31 Jul

BfN Statement on Channel 4 Dispatches Programme 30/07/2018 – Breastfeeding Uncovered

Dispatches presenter breastfeeding her baby

Dispatches presenter Kate Quilton

Negative cultural attitudes towards breastfeeding are common place in the UK and often this is reinforced by media messages.

However, last night’s Dispatches programme demonstrated sensitive and robust journalism on the emotive and polarised issue that is breastfeeding.

The Breastfeeding Network is a charity that supports women and families in their choice to breastfeed in a culture that often treats women negatively for pursuing an unpopular choice.

The programme highlighted the progress that science and medical experts have made in acknowledging the make-up of breastmilk and the impact breastfeeding can have on infant and maternal health. It also looked at the marketing of breastmilk substitutes and how much care has to be taken to ensure breastfeeding is not undermined in health care settings. The lack of evidence-base for formula products’ claims to resolve sleep and colic problems is clearly misleading parents, exploiting families’ tight financial budgets and failing to resolve the problem.

The programme also highlighted the shocking truth that investment in health even where the evidence-base is strong does not always follow, nor can it compete with a multi-billion pound industry that seeks to dominate the choices of parents and families. Protection and scaling up of breastfeeding can only be truly tackled where we work together to create the environment to enable women and their families to choose it.

The programme spoke directly with breastfeeding women and allowed them to voice their concerns around the lack of support for breastfeeding – an issue that BfN are all too aware of – many of our face-to-face peer support services have seen significant cuts in recent months and years, meaning many families are no longer able to access good quality peer support in their local areas.

Many women featured in the programme also spoke out about their concerns around breastfeeding in public.  Many women tell us that they worry about feeding out and about, feeling intimidated and worried about being treated negatively. The presenter Kate Quilton said she sometimes felt like a ‘social outcast’ – women tell us this all the time and that is why having peers in your community to support you is so critical for many women.

We were pleased to see the portrayal of the issues and the balanced journalism presented by Dispatches that reinforces the high quality evidence in the field of infant feeding helps us to continue to change the conversation around breastfeeding and move to its normalisation, so that more parents can feel they can choose to breastfeed.

If you are affected by any of the issues raised please contact the National Breastfeeding Helpline on 0300 100 0212 – open 9.30am-9.30pm 365 days a year.

The programme is available for 30 days on C4 catch up.  If you only do one thing to celebrate World Breastfeeding Week, please share this link with your local councillor and MP.

26 Jul

Breastfeeding and Mental Health

Wendy JonesDr Wendy Jones is the pharmacist on our Drugs in Breastmilk service, receiving around ten thousand contacts from breastfeeding mothers every year. 20% of these are queries about mental health medication.  Beth Chapman is her daughter and a Cognitive Behavioural Therapist. They will be speaking at our conference in October together on breastfeeding and mental health. Buy your tickets here.

“I am very proud to be presenting this session with my daughter Beth who is a Cognitive Behavioural Psychotherapist working within the NHS. It feels like a legacy that my passion for breastfeeding has passed to all my daughters – and my 4 grandchildren. Beth and I have spoken at conferences together before but never co-presented.

Peri natal mental health issues affect very many women, and this is apparent in the media regularly. Add in breastfeeding and worse still add in medication and you have a mass of mis-information and stress for mums trying to find their way through the maze.

One of the problems with society is that it is so easy to get caught up comparing ourselves with everyone else. How good a parent are we? Does your baby gain weight faster than mine? Is mine gaining too fast? What about sleep – shall we avoid the discussion?

When we give birth, we become hyper vigilant to dangers around our babies. It is all too easy for that to become anxiety about everything. Anxiety is horrible – it affects our thoughts, our moods and behaviours and that is where CBT (cognitive behavioural therapy) comes in. It recognises the vicious cycle and provides a way to break that. It isn’t easy, it takes time and perseverance, but it is possible.

Sometimes we need medicines to enable us to challenge the thoughts we have, be they within anxiety or the black dog of depression, the feeling that the Dementors, well known to Harry Potter fans, are nearby.

It is really sad that doctors don’t actually receive training at undergraduate level about breastfeeding and their knowledge tends to be accumulated by experience – possibly by mentors but also by personal and friend experiences. The licensing of medicines taken for any condition in a breastfeeding woman is complex and in our increasingly litigious country it is hard for them to draw the balance between the need to treat the mum and the need to keep the baby safe from the amount of drug passing through milk. I make these decisions multiple times every day and have both experience and expert databases. I also have time which they don’t in a busy surgery.

I’m not going to give away our presentation or you might not come to the conference. We don’t have all the answers, but we may have some solutions to offer and a safe forum for discussion.

See you in Birmingham

Wendy

PS 5-month-old baby Elodie will be with us!”

