26 Apr

Breastfeeding after a Caesarean Birth

Photo: Ashley Marston

As part of caesarean awareness month in April, we’re sharing some information on breastfeeding after a caesarean section. Your caesarean may be planned or unplanned, but either way it needn’t derail your breastfeeding journey – the key is to be informed so you can be as prepared as possible.

First, BfN Supporter Zoë Chadderton shares some information on caesarean births, how they can affect breastfeeding, and steps you can take to help get feeding established – with links to a factsheet by BfN pharmacist Dr Wendy Jones. Then we’ll hear from Alyson, a BfN peer supporter, on her experience of breastfeeding after a C-section.

About caesareans & breastfeeding: Zoë Chadderton

There are three types of C-sections:

  • Planned (also called elective) – this is planned ahead of time, and may be for a number of reasons, e.g. placenta praevia. 
  • Emergency – this takes place during labour, normally because of  slow or no progress in labour  or baby/mum in distress. Despite the term “emergency”, the actual surgery is performed in much the same way as a planned section, it just hasn’t been planned ahead of time.
  • Crash – an actual emergency, mainly if the baby is in danger and needs to be born very quickly.

Most sections happen under local anaesthetic – an epidural or spinal block. General anaesthetics are rare, but can occur.

Generally speaking, a caesarean birth can cause breastfeeding to be a little delayed compared to a vaginal birth because mum doesn’t get the natural surge of oxytocin that can help with her milk supply. However, that absolutely doesn’t mean that you can’t breastfeed after a C-section – just that you need to be aware of the issues that may arise, and how to deal with them to help get feeding successfully established.

Planned sections can be better in some respects because mum isn’t exhausted from the stresses and strains of labour, and she can plan what she would like to happen such as skin to skin in theatre, immediately after birth. Mums who are planning a section can also think about hand expressing colostrum before the birth (antenatal expressing), which may help if baby is delayed in going to the breast, and more importantly helps the mum be secure in her technique in a non-stressful situation (it can be quite stressful learning how to hand express because you HAVE to, because your baby isn’t feeding, rather than relaxed “I’m learning a useful skill” antenatal expressing). Even if you are not planning a caesarean birth, it can be a good idea to learn how to hand express before your baby is born – you can start after 37 weeks, and information on technique can be found here*.

Pain can be an issue – many mums worry about baby kicking their scar – and you may struggle to sit up for a while after surgery, so there are several feeding positions you can try to work around these issues. Lying down on your side with your baby beside you on the bed; underarm (also called rugby hold); and in some cases laid back feeding (also, confusingly, called upright hold or biological nurturing) can be really useful. Try out a few positions and see what works for you (see here for some tips). Check out BfN pharmacist Dr Wendy Jones’ factsheet for information on your pain relief options while breastfeeding – there are many options which are perfectly safe for you and your baby. Don’t be a hero – take that pain relief.

Get some skin to skin contact with your baby as soon as you are able – preferably in theatre immediately after birth. Mention it to the midwives, even in an emergency – it can make a real difference to baby’s instinctive behaviour at the breast by getting hormones flowing for both of you and allowing both you and baby time to get to know each other and start your feeding journey. Finally, be patient. Take your time, baby might not feed as quickly as you expect (this applies to all babies!), but skin to skin, hand expressing and help from the ward staff or breastfeeding peer supporters will all help. Good luck!

*(N.B. this video refers to small babies – however the technique remains the same for all babies, the only difference being that colostrum would more likely be collected in a syringe or cup rather than a spoon.)

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Alyson & Charlie’s Story

I had always intended to breastfeed my baby, and throughout my pregnancy was hoping for as natural a birth as possible. I’d read about how breastfeeding often gets off to an easier start after a natural labour, so I felt I would be giving myself and my baby the best possible chance of success.

But apparently my baby hadn’t read the birth plan. I found out at 36 weeks that he was breech, and to top it off, his head measurement was (literally) off the charts…a trait he inherited from both me and my husband. We were told there was a 50/50 chance that he would turn head-down, but that if he didn’t and we tried for a breech birth, there was a high chance that his big head would get stuck and we’d have to have an emergency (or even a crash) C-section.

I was shattered by the news. I felt like the natural birth I’d planned for was disappearing before my eyes, and my chances of breastfeeding along with it. We decided to take a week, to see if the baby turned, and to fully research breastfeeding after a C-section so that we could be prepared. I was pleasantly surprised by what I found, and realised that a C-section needn’t spell disaster for breastfeeding – I just needed to be aware of what might happen and prepare for it. This was just as well. Despite me doing various bizarre exercises to try to spin him around, the baby remained resolutely breech, so we booked a C-section for 39 weeks…and suddenly everything seemed very real indeed!

