Janine Pinkham, La Leche League NZ
Janine Pinkham has been the LLLNZ Director for nearly four years. She is also a Leader, of 27 years, so from time to time she is contacted for breastfeeding help. She has four adult sons, aged from 22 to 30. Breastfeeding went relatively smoothly with her first two sons, but was significantly more complicated following the premature birth of her last two (twins).
Crash Landing: We would like to talk with you about some of the myths that surround “breastfeeding”. I remember when I became a first-time Mum, I had the impression that breastfeeding had to be “natural” but it was the opposite of that. For the first 5 months, I had all kinds of difficulties. Why do you think it doesn’t come naturally for so many mums?
Janine Pinkham: We often say “breastfeeding is natural but doesn’t always come naturally”. It’s hardly surprising as often the first baby a new mother holds in her arms is her own new baby. Growing up we are unlikely to have had much involvement with babies to get to understand their needs, and even less likely to have seen babies breastfeeding to get an idea of how to do it. Then there is the plethora of books and myths we are bombarded with that distract us from watching our own babies and learning from them. It can be confusing and upsetting in those early weeks and months with your new baby. Encouragement and support are so important. For those who don’t have family and friends to help then a support group like La Leche League can make all the difference.
CL: As a pregnant woman you have easy access to antenatal classes that give you some information about breastfeeding. Do you think that women should also have access to breastfeeding classes once they have the baby?
JP: It is good when pregnant women take breastfeeding pointers on board from antenatal classes, but it’s hard to learn from a picture or even a doll. Usually a pregnant person is so focused on the impending birth that what’s coming later is not thought about, until wham, “now what do I do?” This is where La Leche League meetings can be so helpful. Making contact during pregnancy gives some realistic ideas of what’s to come, the chance to see breastfeeding in action and introduces a support network to call in if the going gets tough postnatally. Making contact once the baby arrives whether or not there are difficulties can be invaluable to get individual support and reassurance either on a one-to-one basis or at a group.
CL: I remember when I was a first-time Mom, I wanted to go to one of your support groups but the times I had planned to do so, I found it impossible to get out of the house with the newborn. Could you tell us more about the online help you offer?
JP: Yes, it can be tricky to time your outing around your baby’s sleep and a specific meeting time. You are always welcome to a La Leche League meeting any time, even ten minutes before the end, sometimes even after. But this is exactly why the online meetings have been so welcome; they are a great place for mothers to meet from the comfort of their own armchair so they can discuss aspects of breastfeeding and having a new baby in the house. Our online meeting happens on the last Tuesday evening of the month, running from 7 to 9pm. This is structured in a similar way to the local group meeting and typically involves 30-50 people. Our live chat is held mid-month on the second Tuesday, from 10am to 12pm, and is more relaxed but like the evening online meeting. The Breastfeeding Support – La Leche League New Zealand Facebook page posts information and encouragement for breastfeeding families. People are always welcome to message the page for specific one to one help. Local La Leche League Facebook pages also offer this form of helping.
CL: Do you have any numbers of how many mothers you are currently helping in NZ through LLL NZ?
JP: I’m proud to tell you that our latest survey of Leader activity, for the year ended 31 March 2019, shows total contacts of 16,774 and total contacts with mothers of 14,180. This includes situations where more than one contact was needed, ie follow up calls for more information or to check progress.
CL: What kinds of help do you offer?
JP: Gosh, let me count the ways! We do meetings, workshops, conferences, phone, email, text, messenger, Facebook pages (national and local), Facebook online meetings, and one to one help is available anywhere a Leader happens to be. The most effective help from La Leche League is at our local meetings where people learn more about breastfeeding and can have their specific questions answered, drawing on the wisdom and experience of everyone there. Our online meetings are popular and are helping to reinforce our great listening, sincere caring and in-depth knowledge and information. We would love to see people from our online meetings getting along to their local group meeting.
CL: I have the impression that another of the “common beliefs” around breastfeeding difficulties is that it mostly happens to first-time Moms. To my surprise, I had even more difficulties breastfeeding baby n3 than with baby n1. Do you think this is another of the common myths too? Or does LLL NZ mostly help first-time Mums?
JP: First time mums are a special group as they have little or no experience to draw from, so yes they may be more likely to seek help. Others who have had previous difficulties are also recommended to include La Leche League in their support network to help avoid those difficulties arising again. However, every baby is different and even experienced mums can be taken by surprise when breastfeeding goes pear-shaped. La Leche League is there to help with all breastfeeding situations whether it is your first, fifth or any number baby.
CL: Are there any other “myths” you encounter in your day-to-day that can make the breastfeeding journey difficult too?
