25 Aug

Black Lives Matter: how the Breastfeeding Network is working to tackle racial inequality

To coincide with Black Breastfeeding Week 2021, BfN CEO Shereen Fisher gives an update on our ongoing work to tackle racial inequality.

The Black Lives Matter movement of 2020 shone a spotlight on the world of racism within UK culture and institutions, leading to worldwide protests to end racial inequality. BLM combined with shocking information coming out on the deep inequalities that exist within our maternity systems for Black and Asian Women through the MBRRACE Report, have caused many charities involved in supporting parents to think about whether our services really are meeting the needs of all parents, babies and families.

This is true for BfN and this blog seeks to state our progress against our published statement that we shared in 2020 in response to BLM and in solidarity against racism.

Here is that statement again:


Black breastfeeding matters

We stand alongside all Black mothers and families, and are willing to do anything we can to ensure mothers and babies get real change for the better.

At the heart of BfN’s values is empowerment of women, and none of us can feel empowered if we are raising our children with threat from racism.

As a charity we have always believed in social justice for mothers and babies, but often we have felt limited in what to do, in part due to our own ignorance – which is our responsibility to correct.

We hear our fellow Black mothers and families and we are committed to doing more – using our core values of empowerment, empathy and actively listening.

We are committed to learning and educating ourselves.

We will share and amplify Black women’s voices.

We are here for you.


Since we made that statement, what have we done?

Nearly a year on from publishing the statement we have already published an update on our progress against an agreed action plan (the previous update can be accessed here). So, this update you are reading is our second and we will continue to keep you apprised of our progress.

For the second year we will provide monetary support to the organisers of Black Breastfeeding Week, we will encourage peer supporters to access training organised during this week and at other times that challenges thinking and supports their skills to support all families. We will continue to promote and raise awareness of the FIVEXMORE campaign in our communications and work.

Following a listening exercise with our own peer supporters we have heard first-hand about the experience of being a peer supporter in BfN and the additional challenges for peers from Black and Asian backgrounds to feel that their experience is represented. While generally being part of the BfN family is overwhelmingly positive we can see deficiencies in some of our group dynamics and limitations in our knowledge and skills reflected in our training.

So, this has led us to review our training materials with some help from an external organisation. We were pleased to see that only a small number of changes were needed so far but we acknowledge that the adjustments to our training content and inclusion of examples will have made a big impact for peer supporters who may have not seen themselves reflected in the experience and knowledge we were conveying. A commitment to ongoing review with the right representatives will help ensure our training and approach to support reflects diverse experience.

Our goal is to be a charity that is able and committed to supporting ALL families and for ALL families to feel comfortable and safe accessing our support, training, volunteering and working for us. This is at the heart of our work and we know that we can only truly achieve it by becoming a more representative and diverse charity.

Going forward, all BfN information will be developed and reviewed by a panel reflecting the skills and lived experience of parents. We hope to have the panel set up by the end of this year.

Guided by the insights from the volunteer working group, Black, Asian and Ethnic Minority peer supporters from BfN, and colleagues from BRAP, we have mapped the areas and actions that we want to work on. This has informed our plan to roll out training for key staff and peer supporters within our network, starting with our Tutor and Supervisor group. This programme of training is ongoing and includes training of BfN Directors this summer. The training for Directors seeks to help BfN’s trustees develop a greater understanding of what it means for BfN to be anti-discriminatory in its practice and discuss the role of leaders in developing and leading an organisation that is committed to culture change.

While progress had been made to engage younger mothers with lived experience of breastfeeding on the Board as Directors, there has been a clear lack of diverse ethnic representation on our Board of Directors for some time. In November 2020 we were pleased to welcome two new board members – Ernestine Gheyoh Ndzi and Joy Hastings – and there is an ongoing commitment to ensure strong representation on the Board to support effective decision-making. Since then we have undertaken another round of recruitment and we are pleased to welcome a further 3 new Directors to the BfN Board soon, reflecting the skills and lived experience that BfN needs to govern.

In respect of our workforce and volunteers we know that BfN attracts a diverse range of candidates for jobs but we need to do more work to see if the people who get offered jobs are also representative and diverse. In July 2021 we launched our first employee survey which will provide an important benchmark to help inform planning and recruitment going forward.

We are committed to diversity and inclusion being on all agendas – wherever we meet we will actively discuss and invite feedback and learning on diversity and inclusion. This includes our Board, manager meetings and meetings of our project leads, tutors and supervisors.