I visited my local breastfeeding drop-in group before the birth, to speak to the peer supporters there and get some information. They were amazing. They showed me some positions (“laid back” feeding, and the rugby hold) that minimised the risk of the baby kicking my incision, and that would mean I wouldn’t have to completely sit up – since my core muscles would take a while to heal. They also explained how I wouldn’t experience the same hormonal changes that I would have done in labour, and how this might mean my milk was a little delayed in coming in. To combat this, they advised lots of skin to skin contact with the baby, starting immediately after birth and continuing throughout the first days and weeks. They explained that this would help to get the oxytocin flowing, and also give the baby a chance to follow his instincts and find his own way to the breast.

On the day of the birth, I discussed our plan with my midwife and surgical team. They were very helpful, and showed me how to put on my gown so it could be easily pulled down for skin to skin. When Charlie was born (complete with frankly enormous head), he was placed onto my chest almost straight away, and I held him like this, skin to skin, for the first couple of hours. I was amazed to see him start “rooting” for the nipple – it sounds unbelievable, but he did a sort of sideways shuffle/crawl until he was lined up, then latched himself on and stayed there for an hour. I had heard about this in my research and my visit to the breastfeeding group, so I knew I should just leave him to it as long as I wasn’t in pain, but it was still amazing to watch.

There was some concern from the midwives that he slept for a long time after this first feed, so we spent an hour trying to wake him up and persuade him to latch on, but he was absolutely zonked out. One midwife suggested we give him some formula, but my instinct (and everything I had read about getting breastfeeding established) was to avoid this if at all possible. While I was not against formula per se, I didn’t want to fill him up with it and therefore reduce the amount he needed from me, which would impact on my supply and potentially delay my milk coming in. Luckily another midwife suggested we express some colostrum into a syringe, so that we could feed him that. She showed me how to hand express, and I was delighted to see drops of thick, yellow colostrum coming out – the midwife told me this was a great sign that things were happening as they should. I’ll never forget her, she was so kind. I managed to express a couple of millilitres, which we carefully dropped into Charlie’s mouth and he lapped up without even waking up! About an hour later he woke up again and latched on for another feed – we were observed by a midwife, who told us that the latch looked good, and that she didn’t have any concerns about him feeding. This was very reassuring.

We were discharged from hospital after 36 hours, and went home to begin our lives as a family of three. Charlie spent the first night at home feeding A LOT. It was pretty constant from about 9pm to 4am, not wanting to be put down, and only really being content on the breast. If I hadn’t spoken to the peer supporters, I think I would have really panicked that the C-section had messed things up, that I didn’t have enough milk and that he was starving – but as it was, I’d been warned that this may happen, that he was just “putting his order in”, stimulating the breasts to kick-start my supply. I don’t know if this was more pronounced because of the C-section – it may well have happened anyway. It was pretty gruelling, but being prepared for it was key…I got comfy on the sofa with a mountain of snacks, drinks and a whole lot of Netflix. I felt very lucky to be facing this after a straightforward birth, rather than an exhausting labour, so that was a definite positive of the C-section for me. I also sent my husband off to get a bit of sleep, so he’d be refreshed and ready to tag in for a while later! Obviously he doesn’t have boobs, so did a lot of cuddling, bouncing and singing for an hour or so while I grabbed a quick nap. This really helped. It’s an absolute myth that dads can’t help or bond with their breastfed babies, there is so much that they can (and do) do.

My milk came in on day 3. I felt like I transformed into a Pamela Anderson lookalike overnight, which was both alarming and reassuring…this breastfeeding thing was really working! Charlie continued feeding like a trooper, and over the next few weeks my supply regulated and I felt more normal again. It was also really useful to use the hand expression technique I’d been taught in hospital, when I needed to keep things comfortable between feeds.

I found the “laid back” position really helpful, semi-reclined on the sofa/bed with Charlie lying diagonally across me. It felt very comfortable and seemed to give him the chance to follow his instincts without too much interference from me. Over time we adapted the position so I could feed him sitting more upright, with him straddling my leg. I found, with a bit of practice, I could feed like this in many situations – useful when we were ready to go out for a coffee! At night, his side-sleeper cot was a lifesaver – because of my incision, I found it really tricky to get in and out of bed in the first few days, so it was great to be able to just slide him towards me and feed in the laid back position.

I was lucky that Charlie took to breastfeeding pretty easily, and never had any real issues with latch etc. After a normal weight loss in the first few days, he gained weight well, and continued to breastfeed for almost a year. My C-section did have an impact on breastfeeding, but since I knew in advance, I was able to prepare and combat it – through immediate skin to skin, understanding frequent feeding (aka normal newborn behaviour!), avoiding unnecessary top-ups, and overall being led by my baby and feeding on demand, to let nature take its course. I was so pleased that we were able to breastfeed successfully, despite not having the natural birth we’d planned. I struggled for a while with the feeling that I hadn’t given birth “properly”, that my body had somehow failed me (I’ve now worked through this and know that any means of safely getting a person out of yourself is the “proper” way to do it, and is the opposite of failure), and breastfeeding really helped me to feel that something was working out the way I intended.

My advice to anyone intending to breastfeed would be to find out as much as you can before your baby is born, including the possible implications of a C-section, whether you’re planning to have one or not. As I discovered, birth plans are just a plan, and they don’t always work out the way you expect. Most of all, don’t assume you’re doomed before you even start – do your research, find a local group, ask your midwife, call the National Breastfeeding Helpline. They will be able to give you support and information, even before the birth, and help get breastfeeding established. You’ve got this!

25 Apr

Breastfeeding Mothers Returning to Work – Top 5 Tips

Law firm Slater and Gordon recently published a report on the rights of breastfeeding mothers returning to work, highlighting the fact that many employers are unaware of the law. Slater and Gordon have written the following guest blog for us, explaining the top five things you need to know about returning to work whilst continuing to breastfeed.

1. Plan your discussion with your employer in advance of your return

Take time to consider the support and facilities you need to help you breastfeed or express at work before you go back to work and plan to have a conversation with your manager or HR, ideally well in advance of your return date. You may wish to use one of your KIT days to arrange a meeting.

The support you need will very much depend on your own personal circumstances. Some mothers would like to visit their baby during the working day and others plan to express breastmilk. 

Check whether your employer has a breastfeeding policy, or a return to work policy outlining the type of support they provide or what you need to do to request support. Most good employers will.

2. Know your rights

The law does not currently allow a simple, straightforward right to breastfeeding breaks though employers are required to provide a place for breastfeeding mothers to rest.

In terms of breastfeeding support, the Health and Safety Executive and guidance from the European Commission recommend that employers should provide:

  • access to a private room where women can breastfeed or express breast milk;
  • use of secure, clean refrigerators for storing expressed breast milk while at work, and
  • facilities for washing, sterilising and storing receptacles.

The ladies toilet for example is never a suitable place in which to breastfeed a baby or collect milk.

ACAS guidance also gives the following advice to employers when asked to consider additional breaks for breastfeeding:

“Employers should consider providing short breaks for breastfeeding or expressing milk, weighing it up against the likely impact it might have on the business. Employers should be careful not to discriminate against breastfeeding employees. If employers are unable to grant additional breaks, they could consider slightly extending normal breaks for the employee such as a mid-morning coffee break or leaving earlier in the day to minimise any disruption to the business.”

3. Consider a request for flexible working, such as for reduced hours

If you have worked for your employer continuously for 26 weeks, you have the right to make a request for flexible working. You are likely to qualify to ask as maternity leave counts as continuous service.

You might want to reduce your hours, change which hours you work (to start later or finish earlier) or work the same number of hours but over fewer days. You may also want to work from home or as a job share, or return part-time. Your employer must agree to flexible working where it can accommodate the request, but can turn it down on business grounds defined in flexible working regulations (there are 8 grounds including inability to meet client demand and detrimental impact on performance). However, it must make sure it does not discriminate and cannot simply refuse a request without fair process or reasons.

Employers are obliged to deal with requests in a reasonable manner. If your employer refuses your request you should have a right to appeal your employer’s decision so that you have an opportunity to clear up any misunderstandings or explore other options. If you do not appeal there is a risk that this implies you accept the decisions made.

If it is still refused you should seek legal advice, as you may have claims for discrimination, including indirect discrimination if your employer for example has a policy or practice which disadvantages women and which cannot be justified by the employer.

For example, an employer might require all posts to be full time. If a breastfeeding employee asked for a temporary alteration in her hours in order to continue breastfeeding and she would be disadvantaged if this was refused (because she would be unable to breastfeed), her employer should grant her request unless there are good business reasons for refusing.

