I’ll tell you a secret.
Doctors (GPs and specialists alike) have very varied expertise on breastfeeding issues, often depending on whether they have personally experienced or supported a loved one through difficulty. Our teaching on the subject at medical school is very superficial and it is not part of the specialist training curriculum.
I know this because I thought, as a GP (with a paediatric background), I would be well placed to manage to breastfeed my first daughter – but I was wholly unprepared for the emotional and physical pain that I experienced in those first few weeks. The gaps in knowledge of some of my colleagues and healthcare professionals to whom I turned to for help has helped me form the basis for this blog.
For many women, breastfeeding is fairly straightforward, but in the UK only 1% of mothers are still exclusively breastfeeding (that is feeding with no additional formula) at 1 year, and I am afraid we in the UK are struggling to support women to successfully breastfeed effectively. So, please consider passing this blog on to anyone who is expecting or feeding a small baby. I hope it helps navigate their breastfeeding journey.
1. ‘Insufficient milk’: In my surgery, when I see mothers at a 6-week check, I often hear ‘insufficient milk’ as a common reason for the cessation of breastfeeding. However, the issue is often the perception of low milk supply based on a lack of understanding of what is normal, OR low milk supply as a result of issues with breastfeeding management. Parents’ confidence improves when they understand that:
- Milk supply is connected to milk removal; therefore frequent emptying is the best way to meet baby’s needs. Babies may have several days when they feed more frequently and may often cluster feed for several hours at a time
- Regular waking remains the norm for the first few months of life (and less regular waking after that), so may not be connected to feeding
- Output from a breast pump, feelings of breast fullness, a baby’s desire for contact and feed length are not reliable indications of a mother’s milk supply. The best indication, as a GP, is adequate weight gain which is monitored under the guidance of a health visitor clinic
2. If a baby appears to be gaining insufficient weight:
- Seek advice from a trained breastfeeding support worker or health visitor to assess breastfeeding management, e.g. assessing baby’s positioning and attachment, and frequency of feeds
- A breast pump can be used to stimulate milk supply further and a GP may advise that the expressed milk is used to supplement normal breastfeeding
3. Breast and nipple pain
- A baby’s positioning and attachment at the breast is the most common cause for nipple pain, damage and deeper breast pain (1)
- Less commonly, a mother may be dealing with a thrush infection or a bacterial infection. Both mother and baby will need treatment if thrush infection is suspected, even in the absence of symptoms (2)
4. Could it be tongue-tie?
- Approximately 1 in 10 babies have tongue-tie (also called ankyloglossia) which will sometimes cause nipple and breast pain and affect milk transfer. NICE guidelines state evidence is adequate to support the use of tongue-tie division to improve breastfeeding outcomes
- Your GP or health visitor should be able to direct you to an NHS tongue-tie clinic where an assessment can be made and the tie cut (usually a quick procedure, taking seconds and not requiring anaesthetic – the baby is encouraged to feed immediately afterwards)
- Check out tongue-tie.org.uk for accredited tongue-tie practitioners near you
5. Mastitis
- If you get mastitis, remember that non-infective mastitis is caused by blocked ducts, which can often be resolved without the need for antibiotic treatment. Once again, having an assessment of latch by a trained breastfeeding specialist (see below) is invaluable rather than repeated courses of antibiotics
- Infective mastitis requires antibiotic treatment; it can present with an infected nipple fissure (or crack) and symptoms not improving, or worsening, over 12-24 hours. It is imperative that the mother continues to feed on the affected breast throughout the course of treatment in ordinary circumstances
- A breast abscess should be considered if there is no improvement by 48 hours, and I would advise an emergency appointment with the GP or attending A+E
6. Mental Health. I am often alarmed when mothers who have mental health problems are advised to stop their medication or to avoid breastfeeding at all.
- Very few drugs or even surgical procedures/scans require you to stop feeding, and if you are advised to do so, please consult the Drugs in Breastmilk helpline on 0844 412 4665. It, and the Breastfeeding Network (thebreastfeedingnetwork.org.uk) factsheets are reliable sources of up-to-date information, including the use of antidepressants alongside breastfeeding
- We know that not breastfeeding increases the risk of postnatal depression. Mothers who plan to, but are unable to breastfeed their babies, and mothers who experience breastfeeding problems are at even higher risk. Access to feeding support has implications for both baby’s and mother’s health (3)
7. Where to find help:
- The local health visiting team will have resources on local breastfeeding support, which may include drop-in groups, clinics run by breastfeeding specialists such as IBCLCs (International Board Certified Lactation Consultants) and access to peer supporters
- There are several breastfeeding helplines in the UK, run by breastfeeding support groups such as the NCT, Association of Breastfeeding Mothers, Breastfeeding Network and La Leche League (4)
8. Your GP can help guide you to local support networks and support you through what can be a difficult process.
- Often there are one or two GPs in a surgery with an interest/background in women’s health or paediatrics and they might be best placed to help. Ask the receptionists if you are unsure of who to see
- The GPs that do the 6-week baby checks will be very familiar with this kind of assessment and advice
9. Get a support system around you in those first few days including loved ones, older friends or family who have experience in breastfeeding, and information on local breastfeeding cafes. Plenty of water, nutritious food/snacks and rest will help with the cluster feeding that is necessary to ‘bring in’ the milk and ensure successful initiation of feeding.
10. Enjoy it
Special thanks to the team at the GP Infant Feeding network @GP_IFN, especially Emma Pickett.
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. myHealthSpecialist makes no representations as to the accuracy or completeness of any of the information in this article, or found by following any link from this article. Please consult a doctor or other healthcare professional for medical advice.
Dr Anjali Gibbs, GP