25 Oct

BfN Central Evaluation 2019 – Results Highlights

Nina White, BfN Programme Manager

Every year, BfN release a survey to help us see what we are doing well, where we can improve and also give us the evidence we need to help secure future funding. 

This year, the survey was live throughout March 2019 and we received 572 responses.  Thank you to everyone who shared the survey link and encouraged people to complete the survey.  We were pleased to be able to send BfN travel mugs to 10 lucky winners from the prize draw.

Responses to the survey came from:

Survey responses

– 89% mothers
– 5% health professionals
– 6% others

Of these, 36% were supported by the BfN Drugs in Breastmilk Service and 12% from the National Breastfeeding Helpline. 

Matching last year’s results exactly, 64% of this year of mothers contacted BfN because they were experiencing breastfeeding problems.

Once again – the most popular topic of discussion with BfN Peer Supporters was positioning and attachment for feeding, with more than half of mothers struggling with painful breasts and nipples.  The next three common topics were frequency of feeding, baby’s weight gain and expressing milk.  Nearly half of mothers asked for information about medication/medical intervention and impact on breast milk/ breastfeeding.  We hope we were able to ensure all these mothers were able to continue feeding their babies if they wished to, since many reported being told to stop breastfeeding unnecessarily.

We asked a variety of ‘before/after’ questions and were delighted with the answers, which proved the value of peer support:

61% agreed they had the information needed to make decisions about feeding their baby before contact with BfN, rising to 95% after support from BfN.

45% of mums could breastfeed without pain before contacting BfN, increasing to 80% after support from us. 

Once again, more than half of the mums questioned (54%) claimed BfN supported them to breastfeed for longer than they otherwise would have done.  Reasons given for this included evidence based information about medication, information about attachment, expressing milk, managing blocked ducts and mastitis, meeting other like-minded mums and knowing what is ‘normal’ newborn behaviour.  There were also lots of comments about general support, building confidence and encouragement.

90% of mums said they felt listened to, that their choices were respected, they were not pressured to do one particular thing and that the support/information they received was specific to them.

98% of mothers were satisfied with the support they received from BfN and 98.5% would recommend us to family or friends.

We feel that these results help to demonstrate how important the support we offer to families really is – and how appreciated our volunteers and staff are. 

21 Oct

Tandem breastfeeding, as a young mum – it can be done!

Newly qualified BfN Helper Naomi Forbes writes about her experiences as a young mum, in particular her decision to breastfeed both of her children in tandem.

Breastfeeding is a big part of my everyday life. I currently tandem feed my one year old and my two and a half year old. Tandem feeding can be challenging for many reasons but it’s something I wanted to do. When I had my first child at the age of 19 and my second at 20, I noticed a lot of people around me did not expect me to breastfeed. I think there is a stigma around “young” mothers, people assume a lot of things, such as “they won’t be breastfeeding”, “they’ll leave their baby with others all the time”, “they’ll be lazy” etc. I found this difficult and hurtful at first as I did plan my pregnancy at a young age and even if I hadn’t it would not have been anyone else’s business.

It can be lonely tandem feeding especially if you don’t know many others in the same position as you, and I’m writing this to make people aware that it is perfectly normal. I assumed most people already knew that there’s nothing “strange” about it, however I spoke to many people during my pregnancy who had no idea that it was even possible to feed my new baby and continue to feed my older child. It’s often hard to do the things you want to do when the people around you are not as supportive as you had hoped they would be, I don’t think people mean to be hurtful I think it’s often down to a lack of education about the subject.

I feel extremely passionate about empowering women and helping them to achieve their breastfeeding/parenting goals just like I have achieved mine. I have recently started to train to become a breastfeeding helper with the Breastfeeding Network, I often focus on the negative responses I have had and not the positive because I want to help educate more people and it’s important to focus on the bad so I know what I have to try and change, but I have had so much support and I feel this is one way of giving something back.

I didn’t really give it much thought before I gave birth to my first child, I had a few conversations about it when I was pregnant and a lot of people told me “you might not be able to breastfeed” and “most women can’t breastfeed”. I just knew I wanted to but I had it in my head that so many women can’t breastfeed and I thought there was a high chance that I wouldn’t be able to. I just decided I was going to try it and see how it went. I’ve found out now that only a tiny percentage of mothers truly can’t breastfeed and that a lot of people say that rather than just admit that they made the choice not to, and of course that’s fine but I don’t think they should be trying to put other mothers off by giving false information, especially as first time pregnant women do tend to look up to people who are already mothers as they believe they will know better than them.

