Every year in August, healthcare professionals and women’s rights advocates mark World Breastfeeding Week (WBW) (Aug 1 – 7) as an opportunity to celebrate the role of breastfeeding in supporting healthy and sustainable families and communities. Midwives are foundational to this work. In recognition of WBW and our campaign efforts to underscore the full spectrum of sexual and reproductive care midwives provide, we spoke with Marley Hall – a UK-based midwife and the author of Midwife Marley's Guide For Everyone: Pregnancy, Birth and the 4th Trimester. Marley has extensive experience in all aspects of midwifery care, including antenatal care as a community midwife, labour and birth care, and postnatal care on both the ward and in the community. Her practice is premised on helping women and birthing people to achieve a positive birth experience, and it is through this lens that she’s supported many families on their breastfeeding journey.
In our conversation with Marley, we unpack the role of midwives in breastfeeding, including the training midwives receive to support women and birthing people to breastfeed/chestfeed, the tactics they employ to facilitate breastfeeding, and the main challenges they confront in providing this care. Our goal here is to ensure our community has an understanding of how midwifery intersects with all aspects of childbirth, including the vital pre and postnatal support women and birthing people require to experience a positive entry into parenthood.
How does a midwife’s training qualify her to support breastfeeding/chestfeeding?
“Midwifery students are taught, during the course of a pre-registration midwifery degree, the anatomy and physiology of breastfeeding and how to support their clients practically,” says Marley. “They should have access to various breastfeeding related study days whilst on placement and practical experience with supporting new mothers as they learn to feed their infants. Some students may also get the chance to support at breastfeeding clinics and observe tongue tie releasing procedures. It’s important that students learn to recognise the signs of breastfeeding problems and are able to know when to refer for further support should it be required.”
While Marley speaks from her experience as a UK midwife, we know from the International Confederation of Midwives’ (ICM) Essential Competencies for Midwifery Practice that all midwives should be trained to provide breastfeeding support, both during the pre-pregnancy and antenatal period, and as they provide ongoing care to women and newborns.
Importantly, Marley underscores the importance of all midwifery students learning the International Code of Marketing of Breast-Milk Substitutes and the Baby Friendly Hospital Initiative and understanding how both impact the care they provide to women and newborns.
What are the common tactics/strategies a midwife will employ to support a mother to breastfeed/chestfeed?
Marley stresses that education during the antenatal period is key to supporting a woman to breastfeed. “Midwives are not supposed to ask how one intends to feed their baby/ Instead they should provide information about breastfeeding so that persons can make an informed decision on how to feed their infant,” says Marley. “At birth, a midwife should assess a breastfeed to make sure the baby is latched and positioned appropriately. This is to avoid nipple trauma and ensure a baby is receiving enough colostrum [the first form of breastmilk that is released by the mammary glands after giving birth].”
In their Call to Action on Removing Barriers to Breastfeeding, UNICEF UK notes that successful breastfeeding is premised on women being able to access “face-to-face, ongoing, predictable support, starting in pregnancy and into the early weeks and months of their child’s life. This means that midwives and other healthcare professionals must be supported within healthcare systems to reach women after they’ve given birth.
“During postnatal appointments, a midwife will ask how the feeding feels, if the baby is having at least 8-12 feeds in a 24-hour period, assess weight at indicated intervals, nappy output, and conduct an oral examination of the baby if indicated,” says Marley.
What are the challenges midwives confront in supporting women to breastfeed?“One of the biggest challenges is that many midwives feel that by simply talking about breastfeeding, they will be perceived as being ‘pushy’,” says midwife Marley, echoing observations made by midwife leaders at ICM who are concerned with terms such as ‘breastfeeding mafia’ which seeks to paint midwives and other healthcare professionals as militant and irresponsible in their efforts to support women to choose to breastfeed.
“There are times when a mother genuinely wants to breastfeed but if the baby becomes fussy regularly and seems to want to feed all the time, relatives and/or friends can put pressure on her to offer a bottle of formula, even when the baby is gaining weight and there are no other concerns”, says Marley. “Rather than seeking advice or support from a professional, many new parents will believe they don’t have enough milk to satisfy their babies. They are made to believe that ‘hungry baby milk’ is what they should give, even when we know these milks are a marketing ploy that are rarely beneficial to babies.”
To combat these misconceptions, Marley focuses on educating parents and their extended families on what to expect when their baby arrives. “Understanding hunger cues, the importance of responsive feeding, skin-to-skin, the physiology of breastfeeding, are essential learning for expectant parents, as are recognising when the baby isn’t getting enough milk and the signs of dehydration and poor attachment.”
From the State of the World’s Midwifery (SoWMy) 2021, as well as the newly launched Midwives’ Voices, Midwives’ Demands report, we know that the global shortage of 900,000 midwives is contributing to overstretched health systems where midwives aren’t receiving the education, support, and resources required to provide adequate care. As Midwife Marley notes, this impacts the quality and quantity of breastfeeding support families receive. “Midwives rarely have enough time to support breastfeeding parents in the way most would like due to high workloads.”
From your own practice, what are some of the major concerns/questions women and other birthing people have regarding breastfeeding/chestfeeding?
“From experience, the two major concerns women have are milk supply and pain when feeding,” says Marley. “Too many new parents aren’t informed about the physiology of breastfeeding and the importance of regular, early, responsive feeding. Many are worried that if they can’t see milk dripping from their breasts moments after birth that they have no milk.”
Marley believes that the antidote to these concerns is education. “Teaching new parents about colostrum and the role of hormones in relation to the mother/baby dyad is extremely important, says Marley. “Some parents are worried about pain whilst breastfeeding — sore nipples are extremely common, particularly when a baby first latches, but pain throughout a feed is not normal. Any problems should be identified by a suitably qualified breastfeeding professional.”
To stay connected to Marley’s work on breastfeeding and all things midwifery, follow her on all social media channels, @midwifemarley
Here are other helpful resources to support your understanding of the role of midwives in breastfeeding: