Date: 23 February 2017
A new compilation of NIHR-funded research brings into focus a number of factors before, during and after pregnancy which could improve maternal and child health. Many of the studies in Better Beginnings – Improving Health for Pregnancy reflect public health priorities, such as support for smoking cessation, healthy diet and weight, with evidence that prevention is cost-effective and offers return of investment in the short and long-term. This may be especially so for interventions during and after pregnancy, as effective care could enhance the health of women and their infants during their life-course.
Choosing to breastfeed is absolutely a woman’s prerogative, although it’s a choice likely to reflect multiple influences, including a woman’s cultural and socio-economic background and the views and support of her peers. Among many health benefits, breastfeeding can help women to manage their weight postnatally and prevent their infants from developing obesity in childhood and later adulthood.
Yet many UK women decide not to breastfeed, or if they initially start breastfeeding, don’t continue much beyond the first two weeks of their infant’s life. Despite universal NHS maternity services which should support women who want to breastfeed to do so successfully, the UK has among the lowest rates of breastfeeding internationally, with only around 1% of UK women exclusively breastfeeding at 6 months postnatally. It’s a hugely important public health intervention that we don’t do very well. One only has to consider how few breastfeeding women we encounter when out and about in our daily lives. If I’m hosting international visitors to my university I often set them the task of spotting a woman breastfeeding in public in London.
Low rates of breastfeeding should be a real cause for concern given the changing health profile of women in the UK who become pregnant. Rates of maternal obesity are reaching epidemic proportions, with around half of women commencing pregnancy overweight or obese.
Maternal obesity is increasing the health care burden of the NHS as obese women are more likely to develop gestational diabetes, require caesarean section and have infants who require neonatal care. It’s not just outcomes of the index birth that are implicated, with consequences of obesity on longer-term maternal and child health becoming clearer.
Weight loss in pregnancy is unsafe, although dietary and lifestyle interventions could minimise excessive gestational weight gain, prevent some medical complications and reduce postnatal weight retention. As we don’t have UK guidelines to recommend pregnancy weight gain in obese women (with debate as to whether guidance is appropriate, given uncertainty surrounding recommendations including those from the USA Institute of Medicine), it’s not surprising women receive mixed messages about weight gain in pregnancy.
Messages all pregnant women should be offered include that they don’t need to ‘eat for two’ and the importance of a balanced diet which limits sugary drinks and processed foods. As pregnancy is not an optimal time to address weight change, focus is turning to healthy weight management prior to conception and after giving birth. Evidence of ‘what works’ is needed with relevant NIHR funded studies underway.
High breastfeeding attrition rates beg the question of why we’re continuing to fail women, particularly those who may have most to gain in terms of health benefits. One answer may be that we need to tailor advice and support to women’s needs, rather than offer the same level of breastfeeding advice and support to all women or accord breastfeeding support low priority as if it doesn’t really matter, when it so clearly does. I’ve met women who had such poor breastfeeding experiences that months later they were unable to discuss it with me without getting upset because they considered that they had ‘failed’ their infants.
Difficulties latching their baby on the breast and poor body image have been reported, with women also facing barriers due to lack of timely and appropriate advice from health professionals who don’t know how to advise them on how to commence and continue to breastfeed. Maternal obesity is too great an issue to ignore. Breastfeeding could provide enormous return of investment for something most women should be able to do - with the right level of support.
Breastfeeding can help women to manage their weight postnatally and prevent their infants from developing obesity in childhood and later adulthood.
Debra Bick is Professor of Evidence Based Midwifery Practice at the Florence Nightingale Faculty of Nursing and Midwifery, King’s College London. She leads a programme of research on maternal physical and psychological morbidity and is Editor in Chief of ‘Midwifery’, an international journal.