Nadia and Michelle, thank you so much for sharing your stories. You are
both very brave in your work with breastfeeding families. Your stories were
hard to read but so, so incredibly important to read.

As an IBCLC in private practice I have seen women struggle with outside
pressure or physiological issues and so not meet their breastfeeding goals.
Some women just seem to run out of steam emotionally due to the hurdles
they face. Private practice in Northern Ireland (where I live) is largely
among middle-class women. Most women take maternity leave of 9-12 months
due to our system. I can’t imagine how much pressure must be on a mum
having to go back to work at 6 weeks – which presumably affects milk supply
badly.

Northern Ireland sadly boasts among the lowest breastfeeding rates in the
world. Ours is very much a bottle feeding culture. West Belfast has either
the lowest rates of breastfeeding in Northern Ireland or nearly the lowest.
I’d like to share my story of working for 4 years in a SureStart (similar
to a WIC) in West Belfast. I was employed for 16 hours a week as the
Feeding Support Worker. As enrolling in SureStart is voluntary we couldn’t
compare initiation rates with the rest of the community but our
breastfeeding duration rates were excellent compared to the rest of the
community with duration rates at 1 and 2 years being very good. I was
delighted with the work our maternity team were doing – my immediate boss
was a midwife and the other member of the team was an NCT trained
ante-natal teacher. My immediate boss had only breastfed for 2 weeks
herself due to hitting problems that no one around her, at the time, knew
how to solve, but she was passionate about helping women to breastfeed and
great to work for. Our manager shared our breastfeeding stats at a research
conference and apparently received a gasp from the audience at how good
they. Apologies for the long preamble – that was meant to set the scene.
Also giving women extra support works.

Apologies in advance – the following is in layperson’s terms and is
observation based on science that I have read. What I observed and learned
was around trauma-informed-care (TIC) – our manager was passionate about
this and I have seen the effects of trauma on my husband and his family.
However no one was really looking at how a lack of TIC was impacting
breastfeeding. I am sure you all know from baby brain development that when
babies and children are impacted by trauma and stress they have too high a
level of cortisol in their system and this can affect their brain
development but it can also put them into a constant state of fight or
flight continuing into adulthood if left untreated – in practice this means
that if they perceive a threat they are over stimulated already and can
react in a more heightened way than less traumatised people. Nadia’s story
reminded me of this as the people of West Belfast were deeply traumatised
by the Northern Irish troubles and historically had suffered trauma due to
institutionalised discrimination and violence. At a practical level women
who were breastfeeding happily or reasonably happily could easily stop
breastfeeding if there was a perceived threat to their baby’s health - I
suspect they went into heightened fight or flight and the oxytocin stopped
flowing. Breastfeeding is not seen as the norm so the culture didn’t
support them at all – it’s possible the health professionals actually push
formula to protect their own mental health (formula is normal but a
breastfeeding mum is an unknown risk so the health professional is more
stressed by a breastfeeding mum). A couple of women who wanted to
breastfeed and saw me antenatally were asked very quickly after the birth
‘Do you want to breast or bottle feed?’ so they just went for bottle – I
can’t prove anything but I think being asked too quickly after the birth
got in the way of the oxytocin flow and they chose what was normal. If the
midwives had assumed these mums were breastfeeding who knows what would
have happened. I have known about the problems of stress for years, but
working in West Belfast gave me new insights into trauma. The staff I
worked with were mostly from the area and were lovely and most of them had
some kind of chronic illness.

My thanks to Kathy Kendall-tackett for her articles over the years and also
to information from the ACE studies.

Best wishes,

Sarah McCann LLL Leader, IBCLC, PgDip

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