4. Consider whether there is a health and safety risk to you and your baby, and know your rights

Is there a risk to your health or safety or that of your baby from your working conditions or hours?

All employers have a duty to protect the health and safety of their employees. While you are breastfeeding, you and your baby have special health and safety protection under the same regulations that give protection to pregnant employees.

Employers of women of childbearing age employers must also carry out a ‘specific’ risk assessment of risks to new and expectant mothers arising from ‘any processes, working conditions, physical, biological and chemical agents’.

Some hazardous substances can enter breastmilk and might pose a risk to your baby. If your work brings you into contact with a dangerous substance, your employer should take appropriate steps to make the job safe, remove that risk or if that is not possible they may have to explore temporarily changing your working conditions or hours, such as working shorter shifts, giving regular shifts or avoiding night work or overnight stays.

Reasonable action to protect your health and safety while you are breastfeeding could include adequate rest breaks to ensure proper nutrition, access to water and washing facilities. Your employer should ensure that the environment is not too hot or too cold. Employers should also consider levels of fatigue, stress and changes in posture.

If adjustments to your working hours or conditions would not remove identified risks, then you should be given a temporary transfer to alternative work, or suspended, without loss of pay.

5. If your employer is not supportive and you have concerns about harm to you or your baby or in relation to possible discrimination of harassment, know your options

If support is not forthcoming, then it may be concerns need to be raised. It’s usually best to raise concerns informally initially with your manager or HR, and if that isn’t successful, it may be necessary to raise concerns more formally in writing through a grievance process.  If the concerns relate to working hours, you may wish to firstly consider making a formal flexible working request. If support is still not forthcoming, you have to consider a more formal route again, such as exploring potential legal claims. You should seek support from your trade union or seek legal advice in these circumstances.

Do keep a record of the requests being made, the experiences you’ve had and the responses received.

It is worth noting that if you consider your situation is serious enough to merit taking legal action, there are strict time limits and you only have three months less one day from the date the last act of discrimination took place to lodge a start the compulsory ACAS Early Conciliation process with a view to bringing an Employment Tribunal claim.

It is important to take advice quickly and you should seek support from your trade union or take specialist advice if you find yourself in this situation.  

You can find information on returning to work, discrimination and flexible working on the Slater and Gordon website, and on the ACAS and gov.uk websites.

18 Apr

Guest post: What We Mean When We Call For More Support For Breastfeeding Mothers

Professor Amy Brown

Yes, support for breastfeeding can mean someone to sit and help you latch your baby on – but it also means acceptance, a better environment to feed in, and investing in infrastructure to make it easier.

The phrase ‘we need better support for breastfeeding’ can sometimes feel like a suggestion that if women just had a little more help latching their baby on, and tried a little harder, then all their problems would disappear. It can attract a lot of backlash, and with that perception you can understand why.

But when we call for ‘more support’ we don’t mean that at all. Yes, support for breastfeeding can mean someone to sit and help you latch your baby on, moving them a little left or right so that latch is more effective and comfortable for you. And timely, skilled support like this can make all the difference to breastfeeding working out.

But it’s certainly not the only thing we mean. We mean that women deserve high quality information about how to know when breastfeeding is working… and when it isn’t. A better environment to breastfeed in. Acceptance. Value in what they are doing. Investment in the infrastructure that makes it that bit easier. And more than that again.

So here’s a run down of what ‘more support’ actually encompasses.

1. In the early hours and days…

High quality information antenatally about what breastfeeding is like – how milk is produced, how often babies feed, what normal baby behaviour looks like. 

Individualised support during birth that reduces risk of unnecessary complications and interventions. Information on how any interventions might affect milk supply.

Support after the birth to breastfeed as soon as possible. Continued support with picking up and positioning if the mother is in pain or immobilised.

Infant feeding specialists on the hospital ward and in the community, who can visit as often as needed. Peer supporters working alongside them. And time. Time for them to sit, really listen and give emotional support too.

Accurate information on how to increase milk supply. The importance of responsive feeding is. How to spot effective milk transfer. When is feeding often, too often?

2. For more complex cases…

If babies aren’t gaining weight, support with increasing supply or transfer of milk. Support with topping up. Guidance on when formula might be necessary, and how to ensure you carry on increasing your own milk supply alongside using it.

Good advice on how to use a pump if required. A high-quality pump being available. Information for women who decide to exclusively pump. And information for women who need to mix feed for whatever reason.

If a baby has tongue tie, then rapid identification and treatment where necessary. And for other complications that might make breastfeeding more challenging like cleft lip and palate. Identification, expert support, and accurate information.

