In current times, parents have a decision to make about how they intend to feed their infants. That decision is being influenced long before pregnancy, by the family and community each person is born into and grows up in and the various people and professionals they have contact with throughout their lives, as well as other influences, such as advertising.

As such, the needs of a parent in terms of antenatal education vary by the community and society they are part of. In some communities, breastfeeding is the cultural norm. Members of these communities usually do not need to be encouraged to choose breastfeeding, they expect to do so, and their needs around antenatal education and promotion of breastfeeding centre around the provision of education and dispelling of myths around breastfeeding to anticipate and avoid any potential hurdles in their journey and support them in successful breastfeeding.

In developed countries it has been shown that between 1/2 and 1/3 of mothers make their decision on how to feed their infant before they are pregnant

(HALLY ET AL, 1984; NEIFERT ET AL, 1988;
DIX, 1991; GRAFFY, 1992)

The remaining half to two thirds of mothers have not made their decision and will do so during pregnancy. It is important to provide antenatal breastfeeding education and promotion to all mothers and their partners/families at every opportunity, as these decisions are not set in stone and may change as the family experiences the changes of pregnancy and the new arrival.

Step three of the WHO ten steps to successful breastfeeding is

“Inform all pregnant women about the benefits and management of breastfeeding”

Step Three of WHO ten steps to successful breastfeeding

I would include their partners and families in this, if they also have contact with healthcare professionals. For many reasons, not all mothers attend antenatal classes, so each professional who has contact with her during the pregnancy should take the opportunity to provide information and guidance about breastfeeding. Members of the mother’s family, in particular her mother, her partner and her friends as well as the wider community in which she lives can all play a role in her initiating or continuing breastfeeding and if they are involved in the process and well informed, they may be more likely to offer her support on the journey.

The healthcare professionals who have contact with the mother and her family also influence her choices. Even simple gestures such as having breastfeeding friendly posters up in the clinical setting and encouraging other patients to breastfeed in the waiting room for example can have a big impact on normalising breastfeeding and increasing breastfeeding rates. A large study in the USA showed that encouragement from their healthcare providers increased breastfeeding rates in that population irrespective of social and ethnic backgrounds (Lu et al, 2001)

At antenatal visits, the WHO suggests that breastfeeding education should cover

  • the importance of exclusive breastfeeding for 6 months
  • the benefits of breastfeeding
  • basic breastfeeding techniques

Of course it should be tailored to the individual and this is just a guide. As the pregnancy progresses, the mother may have specific questions. It is good to encourage the first feed as a start, and taking things one feed at a time to avoid the mother feeling pressure and allowing her to celebrate each individual goal as it is achieved.

Encourage trying the first feed, then taking things one feed at a time

Each mother and family is unique and has a unique learning style. Written information is a good support to the breastfeeding education and promotion programme but alone it has not been shown to increase breastfeeding rates (Guise et al, 2003). Long sessions are not required but spoken information from the healthcare professional with practical demonstrations or visual aids if possible, combined with written information may be more successful.

Consistency is key, it is important to continue and add to the education at multiple visits and, combining antenatal educational interventions with interventions postnatally has been shown to have better impact on breastfeeding rates. (Chung et al, 2008)

References and Useful Links

  • Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey
  • Guise JM et al. (2003) The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force.
  • Chung M et al. (2008) Interventions in Primary Care to Promote Breastfeeding: A Systematic Review

evidence for the ten steps to successful breastfeeding linked above