But even I've been taken aback recently by just how passive some of the care provided is - and what could often potentially be the consequence.
I've seen mums with scabs covering the entire tip of the nipples, coming out misshapen post feed. Very very low weight gain or static (to the point of being of concern to me - but weirdly in this situation nobody seemed too concerned that at three weeks baby had remained static since the day 3 loss.) Babies never showing signs of sation after mums have been sternly instructed to only use one breast. Who have all been told to "stick at it it will click".
For some mums, should they not contact alternative support - I often don't see how things will resolve.
One mum in particular lived a long way from me, I contacted (with mum's permission) her HP's myself to ask if they could please refer her to their IBC:LC Infant Feeding Advisor (IFA) - because the weight situation made this a clinical case that needed to run alongside specialised HP's (and I knew an IFA covered that area, but mum was getting nowhere asking her health visitor!). The reply was that she had never done that before so wasn't sure. It was only when I expressed concern at the weight situation, the health visitor sat and worked out the weights - right before panicking!
Place your bets on what comes next?
"OK it's time to give a formula top up", mum was told. "You've tried this and stuck at it long enough now - but baby clearly needs "more"."
So it went from "stick at it", with no other effective help - to top up....And I see this over and over....Often before weight loss has got so significant, but not always; there is a massive gap in effective care at this crucial time.
For those who say mum can't have tried hard enough - let me tell you that I've seen mums who have seen no less than five, six or seven, health care professionals in total to specifically help with breastfeeding. These ranged from a peer supporter to midwives (and "breastfeeding specialist midwives"), and health visitors. Mums who are on the phone constantly asking for help - yet was persistently told things were "fine" or to "stick at it and they would improve" or the gem of the lot "this is what breastfeeding is like".
In reality what is often happening is that due to baby feeding so ineffectively at the breast, supply by now determined by baby's appetite - dwindles fast. But at this crucial point nobody notices that...
In the end I located the IFA myself and fed the mum back into the system.
The trouble is if nobody finds the cause of the problem, but keeps treating the symptoms - no amount of "persistence" will improve things if there is an unresolved underlying fundamental issue. Mums are left with a reduced breastmilk supply - because of all that had gone before! We also know that more evidence now suggests those first few weeks of breastfeeding can be crucial in supply later ie 4-5 months.
For some mums, even if they get past the initial pain, or weight issues - other problems may remain; a forever windy/unsettled/refluxy/colicky/never settling infant, often not resolved by swapping to alternative milk and a bottle.
I can see how women can believe they truly couldn't breastfeed - that they tried everything they could think of yet nothing worked; that they reached a point they simply couldn't take anymore trying.
Let's always remember that we don't know someones back story or what they endured trying to breastfeed. That it's not always a case of just "trying harder" or "persisting longer"; in the above case persistence alone would never have resolved the issues - it's about effective help, emotional and mental support and accurate information - and most importantly it's about getting it at the right time.