20 Oct

Supporting positive conversations about feeding choice and mental health in the perinatal period

The relationship between how a woman feeds her baby, and her perinatal mental health is a complex one.

Our emotional state and mental health in the perinatal period may affect how we decide to feed our baby. Choosing how we feed our little one may be based on many things such as how our own mum fed us, advice from professionals and what we have seen friends and family do. Our emotional wellbeing – factors such as how we feel about ourselves, our bodies and our relationships – can also influence this decision.

For women with a diagnosed mental health problem, feeding decisions may be influenced by considerations about how best to manage their condition during the perinatal period. This is particularly true for women who take medication. With the right advice and support, it should be possible for most women to find and use medication that is compatible with breastfeeding if they desire to do so. However, sadly, approximately 15% of calls to the Drugs in Breastmilk Information service are from those who have received inconsistent or negative advice on breastfeeding whilst taking medication for their mental health. Mothers contacting the service regularly tell us of their confusion and hesitancy in combing breastfeeding and their medication. It is a worry that there so many women who may unnecessarily stop breastfeeding or attempt to limit their exposure to medication because they have not received evidence-based consistent information and skilled support about mental health and breastfeeding.  The need for evidence based services such as the independent Drugs in Breastmilk information service that professionals and women can access for advice is so important if we are to create a culture where feeding choice can be respected and supported.

How we feed our baby may also affect our mental health. Research shows that breastfeeding releases hormones which can help reduce stress in mothers, and some women report that it can reduce the symptoms of postnatal depression. A large study found that, for mothers who showed signs of depression before the birth, four weeks exclusive breastfeeding (for those who had intended to breastfeed), exercised a protective effect. For the women who had not been depressed in pregnancy there was no such protection.

However, conversely, some mothers feel that breastfeeding can exacerbate feelings of depression or anxiety. The following quotes show the very different ways in which women feel that breastfeeding affects their mental state:

“I possibly breastfed for longer – it felt like one of the few things I was getting right as a mother.”

“My mental health issues played a significant role in stopping. Once I decided to stop my mental health issues got significantly worse.”

“I think my inability to breastfeed caused the PND.”

“Breastfeeding had a positive impact on my mental health, helping me with sleep & anxiety.”

Women who struggle to feed their baby, or stop breastfeeding before they intended to, are particularly vulnerable to a decline in their mental health. Discomfort, pain or concern about supply, can lead to stress and anxiety for women. Any feeding difficulties, whether breast or bottle, can cause worry and distress. The research cited above showed that there was a particularly high risk of postnatal depression amongst women who planned to breastfeed and then stopped before they intended to, demonstrating both the importance of supporting women to breastfeed their baby, but also of support if this is not successful.

How we feed our baby is such a personal choice, and can, for some people, leave a lasting impact on our lives. Older women who did not feed their child in the way they may have wished to can recount their feeding history to young mothers often with sadness and regret. Our feelings about our feeding decisions can also be influenced by societal pressures. Some women report having felt pressured to breastfeed or feel unsupported to formula feed. We hear of women feeling guilt and judged for formula feeding; women feeling isolated because they are afraid to breastfeed in public; and far too many stopping breastfeeding because there was a failure to support them with practical skills to increase their physical comfort and supply.

All of the evidence and arguments outlined above reinforce the importance of enabling all mothers to access positive conversations, good information and support to enable them to feed their baby the way they wish to, and to do so in a way that is as pain-free, low stress and rewarding as possible.

Support can and should come in many forms; from close family or friends, it may involve a specific breastfeeding supporter or helpline, or a midwife, family nurse, doctor or health visitor.  This should be non-judgemental, encouraging, patient and kind.  The complex and multifactorial reasons for lower breastfeeding rates among women with depressive illness (Pope & Mazmanian, 2016) suggests there may be an opportunity to link the perinatal mental health professionals with those working to support infant feeding.  As part of the developing pathways of care locally, this interdisciplinary working seems like relationship worth nurturing so that professionals are equipped and women can receive evidence based and supportive care whatever their feeding choice and whatever their mental state.

We need to offer a safe place for mothers to discuss their choices around infant feeding. We need to listen to mothers and offer them options, allowing them to make their own informed decisions.

Mothers should be able to get the support that they need when they need it. Their decisions should be respected and honoured and women should feel listened to rather than bombarded with conflicting advice.

