Suzanne and Barbara write about their experiences of low attendance for
breastfeeding classes citing given reasons for this as expectant moms
thinking that breastfeeding is "natural" and "just one more thing" that
takes up their time, and calling for ideas to increase attendance.  Having
taught breastfeeding classes for 17 years and had similar experiences, I
have long pondered the reasons for, and share your frustrations about, low
attendance.  My classes were arranged through a group of physiotherapists
who traditionally offer antenatal labour preparation classes in Harare,
Zimbabwe.  Mothers were referred to the physiotherapists by the
obstetricians, who would then would book mothers for three classes on
various aspects of antenatal preparation, labour and birth, and then I
would teach a breastfeeding class, usually booked as the last class in the
series.  Over the years the labour-preparation teachers varied, and the
locations and times of the classes varied too - we tried teaching in the
late afternoons, after work, and in the mornings, and on Saturdays.  We
offered the classes in the physiotherapists' rooms, at my home, in a church
hall.  We tried actively promoting attendance by fathers and other
support-people.  Sometimes we offered the breastfeeding class as an
optional extra to be paid on the day, and sometimes we only offered it as
part of a complete package - by payment for the full course in advance. We
also offered the breastfeeding class as a separate follow-on to other
ante-natal classes held by other physiotherapists.  And occasionally I
filled in with a breastfeeding class for another antenatal teacher who held
her classes at one of the private hospitals.  This is all in a place where
breastfeeding itself in the maternity hospitals was *not* an option - it
was compulsory.

With all these variables over so many years there was only one consistency
- lower attendance at the breastfeeding classes than at the other antenatal
classes.  Even when mothers had paid in advance, and refunds were never
given.  And if fathers had come to the labour-preparation classes, then far
fewer of them would come to the breastfeeding class too.  From my
experience, from what was said and what was not said, from feed-back from
many sources, these could be some of the reasons:
- first and foremost, I think that expectant mothers see labour and birth
as potentially life-threatening.  To them.  Whereas they don't see
breastfeeding (or not) as life-threatening to anyone.  So the
"need-to-know" factor is missing for breastfeeding.
- I get the strong impression that for many expectant mothers, birth is the
end-point, the culmination.  Although we know that birth is only the
beginning, I think many new first-time mothers don't think too much beyond
the birth.
- following on from that, breastfeeding is just not seen to be very
important.  Or not as important as something else.  I can't tell you the
number of mothers who would phone and let me know politely that they
wouldn't be coming to my class because they had already had so much time
off from work for antenatal classes (mine was an antenatal class too!!)
- when alternatives to breastfeeding are easily available and socially
acceptable, then we have to face the fact that mothers who don't want to
breastfeed wont attend breastfeeding classes.
- for so long as breastfeeding is seen to be a lifestyle choice of mothers
rather than an urgent health requirement for babies, with clear medical
advice to mothers to breastfeed, then mothers will not see the need to
attend breastfeeding classes, and who can blame them?
- for so long as breastfeeding is not seen to be important enough to be
included in medical school curricula, and ethical responsibilities under
the Code are either not implemented or not enforced by government health
departments, then doctors will not be required to recommend that babies be
breastfed, nor see why lactation/breastfeeding difficulties should be
worked through so that breastfeeding can be protected and preserved, and
who can blame them?

When we feel as if we're losing so many small battles, whether it's low
attendance at breastfeeding classes, or mothers who are co-erced into
abandoning breastfeeding for the unimportant reasons we hear about every
day, I think we can attribute the cause to the lack of political will at
the highest levels to actively promote breastfeeding.  You only have to
look at the health, employment and trade policies, and consequent sharply
falling birth rates, of the developed countries to see that children are
not highly valued and, by extension, mothering and breastfeeding is valued
even less.  The exploitation of children just takes a different form, and
somehow the most basic needs of the most vulnerable sub-group of children,
babies' needs for their mothers' presence and their mothers' milk, are
almost completely discounted in favour of *other* agendas.  Which is what
makes our work so important!  We have to keep trying to make a difference
wherever we can.  Good luck with your classes, Barbara and Suzanne.

Thank you to Ruth in Australia for sharing with us information about the
ways that hospitals and antenatal classes can collaborate when the
motivation is there - in this case provided by the hospital's desire to
achieve BFHI status.  BFHI certification requires that a high percentage of
new mothers will have already attended breastfeeding classes, so that the
hospital itself has to make sure this happens.  Not an option, but a
requirement.  This is how it would be if the political will -
baby-friendliness - was always there!

Pamela Morrison IBCLC
(now in Australia, from Zimbabwe)


>I have felt too and heard from moms that it's (BF class) just one more thing
>to do and additional expense.  I'd be interested to know how to market
>better/encourage moms to attend (I haven't done much of that due to
>time/family
>constraints, but now could spend more time doing so).
>
>Barbara Latterner, BSN, RN, IBCLC, RLC

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