Breast is best – or so we're told by our healthcare professionals. But you'd be hard pressed to detect any sign that the message is getting through in Northern Ireland, where breastfeeding rates are among some of the lowest in the world, despite the evidence that it protects babies against a host of health threats.
Now the debate over breast versus bottle has been reignited after US academic Joan Wolf delivered a controversial talk in England arguing that the scientific evidence for breastfeeding is weak.
She insists breastfeeding is being "oversold" to new mums because we're obsessed with eliminating risk, no matter how small.
And she says we're in danger of ignoring the drawbacks of breastfeeding, such as potential loss to women's earnings – an argument that particularly resonates in America because of the lack of maternity leave.
"You end up having this very strict set of rules about what mothers can and can't do," she says.
"One of the greatest lies promoted by breastfeeding advocates is that breastfeeding is free. But it's not free if you count mother's labour. For many you could say it has an extraordinary cost and is probably not worth the effort of continuing to do it."
Yet her message was delivered days before Save the Children issued a stark warning – that the lives of 830,000 children a year around the globe could be saved if new mums breastfed within an hour of giving birth. So the pressure is back on.
When I was waiting for the arrival of my daughter Neve, I wanted to at least give breastfeeding a go. I signed up for a breastfeeding class with the hospital, thinking I'd know what I was doing when she arrived.
Neve had other ideas. She made her debut two weeks early, heralded by 21 hours of labour and an emergency C section that left us both groggy with drugs. And she just wouldn’t latch on at all.
I can’t remember much about those first few days — just a haze of tears and sleeplessness from me and endless screaming from a tiny, hungry baby. And it really hurt — it didn’t help to know that this was because of a ‘bad latch’ because there seemed to be nothing I could do about it.
Once home, it took painful weeks before Neve latched properly. And breastfeeding devoured huge swathes of time, up every three hours at night for another interminable session, feeling like I was failing her every time I supplemented with a bottle of formula, growth spurts that fuelled even greater levels of hunger, with one particularly memorable feed dragging on for a body-draining four hours.
It couldn’t have been done without an awful lot of support — many visits from midwives, housework and cooking, and glasses of milk from my husband and mum, fortnightly visits to a breastfeeding group where other mums assured me it really would get better.
While the midwife support was crucial, it often left me feeling torn in every direction. Every visit brought a different midwife, with different notions. Some said exclusively breastfeeding was the only way — others told me Neve wasn’t putting on enough weight and I needed to supplement with formula.
But the amazing thing was that at around the six-week mark, everything suddenly came together. It stopped hurting. The marathon sessions turned into minutes rather than hours.
Suddenly nursing became a pleasant, relaxing thing that became a special bond between Neve and I. I’ll never forget those golden night-time feeds curled up half-asleep in bed with my contented infant.
Sadly, I’m told that this is usually the point at which struggling mums finally give up, not realising that easier times are just around the corner.
But as all the elements fell into place, I felt like I could go on and on. I breastfed through to the introduction of solids and my return to work, expressing in a secluded room. I kept going even after Neve was able to switch to cow’s milk on her first birthday.
By the time I stopped at 15 months on the advice of my GP, Neve was only feeding for a few minutes at night, a quick wind-down that helped her to drift off. And I really missed it — it was a wrench to have to give up those precious drowsy moments with her.
I do feel the UK’s more supportive maternity leave regime makes a huge difference to mums who want to nurse, and it certainly helps your resolve to have a health system that proactively pushes breastfeeding. But sometimes that support can tip over into pressure — and cause a lot of anxiety when you don’t need it.
And it seems to me that new mums are put off breastfeeding because it just isn’t accepted here the way it is in other countries. You can promote breastfeeding all you like to new mums but maybe some of the effort needs to be directed towards tackling the unforgiving attitudes in our wider society.
Claire: ‘I introduced bottle when I got home’
Full-time mum Claire Smyth, who combination-fed daughter Emmie for 14 weeks and is expecting her second child in August. She lives in Belfast with husband Gareth. She says:
Emmie came three days early and arrived the day before my birthday, after only five hours of established labour. My thoughts beforehand had been that I would give breastfeeding a go but I put no pressure on myself and I decided I would introduce bottle-feeding from the start.
I wanted to go for combination-feeding because I know I can’t survive without sleep, but I wanted the majority to be breastfeeding. I breastfed straight away in the hospital and I had no difficulty. All that evening and night she fed continuously. From that first night I had cracked sore nipples so I had to take a break and it took a long time for them to heal. I introduced the bottle as soon as I got home.
I breastfed partially for the first 14 weeks, then gradually less and less. I gradually favoured bottle-feeding more.
