Tuesday 5 June 2012

Breastfeeding in the UK and the USA

Before I moved back to the UK I was excited that there is such a great maternity leave allowance in the UK and I imagined a breastfeeding heaven of sorts, women being able to breastfeed for as long as they wanted because they had no need to go back to work at 12 weeks or less like so many women have to in the US.  In the United States full time workers are entitled to a maximum of 12 weeks leave for a number of reasons (including the birth or adoption of a child).  There is no pay involved, and the company has to hold your position for up to twelve weeks if you have completed a minimum number of hours at your job in the last twelve months.  I was lucky that when I gave birth to William in the US I had accrued enough annual leave so that I did not have to lose any pay during my twelve weeks leave.

There are a number of benefits for going back to work so quickly after the birth of a child and I'll go through them in a minute, but I was definitely concerned that I wouldn't be ready, and that I wouldn't have established our breastfeeding relationship  enough to withstand the time I would be spending at work away from William.  Many women that I met through my work were not in the same position as me and had to return to work as early as two weeks after birth due to financial reasons or because they had not been working at thier job for long enough to request any more time away.

I definitely belief that parents should have the option to be able to build a relationship with their newborn, and that a Mother should have the opportunity to build a strong breastfeeding relationship and be given the time to establish a plentiful milk supply, but after seeing the differences in both countries it's hard to say exactly who has the correct policy.

Breastfeeding in the US

From the time you first visit a maternity store or visit your physician to start your maternity care you are bombarded with formula advertising.  The formula companies even provide a breastfeeding kit for the Doctors to give to everyone who is pregnant, and many companies will sell your details to formula companies so that a couple of cans of formula are waiting on your doorstep when you get home from the hospital, along with the free diaper bag from the hospital containing ready to use formula and pre-sterilised teats.

If you get past the first few days and the bombardment of coupons from the three biggest formula companies (in the US) coming through your door, then there were a lot of places to go for help in the State that I lived in.  Many hospitals, although none of them Baby Friendly, had lots of resources including lactation consultants on the wards and breastfeeding support groups for out patients.  Most hospitals rent out pumps, and there are lots of private practise lactation consultants for those that can afford them.  The WIC program also provides a lot of services for those on a lower income, support groups, free lactation consultant consultations, free pumps and even free nursing bras.  You may even be assigned to a peer supporter who will call you periodically to see how you are doing and then in turn you can call her with any questions you might have.

Going back to work after having a baby will probably be one of the toughest things you will ever have to do, but I think that there is more of a pumping culture in the US because so many women go back to work so soon and choose to provide their babies with breast milk.  Daycare is much more flexible and open much longer hours.  It costs a lot more to have a baby in daycare, so working full time is a must to take full advantage of all the hours you are paying for anyway.  When I returned to work I worked four days, each of ten hours.  I paid for a full time spot which William did not use on Mondays, but he spent a total of 44 hours a week at the centre.  I fed him on drop off, pick up and during my lunch break.  I was welcomed into the centre to nurse at any time, and staff were happy to wait for me if I told them I was on my way to feed.  Spending so much time at the daycare centre also allowed me to get to know the staff really well and learn all the gossip.

I said before that there is more of a pumping culture in the US, and this is shown in a number of ways, one being the new federal guidelines that make sure that employes are entitled to take unpaid breaks in a suitable location to pump their milk regularly.  Many large companies have lactation programs that provide all sorts of benefits from merely a space to pump to a full service of lactation consultant home visits and free pumps to use at work.  I have heard a rumour that the Pentagon has two lactation rooms.  You will also find a pump more easily in the US, available from many chain stores, and as I mentioned before many hospitals and stores rent pumps.  On a visit to the UK in 2008 my pump broke and I found it almost impossible to find a replacement on the high street, I had to call the company and ask for one to be shipped out.  Many high street stores only carry manual or single electric pumps, or those manufactured by bottle companies (ones that I wouldn't consider the best choice).  I've come to think that this is becasue there is less of a need, less of a pump culture.

So, let me summarize.  Women return to work much sooner in the US and pumping is more widespread I believe because of this.  Pumps are more readily available to buy and rent, and the workplace is required to provide adequate space and time for pumping or feeding throughout the day.

