millennium Cohort Study’, PLOS ONE, [online] 10(7), p.e0133547, viewed 29 December 2019, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133547
• Hunter, T and Cattelona, G 2014, ‘Breastfeeding Initiation and Duration in First-Time Mothers: Exploring the Impact of Father Involvement in the Early Post-Partum Period’, Health Promot Perspect., [online] 2(4), pp.132-136, viewed 29 December 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300437/
• Nursing Times 2014, RCM Poll Finds Information on Breastfeeding “Lacking”, Nursing Times, viewed 29 December 2019, https://www.nursingtimes.net/roles/midwives-and-neonatal-nurses/rcm-poll-finds-information-on-breastfeeding-lacking-23-05-2014/
• Maycock, B, Binns, C, Dhaliwal, S, Tohotoa, J, Hauck, Y, Burns, S and Howat, P 2013, ‘Education and Support for Fathers Improves Breastfeeding Rates’, Journal of Human Lactation, [online] 29(4), pp.484-490, viewed 29 December 2019, https://journals.sagepub.com/doi/abs/10.1177/0890334413484387
• Rempel, L, Rempel, J and Moore, K 2016, ‘Relationships Between Types of Father Breastfeeding Support and Breastfeeding Outcomes’, Maternal & Child Nutrition, [online] 13(3), p.e12337 https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12337
• Swerts, M, Westhof, E, Bogaerts, A and Lemiengre, J 2016, 'Supporting Breast-Feeding Women From the Perspective of the Midwife: A Systematic Review of the Literature', Midwifery, [online] 37, pp.32-40, viewed 29 December 2019, https://www.sciencedirect.com/science/article/abs/pii/S0266613816000541
• Sherriff, N, Hall, V and Panton, C 2014, 'Engaging and Supporting Fathers to Promote Breast Feeding: A Concept Analysis', Midwifery, [online] 30(6), pp.667-677, viewed 29 December 2019, https://www.ncbi.nlm.nih.gov/pubmed/23958385
• Sherriff, N and Hall, V 2011, 'Engaging and Supporting Fathers to Promote Breastfeeding: a New Role for Health Visitors?', Scandinavian Journal of Caring Sciences, [online] 25(3), pp.467-475, viewed 29 December 2019, https://www.ncbi.nlm.nih.gov/pubmed/21223346
• World Health Organization 2019, Breastfeeding [online], WHO, viewed 29 December 2019, https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/