Support for breastfeeding is an environmental imperative

As a doctor and recent breastfeeding mother, I would like to highlight a number of points. Breastfeeding is not an automatic bodily function, nor is it free or resource neutral. I was unable to exclusively breastfeed, therefore had to supplement with expressed milk and formula. I had to purchase a breast pump, bottles, steriliser, and formula, in addition to nursing bras, nipple shields, cream, breast pads, and suitable clothing. I would estimate the capital outlay as being approximately £400, excluding formula. The hospital midwifery breastfeeding support was very good, but sadly other NHS antenatal and postnatal breastfeeding services were substandard to the point of being unfit for use. Common breastfeeding problems are glossed over at both the antenatal and postnatal stage. The education of healthcare professionals on how to help mothers breastfeed is inadequate. The UK figures clearly demonstrate that a high proportion of women start breastfeed immediately post-partum, but then this number rapidly falls. The obvious conclusion- that breastfeeding is often very difficult - seems to be ignored. Dichotomising the situation as a choice between breastfeeding vs formula is simplistic and unhelpful. Articles such as this add nothing to the situation. If the BMJ wishes to promote breastfeeding then an up to date, comprehensive clinical practice article on the management of common breastfeeding problems would be of much greater value.