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Promoting breastfeeding across the UK

Mary Fewtrell
MD MRCP FRCPCH
Clinical Scientist
Honorary Consultant Paediatrician
MRC Childhood Nutrition Research Centre Institute of Child Health
London

Breastfeeding is widely accepted as the optimal nutrition source for infants during the first months of life, with health benefits for both infant and mother.(1) In 1995, 66% of women in the UK breastfed at birth, but this figure fell to 53% at 2 weeks, 42% at 6 weeks and 21% at 6 months.(2) These figures are for any breastfeeding; rates for exclusive breastfeeding are even lower. Of mothers who stopped breastfeeding before 4 months, 80% would like to have breastfed for longer. The most frequent reasons given for stopping were "insufficient milk" (48%), "baby would not suck" (21%) and pain (25%). In many cases these problems might have been avoided or prevented with better support and education of both mothers and health professionals.
Breastfeeding rates within the UK vary geographically and are significantly related to the mother's social class, age and educational attainments. However, the likelihood of continued breastfeeding at 2 weeks is increased by putting the infant to the breast as soon as possible after birth and by avoiding any formula feeds unless medically indicated.

Breastfeeding difficulties and support
Although breastfeeding is the natural way to feed an infant, mothers frequently experience practical difficulties during the first few days, many of which can be resolved with appropriate support. Common problems include difficulties in positioning the infant, sore nipples, mastitis, engorgement and thrush. Mothers may also fail to appreciate that frequent feeds (as often as hourly) are common, and may worry that this is because of an inadequate milk supply. The NCT now has a National Breastfeeding Helpline (see side panel) and will put mothers in touch with a local breastfeeding counsellor.
The UNICEF UK Baby Friendly Initiative aims to provide a framework for the implementation of best practice by NHS trusts and other healthcare facilities via its "Ten Steps to Successful Breastfeeding" and the "Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Care Settings". Facilities meeting the required standard can be accredited as "Baby Friendly". To date, two GP surgeries have obtained this status (Charnwood Surgery, Derby, and Northgate Surgery, Pontefract). The UK Baby Friendly Initiative website contains useful information on its activities, background information and other breastfeeding issues for both health professionals and parents.

Breastfeeding duration
Current UK recommendations are that infants should not be given solid foods before 4 months, that a mixed diet should be introduced by 6 months and that breastmilk should be part of the diet for at least the first year.(3) The World Health Organization has recently altered its recommended duration of exclusive breastfeeding to 6 months, although it recognises that in many countries this is unusual and increased support of lactating women is required.

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References

  1. American Academy Work Group on Breastfeeding. Policy statement on breastfeeding and the use of human milk. Pediatrics 1997;100:1035-9.
  2. Foster K, Lader D, Cheesbrough S. Infant feeding 1995. London: HMSO; 1997.
  3. COMA Working Group on the Weaning Diet. Weaning and the weaning diet. London: HMSO; 1994.

Resources
National Childbirth Trust
T:0870 444 8707
W:www.nct.pregnancyandbabycare.com

Breastfeeding Helpline T:0870 4448708 (9am-10pm)
UK Baby Friendly Initiative
T:0870 6063377
W:www.babyfriendly.org.uk

La Leche League GB
W:www.laleche.org.uk