Breastfeeding and natural birth are emotive subjects and sadly surrounded in controversy.

These two subjects trigger all kinds of feelings in women and for those who wanted to breastfeed or who wanted a ‘natural’ delivery but did not succeed, for whatever reason, those feelings are often tinged with deep sadness, regret and guilt which can contribute heavily to postnatal depression.

This poses a great dilemma for educators. We are charged with not building up ‘unreal expectations’

Why natural birth is ‘difficult’

In American hospitals, the chips are stacked against anyone wanting a delivery without interventions as labour without augmentation with pitocin (artificially increasing the intensity and regularity of contractions) is increasingly rare. The spiral of interventions is fast and furious. Pitocin often makes contractions unmanageable by the body’s own hormones, which makes epidural pain control essential, which restricts the body’s ability to push and the woman’s ability to move and remain upright.

Why breastfeeding is ‘difficult’

Similarly, breastfeeding is challenged by unfair tactics – caesareans make breastfeeding more difficult, criticism of bedsharing threatens one of the most natural ways for you and your baby to share closeness, triggering hormones which aid milk production and more subversively, marketing of formula milk (free samples on the labour ward for example) hints that it is condoned by medical professionals, that it is just as good as breast milk. Most critical of all is the lack of support. Few of us are lucky enough to have experienced family around us who can help out with breastfeeding. Not enough professional breastfeeding counsellors are available (although the NCT in the UK or La Leche League in the US are always great places to shout for help with breastfeeding if you need it!) and maternity wards are understaffed – they simply don’t have the time or resources to give every woman the support she needs to breastfeed. According to the USA’s CDC figures for 2003, 71% of women tried to breastfeed in hospital. By 6 months, only 36% of women are still breastfeeding at all and only 14% still breastfeeding exclusively. Figures for the UK Office for National Statistics 2005 are worse, showing only 35% of women exclusively breastfeeding at one week and only 3% at five months.

The World Health Organisation recommends breastfeeding until two years and exclusive breastfeeding up to six months.

It’s a gloomy picture isn’t it? And for educators teaching to a hospital curriculum, the challenge is nearly insurmountable. How can we tell women they can have the birth they want and feed in the way they want when the odds are so heavily against them? Aren’t we just setting them up for failure? Isn’t the guilt just compounded when we teach that bottlefeeding increases their baby’s risk of SIDS or leukemia.

Can you plan for birth?

One argument I come across is that birth is ‘random’ and that birth plans are frequently laughed at by hospital staff. “The one way to jinx your birth is to write a plan” they say. Well, while it is true that birth can be unpredictable, it’s not the same as saying that it is completely out of control. A percentage of births are easy – labour is relatively short and the baby comes without too much effort. Another percentage of births are very difficult. No matter what the mother or the staff do, the baby is badly positioned or ’stuck’ and needs intervention to be delivered. I would suggest that a large percentage of births fall somewhere in between – that a natural delivery is feasible, but if poorly managed, they may be written off as a ‘failure to progress’ and progress to caesarean or instrumental delivery. It is for this large group that active birth is so crucial. Staying upright, moving around, drinking raspberry leaf tea, using a doula, using a birth ball, swaying the pelvis, relaxation and visualisation may all swing the balance, stave off stress and help labour to take its natural course.

Breastfeeding is very similar. A small amount of women may never be able to breastfeed, another percentage will find it easy. Most will need some support and to overcome a few obstacles to really settle into it. Once again, the right support can really swing the balance, yet as we have seen that support is frequently lacking.

The real difficulty for educators is that attitude makes a difference. Imagine a scale from one to ten, when 1 is “I don’t want to breastfeed”, 10 is “I definitely want to breastfeed” and 5 is “I want to give breastfeeding a try.” Those pregnant women who score themselves nearer to 10 are more likely to succeed in breastfeeding than those who score a 5. They are more likely to seek help, support and push on through difficulties. Similarly, a scale from 1 to 10 might exist for giving birth without an epidural. Those who are dead set against an epidural will be likely to try anything else first.

Of course, in both cases, nothing is guaranteed, no matter how determined you are. And it is possible that someone scoring a ‘1′ that they don’t want to breastfeed might have a change of heart and try anyway, or someone scoring a ‘1′ that they definitely want an epidural might realise in the delivery room that they are coping fine without. But scoring higher definitely boosts the chance of success.

Education is likely to raise those expectations. A woman who originally scored a ‘5′ that she might like to try breastfeeding (perhaps her family all formula-fed) could well shift her score up a few notches if she learned how it might benefit her baby. Similarly, a woman might become more determined to try birthing without an epidural if she learned more about the pro’s and con’s.

The difficulty here is that it sounds as if I’m arguing that success depends on determination. I do believe determination plays a part in both birth and breastfeeding, but as I have already pointed out, it is only part of the equation. Occasionally birth or breastfeeding have real physical reasons why they cannot work. Sometimes the support just isn’t there and sometimes women just don’t have access to the information they really need (their doctor perhaps tells them that an epidural is very safe and that they don’t need to suffer).

I would love to see the guilt taken out of these aspects of parenting. I would love to see women feel comfortable and happy with their choices. What stood out for me is that in the UK’s 2000 birth survey published by the Department of Health, ninety percent of women who gave up breastfeeding in the first six weeks wanted to continue. So who is to blame when it goes wrong? Clearly not these mothers.

The answer is complex. It comes down to a lack of support, from maternity wards to policymakers, from employers to public baby ‘unfriendly’ venues, from formula marketeers to family. There is a great need for education and for professional support. There is a massive demand for breastfeeding counsellors and consultants. I hear so many stories of women whose ‘milk never came in’ when they weren’t shown attachment techniques, skin-to-skin contact, frequent feeding, co-sleeping and so on. When they thought colustrum wasn’t enough. Similarly, where birth is concerned, there is a need for education, for evidence-based decision making in hospitals rather than unhelpful policies and procedures, for doulas and for the opportunity for women to really get active and work with their bodies rather than with hospital demands for restrictive monitoring, fasting or bedrest when not strictly needed.

What we need is to stop blaming ourselves. To have strength, determination and hope so that it can go right whenever it is possible, and when it occasionally doesn’t, we can be gentle on ourselves, and once we have mourned what was not to be, we can regroup and move forward.

xx