29 Oct

Response to the Guardian article Wednesday 24th October – Breastfeeding rate declines in England as advice goes unheeded

Image result for shereen fisherOur CEO Shereen Fisher responds to the recent Guardian article on declining breastfeeding rates.

The appalling fact that England (one of the biggest economies in the world) lags behind in breastfeeding rates often makes headline news and it did again last week. However, the suggestion in the Guardian article is that this is because current strategies employed by public health are not working, and women are not listening to the advice they are given. The generic claim that all breastfeeding rates are declining is also a bit misleading.

It is true that our national rates are low compared with other countries and that our very unequal society means that in many areas of the country to breastfeed will make you feel like a social outcast. However, broadly speaking initiation rates are good in the UK with around 80% of women breastfeeding their babies at birth. This presents an enormous opportunity to work with the early desires of women and families to breastfeed – the Unicef Baby Friendly Initiative along with improved antenatal education has made an important contribution to progress in initiation. However, then the picture becomes more complicated. More than 3 in 5 women stop breastfeeding earlier than they want to and often the emotions around not being able to breastfeed can cast a long shadow of disappointment. Whatever one makes of breastfeeding and the state of it in the UK, it is unarguable that breastfeeding matters to women and families. It is also unarguable that women and families don’t get the support they need to sustain breastfeeding.

The uneven and variable nature of support was well-depicted in the recent Channel 4 Dispatches programme – ‘Breastfeeding Uncovered’. We know that breastfeeding in the north of England, (where in some areas fewer than 1 in 5 mothers sustain breastfeeding to 6-8 weeks) is considerably more difficult than in some London boroughs where more than 4 in 5 reach the same. It doesn’t take a genius to know that the missing ingredient that helps to explain the difference is ‘support’. The sad truth is that we know that the vast majority of reasons women give for stopping breastfeeding are issues that can easily be resolved with good quality support.  Support should be honest, unique, independent, and personalised. It needs to be well-funded and it should not operate in a vacuum. It should be evidence-based and integrated with a whole system approach that cares for a women in the pre and postnatal period. Where women choose not to breastfeed or are unable then their choice should be supported and respected as well so the health and wellbeing of all babies can be upheld.

The provision of support for new mothers and their families is grossly inadequate and varies widely across the UK.  Women are very aware of the benefits of breastfeeding through health promotion but receive very little support in making breastfeeding work for them. This leaves women feeling that they have failed, but actually they have been failed by the lack of support available to them.

It’s not that advice on breastfeeding is going unheeded by families, it is that there is not enough support built in at the right time and in an organised way for women and their families to feel they can act on this advice.

We don’t have to look too far to get ideas as to what it takes to improve the situation for women and breastfeeding. Scotland, through their Programme for Government fund, have taken the key next step to invest in breastfeeding at every level, this is despite years of low breastfeeding rates. They are moving to strategic action that is rooted in the best evidence to uphold the health and wellbeing of women and babies – other countries should follow this example.

References

The UK has some of the lowest breastfeeding rates in the world:
81% breastfed at birth but falls to 17% exclusively breastfeeding at 3 months and 1% exclusively breastfeeding at 6 months
http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/UK-Breastfeeding-rates/

Health benefits of breastfeeding are well researched and evidenced – there are benefits for both mother and child:
http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/
This includes the potential to reduce infant mortality from SIDS and Necrotising Enterocolitis, Infant mortality rates in the UK are currently around 4 deaths per 1,000 live births, with babies born to younger mothers being at increased risk at 5.5 deaths per 1,000 live births:
http://www.ons.gov.uk/ons/rel/vsob1/child-mortality-statistics–childhood–infant-and-perinatal/2012/stb-child-mortality-stats-2012.html  (accessed 17/06/2015)

The financial benefits of breastfeeding have been shown – on an individual level, infant formula is expensive for families to buy and on a national level, there are huge savings to be made in the NHS if more mothers were supported to breastfeed their babies for longer:
http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health-Professionals/Writing-policies-and-guidelines/Preventing-disease-and-saving-resources/

More than 3 in 5 women stop breastfeeding earlier than they wanted to:
http://data.gov.uk/dataset/infant-feeding-survey-2010  The vast majority of reasons women gave for stopping breastfeeding are issues that can easily be resolved with good quality support.

