Long-term breastfeeding poses many challenges — but help is out there
Ireland's breastfeeding rates remain among the lowest globally.
According to UNICEF data, south Asian countries have the highest exclusive breastfeeding rates, 57%, for babies up to five months old. Eastern and Southern Africa hold the second-highest breastfeeding rates at 55%.
The American Academy of Paediatrics (APP) recommends breastfeeding for two years or more, but there are few supports in place to encourage long-term breastfeeding, which research has linked to health benefits for mothers and infants.
Children who are breastfed for longer, say the HSE, have lower risks of chest, ear, and tummy infections, and it protects those in childcare from catching bugs and illnesses. Added to that, long-term breastfeeding protects children from being overweight.
“For the mother, breastfeeding can reduce the risk of breast and ovarian cancers, type 2 diabetes, and high blood pressure,” says Prof Afif EL-Khuffash, consultant neonatologist and paediatrician at the Rotunda Hospital. “The burden of the complications related to diabetes also appears to be reduced.”
Some women can develop high blood sugar (blood glucose) during late pregnancy, leading to a greater risk for type 2 diabetes later in life.
However, breastfeeding can reduce the risk as it helps the body process glucose and insulin better, according to research published in the in 2015. Breastfeeding for longer further lowers the risk.
The risk of other cardiovascular diseases, including coronary heart disease and stroke, is also reduced with longer durations of breastfeeding associated with higher protective effects, according to researchers from the Sydney School of Public Health at the University of Sydney.
EL-Khuffash adds that breastfeeding can help reduce the baby’s risk of sudden infant death syndrome (SIDS) and cardiovascular disease in adulthood.
“New data highlights the protective effects of breastfeeding on the development of asthma,” he says. “Infants who receive antibiotics without breastfeeding over the first few months after birth are three times more likely to develop asthma when compared to babies who receive antibiotics while breastfeeding.”
Carroll suggests the HSE breastfeeding statistics indicate mothers are not getting timely and appropriate breastfeeding support when needed.
“We know our maternity services are under severe pressure, and it is unfair to ask already overworked and under-resourced midwives to bear the burden of this,” she says.
“While the HSE has made good inroads into improving access to IBCLCs (International Board Certified Lactation Consultants) for the more complex issues which can arise with breastfeeding, improved breastfeeding training and knowledge for all who encounter new parents would be most welcome.
"Research shows access to good quality breastfeeding peer support can have a huge positive impact on breastfeeding duration.”
“With my first baby I never planned to breastfeed past six months,” says Kitty Hackel, who tandem feeds her four and one-year-old and works as a doula and lactation consultant.
“When I fell pregnant with my very much hoped-for second baby, I simply wasn’t ready to wean, and neither was my first son.”
Breastfeeding throughout pregnancy was difficult for Hackel but she leaned on her support system and created “gentle nursing manners”.
Her children learnt to use soft hands, to ask nicely, and not twiddle her breast while feeding.
“A mother may fall pregnant before the two years comes to a close and so go on to tandem feed both babies,” says Hackel.
“I found that tandem breastfeeding can reduce jealousy and help to increase bonding between siblings. The bond my two boys have is like no other, and they loved each other from the start.”
Hackel is a strong advocate for extended breastfeeding but recognises that while breastfeeding is natural, it is a learnt skill.
“I had plenty of milk but I struggled with many other factors,” she says, “such as sore nipples, tongue tie, fast let down, mastitis, and blocked ducts. But we kept going. They nurse less often now — they are too busy for mama cuddles.”
Hackel says she is “very lucky” to be self-employed, making the balance of work and extended breastfeeding easier than if she was working for the HSE as she had been previously.
“We have a nice rhythm to our days. Breastfeeding is a wonderful cosy time to reconnect and pause during the day no matter how hectic life is, and it forces me to slow down.”
As mothers are encouraged to breastfeed for two years or longer to maximise the health benefits, this guideline may be unrealistic for many, especially for women who work outside the home.
Competing commitments between working life and extended feeding, along with often inadequate resources and supports, can complicate long-term breastfeeding.
However, UNICEF argues that with education and support, ongoing breastfeeding can work for many families, saying: ‘Breastfeeding support in the workplace is critical to maternal health and well-being, infant health and development, and gender equity in the workplace’.
“Maternity leave in Ireland currently supports mothers to take at least six months leave after their baby is born,” says Carroll.
“Continuing to breastfeed while returning to employment can be a positive experience for mothers and babies. Recent changes in work practices such as hybrid working and a shortened working week can make the transition more family-friendly, and it is worth having a conversation with your employer to look at all options around your return to work.”
“They think it would be too much or too demanding,” she says. “But most babies are well established on solid food and drinking from a cup or bottle. Many mothers will cut down on feeding before returning to work so they won’t have to express milk during the working day.
"Others work with their employers to find a place to express and store their breastmilk. But some mothers tell me breastfeeding is such a private thing and they don’t want to tell their employer.”
Finding and supporting a feeding plan and structure that works for the family is the best way to encourage and advocate for the AAP guidelines.
“There is legislation for mothers returning to work when their baby is under six months,” says O’Byrne.
“Civil servants, teachers and HSE employees can now take breastfeeding breaks up to two years after having a baby. Many private multinationals also have provided facilities for their employees. Employers are legally obliged to provide a place to pump with washing facilities and a fridge to store breastmilk. Mothers can take breaks to pump or leave work early to go to their babies.
“Breastfeeding is not just about the milk,” says Carroll.
“The breastfeeding relationship can help babies and mothers navigate the milestones of those first few years — teething, first steps, separation anxiety etc with a unique way to comfort, soothe and reconnect with each other.”
It’s a view Hackel agrees with.
“Breastfeeding means an awful lot to me,” she says. “I can feel the end is nearing. I am excited to celebrate our journey and in other ways sad that this chapter will be over.”
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