Five ways to help when breastfeeding doesn’t go as expected

Sometimes breastfeeding doesn’t go as hoped for, or as expected. Some of those mothers, with a little support, guidance and practice, quickly move to a place of comfort and enjoyment and they don’t look back as they overcome challenges. But some don’t . Some of them need incredible determination to overcome problems and difficulties. Some go far beyond what even they thought they would do. And some reach a point where they run out of energy and emotion to keep going.

What do they need from those around them?

How can partners, family, friends or health professionals support them in a way that helps those who are discovering that breastfeeding isn’t going as well as they expected? Here are five areas for supporters to consider:

1. Help her find the right support

Unicef has shown that eight out of 10 women stop breastfeeding before they want to. And that “For breastfeeding to work, you need someone to turn to who believes it’s important and believes you can do it.”[1] And that means helping her find a qualified, informed breastfeeding supporter; for example, an LLL Leader or other breastfeeding counsellor[2] or IBCLC (International Board Certified Lactation Consultant).

The first step is almost always to explore what’s happening with breastfeeding – not suggest alternatives. The cliché ‘Breastfeeding problems have breastfeeding solutions’ has great value. It’s saying that even if additional solutions are needed to overcome problems and meet the baby’s needs, the first step is to look at what’s going on with breastfeeding. Finding someone for her who can offer breastfeeding expertise and knowledge, and who will look at the mother and baby as a unit, might be the biggest act of support you can give her and the baby.

Care and concern come from a good place. Of course no-one wants to see someone they love or care about struggling or distressed. And no-one, least of all the baby’s mother, wants to see a baby do anything but thrive. The first rule is always feed the baby. And helping her to find the right support to do that is the best help – to help her achieve her breastfeeding goals or make the decision to change those goals.

2. Listen to her

Mothers and parents are already facing a society and culture where bottle-feeding is seen as the norm. By the time a baby arrives, their parents will have already been bombarded with adverts and images of the best bottles and formulas. Mothers talk about pressure to breastfeed – and also about pressure NOT to breastfeed. It can already feel like swimming against the tide for anyone who WANTS to breastfeed, even with a supportive partner.

And so supporters have a huge role in helping a mother to focus on what she wants to do. Sometimes mothers will say they can’t talk to their family about difficulties anymore because they just say, out of care for her, “you’ve done so well, you could stop now”. And some say they are told that “You know you don’t have to breastfeed”. But what if she wants to?

Instead, supporters can ask her what she wants to happen? Where would she like to get to with her baby? What are her goals and ideals for feeding her baby? Without knowing the answer to what she wants, those around might offer the mother solutions that don’t help her and in fact make her feel more isolated. Just like those around her, her priority will be to make sure her baby’s needs are met – she’s not breastfeeding ‘just for herself’.

Sometimes a mother’s reasons for struggling aren’t obvious but are deep-rooted, perhaps she is finding it hard because of hidden issues or historical experiences around her body and breasts and how she feels about herself or her body. Breastfeeding can unearth hidden hurts, complexities and sensitivities about how mothers view their bodies, their breasts and themselves. None of which may be visible or apparent to someone supporting them and yet can make them feel all the more scared and isolated if they are struggling with breastfeeding.

3. Understand she is driven to breastfeed beyond what she expected

For many mothers the instinct to breastfeed is powerful. And that drive can be really hard for supporters to understand. Mothers often say that they didn’t realise it would matter so much to them. Just as sometimes a woman has an inexplicable desire and urge to have a baby, the drive to breastfeed can often come as a surprise to the woman herself. The fundamental biological instinct to feed her baby is so ingrained in what it means to be a mother, that it is beyond words. Mothers talk about “just knowing they wanted to breastfeed”. Mothers are biologically hardwired to breastfeed their babies.

Petra Hoehfurtner, LLL Leader and IBCLC, in her excellent article Breastfeeding – A Woman’s Right[3] talks about the biological drive to breastfeed and she says:

“But at the end of the day – when it comes to breastfeeding – our bodies and minds are run by our instincts. Therefore, if a woman, for whatever reason doesn’t succeed in breastfeeding her baby, the sense of loss and failure goes much deeper than intellect or emotions; it connects on an instinct level… This woman has ‘failed’ the human race as she hasn’t been able to do the most basic thing: to feed her baby. This sense of failure goes much deeper than any other failure someone experiences in their life.”

Mothers are driven by the biological need to make sure their baby thrives. When it doesn’t go smoothly or there are challenges, many have a single-minded commitment to making it work. Not out of any external pressure to breastfeed (though others might think that), but because they want to, because it’s what their body and mind expect to happen. And they are often surprised by the shift from “I’ll try to breastfeed if I can, but I won’t worry about it” when pregnant, to “I am determined to do this, I NEED to do this” when their baby is in their arms.

Some say that they didn’t expect to feel so strongly that they wanted to make it work, and that they are finding depths of determination they didn’t know they had. And this is in the context of a culture which already makes breastfeeding complicated in so many ways.