It was easier and my husband could do the feeds and I could supply the rest. You feel like you are obliged to continue to breastfeed but my health visitor said I had given Emmie the best of it, so if I felt I didn’t want to she wouldn’t suffer. I was encouraged to breastfeed for at least four weeks but not pressurised. I have been very fortunate with my health visitor and midwife that I wasn’t put under any pressure. I have heard of other people really going through the mill.
Because I was confident, I didn’t care what other people thought about breastfeeding in public and if somebody had said anything to me, they would have got an earful!
I am more apprehensive for the second baby because I have a second child to look after and I am going to be at home with the two of them.
Even though I will attempt it, I may go for the bottle quicker.
Lesley: ‘The staff didn’t put any pressure on me’
Full-time mum Lesley Locke (32) who lives in Belfast with partner Gary, bottle-fed Liam (3) and Caithin (8 weeks). She says:
I always knew that I was going to bottle-feed Liam because I’m a social person and I’m always out in social groups.
I don’t think breastfeeding is a very social thing — it’s not accepted socially. That’s why I decided to bottle feed, because I was going out to different mums and tots groups and different church groups. I knew breastfeeding wouldn’t really be accepted and it would be more difficult to feed.
It’s time consuming and you are feeding on demand. I wanted to have more of a routine for Liam.
When I had Liam, I had to have a blood transfusion.
I was so weak I wasn’t even allowed to hold the baby after he was born — my blood had gone down to less than half of what I should have had.
I shared the feeding with my partner and family members were able to help as well. If I’d ended up breastfeeding I would been even more exhausted and more prone to post-natal depression. When I came home from hospital, my mum could help out during the day.
I know a lot of people would say the baby is healthier if you breastfeed, but I had a very healthy wee boy. He would very rarely be sick, yet other kids around him get bugs all the time.
Staff in the hospital where I had Liam asked me what I wanted to do and they supported me in my decision to bottle feed. They didn’t put any pressure on me to do it differently.
Friends have told me they had a lot of pressure and they ended up feeling that they weren’t able to mother their child properly. They felt they were not succeeding at being a good mother because they had chosen not to breastfeed.
Lisa: ‘You can just feed them anywhere’
Full-time mum Lisa Fagan (44), breastfed twins Scarlett and Heidi Gunning until they were 28 months. She lives in Belfast with husband Peter Gunning. She says:
The girls were born six weeks prematurely which isn't unusual for twins. They were delivered by C-section at Altnagelvin Hospital in Londonderry, weighing 4lbs 11ozs and 4lbs 1oz.
They spent 12 nights in the neonatal unit. At 34 weeks, babies don't have a suck reflex so they had to be tube fed with formula, topped up with the small amounts of breast milk I was able to express. I would express every four hours, day and night, to stimulate my supply. I had lots of support from the nurses who helped me put the girls to the breast at every feed.
Scarlett was bigger so she was first to learn how to latch on and feed. A few days later, Heidi got the hang of it too and we were allowed home.
I was almost 42 when they were born and I’d given up my job so I was happy to devote myself to them. I hoped that breastmilk would help them overcome the disadvantage of being premature. The first few weeks were tough and there were days when I didn’t get out of the bedroom. It was a good day when I managed to have a shower and get dressed. I was at a low point one morning because I'd been feeding day and night when the health visitor arrived to weigh the girls. In two weeks, they'd gained 14ozs and 13ozs which made it all seem worthwhile.
I introduced solids at six months and gradually the girls reduced their milk intake until, by the end, they were feeding for just three minutes in the morning and three minutes at night. They weaned easily at 28 months and have never looked back. It's given them a great start. Breastfeeding is so handy because you can feed your baby anywhere. I was lucky because I had a good supply and the support of my husband.
We live in a bottle feeding culture, so each mummy who breastfeeds is helping establish breastfeeding as the norm. But aside from all the health benefits and the special bond it creates, breastfeeding is bliss for babies. In the end, that's the best reason to do it.
Breast not best in Northern Ireland
Northern Ireland has one of the lowest breastfeeding rates in the world, according to last year’s Breastfeeding Strategy for Northern Ireland.
The initial breastfeeding rate in 2010 was lowest in the UK at 64%, compared with 83% in England, 74% in Scotland and 71% in Wales, the Infant Feeding Survey 2010 shows. This figure includes all babies who were put to the breast at all, even if this was on one occasion only, and also includes giving expressed breastmilk. The highest incidences of breastfeeding were found among mothers aged 30 or over (74%), those who left education aged over 18 (77%), and those in managerial and professional occupations (81%).
Prevalence of exclusive breastfeeding was lowest in Northern Ireland compared with England, Scotland and Wales. For example at six weeks, it was 13% in Northern Ireland, 24% in England, 22% in Scotland and 17% in Wales.