10 things I wish every GP knew about breastfeeding

As founder and admin of my local breastfeeding group, and member of many others, the inconsistency in breastfeeding knowledge and support from your average GP is frustrating, infuriating sometimes. It is an issue that arises frequently. You may be surprised to learn that the extent of their training about breastfeeding is little more than a multiple choice questionnaire which takes very little time to complete. Unless they opt for continued learning in that area, that’s where their ‘training’ ends. And I get it, I do – as a teacher, I opted for CPD in the areas I was most interested in, or that I needed most regularly. In an ideal world, every one of us would have had extensive training in all aspects of teaching and learning but time and money are in short supply in the public sector, and that would have taken us away from where we needed to be: the classroom, just as doctors need to be available at their surgery.

So, in the hope that this might make it onto the radar of just one medical professional and make a difference to a handful of women and babies in their breastfeeding journey, here are ten things I’d love them all to know…

1. Breastfeeding isn’t just about food. Up to six months, milk is the sole source of nutrition for any baby, but the benefits don’t suddenly stop thereafter. The WHO recommends exclusive breastfeeding for six months, and alongside complementary foods for two years and beyond. Breastfeeding provides comfort, sleep hormones (tryptophan) at nighttime, automatically adjusts to the weather/temperature, produces antibodies specific to baby’s needs, is a natural analgesic and reduces the risk of ear infections, gastric problems, SIDS, leukemia and heart disease in adulthood. For mums, too, the benefits are many, with reduced risks of breast cancer, ovarian cancer, heart disease, obesity and osteoporosis.

2.”Too much birth weight lost” and ‘low supply’: This is something that crops up regularly. The best article I have ever read on the topic is this one. Parents of babies who lose more than 10% of their birth weight are often advised to supplement with either expressed milk, Image result for the top up trapor formula. There are a couple of important issues here. Firstly, if a mother was induced, had pain relief, or any fluids in labour, a baby’s weight can be artificially inflated at birth. There are some who believe that not weighing a baby until 24h after birth would generate a more realistic weight. Secondly, many babies lose weight as they are swaddled and expected to sleep away from mum, often alongside ‘stretching out’ the time between their feeds to 3-4 hours. Their bodies go into survival mode when they are separated from mum and shut down vital processes in order to conserve energy in a scenario that it feels is unsafe – remember that these babies have exactly the same inherent needs, responses and reflexes as babies born thousands of years ago. Skin-to-skin isn’t something that’s needed just after birth and never again; it’s very important for days/weeks for a baby’s wellbeing and optimal growth. (Even if baby isn’t feeding at the breast, continued skin-to-skin is more likely to see their weight stay healthy, than if they are put in a cot beside the bed). Finally, the issue with supplementing, particularly with formula, means less time spent at the breast, stimulating milk supply. Milk is produced on a supply and demand basis so, if baby isn’t suckling, the body won’t build up, or keep up, its supply. The first six weeks are crucial in allowing the body to regulate its supply, and interference can be detrimental. If supplementation is truly necessary, ideally this will be expressed milk from mum, otherwise donor milk, before formula is used. Ideally, milk will be given via syringe, spoon or small cup but, if a bottle is used, paced feeding is crucial, to avoid nipple confusion. Whilst a small proportion of mothers do experience natural low supply, many more are led to believe they have it when they do not, or end up with lowlow milk supply false alarms infographic supply through poor advice in the early days of breastfeeding. This graphic by ‘Love and Breastmilk’ covers almost all of the things destined to make new mums panic about their supply (the full article is here). Again, women need reassurance in the face of these experiences, not to be told that their milk isn’t enough, or that they have a ‘hungry baby’ who needs formula (or solid food before six months). Breastfed newborns need to feed regularly; more frequently than formula fed babies, as breastmilk is roughly 88% water and is quickly digested. Frequent feeding/feeding on demand (not on a 3-4 hourly schedule) should be encouraged and, as long as baby is having plenty of wet and dirty low supply, breastfeeding, breastmilknappies, mothers should be reassured. This La Leche League (LLL) article covers newborn feeding and ways to tell that enough milk is being transferred, plus indicators that it may not be. There are always instances when milk isn’t being correctly transferred and the most common reason is an ineffective latch, not low supply. Referral to a Lactation Consultant or breastfeeding specialist is crucial, so help can be given and a plan put in place to protect supply. In the event of he LLL recommends ‘The Three Keeps’: 1) Keep your baby close (plenty of skin to skin) 2) Keep your baby fed (see point three above) and 3) Keep your milk flowing (pumping, and breastfeeding as often as possible).

