30 Apr

The Breastfeeding Network and Support for Mothers with Mental Health Issues

Wendy Jones is  BfN’s Pharmacist for our Drugs in Breastmilk Service. Here she talks about how we support mums with mental health issues, and points to some of the research, statistics, and useful resources about maternal mental health that inform her work.

wendy-300x300The Breastfeeding Network Drugs in Breastmilk Service has around ten thousand contacts with breastfeeding mothers annually. Some 20% of these queries relate to issues around mental health. We are passionate about supporting these mothers in accessing therapy and medication which enables them to continue to breastfeed if that is what they choose. As everyone who works within the service is a trained BfN helper or supporter we are also able to offer information on breastfeeding difficulties either on line, by using links or referring on to the National Breastfeeding Helpline.
A survey monkey questionnaire we sent out last year showed that the dilemmas for mothers fell into several categories;

•  Problems with breastfeeding was making the mother anxious or depressed
•  Breastfeeding was a positive part of the mother’s relationship with her baby, but she needed medication to support her mental health issues
•  Mothers for whom breastfeeding was going well but whose doctors or mental health team said that they couldn’t be prescribed medication unless they stopped breastfeeding
•  Situations where mothers chose not to discuss their infant feeding with their professionals to avoid expected censure or debate, and where a drug had been prescribed with the doctor unaware that the mother was breastfeeding
•  Mothers who were desperate not to take medication, but were struggling with mental health issues
• Decisions made the mother to stop breastfeeding to take medication

ieso bethSome of you may know that my second daughter Beth is a CBT (Cognitive Behavioural Therapy) psychotherapist working for IAPT in the NHS and through IESO; a service which is also available for online support in some areas through the NHS. It isn’t surprising that often our conversations veer towards breastfeeding and mental health (we are mutually influential!). One of the points I have taken from her is the concept of being a “Good Enough Mum”.

So many of us strive to be the perfect mum, reading lots of books, watching social media, running ourselves ragged to be at every group in order to give our children the best start. This not unsurprisingly leads to tiredness, depression and anxiety. It is something I remember doing 30 odd years ago with my babies. They must do Tumble Tots, must learn signing, must learn nursery rhymes leading to rhythm and pitch a precursor to music lessons, must learn to swim, must learn to share, must ………. Actually, what they remember now is being loved and happy. Some of the best times I spend with my grandbabies involves playing in the sand or sploshing in puddles etc.

Does social media add to the pressure and engender more depression and anxiety?
Our Drugs in Breastmilk service operates through Facebook. People can message me, and a team of other trained volunteers, and ask their medication and breastfeeding questions and we get back to them with an evidence based answer. However, the relationship between social media and mental health is a complex one. Professor Amy Brown, Associate Professor for Child Public Health at Swansea University, has shown some fascinating insights

Other research links Facebook use per se with depression 

But social media can be a lifesaver in the middle of the night when you ask your trusted group for advice – or the opposite. Google searches can make you decide that you and/or your baby have some rare condition the outcome of which is terrible. Google (other search engines are available!) is not selective of evidence-based materials. If you look long enough you can find any viewpoint you want – it can reassure, and it can terrify.

Most of the contacts to the Drugs in Breastmilk service now come via social media – not just from the UK but across the world. We are continuing to develop fact sheets to answer the frequently asked questions. Nevertheless, many mums need reassurance that their personal situation is covered by the sheet be that in terms of dose, age of baby, other medications and we are happy to answer those questions. We also increasingly supply more in-depth information to healthcare professionals.

Relevant Statistics

Taken from “The costs of perinatal health problems
• Between 10 and 20% of women develop a mental illness during pregnancy or within the first year after having a baby

• Perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

• About half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

• Suicide is a leading cause of death for women during pregnancy and in the year after giving birth.
Prevalence of mental health conditions

• Antenatal depression; 7.4% in the 1st t trimester rising to14.8% in the 3rd trimester.