Whether breastfeeding, formula feeding or doing a bit of both, all mothers need consistent support.  This might be in getting breastfeeding established, continuing as long as they and baby choose, or in stopping – whenever that may be– without judgement. Support may also need to be in how to make a formula feed up correctly and safely, or how best to position your baby with a bottle.

Whatever our decision is to feed our little one, and however our mental state is affected during this time, we should expect to feel supported and respected in our feeding decision, and with our mental wellbeing.  With many support services for mothers cut to the bone we are all going to need to understand mental health and breastfeeding better – partners, grandparents, friends of new mothers will need better information to offer support. It’s vital that we share information and research on the relationship between breastfeeding and maternal mental health.

By Shereen Fisher, Chief Executive of The Breastfeeding Network and Wendy Jones , Pharmacist and registered Supporter and Trainer with the Breastfeeding Network. Also Beckie Lang, Interim Strategic Lead, Mothers and Babies in Mind at the Maternal Mental Health Alliance.

This blog was previously posted on The Maternal Mental Health Alliance website, here

Resources:

http://www.rcgp.org.uk/clinical-and-research/toolkits/-/media/B789CC91113D4FB3816D11C5C99BB2B4.ashx

Explore MABIM’s tools for leaders working in perinatal mental health: www.maternalmentalhealthalliance.org/mumsandbabiesinmind/mabim-tools

Mums and Babies in Mind supports local leaders in four areas of England to improve care and quality of life for mums with mental health problems during pregnancy and the first year of life, and their babies. 

 

07 Oct

20th Anniversary Conference live blog

We’ll be live blogging the conference throughout the day here, scroll down and see the live updates below. Here’s the programme so you know what to look out for:

09:30-09:45 Shereen Fisher (CEO) Opening remarks and welcome
09:50-10.35 Dr Amy Brown  

Who really decides how we feed our babies?

10:40-11.25 Dr BJ Epstein  

Supporting LGBTQ families

11:25-11:45                                                          Break
11:50-12:30 Dr Katie Hinde, supported by Professor Sophie Scott What we don’t know about mothers’ milk – video, pre-recorded keynote speech, microbiome, followed by Q&A session.
12:35-13:05 Dr Kirsty Darwent The Infant Feeding Genogram: A tool for exploring family infant feeding narratives and identifying support needs
13:05-13:45 Lunch: including an informal session with Lorna Hartwell and some other founder members looking back at the early days of BfN – sharing their memories and taking you back to where it all began 20 years ago!
13:50-14:50 Small group discussion/training sessions  

Dr BJ Epstein – Supporting LGBTQ families

Lynn Timms – Tongue-tie: how can YOU support these babies with their feeding?
Dr Kirsty Darwent – The Infant Feeding Genogram: Supporting Women and Families in Practice
Walk and Talk – a walk (or run) round Birmingham city centre while chatting about mental health and breastfeeding #RunChatCake
14:55-15:35 Mairi Hedderwick Author & illustrator, Katie Morag (banned artwork)               – The Fuss Katie Morag caused
15:40-15:50 Felicity Lambert  

The National Breastfeeding Helpline Awards

15:50-16:00 Shereen Fisher Closure
04 Oct

Mothering the mother – a vital part of increasing breastfeeding rates 

Amy BrownDr Amy Brown is Associate Professor in Child Public Health at Swansea University. She is also the author of Breastfeeding Uncovered, a book which aims to highlight normal breastfeeding, challenge barriers and call on society to support breastfeeding. She will be the key note speaker at our conference on Saturday, and has written this guest blog for us ahead of her speech.

 

“Mothering the mother is a phrase often heard during pregnancy and birth. Look after the mother, care for her, support her emotional needs … and she will feel more empowered to grow, birth and care for her baby. A phrase (and actions)  that makes so much sense and is seen in many cultures across the world.

But might this form of love and care also be a key part of increasing our breastfeeding rates too? Of course, education, guidance and support directly about breastfeeding are vital parts of ensuring new mothers are knowledgeable and equipped to breastfeed. But if we really want to stand a chance of making this work, we must look outside of breastfeeding too.

Having a baby is hard, especially the first time. It is life changing and can be so overwhelming. Suddenly you have a brand new person to care for who is reliant on you for all their needs. And they communicate this well – after all, if they didn’t they wouldn’t survive. We aren’t baby giraffes who can get up and walk shortly after birth; we are entirely reliant on our caregivers for warmth, protection and food. Our babies need us, and we are hardwired to need to respond to them.

