The difficulties of breastfeeding beyond the cracks: little training of professionals and not taking care of maternal mental health

Cristina Pedroche recently published on her Instagram, an account in which she has three million followers, a post in which she writes: “Breastfeeding. How beautiful you sounded to me when I was pregnant, how ‘easy’ it seemed having read, studied and consulted so many books and manuals, I even had a session with @albapadibclc (Certified Lactation Consultant (IBCLC) Alba Padró Arocas) to clarify doubts before Laia was born ”. What is happening to the presenter after giving birth to her first daughter in mid-July is normal. Many women experience problems when breastfeeding, a fact that, according to INE statistics, only 41% of mothers in Spain with children from 0 to 6 months have exclusively breastfed. In Europe, the rate of exclusive breastfeeding at 6 months is 28.53% and that of mixed breastfeeding is 18.42%. In other words, the percentage of women who breastfeed at 6 months (only breast or breast and bottle) is 46.95%, according to data from the World Health Organization. Why are there so many women who abandon breastfeeding having, as there is, so much information?

Child psychiatrist Ibone Olza, lactation expert and director of the European Institute of Perinatal Mental Health, has spent years researching and publishing from scientific evidence not only the advantages of breastfeeding, but also the reasons why there are so many failures. “First of all,” he explains, “there are more and more studies that show that breast milk improves the development of the baby’s neurodevelopment and it has been seen that it is associated with better cognitive and intellectual development because the white matter of the brain develops better — deeper tissues of the brain (subcortical)—”. They are small differences, she adds, “but there they are.”

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“I don’t think that the difficulties of many women are due to the fact that we have lost the ability to breastfeed, but I do think that there are two main variables,” says Olza. “One is that most of those who are mothers now were not breastfed or, if they were, it was for a very short time, that is, the culture of breastfeeding has been lost,” points out the lactation expert. As she explains, a large part of today’s mothers come to breastfeed without having seen other women around them breastfeed as girls or young women, much less breastfeed for a long period of time, which makes this something strange for them: “The other factor is that it is having a lot of influence that hospital routines that go against good breastfeeding continue to be practiced, for example, they continue to resort to inducing deliveries, scheduled caesarean sections without a medical reason, separating the newborns from their mothers carrying them to the nest…”. For the psychiatrist, all this generates a very high stress in the woman that makes her emotionally unwell, “so breastfeeding is very difficult.”

In any case, Olza recalls that the attachment between mother and baby has other ways of occurring beyond breastfeeding and they happen, above all, through skin-to-skin contact. For her, what is really failing is the social issue; the loneliness of many postpartum women; the lack of care for maternal mental health, and the enormous pressure also due to work. “If the woman doesn’t want to breastfeed, of course, you shouldn’t judge her, she may have one or mountains of reasons for not wanting to and you should never pressure her, although it is important to talk to her about why she doesn’t want to.”

Carmela Kika Baeza, family doctor, director of the Raíces center and lactation expert, assures that breastfeeding the baby is easier and more natural when the delivery is “normal”. “That is to say, that it starts alone, that in it the woman is moving as she wishes, adopting the positions that she feels are best to help lower her baby, that she is accompanied by whoever she wishes, discreetly, who only they carry out medical acts in case of necessity and not by protocol”. “And, above all,” she continues, “that at birth the baby is placed on her mother and they remain together, in skin-to-skin contact, for the first few days.”

For this expert, when all this happens, breastfeeding difficulties are much less frequent and, if they do occur, they are much easier to solve, because “nature is being allowed to sustain the process.” In addition, and according to Baeza, the mother and the baby who spend a lot of time in intimate contact learn to know and understand each other much sooner than if there is separation. “Breastfeeding tends to work if we create the right environment: the environment for the baby is its mother’s body and the right environment for the mother is the one in which she receives the support and care necessary to have to deal with her child alone.” ”.

“In recent years, more and more professionals are trained in breastfeeding,” Baeza emphasizes. “Any woman who is in pain, has cracked nipples, feels anguish or fear, has a feeling that she has little milk or thinks that her baby is starving, she can find help,” she adds. According to her, breastfeeding is studied little (or not at all) in Medicine and Nursing, and for this reason many professionals are poorly trained in this regard. But it is also true that in recent years, “because of our own maternity wards or because we realized that we did not know how to help our patients, many of us have trained to be able to provide this support at different levels.”

The family doctor argues that nowadays midwives, paediatricians, family doctors, nurses or physiotherapists with excellent training in lactation and willing to help can be found: “There is also the international title of certified lactation consultant, IBCLC (International Board Certified Lactation Consultant), which many professionals already have and whose list can be accessed at ibclc.es”.

The psychological component in the success of breastfeeding

In addition, Baeza emphasizes that the puerperium —the period that goes from the moment immediately after the birth until 35-40 days (whether there is breastfeeding or not)— is a very intense psychological period, with many changes, adaptations, coping with with their own limits; of dismantling expectations and, at the same time, of joy and emotion: “A roller coaster of feelings that must be listened to and accompanied in the lactation consultation.” “We can’t limit ourselves to just treating a crack,” she continues, “the one with that crack is a new mother, with her entire psycho-emotional world turned upside down.” Baeza adds that anguish or sadness are not the cause of the cracks (they are simply wounds) and that healing the physical wound is not enough, because good mental health, enjoyment of motherhood, and well-being are sought in this powerful stage. of the life.

The evolution of breastfeeding will greatly determine maternal mental health: “Very complicated breastfeeding can create in the mother feelings that she is not capable of feeling anguish, anxiety, loneliness, postpartum depression and even postpartum psychosis.” These thoughts in complex postpartums are more common than you think, because when they occur it is often scary to share them: “It is important that they are discussed and that there are safe spaces, such as professional consultations or the Mama Importa Forum.” A pleasant breastfeeding, Baeza maintains, is an immense help for parenting: “It helps our maternal brain intuitively understand the needs of the baby, it helps to rest and sleep, to have more patience and to better manage our resources.”

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