• Postnatal depression. 7.4 -11.0% in the first 3 months after childbirth, 7.8 – 12.8% in the 3rd to 6th months and 8.5 -12.0% in the 6th to 9th months

• Anxiety 11.8% – 15.3% during pregnancy and 8% in the period after birth

• Psychosis (refers to bipolar disorder, schizophrenia or very severe forms of depression). 0.2%. There are some developing studies that the condition may reach another peak following weaning (unpublished data reviewed)

• Obsessive Compulsive Disorder. 2.1% during pregnancy and 2.4% during the postnatal period compared with 1.1% in the general female population suggesting that pregnancy and giving birth might trigger the onset of the condition.

• Birth Trauma (Post Traumatic Stress Disorder (PTSD) that occurs after childbirth) 1.9-9% of births

Provision of mental health services

The provision of specialised support services and in particular the availability of mother and baby units varies widely across the country. Access to CBT and other talking therapies may involve leaving the baby with another carer which may not always be possible. To deal with mental health issues isn’t easy in some areas! According to data released April 2018 by the Maternal Mental Health Alliance “24% of pregnant women and new mums in the UK still have no access to specialist perinatal mental health services

Insights from mothers experiencing maternal mental health issues

The Boots Family Trust wrote a fascinating report on Perinatal mental health experiences of women and health professionals 2013, which gives us some perspectives from the mothers themselves.

insights from mumsOne of the findings is that mothers may be reluctant to discuss their in depth feeling of depression and anxiety for fear that they will be judged as not good enough and have their baby removed by social services. It is actually most unlikely that this will happen but may be far more likely in fact open up other means of support.

 

 

symptomsSymptoms described vary widely as shown in this image. Recently I shared a post to Facebook
“How many of you have had a night out planned or arranged coffee with friends and suddenly the 4 walls you inhabit seem the only haven because it’s the only place you don’t have to pretend you are ok, so you cancel. Or when you are invited out you tell them how terribly sorry you are, but you’re already booked up that weekend, when you are actually just really busy holding it together in your safe box. And so, the first problem starts, all by itself. People stop asking you and the isolation that at first wasn’t true becomes your only truth”.
Several people who the outside world would see as confident and outgoing readily identified with the statement. Feeling socially anxious or in a place where you don’t want to go out is normal – let’s not stigmatise the feeling.

Mindfulness may help

Just before Christmas I was whiling away half an hour before catching a train, in a bookstore on Waterloo station. I bought a copy of “Frazzled” by Ruby Wax and devoured its contents. She felt like she was in my brain and understood ME. She is so honest about the stresses of life that crowd into our head – the buzzing in the brain which never ceases.

Tonight, I was listening to a radio 4 podcast by her and another lightbulb moment for me. “I wake up at 3 in the morning” she said, “and start doing emails frenetically, when I run out I check the spam box just in case then press refresh!” Oh, that is so what I do! She went on to say it is ok to rest, to watch a blackbird in the garden, to read poetry, to just be in the moment. I am currently trying to learn and practice the skill of mindfulness regularly. To be present in the moment, not the one which has just passed, not the one to come but just to be present at that instant. To accept thoughts but let them pass and not dwell on them.

This is a technique being more and more widely advocated for depression and anxiety. It isn’t easy as a mother to have as the wonderful story book my children loved “Five Minutes Peace” but just one minute can be enough to calm the brain, lower the adrenaline, stop the panic. I posted this guided mindfulness exercise on my own Facebook page recently which maybe some of you may find helpful. Keep going, don’t judge yourself, it isn’t a test it’s just being Mindful.

I have no financial link with any of these resources but have used and valued them myself.

Mental health and breastfeeding

Perinatal mental health issues affect many mothers. Some issues are caused by breastfeeding difficulties – the solution is to make more evidence-based, well-informed breastfeeding support available or to help mothers come to terms with why breastfeeding may not be for them in a positive, mother-centred, empathetic manner. Some issues need medical interventions which can be used during breastfeeding if the mother so wishes. Support of breastfeeding to the age of 2 years and beyond by all health professionals should be implicit. This is unlikely until breastfeeding is covered as a health promotion intervention in all undergraduate courses.