Accurate advice for women who need to take a medication, including alternatives, rather than misinformation that they always need to stop.

More research into unexplained low milk supply and other complications.

A full explanation, debrief and support with formula feeding for those who wanted to breastfeed but were unable to do so.

Enhanced donor milk provision so that all sick and premature babies whose mother cannot produce enough milk, can be offered it rather than just the most vulnerable.

3. From friends and family…

Better support for mothers to recover after birth and get to grips with feeding. That might be from a partner or family. Or it might be from a doula. Or peer supporter. Or all of them. Anything that means new mothers are nurtured in a way that focuses on caring for her, not offering to give the baby a bottle.

Knowledge of how breastfeeding works, how to spot difficulties, and that there are other ways to bond with than using a bottle.

Advocates that stand up for the mother if she cannot get the support she needs or is feeling pressured unnecessarily to stop breastfeeding.

A shoulder to cry on when things are tough rather than an automatic suggestion to stop breastfeeding if she is not ready.

4. In the community…

A knowledgeable community that understands how breastfeeding works. That understands frequent feeding, normal infant sleep and a baby’s need to be held. That shares this knowledge with others, so that it becomes common knowledge.

Well-funded peer support groups so that mothers can spend time with others who are going through the same challenges, or have come out the other side.

A society that recognises breastfeeding as an utterly normal thing to be doing in public. One that sees it as a baby needing to eat, rather than an act of exhibitionism by a woman.

A society that values mothers, recognising that what she is doing is important. Not one that suggests she is failing if she doesn’t get her ‘life back’, ‘body back’ or ‘get back’ to paid work asap. One that celebrates her new normal rather than suggesting she is somehow failing.

Educational programmes that ensure children grow up knowing how the female body works, how breastmilk protects babies, and how breastfeeding is a reproductive right.

5. At a government level, one that invests in breastfeeding by ensuring…

Hospitals and communities are well staffed, so that every mother who needs support gets it.

Generous and well-paid maternity and paternity leave, so that families have the time to establish breastfeeding.

Full legislation to support breastfeeding mothers on return to work, and workplaces are encouraged to support them.

Educational programmes based on the best possible research to update professionals across the spectrum.

Legislation to ensure formula milk is an accessible, high quality affordable product, not pushed on families by industries wanting to capture their ‘market share’.

‘More support’ doesn’t suggest that with a bit of help and determination that all women can breastfeed. Rather it highlights how women are currently being let down at every level. The list is long, and likely incomplete. We have far to go but while women are still falling through the gaps at every stage we will keep fighting for ‘more support’ across every dimension this entails.

Professor Amy Brown is based in the Department of Public Health, Policy and Social Sciences at Swansea University in the UK where she leads the MSc in Child Public Health.  This article was originally published on Huffington Post, here, and is reproduced here with the author’s permission.


10 Apr

Guest post: Breastfeeding through pregnancy and beyond

Emma Pickett is the chair of the Association of Breastfeeding Mothers, and also works as a lactation consultant. Here we share her article on breastfeeding through pregnancy, and potentially continuing to breastfeed two (or more!) children, known as tandem nursing.

Let’s imagine you are breastfeeding your toddler and you discover you’re pregnant. It’s a much wanted pregnancy but perhaps you weren’t expecting that positive test quite so quickly. And now here you are, pregnancy test still drying, teeny tiny new person inside you and less teeny person on the outside, very much still in love with breastfeeding.

By still feeding your toddler, you’ve already been up against it in terms of what most modern cultures find comfortable and acceptable. Now you’re ticking the box for another misunderstood area of breastfeeding: one full of myths and nonsense and one lots of uneducated people claim to be experts about.

A useful starting point is finding a group online of mothers who have breastfed through pregnancy and beyond. That can be reassuring and immensely helpful but it’s worth remembering that every woman’s experience is different and it’s very hard to make predictions about how things will go for you.

I’m going to guess that when many people are looking at the drying pregnancy test, their thoughts shift to the consequences for their current nursling. Then soon, you wonder about the baby-to-be. Is breastfeeding during pregnancy ‘safe’?

What does the research say?

Let’s look at this study from 2012: A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes. Madarshahian F, Hassanabadi M. The study looked at 320 women in Iran, some breastfed during pregnancy and some did not. It showed that, “Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group.”

So, breastfeeding during pregnancy didn’t ‘take nutrition away from the baby’ and it did not cause prematurity.