20 Jul

How to make public spaces more breastfeeding friendly

Aimee GrantAimee Grant, PhD, is a Wellcome Trust ISSF Fellow at the Centre for Trials Research, Cardiff University.  She will be speaking at our conference in October on what the evidence says helps and hinders breastfeeding in public spaces, like shops, cafes and public transport.  Here she gives a taster of what will be covered. Find out more about the full line up of speakers and buy your tickets to the conference.

“In 2012, I started doing research on infant feeding for the NHS.  I come from a British working class background and had never seen breastfeeding before my early twenties, so I can still recall wondering what all of the fuss was about; surely you pop the baby on the boob and everything just works.  How wrong I was about so much! 

Fast forward a few years, and last year, I published a small study where we spoke to mothers and grandmothers from south Wales about their experiences of feeding babies (you can find a blog with the findings here, and the full text here).  We found that mothers reported more intrusive looks and comments from strangers than their grandmothers had experienced.  I’ve also looked at how breastfeeding in public spaces is considered on social media and Mail Online reader comments (my advice is it’s best not to look at the Mail Online comments!), and found the public have a lot of misunderstandings about breastfeeding, and the legal right to breastfeed in England and Wales. 

So, how does this link to what I’ll be talking about?  Much of what the NHS does in relation to breastfeeding is aimed at trying to change individual mothers by giving them support.  My research (which has been confirmed by lots of other research in the UK and abroad) showed how difficult our society makes it for women to breastfeed outside of the home.  As I’m sure you all know, if a mum can’t breastfeed outside of the home, this is going to make life as a breastfeeding mother very difficult.  Because of this, I decided I wanted to focus my research on changing society, to make it more breastfeeding friendly. 

In October, I was fortunate to begin leading a Wellcome Trust funded project doing just that.  Myself and colleagues at Cardiff University have reviewed every academic paper for 10 years that looked at experiences or views of breastfeeding in public (38 of them in total!).  I will discuss our findings, the barriers and facilitators, and I hope that together we can think about ways to take these findings forward to change the UK for the better! 

As an aside, the second part of the Wellcome Trust project will be looking at existing programmes that try to make it easier for mums to breastfeed in public.  If you are aware of projects, programmes or interventions that aren’t published in the academic literature, I’d really appreciate it if you dropped me an email with details and any evaluation reports you have (my email address is:  GrantA2@cardiff.ac.uk ).  You can also find me on Twitter: @DrAimeeGrant”

12 Jul

How do we help families to trust responsive feeding?

Emma PickettEmma Pickett, IBCLC and Chair of the Association of Breastfeeding Mothers, will be speaking at our conference in October about responsive feeding, and the dangers of focussing on feeding intervals. Here she gives us a little taste of what her session will be about. If you’d like to hear her speak, you can buy tickets to the conference here

“I first started talking about responsive feeding because I was angry. I was angry when I read about breastfeeding mothers who were successfully caring for their babies by every definition, but they were being told they were ‘doing it wrong’. Babies were healthy and putting on weight. Everyone was getting enough sleep – just about. Mums, and their partners, were feeling good until someone told them their baby was feeding too often.

“Does he really need to feed again?”

“But you only just breastfed him!”

“Shouldn’t you be stretching him between the feeds a bit now?”

“He shouldn’t be waking up for milk that many times, surely?”

I was angry about the mum who had asked me how to stretch a feed because ‘that’s what she was supposed to do’ and it was making her and her baby miserable, and the mums that doubted their milk supply when it didn’t seem to be possible.   I was angry about the mothers on an internet forum who again and again were ending exclusive breastfeeding – when they didn’t want to – to chase this idea of the ‘perfect interval’ between feeds. I’m talking about the mother who is at home and it’s 1pm and she’s in tears because her baby last fed at 11am and she was hoping to make it to 2pm. Artificial. Nonsensical. Depressing. And sometimes literally depressing.

‘Watch the Baby not the clock’ has been said for a long time. We’ve all been saying it. But it’s important to understand WHY it matters and what can happen if we try and stretch artificially. It’s important to understand that we can say it, but it doesn’t mean it gives mums the confidence to believe it. Watch your baby and not the clock is what science and biology tells us. Science says breastfeeding is so much more than a milk delivery system. And if we try and stretch the intervals between feeds some mums will reduce their milk supply – the last thing they were intending to do.

The message that very young sleepy babies – perhaps with jaundice or after birth complications – ideally have around 8 feeds in 24 hours as a minimum has very often become twisted to mean that 3hrly feeds is the norm. This is the misunderstanding we must work against. And the myth that a baby who is feeding more frequently must have a mum with a low milk supply is common.

Research from the 1990s in Australia transformed our understanding of how breasts work and the concept of storage capacity. While breasts ARE streams or rivers not reservoirs, and production happens constantly, the flow slows down as the breast empties and there is an element of storage going on.