Mothers need to be listened to and their choices valued – whether that be in infant feeding choice or use of medication. Every one of us is an individual – that is what makes the human race so special, we are diverse and special.

What does the Breastfeeding Network do to support mothers with mental health issues in May 2018?

1. We have Drugs in Breastmilk fact sheets specifically written about:
•  depression

anxiety 

OCD

Bi-polar disorder 

2. We provide additional information via social media and emails about the drugs used for mental health disorders

3. We are working with other organisations to support perinatal mental health

4. We are looking at how peer breastfeeding supporters can signpost to information on mental health

5. I deliver presentations to peer supporters and professionals normalising mental health conditions and looking at the safety of the drugs used to treat these conditions during breastfeeding

6. We are always striving to make links with other organisations supporting mothers and to work with them

7. We have made links with fathers who have mental health issues after the birth of their children

This was a comment on social media recently which I hope is exactly what I strive to do “Thank you so much. You provide a wonderful service and so much more than just drug knowledge “

Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

I will be fully engaged with Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

Tuesday 1 May Facebook Live session 7.30 pm Perinatal Mental Health Partnership

Friday 4th May Facebook live session from Mama Conference Glasgow, where BfN have been nominated as breastfeeding champions and I have been nominated as individual breastfeeding champion

 

27 Apr

The non-runners guide to our Mum’s Milk Run 2018

The beauty of our virtual run is that you can complete it any way you like. You don’t have to run it at all if running is not your thing. To give you a bit of inspiration for our Mums Milk Run 2018, we have interviewed two of our supporters who did the Mums Milk Run a different way last year

Sukie is Vice-Chair of the BfN board, and last year did the Mums Milk Run through spinning.

I don’t like running, I’m not built to run, and I find it boring! But I’m a member of my local YMCA gym, and they do spinning classes every day, which I love. I do six of those a week. So last year, I decided to do 20 spins in a week for the Mums Milk Run.

I really wanted to be part of the Mums Milk Run because I’m the Vice-Chair of the BfN board, and the longer I’m involved with the organisation, the more I see the inequalities in breastfeeding support, and I really want to help do something about that. I did it because I know we need the funding, and we need to raise awareness.

So I decided on 20 spins in a week, because that seemed like a good challenge compared to my usual six, and I thought it was something people might give me money for. And last year was the 20th anniversary of BfN so 20 seemed like a good amount.

The main challenge was that I couldn’t wash my gym kit quickly enough! It’s an average of three spinning classes a day. Towards the end I was wearing really unflattering mis-matched cobbled together outfits!

I felt extra fit by the end of it. My clothes started to feel loser, and I felt so good about myself, it really helped my self-esteem.

I definitely would recommend spinning to others – I think it is great fun. The music is great, there are some great instructors, and we have a laugh, it’s not too serious. And it’s a great community of all ages. There’s a couple who regularly sit next to me who are 82. They always save me the bike they know I like! I always say I see more of my spinning friends than I see of my husband!

 

Nina is Programme Manager for BfN and last year did part of her Mums Milk Run in Lake Windermere!

Nina at Lake WindermereI am a keen runner, I’ve been running for a long time, and I love long distance running. I’ve done marathons and ultra-marathons. Last year I had to have a knee operation, and by the time the Mums Milk Run came around, the doctors said I could only do a short slow run – 1 mile at the most – because I had to build back up slowly. So I thought ‘OK I will do my Mums Milk run in 20 short little physio runs, getting my strength back’. I really wanted to be part of the Mums Milk Run if I could, because I’ve received so much support from BfN, and I want other people to be able to experience that support.

When all my other running friends were doing spring marathons, for me it was getting back to running after the operation. It could have been quite a lonely time for me, as running is a big part of my social life. But instead of feeling like I was missing out on all the long runs, I became part of such a lovely group of BfN ladies supporting each other through the Mums Milk Run.