Breastfeeding in the UK

I know a little less about breastfeeding and working in the UK, mostly because I was pregnant when I moved here and didn't think anyone would hire me in such a state.  I would not have been eligible for paid maternity leave, and childcare for two children would have been very difficult to justify.  I have spent a lot of time in the company of women who work and who have taken time off after having a baby.  I've made the following observations -

  1. women start their maternity leave really early, I think because they get so long there is no real need in their eyes to work up to the final moment saving precious leave to spend every minute with the new baby.  I've known quite a few women in the US start labour while at work because they needed to save as much time as possible to spend with the baby, so from that point of view it does seem a little wasteful.
  2. I thought that a longer maternity leave would mean that more women would breastfeed longer, but that hasn't been the case as far as I can tell.  The majority of women that I have met so far consider three months as the time to stop, six months at the most.  I guess I had this romantic idea that if a woman was given the time to breastfeed then she would do it as long as she possibly could.
  3. When talking to women about their return to work, I have yet to meet one that has even considered pumping, and when I ask them, they say that there is no way that their employer would ever allow it and there would be no point in asking.  It does bother me that they haven't even tried, but I do wonder if people went back to work earlier whether pumping would seem more of a priority.
  4. Access to breastfeeding help can really depend on where you live and how much money you have.  Being able to afford an NCT antenatal class in my area can really open doors for you because you do get "assigned" a breastfeeding counselor who will, in some cases even come to your home to help after the baby is born, but at a minimum will answer the phone if you call for help.  The NCT also provides hospital grade pumps for hire.  We are lucky that more and more support groups are being made available and that some Surestart centres have decided to loan pumps at a reduced rate.  We even have a local tongue-tie service which is something of a breakthrough in my opinion.
I guess I am trying to determine in my mind whether extended maternity leave in the UK has benefited babies by leading to higher rates of breastfeeding and longer durations of breastfeeding.  I don't have any statistics to go by, but in my observations in my own local area I'm not seeing the breastfeeding Utopia that I expected to see when dreaming about longer maternity leave in the US.  Higher rates of breastfeeding have been seen in Scandinavian countries where maternity leave is pretty long and pretty highly paid, so maybe we need to look at why the rates in Britain are not higher.  Could it be that breastfeeding is a more acceptable way to feed in Scandinavia, nursing in public is such a contravercial subject in the UK and US.  Could it be that hospital policies are more baby friendly so that women leave the hospital breastfeeding well and supported throughout to reduce the need for supplementation?

I don't know the answer, but I think it's interesting to think about these things and consider the reasons behind them.  What do you think?

If you have enjoyed reading this post, you may want to check out these other bloggers who are writing about breastfeeding during the month of June.  You may also want to check out The Lactivist for some amazing Keep Britain Breastfeeding Goodies.  Lisa, the owner designed the logo for this scavenger hunt and has some really cute mugs, hats and infant t-shirts for sale with many cute and funny breastfeeding slogans.  Lisa is also running an additional competition here today so that you can win your very own infant T-shirt wth the slogan of your choice.  Enter below using the rafflecopter.

Really Rachel

Thank you for reading.  Please complete the following Rafflecopter to enter the competition for the Keep Britain Breastfeeding Grand Prize.

a Rafflecopter giveaway


  1. Breastfeeding help is available 24 hours a day in the uk by the phone:
    the breastfeeding network helpline: 0300100210
    national breastfeeding helpline: 03001000212
    la leche league: 08451202918

    peer support workers work in surestarts,and maternity centres and midwives *should* be able to give you help and support. Lactation consultants are available in some hospitals (probably more likely in a baby friendly hospital)
    La leche league also has trained professionals and groups you can attend.

    there is alot of support out there but its not pushed enough I think, it should be better well known with tv adverts but that would never happen!

    There are women who do pump, and your employer legally has to give you time, a private place, and somewhere to store your milk. surestart pump hire is free in this area.

    As for why people don't breastfeed, or not past 6 months, I wonder. sometimes midwives and drs push formula for whatever reason when they arnt trained enough (baby not gaining weight etc) and also its very much pushed that you feed for 6 months, and then they can have formula (as follow on formula is advertised) and sometimes people just dont know where to find the support in the first place and turn to formula because its easily accessed.

  2. oh and my favourite benefit of breastfeeding? when they're ill and you cant get anything in them, they still take the boob. its brilliant.

  3. My favourite bfing benefit - not having to haul equipment around with you or be faffing around at home with powder, kettles, bottles etc when baby is hungry and upset. It's the ultimate convenience food, and the healthiest convenience food.