Our communications team do and will continue to ensure that our values around diversity and inclusivity are publicly demonstrated.  This covers our newsletters, all social media channels, blogs, campaigns and printed materials.

Externally, we see the potential for the positive impact to come through our openness to partners and willingness to work with others. In late 2020 we joined a collaboration made up of several other organisations including Oxford Breastfeeding Support Group, ABM, GPIFN and others to build an open resource of images depicting different clinical issues of the lactating breast represented on different skin tones. The issues of a lack of diverse images have been highlighted by Nekisha Killings ( Nekisha Killings on Breast Assessment and Non-White Skin Tones | GOLD Learning 2020 Speaker – YouTube) we hope to be able to collectively support the progress and availability of ‘Spectrum’ in the near future.

What happens next?

We are committed to taking lasting and ongoing action and progressing our plans publicly. The Board approved action plan on inclusion and diversity reflects ongoing commitment and progress in this area.

We are grateful to the many peer supporters in BfN from Black, Asian and other Minority Ethnic backgrounds who took the time to talk with us about their lived experience of our support, training and volunteering. We welcome any other feedback, especially where you think we could do better. Please contact us ceo@breastfeedingnetwork.org.uk


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19 Aug

#BfNConf21 Guest Blog: 10 Things You Don’t Expect About Nursing Aversion

Zainab Yate explains the often complicated phenomenon of nursing aversion. To hear more, come along to BfN’s annual conference on Saturday 2nd October, where Zainab will be giving a talk entitled, “Help! Breastfeeding Makes Me Feel Sad, Mad and Bad.” Tickets for this virtual event are available here.


Many mothers and those who support them do not know that they can experience negative emotions associated with breastfeeding. In modern society breastfeeding is often used – problematically – to exemplify myths about motherhood and maternal love, and is bound up with ideas of what makes a ‘good mother’. In this context nursing aversion and agitation – intense, distressing feelings that are experienced by the mother during breastfeeding – can be both unexpected and hugely upsetting, particularly when women may have already overcome significant challenges in order to breastfeed. In a new book on the subject, When Breastfeeding Sucks, Zainab Yate examines what we know about this poorly understood aspect of infant feeding. Here she sets out the 10 most common misconceptions…

1. Breastfeeding mothers who experience aversion do not always want to stop breastfeeding!

Breastfeeding or Nursing Aversion (aversion) is when breastfeeding appears to trigger particular negative emotions like anger and agitation, skin-crawling sensations and an overwhelming urge to de-latch. You can also feel like a prisoner when breastfeeding or have thoughts of pushing your nursling off you and running away. Although it creates an emotional burden for mothers, and a strain on their breastfeeding relationship, mothers do not often want to ‘just stop breastfeeding’. What most of them desperately want is for aversion to go away.

2. Aversion can strike at any point in any breastfeeding mothers journey.

Whilst many in the infant feeding and mothering world knew that aversion can strike when a mother is breastfeeding while pregnant or when she is feeding an older nursling, it can actually happen at any point in a breastfeeding journey – with some mothers experiencing it at the newborn stage. Even though there is a strong argument that aversion is a natural biological trigger to start the weaning process in older nurslings, if you experience aversion and your nursling is under 12 months old, milk is their main source of nutrition so it is best to seek advice from an infant feeding specialist.

3. One reason for aversion could be oxytocin!

In some mothers, it is possible that they have a negative association to breastfeeding, whether it is due to being a survivor of previous sexual abuse, childhood trauma or simply because the start of their breastfeeding journey was very painful or challenging for many weeks, even months. I argue that these can cause a stress response due to the oxytocin, instead of loving, calming feeling it is well known for when breastfeeding. This is because oxytocin actually plays a role in stress regulation, and can cause fear and stress in negative experiences as it activates a part of the brain that intensifies the memory.

4. Some mothers self-harm in order to continue to breastfeed through aversion if they find breastfeeding painful.

This is known as the gate control method, a scientific theory that asserts the activation of nerves which do not transmit pain signals can stop or interfere with signals from pain fibres. So digging your nails into your thighs or biting down on your hand can inhibit the perception and therefore the sensation of pain in your nipple when breastfeeding. Many mothers in this predicament seem to instinctively do this. This would be a particularly severe level of aversion, as aversion can be experienced on a spectrum. If you feel like this, please seek advice from a health care professional or infant feeding specialist.

