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Rapid response to:

Practice Practice Pointer

Providing effective evidence based support for breastfeeding women in primary care

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-065927 (Published 01 November 2021) Cite this as: BMJ 2021;375:e065927

Rapid Response:

Re: Providing effective evidence based support for breastfeeding women in primary care

Dear Editor

Two excellent reviews in BMJ have provided useful information for clinicians in supporting women to breastfeed (https://doi.org/10.1136/bmj-2021-065927 & https://doi.org/10.1136/bmj.n1628) . Both identify various potentially remediable problems to which painful breastfeeding may be attributed. Whatever the specific causes, health professionals should more openly acknowledge the challenges faced by many women in initiating and maintaining breastfeeding. The platitude that ‘breast feeding shouldn’t hurt’ can lead women to experience feelings of guilt for ‘doing it wrong’ and inadequacy for dreading the pain of breastfeeding during an already stressful time when mental ill health is common.

Our reticence about discussing the difficulties many face in breastfeeding may stem from a paternalistic concern that women might choose not to breastfeed were they to be fully informed. Such good intentions may well be counter-productive for women who feel unprepared and misled when they confront an experience of breastfeeding that differs from that presented to them during pregnancy. We should feel confident enough about the benefits of breastfeeding and of the capacity of women to make appropriate decisions to acknowledge that that while many women breastfeed without difficulty or overcome initial challenges, for some women breastfeeding remains painful or complicated by problems like recurrent mastitis despite persistence and support.

Competing interests: No competing interests

24 November 2021
Stephen H Bradley
General Practitioner & Research Fellow
Leeds