    But whilst we're thinking about bfing "benefits" it ought to be said we need to check our language - it is not that bfing is some kind of "bonus" option, it ought to be the norm. In fact it is for most of the world, for the moment thankfully. EG It is not that BFing reduces the chances of ear infections, but that FFing increases it and so on.

  4. I did a quick search once for the "legal" rights to pump at work in the UK and found a really vaguely written piece about how it was good practise to allow women to pump in the work place, but not mandatory. I don't know if anyone has a link to a document stating that we have a legal right to pump at work in the UK, please share it with us.

    Mountain Madre, you are completely right, we should be talking about the risks of formula feeding, but then the G word (guilt) starts to rear its ugly head and I thought we could try to stay away from that this month. I think people get scared when they hear that formula increases the chance of all of these health concerns and conditions, but I know that I would feel cheated if I had not been given all the facts before having children, and no, no health professional told me about them, I had to learn them for myself before I had kids.

  5. The only reason I don't pump it that I can't. I have tried manual and electric pumps as well as expressing by hand and cannot get more than an ounce each time

    1. I have the same problem, Rachel. With both girls, I tried and tried and tried to get something out. With my first, the most I ever got was 1/2 oz. after nearly an hour of pumping. With my second, I only did marginally better with 1 oz. after several bottles of water and an hour plus of pumping. Some women just don't respond to pumps.

    2. I guess that I didn't have a choice and had to start pumping very early with my son when he refused the breast once we left the hospital, maybe it would have been different if I had waited to pump as I intended. I do know that my breasts respond to the pump in different ways, one pours and one doesn't and so I ended up only pumping on the good pumper side. I have spoken to many women who have had problems pumping but never thought to ask for help but may have the wrong sinzed flange (funnel bit) or may have started out using the wrong type of pump (I have written a post about choosing a pump for later on in the month). Pumping can be hard for a number of reasons, I had a friedn who worked full time but hand expressed because she got more than with a pump, and then there are just some really bad pumps. It can take time for the body to adjust to pumping, sometimes a reminder of the baby can help with let down like a picture, a recording of them or a blanket that smells of them can help. I personally think that 1 oz is really good, but I don't know the background. Thank you for your comments.

    3. yes I'm in that can't pump group too! So nice to hear it's not just me :) On average only got about 1/2 ounce out after an hour, and managed to actually get more out by hand, but it was trickier to aim it into a container so ended up wasting some.

  6. My favourite benefit has to be the cure-all element of the magical milky - hit your head? milky - upset? milky - tantrum? milky - tired? milky - bored? milky - and on and on!

    1. Nursing is my favourite parenting tool, it really helps to calm them down and kind of reset.

  7. I don't know what circles you move in, but most of my friends breastfed beyond 6 months. Maternity leave is not just about bfing though. I personally would not want strangers raising my child for me, not as you say for 40+ hours a week at 12 weeks. Institutionalized child? No thank you! Oh, and I find expressing soul destroyingly hard and my baby won't take a bottle anyway!

  8. I moved from an area where I was surrounded by people who thought breastfeeding beyond a year was the usual to an area where breastfeeding beyond 6 months is mostly hidden and not spoken about very often. I miss my old home for this reason, but I am glad that there are areas where breastfeeding until baby decides to wean are out there and I'm jealous. I spent a beautiful Thursday afternoon with one such group of people which made me miss it even more, so thank you (you know who you are).

    I completely understand that strangers raising your baby is not ideal, but it can't be helped for a lot of people. I think it's really hard to find that balance of being financially stable enough to afford having children and being young enough to lower the risks of complications. I had my first while my husband was still at school and I brought home the larger income. I had come to a point in my career where I could accept an increase in pay but lose my annual leave, so we had the decision to either have a child and use the annual leave as maternity leave or take the pay increase immediately and wait another 3 years to have children when I had accrued enough leave again. I think that maybe in an ideal World women would not have to think about going back to work once they had a baby, but whose ideal World is that? I loved my time with my baby for those 12 weeks and then when I was at work I loved the time we had together for those 3 days a week when I wasn't working, and we spent many precious lunchtimes together at nursery inside or having a picnic outside. I also enjoyed going back to work and doing something that I loved and was passionate about. Many of the Mums that I worked with had only 2 weeks off after delivery unpaid, some worked nights so that they didn't have to pay for childcare and never got to spend any time with their OH. There are some amazing parents out there doing the best that they can. There are also some amazing child carers out there that love and cherish the children under their care, so I wouldn't say that they are institutionalised. While I don't agree with you that having your child in nursery is a bad thing, I do agree with you that pumping is hard.