Breastfeeding Uncovered – Dispatches
https://www.channel4.com/programmes/dispatches/episode-guide

Scotland – Programme for Government – Breastfeeding
https://beta.gov.scot/publications/nation-ambition-governments-programme-scotland-2017-18/

26 Oct

What Breastfeeding Looks Like

We recently appealed for photographs showing what breastfeeding looks like in your everyday lives. The response has been immense, and the photos are so wonderful and varied, showing breastfeeding anywhere and everywhere…often in some quite comical situations!

Everyone has a small part to play in normalising breastfeeding and removing the stigma that can be attached to something that should be as commonplace as eating a sandwich. This might be by feeding your child in public, or by supporting others who you see feeding, with a kind word or just a smile. Thank you so much to everyone who contributed photos for this project, it is our hope that they will be shared and seen widely and will also do their bit to help make breastfeeding the norm.

Here’s a full round up of all of the photos we received – click on each one to view the full image, and hover to see accompanying captions and comments. Unfortunately we are only a small team and are unable to accept any further submissions for this page or the original Facebook album – however if you’d like to share your image, you can do so by adding it as a comment to the Facebook album.

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This project was originally inspired by this post:
https://www.romper.com/p/what-does-breastfeeding-look-like-these-photos-celebrate-the-diversity-of-experiences-9926018

 

19 Oct

Facing Fears

Kirsty Cummins is one of our National Breastfeeding Helpline Link workers, who has written this post about her own experience of anxiety and how she is beginning to overcome it in her role as a breastfeeding supporter.  

Fear. It’s a funny thing isn’t it. Most of us live in fear of something. Chest squeezing, breath taking fear tucked away inside our breast, kept on a low burn as much as possible it can rear up and get you when you least expect it. Taking the wind out of your sail and putting you firmly in your place.

I have lived in fear nearly all my life. From small person wobbles such as the squirmy, unknown feel of the sea bed under my feet when my Mum forced me to paddle, to the terror I felt when I happened upon “Jaws” being viewed in a neighbour’s living room in all its terrifying splendour at the age of 5. (I haven’t been able to watch it since.)

As I grew older I developed an anxiety disorder. I didn’t know that’s what it was.  I just thought I was mad and panicked all the time that I couldn’t control life. Would someone die if I didn’t turn the light on and off a certain number of times, would something terrible happen to a loved one if I didn’t wash my hands in a certain way? What I didn’t realise at the time was that in trying to control life and death, stuff that I actually couldn’t control, I was unable to deal with the things that were my responsibility, such as study and relationships and other such teen angst. I would never socialise and talking on a phone has always been difficult because of the fear of the unknown and the need to keep myself tiny and unnoticed.

I have had treatment. I sought help when I couldn’t look after myself any more. And that was and is a long term project but also a wonderful thing. Through years of up and downs, undiagnosed post natal depression and other such low jinx I wished of a way to take control.

This insight into a life of worry and nervousness has made me wonder often about our fears. What fears we have as parents and how our modern life affects those to a lesser or greater degree, with instant access to answers or opinions that we used to have to seek in other ways. The need for us all to go back to trusting our instincts, hidden under a huge pile of ‘other’. The voices that live inside us, and the knowledge passed down from Grandmothers and from inside the cells in our bodies, carried through the generations, is still there but no longer encouraged in quite the same way.

Recently I have been pondering the fears we carry as volunteers supporting other parents through times of worry or uncertainty. What makes some people fearless and certain they can make a difference, whilst others hide their knowledge and instincts, terrified they might get it wrong?

My reluctance to be a helpline volunteer has always been based around fear. The fear that I am not good enough to support another person. That if I get it wrong something terrible might happen. In a bid to avoid manic light switching or some such antic aimed at being the high master of control, I avoid. Avoid. Avoid. In talking to people who wish me to support I feel unable to be honest, with them or myself and have always talked vaguely about my true feelings out of embarrassment.

A plethora of excuses may come up that loosely express my fear, but not enough to convey just how terrified I am. Our greatest defence in the fight against fear is, more often than not, knowledge. If we know more we may fear less. When the terrified abseiler is gently guided through moving themselves down the rock face passing the rope through their hands, they are guided by the words of the instructor. That knowledge from another gets them down and the feelings of elation when reaching the bottom make it all worthwhile.

When I look down into the pit of worry and feelings that I am not good enough, I don’t believe in my knowledge, or intuition or listening skills. They don’t feel good enough to guide me.

Someone very brilliant recently talked to me about voicing those helpline fears out loud. As I said how I felt it made total sense. “It sounds so silly but it isn’t silly” I said as I expressed my fear that it felt like a baby’s life was in my hands if I took a call. The ugly face of not good enough was there again, taking control and making me feel useless. But actually as I said it I realised that I do have the tools to support and with that added bonus of modern tech allowing us to signpost instantly, we have so much to give.