Another study of 57 Californian women from 1993: Breastfeeding during pregnancy. Moscone SR, Moore MJ. Just under half continued to breastfeed through pregnancy and after the new baby arrived. The new babies were healthy and appropriately sized.

However, it’s not all clearly positive. Another research study on 133 women in Peru found a link between breastfeeding through pregnancy and 125g on average less weight gain for the new baby in the first month. (Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy. Marquis GS, Penny ME, Diaz JM, Marín RM. 2002)

Another study looked at 540 women in Egypt with sub-standard nutrition. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study. Shaaban OM, Abbas AM, Abdel Hafiz HA, Abdelrahman AS, Rashwan M, Othman ER (2015). This was not all positive news with increased risk of maternal anaemia and issues with infant growth. BUT there was NOT an increase in miscarriage risk when women breastfed through pregnancy.

How’s your nutrition and how are your iron levels? If you are a mother with access to good nutrition, it appears you have less reason to be concerned.

Does breastfeeding trigger early labour? Even for those women who were struggling with other issues, it doesn’t appear so.

Hilary Flower is the go-to person on the subject of breastfeeding during pregnancy. Her book, “Adventures in Tandem Nursing” is considered the bible on this subject. It was first written in 2003 and is now out-of-print but a second edition is currently being worked on. Her focus was on bringing the facts to pregnant mothers and she looked at this idea of triggering contractions or early labour in detail. She reminds us that we need oxytocin to trigger a milk ejection reflex (the letdown reflex) and this is also the hormone that can trigger uterine contractions. However, this doesn’t mean that breastfeeding in pregnancy triggers risky contractions and there are several safeguards in place. We need hormone receptor sites to exist before hormones get acted on by the uterus and they remain small in number until around 38 weeks of pregnancy. And even the hormone receptors that are in place can’t really do their job of causing contractions as there are oxytocin blockers in place like progesterone (made by the placenta) and proteins missing which would act as special agents to help the oxytocin do their job. Triple protection! So, oxytocin can carry on doing its breastfeeding jobs while baby remains protected in the uterus.

I think we can say science is on our side. Which makes sense when you think that throughout history women have been breastfeeding older babies and having sex and getting pregnant.

Do you know anything about the history of pregnancy testing? Today, we might know we are pregnant days after conception. For generations, it was based on guess work, someone examining your urine’s appearance and something about rabbits (early 20th century pregnancy tests involved injecting urine into a rabbit and observing a change in their ovaries). A lot of breastfeeding women couldn’t rely on whether they had missed a period as periods may only just be settling in or may not have even appeared yet. Some breastfeeding mums get pregnant without yet having a period. They ‘catch the first egg’. Then they go and see their doctor and the doctor brings out the chart that predicts due date based on last menstrual period, “errr…2015?”

Nature isn’t daft. If breastfeeding during pregnancy was hazardous, I doubt you nor I would be here. Hilary Flower mentions that if you have a high-risk pregnancy, you should talk to your health care providers about your specific situation but if you are safe to continue sexual intercourse, breastfeeding is very very likely to be fine too.

Science might say that breastfeeding during pregnancy is safe but that doesn’t mean you have to do it, or that it’s super easy for everyone. There is a wide range of experience and you need to reflect on what feels right for you.

The age of your current nursling might be a factor in your decision. If they are 7 months, you might feel differently than if they were 4 years old and you were getting a bit tired of breastfeeding a plastic truck several times a day.

If your baby is 7 months, or at any age where milk is still a significant proportion of their nutrition, you’ll need to do some thinking. It’s likely they will need an alternative source of milk (still doesn’t mean breastfeeding needs to end). Most women who are breastfeeding when they are pregnant do notice a decrease in milk supply – often a very significant one. This can start as early as the first few weeks after that positive pregnancy test. Whatever you do, your body will be resetting in its lactation story and you will go back to making colostrum during your pregnancy. It happens at different times and some mums might go through a period of feeling like they have virtually nothing and their child is ‘dry nursing’ before colostrum then appears and quantities seem to increase again.
Nurslings behave differently during the changes of pregnancy. Some self-wean as the quantities drop. Some self-wean when things seem to taste a bit different. Some care not a jot that changes are happening and would carry on breastfeeding whatever was coming out or if nothing was.  Word of warning: colostrum has a laxative effect. That’s one of the reasons it’s so great for newborns as it helps them to pass meconium. Potty training a toddler? Brace yourself.

What else can you expect? For some women, not much else. Pregnant and breastfeeding felt a lot like not pregnant and breastfeeding. You’ve just got to worry about the bump being in the way towards the end. (This was my experience).