For more information about tandem feeding, check out this guest blog post that Emma Pickett (chair of the Association of Breastfeeding Mothers) wrote for us: https://www.breastfeedingnetwork.org.uk/guest-post-breastfeeding-through-pregnancy-and-beyond/

If you need support with any aspect of breastfeeding, call the National Breastfeeding Helpline on 0300 1000212 (9.30am – 9.30pm, 365 days per year) or send a private message to our team on Facebook: https://www.facebook.com/TheBreastfeedingNetworkUK/

09 Oct

“Advancing Our Health: Prevention in the 2020s” – BfN’s Response

BfN sees supporting women and families with breastfeeding as an important way to tackle some of the causes of preventable ill health in England. Here is BfN’s charity response to the Government’s Advancing Our Health: Prevention in the 2020s. Our response focuses on several themes important to the protection and promotion of breastfeeding, making a special call for early days support for all women and families. For our full response read on below. The consultation closes on 14th October so there is still time to submit an individual response. 


From Life Span to Health Span

Which health and social care policies should be reviewed to improve the health of people living in poorer communities or excluded groups?

Young, poor and less-educated women are less likely to breastfeed. This is also true of minority groups such as gypsy, traveller and Roma communities. Not breastfeeding widens the health inequalities gap for groups who already experience hardship and compromises maternal and infant health outcomes. The Healthy Start welfare food scheme needs an overhaul as eligibility has declined and it fails to catch the most vulnerable groups in society. Also, the scheme offers no breastfeeding support.

Improvements to breastfeeding support overall would make a difference, but targeted efforts to encourage and support these excluded groups to breastfeed needs investment and engagement with the voluntary sector as delivery partner as often charities have established local buy-in from communities.

More broadly, education policy doesn’t adequately address choices around infant feeding at primary or secondary level. It would be a great advantage to future generations if discussions around infant feeding could be introduced at an earlier age.

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Intelligent Health Checks

Do you have any ideas for how the NHS Health Checks programme could be improved?

Family culture and beliefs are passed through the generations within families and influence how an infant is then cared for. This includes infant feeding decisions where a family history and support network congruent with women’s infant feeding intentions has been shown to be important to women’s breastfeeding experience. This is reflected in breastfeeding rates where women who were not breastfed themselves are less likely to initiate and continue with breastfeeding. Given the importance of family infant feeding history in the initiation and duration of breastfeeding, and the limited ability of some families to provide support; it is unclear why infant feeding family history and support networks are not explored during pregnancy. There should be routine information collection on infant feeding history as part of family history data. An infant feeding genogram could be included as a time efficient tool to assist health professionals and support workers to stimulate discussions around breastfeeding and help design support interventions.

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Supporting Smokers to Quit

What ideas should the government consider to raise funds for helping people stop smoking?

Helping people to stop smoking is a fundamental part of preventative health work in the UK and should be funded by government without need for external funding. While BfN welcomes the steps the UK has taken to ban and control use of tobacco the loss of many local authority funded cessation services has been a retrograde step. We would like to see smoking cessation services be reinstated and include dedicated antenatal smoking cessation support.

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Eating a Healthy Diet

How can we do more to support mothers to breastfeed?

Women tell us they struggle to breastfeed because of pain, worries about milk supply and because there was no skilled support to help them. Women frequently report a lack of consistent information on feeding their babies given at the right time including on the safety of medication in breastmilk.

The vast majority of the issues women raise as barriers are amenable to good support and the following actions would help:

  • Develop a National Infant Feeding Strategy Board with all relevant government departments, health and third sector stakeholders driven by appropriate leadership.
  • In a national infant feeding strategy/plan include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • Implement the Unicef UK Baby Friendly Initiative across all relevant services.
  • Protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law.
  • Commission and fund universal, evidence-based breastfeeding support programmes and services delivered by peer supporters with accredited qualifications and specialist/lead midwives and health visitors.
  • Maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline.
  • Deliver universal health visiting services and the Healthy Child Programme (including the 5 mandated contacts, plus an additional review before the 10-day visit to resolve early feeding issues)
  • Establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.