JP: It’s hard to know where to start with this question! Because breastfeeding is not as well practiced as it could be there are a lot of reasons for mothers to lack confidence: most commonly is an expectation that breastfeeding will be painful and/or a perception of low milk supply. There is frequently a lack of awareness that feeding a baby up to two-hourly is perfectly normal and sleeping through the night can take many months to establish and is related to the disposition of the baby rather than any tactics the parents may try. Feeding your baby to sleep is not creating bad habits. There are all sorts of myths about how breastfeeding will ruin your body or lifestyle, when in reality breastfeeding can make caring for a baby or a toddler easier and is always nutritious; and it’s pregnancy that makes your boobs droop. Family experience and support is very influential and perpetuation of myths or undermining of a new mother’s breastfeeding efforts can have devastating consequences. There is no end of silly things mothers tell us they have heard that work against a smooth breastfeeding journey.
CL: I have the impression that in NZ the government (through health agencies, hospitals etc) does as much as possible to promote breastfeeding among Mums. What’s your opinion about that? Do you think more can be done?
JP: I agree, breastfeeding is well promoted; most people accept that breastfeeding is how a baby would ideally be fed. Unfortunately, this message is heard in isolation. It would be helpful if along with the promotion of breastfeeding there was a general awareness of why breastfeeding is so important, of the many positive impacts on health, both short and long term. Research is revealing new factors all the time about how breastfeeding helps the health of the baby and the mother. And along with promotion, support is just as important. Access to skilled professional and peer breastfeeding support is patchy across New Zealand. It is heart-breaking to see families totally committed to breastfeeding their babies who encounter problems through lack of timely support. Increasing the resourcing of maternity and breastfeeding support services would help to even up the odds.
CL: In your work as LLL NZ Director, have you identified some of the main problems that women face when trying to breastfeed their babies (is it mostly latching difficulties they complain about… pain… lack of support?)
JP: Latching is a big issue, after all if the baby isn’t latching feeding is not going well. Latching, pain, and worries about supply are the big issues. Matching expectations with reality is another big factor, and babies following their own pattern not one found in a book can confound new parents. For some lack of support is the breaking point. It is well known that the support of the mother’s partner is the most important element; without that, breastfeeding outcomes are less positive. Modern issues are; embarrassment about breastfeeding out and about, and combining breastfeeding with paid employment where the mother and baby can’t stay together. In both of these issues a more supportive environment is needed.
CL: If a Mum is reading this interview… and she feels that she can’t see the light at the end of the tunnel… What would you tell her? In your experience, does persistence usually pay off? How many “impossible” cases have you dealt with?
JP: Firstly, “you are doing a great job, it’s not easy and it’s understandable you are so upset”, often such a contact would be accompanied by tears; hers and probably also mine. Then we would go over what she is experiencing, and I would offer reassurance and information as appropriate. Persistence is incredibly important, but accurate assistance with latch or supply management is crucial first. Ongoing support while the family work on the breastfeeding problems is important. So if a mum doesn’t think she is making progress in resolving her problems, then seeking out help is valuable, even if it ends up being simply moral support and the mother is “doing everything right”. Some babies just need more time to get themselves organised, especially if they have arrived early or after a difficult birth. I am amazed sometimes at the persistence of mothers, when others seem to stumble at the first hurdle. You can’t judge one as trying harder than the other as it is not possible to know all the barriers that either woman has faced. There is a real hormonal drive to make breastfeeding work, but everyone has their breaking point.
CL: I think that most women looking after a newborn at times are too depleted to know who/how to ask for help. Besides LLL NZ, can women in NZ access other kinds of government help if they’re having breastfeeding difficulties? For example, can a new Mum get the (free) help of a lactation consultant through government agencies like Plunket? Or once the baby is here, is the only help they can get through LLL NZ?
JP: You’re right, and this is why getting a breastfeeding network set up during pregnancy is helpful, so when problems come up they know where to turn for help. There are actually quite a few options for help available. The first port of call is the LMC, usually a midwife, who will be alongside during the whole pregnancy, birth and the first six or so weeks. Ideally a midwife will be giving information about breastfeeding during pregnancy, will help get breastfeeding off to a good start at the birth and will be around for the first six weeks to help get breastfeeding established. Once the midwife is no longer available most families follow on with a well-child service, eg Plunket, or a GP, and breastfeeding is part of the expertise of these services, or there are pathways to other help. Plunket now, through Plunketline, has a video-conference lactation consultant service to help with serious breastfeeding issues, and this is particularly helpful for those in remote places where in-person contact is not possible. Some centres, mostly in cities, have lactation consultant services that are either hospital based and available postnatally, hosted by other health services in the community, or offered by health professionals in private practice. Lactation consultants can be free or incur a fee. There is no uniformity throughout New Zealand on access to lactation consultants. In addition, some regions have government funded breastfeeding peer counsellor programmes, with trained Peer Counsellors available either on a one-to-one basis or at breastfeeding support groups. These have been established from an initiative of La Leche League providing the training of the Peer Counsellor Programme Administrators. And then, La Leche League is the only national parent-to-parent breastfeeding support service with trained volunteers. We have 35 groups and 122 Leaders throughout New Zealand from the Bay of Islands to Invercargill.