• The initiation rates of breastfeeding in 2005 were 78% in England, 70% in Scotland, 67% in Wales and 63% in Northern Ireland. This was the first survey which separated results from England and Wales. These rates represent an increase in initiation of approximately 5% taking into account the age and educational profile of the mothers.
• Prevalence of breastfeeding apparently also increased, but when related to the increased initiation, the proportion still breastfeeding at six weeks and six months was the same as in 2000.
• The prevalence of exclusive breastfeeding has not increased with the UK percentage exclusively breastfeeding at birth being 65%, six weeks being 21%, and at six months negligible.
Antenatal care
• 70% of mothers reported that they intended to breastfeed
• Approximately 80% of mothers had received some advice about health benefits during their pregnancy, mainly via midwives. Mothers who had received this information were more likely to initiate breastfeeding. However, of these mothers 17% reported that they had merely been asked their feeding intention. In addition the responses of many mothers when asked about health benefits of breastfeeding could be described as common knowledge and therefore not indicative of a meaningful discussion with a health care professional. Commonly described benefits of breastfeeding for the baby were:
• better developed immune system, making it easier for the baby to fight infections(79%)
• breast milk was more nutritious than formula milk (30%)
• increased protection against complaints such as asthma, eczema, and other allergies (21%)
• helps with wind, colic and other digestive problems (16%).
• Bonding (18%)
For mothers:
• helps the uterus contract, thereby helping the mother lose weight (69%)
• reduced risk of breast or ovarian cancer (39%)
• reduced risk of cancer generally (15%).
Birth
• 72% of mothers reported that they had held their baby in skin contact within one hour of the birth. Breastfeeding initiation was much higher in
this group with 87% breastfeeding within the first hour versus 57% breastfeeding in the first hour without skin to skin contact.
• An early breastfeed was associated with later success – 15% of mothers ceased breastfeeding within two weeks after an immediate/early feed versus 22% when the first feed was delayed by twelve hours or more.
Support with positioning and attachment
• 72% of mothers had been shown how to position and attach their baby for breastfeeding. Mothers of first babies were more likely than mothers of later babies to have been given such guidance (89% and 53% respectively). Mothers who had been shown how to put their baby to the breast were asked how useful this advice had been. The majority (85%) of mothers who had received help or advice said it was either very or extremely useful. Advice was seen to be most useful if the person giving the help or advice stayed with the mother either the whole time or until the baby was feeding (returning later to check on them). Almost all (95%) of mothers who received advice this way said it had been very or extremely useful.
Rooming-in/bed-sharing
• 82% of babies were reported to have roomed-in with their mothers (compared with 79% in 2000)
• 49% of mothers allowed their baby to sleep in their bed at least occasionally and this was regular practice for 11%. This practice was more likely to be associated with breastfeeding mothers, however 38% of formula feeding mothers described this practice on occasions.
Giving supplements
• A third (33%) of all breastfed babies born in hospital had been given formula, water or glucose during their stay. This was clearly associated with an increased likelihood of stopping breastfeeding in the early weeks. By the end of the first week, 28% of breastfeeding mothers whose babies had been given one of these feeds had given up, compared with only 8% who breastfed exclusively in hospital. A similar trend was noted at two weeks (34% compared with 12%).
Information regarding support once home from hospital
• 77% of mothers who breastfed on leaving hospital were given information on how to get help from a health professional with feeding their baby after
they arrived back at home however, this fell to 65% who received contact details of a voluntary organization.
Exclusive breastfeeding
• Three-quarters of all mothers had given their baby milk other than breast milk by the age of six weeks, this proportion rising to 92% by six months.
• For those mothers who did not exclusively breastfeed, prior to six months infant formula was the most commonly used option, whereas after six months mothers were more likely to be using follow-on milk as their baby’s main source of milk other than breast milk.
Breastfeeding problems
• A third of breastfeeding mothers experienced difficulties in hospital or during the early weeks. The highest proportion of mothers experiencing problems were those who adopted a mixed feeding approach with 52% of mothers who used a combination of breast and formula while in hospital experiencing problems. Similarly, in the period between leaving hospital and completing the Stage 1 questionnaire (4-10 weeks), 44% of mothers who either introduced or switched to formula after initially breastfeeding said that they experienced problems. Problems encountered mainly concerned difficulties with attachment or failure to feed, sore nipples and unsatisfied babies.
• Approximately 1:8 – 1:10 mothers continued to experience breastfeeding beyond the early weeks. The greatest incidence of problems was again found amongst mothers who introduced supplementary formula, with problems cited being: inability to satisfy baby, a need to top up with formula, and blocked milk ducts.
• Mothers who received help were more likely to continue breastfeeding
• Nine out of ten mothers who gave up breastfeeding within six months would have preferred to breastfeed for longer. Overall, among all mothers ceasing to breastfeed, the single largest factor behind cessation of breastfeeding was insufficient milk (39% giving this as a reason).
Other common reasons for giving up tended to vary by breastfeeding duration:
• Weeks 1-2 insufficient milk, rejection of the breast, and painful breasts or nipples.
• Weeks 1-26 insufficient milk
• Weeks 1-18 breastfeeding too tiring
• Week 26 onwards return to work
• Babies who were breastfed for a minimum of six months were significantly less likely than other babies to experience colic, constipation, sickness/vomiting, diarrhoea, chest infections and thrush. Differences were most apparent for gastro-intestinal conditions.
Introduction of solid foods
• There has been a marked change in the timing of the introduction of solid foods with 51% having introduced this by four months compared with 85% in 2000. However, only a tiny proportion of mothers delay solid food introduction until around six months.
• Later introduction of solids was associated with advice from health professionals whereas when this occurred earlier it was more likely to be based on informal advice sources and subjective criteria such as whether the baby was considered to be sufficiently satisfied with milk feeds. 70% of mothers reported receiving advice from a health professional.
• Early introduction of solid diet tended to be more likely to be based on the use of commercially-prepared foods. By eight to ten months, however, mothers relied less on these with a correspondingly increase in the use of home-prepared foods.
Preparation of artificial feeds
• 69% of artificially feeding mothers said they usually made up several feeds at a time and stored them. Only three in ten followed the recommended practices of either making up one feed at a time as they needed it (25%) or only using ready to feed formula (5%).
• In addition, just under half of all mothers who had prepared powdered infant formula in the last seven days had not followed additional key recommendations for preparation either by not always using boiled water that had cooled for less than thirty minutes or not always adding the water to the bottle before the powder. About a third of mothers did not follow the recommendations for preparing formula when away from the home, either by not keeping pre-prepared formula chilled or by using cold or cooled water when making up feeds.
• Only 13% of all mothers who had made up powdered formula in the last seven days followed all three recommendations of only making one feed at a time, making feeds within 30 minutes of the water boiling, and adding the water to the bottle before the powder.
25 May 2007
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