We support the commitment to undertake an Infant Feeding Survey and this should build on the data previously collected in the 2010 cancelled IFS.

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How can we better support families with children aged 0 to 5 years to eat well?

One in five children are already overweight or obese before they start school. There is a wealth of evidence about the importance of breastfeeding, support for responsive bottle feeding and timing of starting solid food and the difference this can make to both child and maternal obesity levels. Recent government policy on obesity has failed to address the importance of how we feed our babies and early years nutrition. The Government should improve the legal protection and support for breastfeeding, improve availability of caregiving / parental education around introduction of solid foods and feeding responsively.

Where babies are not breastfed, given formula and commercial foods there should be strong legislation in place to regulate nutritional composition and tight regulation of labelling and marketing of commercial foods in line with Public Health recommendations and WHO Europe with implementation of WHO Code.

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Support for individuals to achieve and maintain a healthier weight

How else can we help people reach and stay at a healthier weight?

Children who are obese are likely to become obese adults. More should be done to help prevent children from becoming overweight or obese in the first place. Breastfeeding has a very significant effect on childhood obesity, with some studies indicating that breastfeeding to a year or more could reduce rates by 25-50%. Support for breastfeeding, particularly breastfeeding to 12 months or more, must be part of any obesity reduction strategy.

For some women breastfeeding makes it easier to lose weight, since additional calories are used. This can help some women to return to pre-pregnancy weight more quickly. The role that breastfeeding can play in managing maternal weight should be discussed with a health care professional or peer support worker.

The Department of Education should ensure that all young people learn about the importance of healthy body weight and good diet before and after pregnancy.  Breastfeeding as a normal human behaviour should be more thoroughly explained as part of the curriculum to remove stigma.

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Taking care of our mental health

How can we support the things that are good for mental health and prevent the things that are bad for mental health, in addition to the mental health actions in the green paper?

Up to 20% of women are affected by mental illness either during pregnancy or in the 12 months after giving birth. A woman’s risk of postnatal depression can be lowered by successful breastfeeding. On the contrary, when women who wanted to breastfeed are unable to meet their goals, their mental health can be adversely affected. Given that 8 out of 10 mothers stop breastfeeding before they wanted to, one means of safeguarding the mental health of new mothers is to improve breastfeeding support and protection. This is particularly important soon after birth. https://www.breastfeedingnetwork.org.uk/breastfeeding-ad-perinatal-mental-health/

Being born in a Unicef UK Baby Friendly accredited hospital and supported to breastfeed there has been linked to improvement in child emotional development and maternal mental health.

Data from the Millennium Cohort Study found that term children breastfed for four months or longer had lower odds of abnormal scores on a strengths and difficulties questionnaire compared with never breastfed children. There is also evidence that breastfeeding for less than 6 months compared with 6 months or more is an independent predictor of mental health problems, both internalised and externalised through childhood and into adolescence. Reviews of many studies linking breastfeeding with mental health of mothers and children can be found here https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-mental-health-and-emotional-development/.

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Sleep

We recognise that sleep deprivation (not getting enough sleep) is bad for your health in several ways. What would help people get 7 to 9 hours of sleep a night?

New parents or parents of young children will rarely get 7-9 hours’ of unbroken sleep a night. New parents should be supported to understand that normal infant sleeping patterns involve frequent night waking. New parents should be able to access advice and support to cope with lack of sleep and tiredness from their health care professional, peer supporter or maternity support worker. It is also useful to highlight that exclusively breastfeeding mothers report sleeping for longer than mothers who mix feed or formula feed as a positive effect of hormones. Therefore actions to better support and protect breastfeeding may also have benefits for sleep among new parents.

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Prevention in the NHS

Have you got examples or ideas for services or advice that could be delivered by community pharmacies to promote health?

