Blog entry by Rcgp Learning
The first week of August marks World Breastfeeding Week, which aims to encourage mothers around the world to breastfeed and therefore safeguard the health of their babies. August was chosen because the Innocenti Declaration was signed in August 1990 (and later updated in 2005) by governments and various health organisations to protect, promote and support breastfeeding¹. The awareness week is coordinated by World Alliance for Breastfeeding Action (WABA), a global network consisting of several organisations such as World Health Organisation (WHO), United Nations Children’s Fund (UNICEF) and La Leche League International (LLLI)². World Breastfeeding Week has taken place every year since 1992, and has a different theme and focus each time. As well as a theme, each year there are four objectives: Inform, Anchor, Engage and Galvanise.
The theme for this year’s World Breastfeeding Week is ‘Foundation of Life’, which references the health benefits that breastfeeding provides for both mother and baby: breastfeeding exclusively for 6 months can help protect against infections and therefore reduce newborn mortality. It also provides an important source of nutrients and energy in early life and reduces the likelihood of obesity in childhood and adolescence. For the mother, a longer duration of breastfeeding can reduce the risk of developing breast or ovarian cancer ³. According to a 2014 study on 10,000 new mothers in the UK, breastfeeding was also linked to lower rates in post-natal depression. Mothers who planned to breastfeed and actually went on to breastfeed were 50% less likely to suffer with post-natal depression than those who hadn’t planned to and didn’t breastfeed.⁴
To get the optimum benefits from breastfeeding, WHO and UNICEF recommend the following³:
- early initiation of breastfeeding within one hour of birth
- exclusive breastfeeding for the first six months of life
- combination of nutritionally adequate solid foods with continued breastfeeding up to two years of age and possibly beyond
Despite the benefits the rates for breastfeeding in the UK are among the lowest in the world⁵. According to the latest Infant Feeding Survey in 2010, only 34% of babies in the UK were receiving any breastmilk at six months⁶, compared to 49% in the US and 71% in Norway⁵. Breastfeeding initiation was at 81% and went down to 1% for exclusive breastfeeding by the six month mark⁶.
The Infant Feeding Survey also states that eight out of ten women stop breastfeeding before they want to. Common reasons for stopping breastfeeding included problems with the baby’s latch, painful breasts or nipples and feeling that they had an ‘insufficient’ milk supply⁶. Although most of these issues may be addressed initially with midwives, health visitors and lactation consultants, it’s important for GPs to have enough knowledge about them to advise mothers at their 6-8 week check. For more information about how to deal with these common problems appropriately, you can consult the NICE Clinical Guideline on ‘Postnatal care up to 8 weeks after birth’. NHS Choices also provides more information about specific conditions such as mastitis and tongue-tie. GPs can signpost patients to organisations such as The Breastfeeding Network and LLLI for further support and advice.
Although breastfeeding is the recommended infant feeding method by many health organisations, GPs may also be asked for advice on formula feeding as an alternative. While the role of the primary care team is crucial in promoting exclusive breastfeeding both pre and post natal, it is crucial to offer support to women who chose the alternative. The RCGP offers a FREE eLearning course on Infant Nutrition, which covers the basics of formula feeding and provides an understanding of common feeding problems.
For further information about breastfeeding and the GP’s role, the RCGP has recently launched an eLearning course on Breastfeeding, which is FREE to all healthcare professionals.
¹ World Health Organisation (WHO). World Breastfeeding Week 1-7 August 2016. [Internet} Available from: http://www.who.int/mediacentre/events/2016/world-breastfeeding-week/en/
² World Health Organisation (WHO). BREASTFEEDING: Foundation of Life. 2018. [Internet]. Available from: http://worldbreastfeedingweek.org/
³ World Health Organisation (WHO). Infant and young child feeding. February 2018. [Internet]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/infant-and-young-child-feeding
⁴ Borra, C., Iacovou, M. & Sevilla, A. Matern Child Health J (2015) 19: 897. Available from: https://doi.org/10.1007/s10995-014-1591-z
⁵ Victora CG, Bahl R, Barros AJD, et al, for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475–90
⁶ McAndrew F, Thompson J, Fellows L, Large A, Speed M, Renfrew MJ (2012) Infant Feeding Survey 2010, Health and Social Care Information Centre. Available from: https://files.digital.nhs.uk/publicationimport/pub08xxx/pub08694/infant-feeding-survey-2010-consolidated-report.pdf