Fear, my old nemesis, can be thwarted if I use my greatest weapon. Honesty. Being truthful to myself about my fears and using the support I know I have available could actually get me past this block.

The warm hand of support from a helpline volunteer can and does make all the difference to new families. And that is possible over the phone. Your love, warmth and ingrained desire to be part of the supportive community – the grandmother full of wisdom just for ten minutes in someone’s life – is what you have control of and what changes lives. Yours and theirs.

04 Oct

Guest Blog by Smita Hanciles – The Power of Peer Support

Smita Hanciles works for Central & North West London NHS Foundation Trust and leads the Camden Baby Feeding Service. Here’s a taster of her presentation at our conference this Saturday (6th October), on the power of peer support. If you’ve been unable to get a ticket, follow #BfNConf18 on social media to catch our updates throughout the day.

There is evidence that establishing breastfeeding can be protective of maternal mental health and aids with bonding.  When establishing breastfeeding is challenging or even unsuccessful, particularly when a mother really wants to breastfeed, the mother can be left vulnerable and at increased risk of post-natal depression. At points of such vulnerability, does having access to a trained breastfeeding peer supporter in addition to her own network of relationships provide a source of emotional co-regulation and co-learning?  Does this help increase resilience and possibly decrease the risk of anxiety and depression and any negative impact on bonding?   These are the questions we have been asking in Camden as we introduced a group of new volunteer breastfeeding peer supporters into the Baby Feeding service.

We often think of support for breastfeeding and support for perinatal mental health separately and services generally focus on one or the other.  There are peer support projects for mothers who need help with feeding their baby and there are now separate peer support projects for mothers experiencing mild to moderate postnatal depression and anxiety. However, this way of delivering care doesn’t factor in that one impacts on the other and can’t easily be addressed separately.  What would happen if we supported new mothers in a much more holistic way?  Or maybe we already do this as peer supporters but just don’t describe it as such.

Having reflected on what we actually spend our time doing in the Baby Feeding drop-ins in Camden and on the stories of mothers we support, we recently decided that instead of describing ourselves as solely providing peer support for women experiencing difficulties with feeding or establishing breastfeeding, we would emphasize that we also provide listening support to those who had intended to exclusively breastfeed but were experiencing challenges or were not able to for various reasons.  We added the Baby Feeding service to the Camden Perinatal Mental Health services register under services for the ‘mild /moderate’ end of mental health concerns. We hoped this would help with the recognition of our role in providing emotional as well as practical feeding support and as a place from which referrals to more specialist help could be made if necessary.

I recently saw a poster with the words ‘I sat with my anger long enough, until she told me her real name was grief’. Mothers struggling to breastfeed can feel angry with services that failed to provide the right support or even at themselves or their baby. However, the anger could be borne from a sense of grief over the loss of the breastfeeding relationship they had wanted or looked forward to.  They are unlikely to seek help from other mental health services in this situation but still need to be listened to and for their feelings of loss to be acknowledged as a normal response and justified.  They don’t want to be told their feelings are unreasonable because they can always just give a bottle and as long as the baby is fed, it’s all ok.  They also need support to accept and embrace a different feeding relationship from the one they had anticipated whether it is mixed feeding or bottle feeding with EBM and /or formula.

We approached the Maternal Mental Health Alliance and began a discussion about how to join up different elements of support for new mothers and how we could best train and develop our volunteer peer supporters to work in a more holistic way. This resulted in a diverse and knowledgeable working group coming together including all the main voluntary sector organisation that train peer supporters to develop competencies for the Infant feeding workforce in relation to perinatal mental health.

We know from countless stories of mothers we have supported that breastfeeding peer support has the power to change a mother’s story and experience of care. Those of us who provide peer support have the privilege to hear a mother’s story, to become part of her story as we come alongside to help empower her to find the way forward that is right for her.  Can receiving peer support help a mum change the way she views her own story?  Providing peer support can often help reframe our own stories and see them differently.   If our story was one of painful experiences or even trauma, we can often realise the pain wasn’t in vain but has provided the backdrop to another mother feeling supported and empowered.

We are now looking for ways to collect evidence of the impact breastfeeding peer support has and how it contributes to perinatal mental health. We are still very much on a learning curve with this piece of work and I hope to share more during my presentation.