The massive variation in storage capacity between women doesn’t impact on 24-hour intake for the baby provided the mother with the smaller storage capacity feeds more frequently. But if a mother was to try and ‘wait’ or ‘stretch the intervals’ her breasts would reach maximum storage capacity, her prolactin receptors become distended, she will accumulate that polypeptide protein known as feedback inhibitor of lactation. She will send messages to her body to reduce milk supply. Some women might never have a baby who goes ‘3-4 hours’ between feeds, while her mate with larger storage capacity might. It doesn’t mean that she has low supply or that her baby gets less milk overall provided she can feed responsively.

So, women ‘stretching babies to a magic interval between feeds’ are doing what we know works to decrease milk supply. They are sending messages to reduce production. 3-4 days of desperately trying to ‘get to 3 or 4 hours’ and ‘waiting for the breast to feel full’ could be harming their ability to meet their baby’s needs in the long term.

We can say to new mums if you want to count something, instead of counting minutes, count poo. Reassurance comes from mums knowing the relationship between effective breastfeeding and frequent pooing for the first few weeks. Let’s ensure mums know that for the first 4-6 weeks a breastfed baby should be pooing at least twice in 24 hrs and ideally more and only after that might it slow down.

Is it helpful to count minutes and record them on your app? What are the positives and what are the negatives of doing that? Is it helping you to count the millilitres you can pump and think that tells you all you need to know about your supply? Instead, what is your baby telling you? With their nappies and their weight gain.

But of course, breastfeeding is only a bit about milk. You don’t always have to know why a baby wants to come to the breast. It’s useful to know what milk transfer looks like but you can lose the plot if you focus on feeds as simply being about milk delivery.

“He’s using you like a dummy!!!” can be something to celebrate too. Because breastfeeding is meant to be about comfort and safety and reassurance and relaxation.

In antenatal classes, we sometimes say to expectant couples count all the times you eat and drink in 24 hours. Look how often you’re doing it and you aren’t trying to double your weight! Let’s also say to them, what about counting all the expressions of affection and love and communication? That’s what you are trying to do when you count breastfeeds.

How do we help families to feel safe and to really be able to trust responsive feeding and to stop it being just theory? Peer support is a big tool in helping this to happen. It’s as simple as connecting mums who don’t yet quite trust it with the mums who do this every day. It can be about the Facebook group where people have DONE this. It’s great to see the pregnant mum arriving at the Facebook group where everyone breastfeeds.  They are bombarded with the norm of every day breastfeeding and it works and even when people are struggling, answers are being found. That smartphone can be a life line when it’s not an app measuring feeding intervals. It enables you to join the sea of other mums out there who understand you don’t need to press a finger into their breast to ‘help baby to breathe’, who are finding ways to sleep safely, who have 8-month olds and older. Their milk is this colour. This is how they breastfed in public without a pillow. It’s normal to only get this much out when you pump? Yes! My son didn’t sleep longer than 4 hours until he was 6 months old. And me and me. 4 hours, you’d be lucky!

That feeling of it being just a little bit scary is eroded with ten minutes of Facebook browsing here and there in the last few weeks of pregnancy. And this is the team you come back to when you run into some problems in the early days. And if they are the right team, they signpost you to find the right help when you need it. They share the number for the National Breastfeeding Helpline (0300 100 0212) and they talk to you about finding a breastfeeding group. Because of course it’s not just the Facebook connections, it’s the real life connections beyond that. The drop-in group where you connect with mothers for whom breastfeeding is normal has a special power. The word ‘responsive’ means reacting positively. That comes from confidence.

I think the word ‘breastfeeding’ is doing us no favours.  It starts with a word that we’re not all comfortable saying and ends with a word that makes us think it’s just about feeding.

I don’t think the word ‘nursing’ quite works in the UK. That was originally about avoiding saying the word  <whispers> ‘breast’. It’s not the breast bit I have a problem with but the ‘feeding’ bit. In Germany, it’s ‘stillen’. It can mean calm, quieten, please, fill, satisfy.

At the moment we’ll have to stick with ‘breastfeeding – or rather ‘I wish it wasn’t called ‘breastfeeding’ because really it’s so much more than feeding’. All we can do until a new magic word is invented is explain that the word isn’t quite right. It’s only a bit about milk.

When we can get the message right, it can be magic. When you get stopped on the street by the woman holding the hand of a toddler and she thanks you for some conversations you had a year ago, or when you hear from the mum still breastfeeding her 20-month-old and she’s got a quick question from her cousin, there’s not much like it.

If we can connect women to other women and to the feeling that breastfeeding is not feeding and that’s not just OK and acceptable and the norm but that’s wonderful, we’ve done our job right.”