That year I even swam part of the Mums Milk Run. I always enjoyed swimming before I was a runner, particularly outdoor swimming. That May I was supposed to run a marathon around Lake Windermere, but I had to defer. I still went anyway to cheer my friends on. Whilst they ran around Windermere, I went and swam the last mile of my 20 miles across the lake. As I was swimming I could see the runners running by, it was lovely, and I felt like I’d achieved something that day.

I do love outdoor swimming. It’s peaceful and calm. When you’re running you can hear other runners, chatting, pounding of footsteps, panting and grunting. In the lake it’s absolutely quiet and peaceful. I regularly just stop and float on my back, because it’s not about the swimming for me, it’s about the quiet and the beautiful views. It’s invigorating. You come out the other end and feel amazing. 

Registration is still open for our Mums Milk Run 2018. If you fancy doing it, but don’t like running, why not do some exercise you do like. It all counts and every registration raises much needed funds for BfN’s work providing independent evidence-based support about breastfeeding. This is all about raising funds and having FUN, plus you will get a unique BfN medal at the end!

 

17 Apr

Why I do the Mums Milk Run

claref - run2018Ahead of the Mums Milk Run 2018, we interviewed some of our regular fundraisers to find out what they get out of doing our bi-annual 20k virtual run. Clare Farquhar is BfN’s Central Support Manager and she got into running recently. Here’s her story.

Why do you run for BfN?

I have been doing the Mums Milk Run virtual run for BfN since the first event in 2017. I used to volunteer as a breastfeeding supporter, but I find I don’t have time for that now, so this is my way of supporting BfN on top of the job I do as BfN Central Support Manager.

I think there are a lot of similarities between running and breastfeeding in terms of things that help make them successful. Being single minded, determined, not caring what others think or say (no one did say anything, but I was worried) are all factors that helped me get into running and into breastfeeding. There’s also the physical and mental health benefits, of both activities, and the sense of achievement when you reach your own goals. They’re both free, you can do them as a group or on your own, at home or out and about. Mentally, breastfeeding and running have a lot of the same challenges, so running for BfN makes so much sense to me.

How did you get started?

I’m from Newcastle, and that’s where the Great North Run starts. Every year I would see the run on TV and wish I could do it, but I never thought I could. Then one year, I don’t know why, I just thought ‘this year I’m going to do it’. That was in 2016, and I was so determined that when I didn’t get a place in the ballot, I signed up to run for a charity – I did it for Mind.

I had never run before, I always hated running at school, and wasn’t really very active at all. I’d just done a bit of netball. But I got a free training plan from the Great North Run website, which was for beginners, and I stuck to it rigidly.

The race was brilliant, and also very emotional for me. It was held on my Dad’s birthday that year, and I wasn’t to know but it ended up being his last birthday. It was held in the September and he died in the January.

I think it was my Dad that motivated me to do the Great North Run in the first place. My sister did it a long time ago, and he’d always said he was proud of her, and I wanted him to be proud of me too. When I look back on it, it’s strange that that year I was suddenly so determined to do the run. My sister did it that day too, although she was a lot faster than me, and I think he was very proud of us both when we came back with our medals.

I completed it in 3 hours and 22 minutes and I did the whole thing on a run/walk basis, which means I ran for a couple of minutes, then walked for a couple of minutes repeatedly.

Since then, running has really helped me get through the bereavement. I think it’s so good for your physical and mental health. When I go running I get to clear my head, and I don’t really think about anything else other than how I’ll get through the next half mile.

What do you like about running?

I like going running on my own, it’s time to myself, and I enjoy listening to my music while I run. Some people like running groups, but they’re not really for me. It’s the peace and quiet I like – being able to go out under my own steam and leaving the house with just a front door key and a bottle of water – it’s quite liberating!

How do you keep going when you really don’t feel like it?

It’s determination that really got me through the tough times when I first started running. I wanted to do it, and so I just did it. Initially I felt a bit self-conscious and was worried what people might think – a woman in her 40s running around, and not having the right gear. But eventually I just decided, I don’t care what other people think. I actually got a lot of support from family and friends, and still do. Occasionally someone will beep their horn at me, and I nearly always automatically assume it is someone having a laugh at my expense, only to find out later it was someone I know beeping to wish me well!

