Rates of breastfeeding initiation have been on the rise in Hong Kong – more than 85% of women are now initiating breastfeeding. That being said, according to a 2017 Department of Health survey, at the six-month mark, 47% of Hong Kong mothers are breastfeeding but only 27.9% nursing exclusively.
Why the drop in nursing between birth and six months? What can Hong Kong women expect when breastfeeding? And how can Hong Kong women prepare to meet their breastfeeding goals?
We spoke with Dr. Marie Tarrant MPH PhD RN, Honorary Professor at the University of Hong Kong and Professor at the University of British Columbia. She has done extensive research on breastfeeding habits amongst Hong Kong women and sits on the UNICEF-backed committee on Baby-Friendly Health Facilities Designation programme.
What are some of the factors causing Hong Kong women to stop breastfeeding early?
In our follow up, we do see a big discontinuation of women breastfeeding leading up to the 8-10-week mark, close to when many women return to work. In the first few months, many women know they’re going back to work and are unsure of whether they will continue to breastfeed once they return. They may hit a few obstacles in the road and start to introduce complementary formula. At some point, they might realize that they’re going back to work in a few weeks and the struggle to get breastfeeding going well is probably not worth it and they would rather spend the time getting to know their baby in a less stressful environment.
Many members of the older generation in Hong Kong raised their children with the idea that formula was better than breastfeeding and that a new mother needs to rest after giving birth. Many new mothers are being encouraged by older family members to rest and give their baby formula in the first few weeks of life. This lack of family and community support pushes women towards formula and away from breastfeeding, particularly if they’re struggling.
Hong Kong is not a very supportive public breastfeeding culture. Even if you’re not embarrassed to feed in public, where do you sit down? Finding a bench or chair can be a challenge in public, especially in the early days when young babies need to feed frequently.
After about 3 months, the cessation rates level out quite a bit. If mothers can make it to the 3 month-mark, many of them will continue to 6 or 12 months.
How can women prepare to breastfeed successfully before the baby is born?
Having a realistic appreciation of the challenges you may face in the first few weeks can make the world of difference. Words like ‘natural’ and ‘best’ are thrown around a lot when describing breastfeeding in the prenatal phase so women expect that breastfeeding will be easy and straightforward. In fact, women and babies need to learn to breastfeed.
Mothers, especially first-time mothers, are really focused on labour and delivery and have a hard time taking in information about breastfeeding. A lot of expectant, first-time mothers think that breastfeeding will be the least of their worries. Actually, for some women breastfeeding is far more challenging than the labour itself.
Mothers need to keep in mind that the solutions presented (such as formula, bottles and pacifiers) may alleviate short term issues such as anxiety, stress or pain but will not help them reach their goal to breastfeed. Breastfeeding needs to happen every few hours in order for milk production to become regular and babies need to avoid bottles otherwise they may suffer from ‘nipple confusion’ and reject the breast.
All that being said, childbirth is such a surreal experience that, for many women, it’s hard to think about breastfeeding. I suppose I would just suggest to arm yourself with information.
Can you share some key tips to succeed with nursing in the first few days in hospital?
- Breastfeed as often as possible. Most women are exhausted and may be in pain but feeding frequently will build up the milk supply.
- Make sure the baby gets the colostrum produced in the first few days.
- The biggest misconception is that women think they’re not making enough milk. It takes time for the milk to come in. We are used to seeing babies drinking full bottles but they’re actually born with stomachs the size of a marble so they don’t need 4oz of milk.
- Feed on demand rather than on a schedule.
- Get help. Support staff in public hospitals are very pro-breastfeeding but they’re busy. It can be helpful to find a friend or relative who has breastfed and can give you the one-to-one help and encouragement you’ll need in the first few weeks.
- Support at home. When women get home from the hospital, family members and friends need to support the new mother and take up some of the household duties so that she can focus solely on breastfeeding and recovery.
The first month of breastfeeding can be hard. Do you have some key tips to succeed with nursing once women leave the hospital?
A lot of women experience sore and cracked nipples in the first few weeks and think it’s normal. It’s not. It’s usually a sign of a poor latch. You can go to your local Maternal and Child Health Clinic (MCHC) and they can look at the baby’s latch and help you. When I was in the hospital after my first son was born, the nurses told me that his latch was fine. Within a few days, my toes would curl every time he fed and I began to dread feeding sessions. I was fortunate and was able to get a private lactation consultant to come to my home and she quickly taught me and my son how to latch correctly. Within 24 hours, my pain was gone and I continued to breastfeed for many months.
In the public system, women need to get themselves to the MCHC to access that care. While it is high quality, it can be challenging for women to physically get themselves and baby out of the house. Again, it’s great if women can find support from someone in their community who has breastfed before.
New mothers also need to know that their babies will need to feed on-demand. This can be difficult when we’re so used to measuring and scheduling everything. There’s no ‘set amount’ that babies need. Familiarize yourself with babies’ hunger signs and know the signs (inconsolable crying, not enough wet diapers) of when to get help.
What is a typical postnatal breastfeeding experience in a public hospital? In a private hospital?
If you’ve had a natural delivery, you’ll get to breastfeed in the delivery room. Soon after birth, you’ll have skin-to-skin time. Some hospitals are doing incredibly well with this – you’ll have 1.5 hours of skin-to-skin contact. The midwives will help you initiate breastfeeding. Just putting the baby on the chest, the baby will naturally crawl towards the breast.
After birth, you’ll be moved to the post-natal ward. Almost all public hospitals have the baby rooming in with the mother. Some of these wards have 6-8 beds so it can be noisy and it can be hard to rest. Most women choose to leave the hospital after 1-2 nights, depending on whether they delivered naturally or by caesarian.
Public hospitals offer post-birth group breastfeeding classes where you can go in and feed the baby. The nurse or midwife is there to teach, help and answer any questions. They’re held 2-5 times a day so you can attend multiple classes as issues arise during your hospital stay.
One-to-one help is usually problem-based because the nurses are too busy. It’s the women who ask for help who are seen one-to-one so it’s important to voice concerns if you want to be seen.
The experience at private hospitals vary as they’re not as consistent in their practices like the public hospitals.
At private hospitals, it’s important to realize that they work under a ‘customer-service’ model. Unless you voice a preference otherwise, many private hospitals will have babies in the nursery rather than with the mother and will have scheduled feedings rather than encouraging feeding on-demand. The idea is that the new mother should have the time and space to recover but the physical distance between mother and child and scheduling feedings both passively encourage relying on formula. Some private hospitals only schedule feeds 4 times a day when most newborns require two to three times that number of feeds in the first 24-48 hours.
None of the private hospitals in Hong Kong are designated ‘Baby-Friendly’. This is, in part, by choice as they want to be able to offer patients more freedom in their post-birth choices. I believe many of them have the capacity to be baby-friendly but perhaps, that’s not what every patient wants. It’s about offering choice in the private system.
How can women get over the stigma of breastfeeding in public in Hong Kong?
Preparation is helpful. Plan your trips out so you know where you can feed when you reach your destination. The first few times are scary and intimidating but you do quickly get used to it. And most people don’t notice.
Try not to let breastfeeding keep you at home. Some women like to use a nursing cover, some like to go to a mother’s room, some are happy to breastfeed in public. Find what works for you.
The government has made progress in breastfeeding policy so we’re heading in the right direction. By law, you can breastfeed in public so know your rights!
A big thank you to Dr. Tarrant for sharing her research and expertise on breastfeeding in Hong Kong. The above is not a verbatim transcript of our interview with Dr. Marie Tarrant but a summary of her responses.