One determined mother said:
“Breastfeeding was something I knew I wanted to do but it was only when I found I had supply issues I discovered that I was willing to walk to the end of the Earth to try to make it work. Rationally I knew she would be fine with formula supplements, but something altogether deeper took over and I found I was willing to do practically anything to return her to being exclusively breastfed as soon as possible.”

For some, that will mean days or weeks of struggling and then they get to a place where breastfeeding is what they had hoped for, and they are so relieved that they didn’t stop. And they are rightly proud of what they have achieved.

And for others, they get to the point, where they make the decision to stop or her goals evolve so that she gets to a place where she is satisfied: even if it is different from what she first hoped for. Only she can make that decision if she is to gain any sense of peace with it. She has to know it’s her choice. And it might be that her goals may change.

4. Tell her it’s okay to be angry

As a supporter, giving a mother space to be angry can be liberating for them. They might feel angry that system has let her down. Many who are struggling with breastfeeding have been failed at some point, by not getting the skilled support and information they needed in the early days. Or worse, that their breastfeeding relationship has been sabotaged by ill-informed support or care in the early days or weeks.

They may have been told “that latch looks fine” but are still in pain or the baby is hardly swallowing, or “only feed your baby from one breast to get the really good milk” or “only feed every three hours to make sure your baby is really hungry”: all common advice which is likely to undo the breastfeeding relationship. Or when their baby fails to gain weight, they are referred to a paediatrician to find out what’s wrong with the baby, rather than anyone looking at what’s happening with breastfeeding and why the baby isn’t getting all they need at the breast.

And so then not only are mothers coping with overcoming their difficulties, but they are also dealing with a sense of betrayal, isolation and lack of trust in those around who they thought were helping. It can be isolating to think “but I thought they were helping me” and feel let down by the people they put their trust in.

5. And if she stops breastfeeding, let her grieve

For some, the hurdles and challenges are more than they can overcome, and they reach a point where they decide that they will stop breastfeeding. But we need to watch our language: she hasn’t ‘given up’; she hasn’t failed. It is never her fault for struggling or stopping.

When mothers themselves talk about ‘giving up’, or when we use that language around her we enhance her sense of failure. Instead, she can own the decision. Just like in birth: when mothers feel in control they have a more positive birth experience whatever it might look like. She needs to be in control of the decision of when she will stop breastfeeding.

And at the point of deciding to stop, especially if it has been an intense, stressful, scary, painful time mothers may feel relief. One mother said:
“I was relieved and I knew it was the right decision. It was the right decision at that time – doesn’t mean it couldn’t have been different, but I’m at peace I made the right decision then. Yes, I regret it wasn’t different. But my memory of stopping is overwhelmingly one of relief.”

And that’s the point. Each mother will feel differently, so it’s important that supporters don’t assume, or don’t placate. We just need to listen to what she wants to say about it. One mother who stopped breastfeeding, said about her family:

“They won’t let me say I’m sad about it – every time I say something like that, they shut me down by telling me ‘I did well’, ‘she’ll be fine’. I know all that. But I want them to just let me be sad about it.”

And then we often hear about GUILT: that the mother feels guilty for stopping. Or she feels guilty and wonders if maybe she didn’t try hard enough or guilty that maybe, just maybe she wonders if just doing this for herself. But guilt is so hard to deal with because no-one can fix it. But if we turn it around: and perhaps help the mother to see she is describing GRIEF, then perhaps she can start processing it. It’s a grief that breastfeeding isn’t as she has hoped for. A grief that her ideal of how she thought it would be for her and her baby isn’t the reality. It’s the grief that Petra Hoehfurtner explains as “the sense of loss and failure that goes much deeper than intellect or emotions.”

But just as with any grief – mothers need to go through the process of dealing with that grief. One model proposes five stages of grief: denial, anger, bargaining, depression and acceptance as part of the framework of moving on. And that can take time. Some may skip or revisit different stages as part of the process. But often the instinct of those around is to want to stop her grieving, and to get her to a place of contentment with her decision. But no-one can do that for someone else – it’s grief and that’s a personal process that has its own timing.

A last word to the mother who knows the struggle

In LLLGB, we often meet or talk with mothers who have gone to amazing lengths to make it work. Some are still breastfeeding, some are combination-feeding and some are no longer breastfeeding. Many have had brilliant supporters, partners, fathers, co-parents by their sides: after all it takes a team to parent a baby[4].

But whatever the outcome, each of them has shown an incredible determination and strength to meet their babies’ needs. It’s not your fault. Be proud of your successes.

And for those of you, who are in the middle of a struggle to make breastfeeding work right now: you are doing an amazing job. Keep asking for support from those who can help you. Celebrate your successes. Hang on in there. We hope you reach your goals – whatever they might be – and that you find a pride and peace in your achievements.

Written by Justine Fieth, LLL Cambridge, 2018