Other women struggle with sore nipples from increased sensitivity that probably has something to do with hormonal changes and sometimes aversion to breastfeeding can be a problem.

The reduction in milk supply can also be upsetting for some. It can come at a time when we might already have mixed feelings about giving birth to another child. We know what positives a new sibling can bring for your toddler but there’s sometimes a feeling of loss or even guilt as we’re concerned how their life is going to change – especially in the first few months. And when milk seems to be going too – that can feel doubly hard. Unfortunately, there isn’t much you can do to increase milk supply in pregnancy when changes are starting. All the usual stuff doesn’t work: pumping, herbs, just feeding more frequently. Many herbs that we might consider when we want to increase production are not thought to be safe in pregnancy. It appears that milk storage is affected for almost all women (only a small minority don’t feel their supply has diminished). You might want to consider using a supplementary feeding system at the breast, so baby can remain attached and get other milk through a lightweight tube.

It’s important to remember though (and this is engraved on the heart of many of us in breastfeeding support) that BREASTFEEDING IS NOT JUST ABOUT MILK. Your little bloke with the plastic truck might not care a jot if supply diminished and milk tastes different because this is only partially about milk. It’s also about connecting to you, relaxation, safety and contentment. That big world out there is only getting bigger and breastfeeding is home.

If you are happy to continue with that, breastfeeding is still working.

You might also be wondering what life is going to be like when the new baby arrives. How does breastfeeding work when there is a newborn and a toddler? Pretty much like it did the last time there was a newborn – nature gets on with it. While breastfeeding during pregnancy doesn’t ‘use up’ colostrum, during in the first few days after the birth, it’s sensible to let the newborn do their thing first before the older nursling gets a turn. And once your mature milk transitions, you can make decisions based on how your newborn’s nappies and weight gain are getting on. Sometimes there is talk of restricting a baby to one breast and a toddler to another. Most lactation consultants agree that’s not sensible. Ideally you want the newborn to have the option of both and continue to have the option of both fully lactating as their breastfeeding experience continues. Toddlers feeding after newborns are very effective at helping a milk supply to develop and tipping into oversupply is more of a worry than running out of milk. A toddler is also fabulous at relieving engorgement in the early days post-partum. Flashback to my 3-year-old son announcing proudly to his grandmother (not entirely on board with natural term breastfeeding) that he ‘helped mummy because her milkies were really full’!

Does the toddler feel jealous of the baby having ‘their milk’? I have yet to meet a mother who feels that’s been a problem. In fact, many feel that it can help in the arrival of a new member of the family. Toddlers are likely to need some extra support, but breastfeeding is still there for them. The thing that has always provided comfort and reassurance. And good news! It’s changing back to regular milk and there’s lots more of it! What might not be sensible is weaning a toddler in the last few weeks of pregnancy so if you are thinking tandem breastfeeding really isn’t for you, it might be wiser to wean sooner rather than just prior to baby arriving. If that’s you, I wrote an article on weaning an older child which you might find helpful:
http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/weaning-toddler-bob-and-pre-schooler-billie-how-do-you-stop-breastfeeding-an-older-child

It sometimes happens that an older child who hasn’t breastfed for a while asks to do so again when a new baby is on the scene. That might be because they weren’t a fan of the colostrum. Or there might be some other things going on in their head. Are they ‘testing’ whether they still get to be your baby? Are they just curious? Some resume breastfeeding at this point. Some are happy to have a taste of expressed milk in a cup. Some ask and run away giggling and don’t mention it again. There’s no right or wrong answer on how to deal with this but ideally, we’re looking for ways to minimise rejection and any refusal is done so as gently as possible.

Still think it’s a bit hippy and ‘risky’? This is the American Academy of Family Physicians (folks on the opposite end of the spectrum from hippy and risky):
“Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned.
Breastfeeding the nursing child during pregnancy and after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.”

We can’t guarantee it’s all smooth but breastfeeding through pregnancy and beyond is something mothers have been doing for millennia and there’s very little to fear and lots to embrace. Those of us who do it are often those who have taken the path of child-led weaning and it instinctively feels right to let the nursling make the call. But you’ll make the decision that’s right for you.

02 Apr

“A lifeline when no one else gives you an answer”: Evaluation of drugs in breastmilk service launched today

2nd April 2019

A new report is published today evaluating the impact of the Breastfeeding Network’s Drugs in Breastmilk Information Service. This service provides evidence based factsheets and one to one support about taking medications or having medical procedures while breastfeeding to over 10,000 parents and professionals each year.