3. Mastitis and tummy bugs won’t ‘poison’ your baby: First up, mastitis. Absolutely not the same as a blocked duct. Both can usually be treated at home, though mastitis sometimes requires antibiotic treatment and mums need to treat blocked ducts as soon as possible to ward off mastitis. This article from Kellymom is an excellent go to, as is this from Breastfeeding Support, covering symptoms, side effects and treatment. The worst thing a breastfeeding mother with blocked ducts or mastitis can do is stop feeding her baby – contrary to advice I’ve heard given by medical professionals, she will not poison her baby, or pass on the infection! This is one of the most common – and frustrating – myths perpetrated by GPs.
Next up, tummy bugs… If a mother has a gastroenteritis, norovirus, food poisoning or an upset stomach, the worst thing she can do is stop feeding her baby. Not only will she become engorged, thus risking blocked ducts, but she will not be passing on antibodies to her baby. The bug will not pass through her milk, but the baby’s saliva, as it comes into contact with her nipple, will trigger her body to create the antibodies needed to fend off the bug, if it has caught it elsewhere. The crucial thing is to make sure mum is cared for, so breastfeeding during illness is manageable – rest, rehydration drinks and tiny amounts of food when possible/bearable.

4. Both mother AND baby need to be treated if either has thrush: I’ve spoken to a few ladies who’ve had nipple thrush, who’ve been given treatment but their baby has not. This causes the infection to bounce back and forth between them. This LLL article covers everything you need to know about treatment and reducing the risk of a recurrence.

5. Most medications are safe for breastfeeding women to take: There is much misinformation when it comes to the safety of certain drugs for breastfed babies. The Breastfeeding Network has a series of factsheets, where many drugs can be looked up in seconds. Otherwise, Wendy Jones (MBE) is always very quick to respond to any questions. There are very few instances where a woman would need to cease breastfeeding, or where an alternative cannot be offered.

6. Reflux, colic and wind are all symptomatic of other issues, rather than being conditions in themselves: Frequently, nursing mothers are told their baby ‘has reflux’ and medication is administered, without investigation into the bigger picture. Some babies are sicky, and a certain amount of posseting is usual. Beyond that, frequent vomiting after feeds is often an indication of an ineffective latch, with too much air being taken in during feeds. Again, referral to an IBCLC or breastfeeding specialist is important here. Less common are intolerances, which can be ruled out by the mother eliminating certain foods, such as dairy, one at a time, not by stopping breastfeeding.
‘Colic’ often happens in the late afternoon and evening, after a baby has been happy all day, and always mystifies new parents. It is exhausting and utterly frustrating. This also tends to be the time of day when babies want to ‘cluster feed’ (feed for hours on end, without stopping). If a parent mentions colic, ask if they’re aware of baby’s need to cluster feed – the two are often (though not always) mutually exclusive. For more on colic, this article by LLL is really useful.
Wind is another common ‘complaint’ but one that is usually very normal for newborn babies – their guts are adjusting to being outside the womb. Many mums say their babies have wind and describe them pulling their knees up, which is the way a baby is designed to move in those days – it’s only our adult conditioning that assumes pulling the knees up is a sign of discomfort. Hard tummies also get mentioned a lot in the context of wind, but this is often due to prolonged bouts of crying. Like colic, these ‘symptoms’ usually dissipate baby is put to the breast and feeds but, because it’s cluster feeding and baby is whingy and fussy,  and because women have been conditioned by socity to not trust their body or their baby, they look for reasons aside from it just being normal.

Image result for natural term breastfeeding
Courtesy of: http://www.thealphaparent.com

7. ‘Extended’ breastfeeding should be encouraged: I feel ALL the rage when mums nursing an older baby or toddler receive negative comments in public. Always borne out of ignorance, it serves only to make the woman feel belittled. Being told the same thing by a medical professional exacerbates my rage. And it happens far too regularly. The worst story I’ve heard is about a GP who looked horrified when a friend told him she was still feeding her 18m old, before suggesting that her husband must be annoyed. Misogyny AND ignorance at their ugly best.
See point one for all the reasons why breastfeeding beyond six months is recommended. Add to this the fact that it is by far the quickest way to get a baby to sleep or soothe them when they’re hurt or upset, and it’s easy to see why so many women who plan to ‘get to six months and then stop’ end up continuing with breastfeeding. From experience, and I know I speak for many nursing mothers here, breastfeeding has become part of the fabric of my mothering. It makes me stop and take a moment to be calm (did you know the German word for breastfeeding is ‘stillen’, meaning ‘silent’?). It attunes me to my child’s needs and, whilst my daughter happily stopped at 18m when I was four months pregnant, I know my son, who is coming up to that age, would laugh me out of town if I tried to cease nursing at the moment. If you come across a woman breastfeeding an ‘older’ baby, just tell her she’s doing a great job!
Whilst we’re on the topic of pregnancy, I’ll shoehorn another myth debunk in here: breastfeeding does not cause early miscarriage, or take essential nutrients away from the unborn baby. As this article iterates, the uterus is not affected by oxytocin until a pregnancy is at full term and ‘even a high dose of synthetic oxytocin (Pitocin) is unlikely to trigger labor until a woman is at term’.

8. Breastfeeding does not cause cavities. Maybe one for the dentists out there, rather than doctors and nurses. Despite this myth being debunked long ago, I still regularly hear from ladies who’ve been warned about the risk of their children getting tooth decay from nursing. I’ll leave this one to The Milk Meg, AKA Meg Nagle (IBCLC) to explain, which she does so brilliantly in this piece.