  9. An interesting post. I think that expressing is not really pushed much over here. Any information given to new Mums makes passing reference to it but it's not something that is really gone into in any depth.

    my favourite benefit of breastfeeding is the convenience factor!

  10. Really interesting post, I can see it being quite frustrating that women in the UK have this brilliant maternity leave and don't make the most of it. FWIW the support is definitely available, just that there is such a 'bottle feeding culture' especially in some parts of the UK that some women just aren't motivated.
    A benefit of breastfeeding I love? The amazing sense of achievement looking at my fat little baby and thinking 'I did that!'

  11. Interesting post regarding the 'pumping culture' in the US...there are so many misconceptions in the UK about being able to go back to work and still breastfeed.

    My favourite bf benefit...it is the solution to most things...pain, sick, upset, needing sleep...when in doubt....use the boob!

  12. When I returned to work there was no discussion about breastfeeding, it was assumed that because my daughter was over 12 months it wasn't relevant. No provision was made to accommodate my needs. This post highlights some interesting differences in legislation and attitude.

  13. I found this a really interesting comparison, thank you. I have definitely witnessed the fact that women can have as much support, encouragement and help as possible to breastfeed, and yet, if their heart isn't completely in it, or they think it's too hard, they give up really quickly. I find it quite sad really.

  14. Not having to worry about remembering to take formula out with you everywhere you go

  15. I love how breastfeeding, now that we've got the hang of it (well, she's almost a year so you'd hope we had by now!), is relaxing for both of us.

  16. Bonding, bonding, bonding - its magical! ... Not to mention the fact that u don't have to sterelise :)

  17. The nutrition you provide for your little one and the health benefits for you both are priceless but i also love the special time you get together and i cant wait to experience it all over again when our second little girl decides to arrive : )

  18. One of my favourite benefits, which fits also with the theme of working as mentioned in the post above, is that it reconnects us after we've been apart for the day on the days I've been at work. This was particularly important when I first went back to work and found it hard to leave him - I'd always look forward to that first feed after I picked him up from childminder :)

  19. It's so hard to list my single favourite benefit of breastfeeding ; but I'm going to go with the immunity boosting benefits.
    My 9 month old has fought off the bugs her elder sister has brought in to the house with ease , and I'm convinced it's because she's a boobie baby!

  20. Interesting post I had my first child in the us and my second here and it was as you said a very different experience. I was very much not in the norm where we were in the us to breastfeed and my company allowed me some additional time graciously beyond the 12 weeks period before I went back, however I only did three months then figured I would rather be at home due to lots of reasons. The lactation consultant in the us hospital was by far the most helpful person I have come across with regards to breast feeding and the pedi was very supportive too! My favourite thing is that breastfeeding is on tap wherever you are not heating or steralising it's just there ready!

  21. I'm a first time Mum to be and currently reading up on all I can about breastfeeding. So many benefits but the one I'll choose and the one I'm most looking forward to is a way of bonding with your baby :-)

  22. My favourite benefits, of which there are so many, must be the portability, and the necessity for me to be with my little girl! I love that we can go anywhere and even if I have forgotten everything I can still feed her. I dread the day I have to let someone else look after her but I know one day she will go to nursery. Until them I am enjoying every snuggle and moment of closeness that breastfeeding gives us. We are already at seven months with no intention of stopping soon.
    Maternity leave is such an odd thing. I am self employed so did not qualify for it but have many friends who did. It would have been the most useful to me to take time off early on in pregnancy, when I felt awful and again at the end. I don't like the way that society now has reached a point that it is hard for women to choose not to go straight back to work. It is great that women can work if they want to, but we should be able to be mums (or dads) without plunging into poverty. Childcare costs are making either option unappealing. I plan on being a full time mum as long as my husband can bear it! At least by breastfeeding I am saving us around £500 a year on formula, let alone all the sterilising hassle!

  23. my favourite benefit is the bond and if i go back to work after 12 months then i will look for a nursery that will allow me to come in and feed at lunch