Pharmacists have a key role to play in promoting and protecting breastfeeding in the community. Women contacting us through BfN’s Drugs in Breastmilk Service for information and support on the effects of medication on their breastfeeding tell us that pharmacists in their community lack sufficient knowledge and understanding of breastfeeding and the effects of medication on it. This means families in the community struggle to get advice on breastfeeding and how to maintain breastfeeding through illness of mother or baby. Often we see that this leads to breastfeeding ending unnecessarily or a mother denying herself medication so she can continue to breastfeed her child. See ‘A lifeline when no one else wants to give you an answer’ An evaluation of the Breastfeeding Network drugs in breastmilk service Professor Amy Brown, March 2019 https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf

Unicef’s infant feeding learning outcomes for pharmacy students set a standard for the level of knowledge and understanding that could be reasonably expected of a newly qualified pharmacist; see: https://www.unicef.org.uk/babyfriendly/accreditation/universities/learning-outcomes/learning-outcomes-pharmacy-students/. Pharmacists should also be aware of local breastfeeding support services and be able to signpost accordingly.

Worryingly, many pharmacists receive information about breastmilk substitutes (BMS) from sponsored materials provided by the BMS industry. This is a clear conflict of interest and means that advice provided by a pharmacist may be inconsistent with advice from other health workers. All pharmacists should be encouraged to work within the WHO Code of Marketing of Breastmilk Substitutes.

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What could the government do to help people live more healthily: in homes and neighbourhoods, when going somewhere, in workplaces, in communities?

Supporting women to breastfeed and for as long as they choose requires societal action and support. All too often responsibility is placed on women to breastfeed when so much more can be done in communities, work, health and education settings to support breastfeeding.

To improve community support for new and young families the Government should provide all Local Authorities with ring-fenced funding to establish, re-establish or support the development of universal Children’s Centres. These should focus on areas of deprivation, with Centres able to offer a range of support services including breastfeeding peer support. Building community support encourages breastfeeding to be more visible. This is key to changing attitudes in the UK to breastfeeding and improving all parents to feel more comfortable when out and about with their infants. Whilst the Equalities Act means that women have the right to breastfeed in public, many women remain anxious about feeding their baby outside the home. Consistent efforts are needed to normalise and support breastfeeding anywhere that a baby needs to be fed.

The Department of Education should ensure all young people, boys and girls, learn in school that breastfeeding is a normal human activity should be explained and de-stigmatised. Government should also follow initiatives in the London Food Strategy implementation plan which aim to improve breastfeeding across London, including looking at how Transport for London can better support women travelling with infants on the network.

Often returning to work or education is seen as a barrier to breastfeeding and a reason for women to stop before they want to.

The current protection for breastfeeding when a women returns to work is inadequate and the burden is placed on the individual mother to negotiate arrangements with her employer, at a time when she is feeling vulnerable and not entitled to ask for support. Explicit protections for breastfeeding protection are missing in the current legislation. Protection should also extend to provision of adequate storage for her expressed milk. Clarity through the policy on storage will be useful to women and employers alike in navigating the practical arrangements that are needed to continue breastfeeding and giving breastmilk.  

Question: What more can we do to help local authorities and NHS bodies work well together?

To ensure that women’s intentions and efforts to breastfeed are upheld and supported following initiation good breastfeeding support needs to be available at every step of a mother’s journey. As a charity that has been involved in delivering peer support services for over 20 years working in communities and also alongside health care professionals in a complimentary way we have learned that moving breastfeeding peer support services from the NHS to local authorities has not only been damaging for families accessing quality breastfeeding support but it has also damaged relationships. Many community services have been lost and an increased burden has been placed on an already struggling health visiting workforce. Supporting breastfeeding requires dedicated skills, time and patience often supporting a Mum for several hours on several occasions.

Many services funded through local authority structures are operating on reduced budgets or have been de-commissioned because of cuts. Previously, many of these services worked well because relationships with health professionals were strong and an engaged local volunteer base was supported. Going forward it is vital that breastfeeding peer support services are protected and there is a close contact between local authorities and NHS services. 

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Question: What are the top 3 things you’d like to see covered in a future strategy on sexual and reproductive health?

Just one thing from BfN’s perspective. There is good research that suggest that attitudes to infant feeding are shaped long before individuals become parents. We would like to see all children and young people learning about breastfeeding and early nutrition at school so that they have the information they need about their bodies years before they become parents. Working with school age children helps open up space to start conversations at home and help normalise breastfeeding in the wider community. To help shift attitudes and future generations to breastfeed the Department of Education should ensure all young people learn about breastfeeding as a normal human activity. This will help explain normal functions of the body and help to de-stigmatise it. The following resources are available for use in schools on breastfeeding https://www.breastfeedingnetwork.org.uk/breastfeeding-information-for-children-and-young-people/ and https://abm.me.uk/resources-for-schools/.