9.Tongue ties: Contrary to popular belief, tongues ties are not becoming more common. We simply hear about them more regularly now as they are more frequently diagnosed. That said, there are still huge barriers to tongue tie division on the NHS, with many weeks’ wait in some trusts. Furthermore, at the time of writing, the Association of Tongue Tie Practitioners (ATP) have taken legal advice about the current regulatory issue meaning its members cannot perform divisions UNLESS they are CQC registered. If a baby has a tongue that is affecting its intake of milk, support must be offered until it can be divided. This LLL article is excellent.
For everything you need to know about tongue ties, here’s a go-to guide by Suzanne Barber (Midwife, IBCLC and ATP co-founder)

10. Not everything is a problem that needs solving: Newborn survival instinct, sleep regressions, growth spurts, developmental leaps, separation anxiety, teething, illness – so many things cause disrupted sleep, changes in behaviour and increased nursing. Nursing mothers need support, encouragement and reassurance that these are normal infant behaviours. Too often they are given outdated, sometimes dangerous information, and advice which flies in the face of current WHO and UNICEF guidelines. ‘Just give them formula’ is a phrase that medical practitioners are still happily spouting, despite the NHS’ awareness that ‘an increase in breastfeeding could save {them} £40million per year.’ Telling mothers to breastfeed whilst simultaneously cutting funding to crucial support networks AND not giving adequate training to medical professionals is criminal. It is little wonder postnatal depression has become so common. Breastfeeding sometimes gets blamed for PND, but it can actually prevent it, IF the right support is in place. With very few exceptions, the ONLY time a mother should be encouraged to stop breastfeeding is because she wants to.

If you are a medical professional and have read this far, thank you for taking the time. I hope it helps extend your knowledge of breastfeeding, making it as current and in-depth as possible.

Huge thanks to J’Nel Metherell (IBCLC and our local LLL Leader for fact checking this for us)

Jo, The Mother Side x

PS: The following resources are exceptionally useful:

Books
The Womanly Art of Breastfeeding (La Leche League)
Baby Led Breastfeeding (Gill Rapley and Tracey Murkett) (This is the leaflet – a brilliant short summary of the full book)
The Positive Breastfeeding Book (Prof. Amy Brown)
Breastfeeding Uncovered (Prof. Amy Brown)
Trust Your Body, Trust Your Baby (Rosie Newman)
Milk: A Story of Breastfeeding in a Society That’s Forgotten How
(Emma Rosen)
The Wonder Weeks (Explains developmental leaps, relating to increased nursing, crankiness and clingyness. Also available as an app)
Sweet Sleep (La Leche League)
The Gentle Sleep Book (Sarah Ockwell-Smith)
The Pinter & Martin ‘Why it Matters’ range, including: Why Breastfeeding Matters (Charlotte Young), Why the Politics of Breastfeeding Matter (Gabrielle Palmer), Why Mothering Matters (Maddie McMahon), Why Mothers’ Medication Matters (Wendy Jones) and Why Starting Solids Matters (Prof. Amy Brown)

Websites
Our breastfeeding pages
Emma Pickett Breastfeeding Support
Lactation Consultants of Great Britain (LCGB)
La Leche League GB
The Association of Breastfeeding Mothers (ABM)
The Breastfeeding Network
Breastfeeding Support
Association of Tongue Tie Practitioners
The Milk Meg (Aus)
Pinky McKay (Aus)
Dr Jack Newman (Canada)
Dr Jay Gordon (US)

Facebook pages
Tales from the Mother Side
La Leche League GB
The Breastfeeding Network
Breastfeeding Uncovered
The Milk Meg
Pinky McKay
The Association of Breastfeeding Mothers
Dr Jack Newman


3 thoughts on “10 things I wish every GP knew about breastfeeding

  1. A good overview and some great reminders here, however I think you might have been a little harsh on us mere GPs… Most of my colleagues will know about most of tips you have stated (although I do often see thrush incorrectly treated) and I feel (at least amongst my colleagues) that GPs/doctors/healthcare professionals are very encouraging of breastfeeding (if a woman chooses, of course). I do agree that tongue-tie is a massively neglected area within the NHS (my son was born with one) with far too many women having to seek private treatment. I would love to see this area massively improved in the coming years. Keep spreading the word! X

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    1. Hello. Thank you for taking the time to respond – It’s heartening to hear that you and your colleagues are up to date with BF information. Sadly, it appears that this isn’t the case for all HCPs 😦 In some cases, I do believe that the advice given is well intentioned, but it is often based on information that is massively outdated. In the last week alone, in one group of 200 BF women, I’ve heard of someone being told to pump/dump after alcohol; an antenatal group told they ‘should be able to get 2-3 hours between feeds’ from a newborn and outdated information on foremilk/hindmilk. My sincerest wish is that ALL HCPs understand ALL the information in this post, so ALL women can rely on the advice they’re given ❤

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