Running for charity really helps, because I get lots of encouragement from friends and family who sponsor me and that gives me added motivation to get out when I really don’t feel like it.

What are your running goals?

I recently completed my first 5k event where I ran the whole way. I was pretty slow but I did it! I’m now working on being able to run the whole way for a 10k. I’ve signed up for the Great Womens Run in Glasgow in June, which is a 10k, so the BfN virtual run will be perfect as part of my training. For me it is all about achieving my own goals and not worrying about what anyone else is doing.

03 Apr

6 Top Tips for New Mums who want to Start Running

trainers on fallen leavesIf you’ve recently had a baby, or even not so recently, getting back into exercise once you are a mum can seem like a big hurdle. Being active is good for physical and mental health, but taking your time and waiting until you feel ready to get back to running or any other exercise you enjoy is very important.

In preparation for our Mums’ Milk Run 2018 we asked some of BfN’s volunteers for their tips on getting active after childbirth. All are mums and have taken that first step back into exercising themselves, so they speak from personal experience alongside their breastfeeding support training. Thank you, Lindsay Cook, Sally Carter, Erica Harris, and Joy Jones for your tips!

1. Take it easy at first

Don’t expect too much from yourself. Pregnancy, childbirth, and beyond put your body through a lot and it takes time to recover. Every mum is different so make sure you wait until you feel ready, some mums are keen to get back to exercising quite quickly and others find they have other priorities once their baby arrives.

Lindsay and Sally advise that walks with the pram, or whilst babywearing, will be enough for most mums in the first few months. If you want to go to an exercise class maybe try and find one where the instructor is post-natally trained so you don’t over-do things.

2. Find a good sports bra

Lindsay says “Get a proper supportive sports bra (or even two layered up), there is nothing worse than trying to run with breastfeeding boobs bouncing around!”

For most breastfeeding mums the best choice will be a non-wired sports bra to reduce the risk of mastitis. It may be worth going to a store that offers a bra-fitting service and getting yourself measured to make sure you get the best fit, and the most support for your size

3. Planning is keycropped-milk-run-189x300

For Lindsay, planning was the key to actually getting out and running: “I have 3 children, the youngest is 3, and I found it hard to get back into exercise, I think it was because I was so tired and the windows for getting exercise in are so few and far between. I recommend planning ahead to make the most of any small opportunity you may get. I always fed mine immediately before exercise to maximise the time I had”.

4. Get into the habit

Another good planning tip from Lindsay: Have some time that is yours for exercise and stick to it, once the habit is formed then it is easier to stick to it.

5. You don’t need to feel guilty

Erica says “Taking time to run (or any activity that takes you away from your baby) does not make you selfish. I think some mums can feel that somehow they are. In fact exercise provides an invaluable space to be “you”. It’s restorative and is a form of self care, which is vital for all, especially parents!”

“And you’re modelling great behaviour for your kids – both because you are keeping fit, and because you are practicing self-care”, adds Joy.

6. Express!

Feeding your baby, or expressing before you go running will make it much more comfortable.

And when you’re ready for entering your first event, take Lindsay’s advice. “Express before you take part, I have a not very fond memory of expressing in the portaloos at the start of the London Marathon…I sterilised the equipment about 5 times afterwards!”.

Mums Milk Run 2018

mumsMilkRun]If you would like to start running, registration is now open for our Mums Milk Run 2018. It is a 20km virtual run challenge open to everyone, raising much needed funds for BfN’s work providing independent evidence-based support about breastfeeding.

A virtual run is a run done in your own time, you can run (or walk/cycle/swim) at your own pace and you can do the run in one go or over several smaller runs spread over the month.  You can complete your virtual race at the gym on a treadmill or running round your local area and you can do it by yourself or with your family and friends. There are four Saturdays in May so you could do the 20km by going along to your local Parkrun each week. There is no time pressure, this is all about raising funds and having FUN, plus you will get a unique BfN medal at the end!