The Drugs in Breastmilk information service was set up more than 20 years ago by the Breastfeeding Network and has been funded by the charity ever since. It was established in response to reports of many breastfeeding women receiving inconsistent or inaccurate advice from some health professionals when they were prescribed a medication or procedure. This service enables them to access the latest evidence-based information on risk, from an experienced pharmacist.

The research, led by Professor Amy Brown in the Department of Public Health, Policy and Social Sciences at Swansea University, will be presented at the All-Party Parliamentary Group for Infant Feeding and Inequalities in Westminster today. It explored the experiences of mothers, health professionals and mother supporters who had used the service.

The evaluation found that the majority of mothers who contacted the service were enquiring about every day medications and procedures, such as antidepressants or antihistamines, where there is an established evidence base that continuing to breastfeed whilst taking these medications is not harmful. Yet women had been told by their GP or pharmacist that they could not continue breastfeeding whilst taking it. On contacting the service, mothers were given the information that they could continue meaning that many had the confidence and reassurance to continue breastfeeding for longer.

Professor Amy Brown explained ‘The findings are a concern as we do not know how many women did not contact the service and stopped breastfeeding through incorrect advice from medical professionals. This service is clearly plugging a gap in the knowledge of some GPs which should urgently be tackled by considering how medical professionals are trained not only in the risks of medications and breastfeeding but also in the value of breastfeeding for many mothers. Mothers highly valued the information they were given by the service as it enabled them to continue breastfeeding and take the treatment they needed. But they also particularly valued the support and reassurance given by the service around making any decision. Mothers described how before contacting the service they often felt dismissed and that their desire to breastfeed did not matter, but after contacting the service they felt reassured and listened to for the first time, describing the service as ‘a lifeline’.

Indeed, the evaluation examined how mothers felt before and after contacting the service, highlighting a highly significant improvement in maternal wellbeing, Mothers reported they felt more informed, confident, reassured, supported and listened to after contacting the service, even if they were given the advice that they couldn’t breastfeed whilst taking a prescribed medication.  

Dr Gretel Finch, Research officer for the project noted ‘We expected to see that the service would be rated positively by those who used it but were struck by just how significant the impact was for maternal wellbeing. Even when mothers were told that they could not breastfeed and take a medication they reported feeling listened to and cared for, rather than simply being told they couldn’t breastfeed. Given what we know about the devastating impact not being able to breastfeed can have for maternal mental health, this service is playing a key role in helping alleviate that by providing women with answers and support, rather than a simple ‘no’.

The report found that for many mothers, if they had not received information from the service, they would have made the decision not to take their prescribed medication, rather than stop breastfeeding. GPs often assumed mothers would stop, but in reality, they valued breastfeeding so strongly that they would put their own health at risk in order to continue doing so.

Dr Heather Trickey, Research Fellow at the University of Cardiff School of Social Sciences explained ‘It is clear that breastfeeding women who are given incorrect information when prescribed a medication face a difficult choice. Many stated that they would decide to continue breastfeeding over taking the medication, putting their own health at risk when in fact there was usually evidence that it would not be harmful to continue breastfeeding. This is a common theme for new mothers when it comes to information about caring for their baby. Many are not given accurate information by health professionals about the real risks to them and their baby putting their physical and psychological wellbeing at risk. Women deserve the level of accurate information and support this service brings.’

The evaluation clearly shows the impact the service has and the gap that it is filling. As a result of the report the Breastfeeding Network are calling on the government to ensure that this gap is not left to a charity organisation to fund.

Shereen Fisher, Chief Executive of the Breastfeeding Network, who commissioned the evaluation, said ‘Many of the mothers who contacted the service stated that they were only able to continue to breastfeed because of the support and information they received. The service is vital for women yet we rely on funding from the charity, goodwill and fundraising appeals to provide it. Given the impact of the service upon maternal and infant health and wellbeing we are calling for the Government to reverse cuts to the Public Health Grant and to provide funding to support the continued work and expansion of the service’.

The BfN Drugs in Breastmilk Service can only continue with sufficient funding.  To donate to help keep the Drugs in Breastmilk Information service running, text BFNDIBM to 70085 to donate £3. This costs £3 plus a standard rate message. Alternatively, you can opt to give any whole amount up to £20 by texting BFNDIBM 5 to donate £5, BFNDIBM 15 to give £15.

Ends

For more information:
Felicity Lambert, BFN Comms Officer felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk
www.facebook.com/BfNDrugsinBreastmilkinformation