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01 Oct

Breastfeeding with a disability

BfN and National Breastfeeding Helpline supporter Katrona Templeton writes about the unique challenges faced by breastfeeding mothers with disabilities, and the ways that they may be supported to achieve their goals.

  • Can a mother with a thyroid problem feed?
  • Does having a colostomy bag affect feeding?
  • Does an autistic mother need different support and information than a non-autistic mother?

The answer to these questions is yes.

Hi, my name is Katrona, I am a 39 year old mother of two beautiful and very ‘lively’ daughters, aged 3 and 4.  I have been a BfN helper for around three years and recently became a helpline supporter.

I am autistic and also have epilepsy and dyslexia.  It was when I began to look for support and information about breastfeeding with these conditions that I realised that there seemed to be a gap in knowledge in this area.  There is little information when it comes to supporting people with disabilities who wish to breastfeed. 

Many mothers with disabilities and/or long term conditions face unique challenges when breastfeeding. For example:

  • Low milk supply and medication worries for thyroid problems.
  • The practicalities of feeding with a colostomy bag, does it need changing during a feed? Ensuring enough calories are consumed and absorbed by the mother for her baby and her own needs.
  • Dealing with a mother who may have read every article on breastfeeding known to mankind and can bring up obscure facts, but wants to feed even through the sensation of the baby latching and suckling makes her feel as if every inch of her skin is crawling with fire ants.

Disabilities, like mothers, come in many forms. Some difficulties are easily solved: sign posting to drugs in breast milk page; getting creative with positioning; discussing distraction techniques to bring the mother’s focus away from the feeding.

The biggest challenge faced is the resistance from health care professionals to support these mothers, with many seeing formula as the easiest option.  This may be due to time constraints, a lack of general information about how conditions can affect breastfeeding, or concern that breastfeeding will put extra pressure on a mother who, in their eyes, already has enough to cope with, with their own health.

A lot of these mothers are more resilient that they seem at first glance, willing to put up with pain, reducing or temporarily stopping some medicines, constantly dislocating shoulders to name a few.

Breastfeeding can be a lot easier for these mothers than bottle feeding. It’s a lot easier to lift a baby, feed it and go back to sleep, than getting out of bed, into a wheelchair, to kitchen, make up the bottle, feed the baby, get out of wheelchair and back to bed.

For some mothers the mechanics of making up a bottle can be daunting, the ability to even screw on the lid can be a hurdle in itself. Reading the instructions on the tin can be hard or impossible for some, as not many formula tins have Braille on them.   The anxiety of asking yourself questions like, “Have I put the right amount of formula to water in the bottle?”, “Is it too hot or too cold?”, “Has the baby had enough?”, “Is the bottle sterilised?” can be overwhelming for some mothers.

Breastfeeding can have extra advantages for some mothers and babies: staving off flares of Crohn’s disease; reducing the amount of time a baby cries helping with sensory disorders; helping the baby wean off the medication they were exposed to within the womb.

So what can be done to support these mothers and enable them to meet their breastfeeding aims? The most basic help is just listening to them, empathising with their problems, and talking through different ideas and methods to support them – from different positions, to ways of finding others with their condition who may have breastfed before and can give them tips and ideas.

Also helping them to face the reality that, in some cases, they may not be able to meet their breastfeeding goals, and may need to consider combi feeding or formula feeding. Supporting and guiding them through their decisions can be invaluable to the person concerned.

When mothers face these difficulties, breastfeeding will often give a sense of achievement for being able to do something that others thought was impossible. Empowerment from doing what they feel is right for themselves, their child and their family situation. A high percentage of these mothers will still breastfeed until the child naturally weans themselves, after fighting so hard in the first place to establish a breastfeeding relationship.

At the end of the day, mothers with disabilities or long term conditions are just like any other mother who is trying their best for their child. To be there for them, to listen to them and empathise with them is what they need. That and maybe some out of the box thinking.

Katrona runs a Facebook support group for breastfeeding mums with disabilities or long term conditions – click here if you’d like to check it out.