But as normal and natural as it is for babies to want to be kept close, this can understandably often feel exhausting and all consuming for new mothers. Many have gone from having freedom (and lots of sleep) one minute to having a baby who wants to feed often, chat at night and certainly doesn’t want to be put down. It can feel like all they do is hold, soothe and feed on repeat. Many weren’t prepared for it and start to worry that something is wrong. Might feeding him again create bad habits? Am I spoiling him? Is he manipulating me? What is this rod for my back people keep talking about?

But babies aren’t broken. They can’t manipulate. And it’s impossible to spoil them. In fact responding to, caring for and simply loving a baby is one of the best things you can do to ensure your baby grows into a happy, confident and loving adult. But society doesn’t recognize how valued just sitting and feeding your baby should be. Get your life back it shouts! Get back to work! The gym! At least get out of the house… and what about your poor partner? You must keep them happy too! And whilst I mention it … have you seen the dust? Your home isn’t looking like that celebrity new baby spread is it … oh and those nails… how on earth haven’t you managed to fit in a manicure? Priorities…

New mothers don’t need to get their lives back. That old life has gone and a whole new world has begun. But what they do need is support. In many cultures mothers are cared for and looked after for at least 6 weeks after the birth. Their meals are cooked, the housework is done and they are nurtured and supported. It isn’t a coincidence that rates of breastfeeding are low and levels of postnatal depression high.  Meanwhile when I recently googled ‘six weeks rest after the birth’ I got back a series of articles on avoiding heavy exercise.

In Western culture mothers often don’t have that support after the birth. Many live hundreds of miles away from home. Families are smaller and dispersed and many grandmothers will be working. Mothers are now often left to care for their babies alone, which we are simply not designed to do. No wonder the frequent needs of a baby feel overwhelming, especially for breastfeeding mums who might feel they do nothing but feed, day and night. And that’s before the pressure to get back in shape and regain your social life comes into play.

Unfortunately industry has jumped on this vulnerability and recognized a gap in the market for isolated, exhausted mothers looking for a solution (and a good nights sleep).  Despite the fact that research shows that breastfeeding mothers often get more sleep overall, the subtle and not so subtle messages coming out of formula promotion are that it will help your baby sleep (nope) or that someone else can feed the baby (missing the fact that they rarely want to do this at 3am). But these messages are pervasive and you can see why many an exhausted mother considers a bottle at that 3am feed. Unfortunately many make this move, it doesn’t affect sleep and they can feel even worse.

But it’s wider than just messages to move to formula. Baby care books promise to get your baby into a sleep and feeding routine and countless devices are arriving on the market promising hands free feeding or to rock your baby to sleep for you. These products are not the answer. Following a strict routine for feeding is linked to stopping breastfeeding, often due to problems with milk supply, as it interferes with everything we know about the importance of responsive feeding for building a good milk supply.  It’s unsurprising that routines often don’t work and sadly leave many mothers feeling even worse than when they began, even tipping them into postnatal depression.

So what is the solution? Simple. We need to care for our new mothers better. Mother them. Love them. Invest in giving them the time and support they need after the birth and throughout those early months and years. Think wider than breastfeeding and ensure that new mothers are as rested, supported and yes, cherished, as much as possible.

Work with partners and grandmothers where possible to explain why new mothers need to be mothered and what that might look like. And no, it doesn’t look like a bottle, even though that might seem like the perfect solution when your partner or daughter is exhausted and desperate for a break. Do some housework. Cook her a meal. Sit with her. If she’s happy to let you, take the baby for a walk between feeds, perhaps in a sling – but always check first. Separating her from her baby might make her feel anxious.

To really make this work though government must step up and ensure that mothers, babies and families are truly invested in. After all, they are our future and ensuring the best possible start in life reaps rewards for all of us. Mothers (and partners) need and deserve extended well-paid maternity and paternity leave and flexible working on return. Promote the importance of men taking time off and being there for their partner. No one should need to go back to work for financial reasons when they are still nourishing and caring for a baby.

Where family cannot be there, invest in creating networks and support groups for new mothers. Enhance access to doulas and invest in high quality support from professionals throughout pregnancy and after the birth, from professionals who have the time to sit and support. Caring for mothers should be seen as a public health responsibility and not something that simply happens if they are lucky.

Having a baby will always be life changing and exhausting but it needn’t be so overwhelming to the point where breastfeeding feels incompatible. With the right support and investment we can nurture a generation of new families and show them just what a valuable role they play. And with it, create an environment and support network that really supports new mothers to breastfeed. Mother the mother and she has the time, energy and peace of mind to get breastfeeding off to the best possible start.