5. Aversion is different from Dysphoric Milk Ejection Reflex (D-MER)

D-MER is a medical condition that can be diagnosed in a breastfeeding mother when her letdown causes her to feel negative emotions like despair, despondency and hopelessness. It lasts a few minutes and is dissimilar to aversion as the latter can last throughout a whole feed, whether it is 2 minutes or 2 hours – like the breastfeeding-to-sleep-marathon that can happen at night. Mothers can, however, experience both, and I believe if you struggle with D-MER you are more likely to experience aversion due to the added difficulty you experience when breastfeeding.

6. Misdiagnosis can occur with aversion.

Some mothers have sought help and advice from their doctors about their aversion when breastfeeding, but because some of the symptoms of negative emotions are similar to post-natal depression, and because they have just had a baby, health care professionals had wrongly assumed they must be post-natally depressed. If you are otherwise managing fine in day to day life and your emotions, and your difficulty with breastfeeding is just when your nursling is latched, or if anti-depressants the doctor prescribed you do not help your aversion, return back to your doctor and asked for proper screening, assessment and support.

7. Weaning and stopping breastfeeding can be just as hard as carrying on!

Breastfeeding cessation can be very difficult for mothers with aversion because of compounded guilt and shame that they experience in the aftermath of their negative emotions. Even if breastfeeding mothers who experience aversion do decide to wean, many can be surprised at how difficult it is to wean, both practically (if they have a particularly boob-attached nursling), and emotionally, as mothers have to process the feelings of guilt and shame around the negative emotions, and separate that with the guilt of stopping. Understanding that aversion is actually a reasonable response to an intolerable situation, what can alleviate or lessen aversion, and what the weaning process entails can help you get through it.

8. Mothers with aversion fear they are harming their nurslings

So many mothers I support are concerned about having aversion when breastfeeding – that it will harm their nurslings because of the nature of the emotions – but there is no evidence to show this happens. Whether it is feeling stressed or angry when breastfeeding, or even weaning earlier than you or your nursling want due to severe aversion, there is no evidence to indicate there is any long term harm caused to your nursling due to this. We all know the benefits of breastfeeding both mentally and physically as there is a lot of research about this, but we must understand these facts in the context of the research. These studies and statements are about when breastfeeding is going well. With severe aversion and breastfeeding challenges, it is questionable whether all the benefits of breastfeeding and bonding remain, and we know the research shows that when breastfeeding is hard or painful mothers are actually more at risk of post-natal depression.

9. Aversion can lessen or even go away for some mothers

For mothers who figure out their triggers, make lifestyle changes, improve their sleep hygiene, eating habits or use supplements like magnesium, aversion can abate and for some, it disappears as quickly as it reared its ugly head. There is always something you can try, and accessing our free online structured support course on www.breastfeedingaversion.com, or our peer-to-peer support group ‘Aversion Sucks’ on Facebook to get tips and tricks from other mothers struggling can instantly help you deal with aversion.

10. You don’t get aversion with every nursling.

Sometimes mothers worry that because they experienced aversion with their first nursling they will automatically get it again, but this isn’t always the case. As I outline my biopsychosocial theory of the phenomenon of aversion in my book ‘When Breastfeeding Sucks’, I cover why some physiological, psychological and societal causes can mean you experience aversion. I believe forewarned is forearmed, and the second or third time around as a breastfeeding mother you know more and are more empowered to protect yourself against things that can compromise your physical and mental health and therefore to protect you against aversion.

This blog was originally published on www.breastfeedingaversion.com, and is reproduced here with the permission of the author.


Zainab Yate BSc, MSc (Medical Ethics & Law, Imperial College London, UK) is a biomedical ethicist, clinical hypnotherapist, independent researcher and campaigner. Zainab is vice-chair and named qualitative lead of a London Research Ethics Committee, with the Health Research Authority (HRA) and has a background in public health and commissioning with the National Health Service (NHS). She published the first peer-reviewed study looking specifically at breastfeeding/nursing aversion and agitation in 2017 and has published the only book on the topic with specialist publishers Pinter & Martin, London. Zainab has been a breastfeeding peer supporter with the NHS for a number of years and is the owner of the only resource site for mothers and healthcare practitioners on aversion (www.breastfeedingaversion.com), she has helped tens of thousands of women and families when breastfeeding triggers negative emotions – both Dysphoric Milk Ejection Reflex and aversion, through her advocacy, free structured support course and peer-to-peer support groups.


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17 Aug

Breastfeeding through cancer treatment: with help from the Drugs in Breastmilk Information Service

Breastfeeding peer supporter Hannah was diagnosed with bowel cancer in 2020, and was repeatedly told during treatment that she would have to stop or avoid breastfeeding. Thanks to the BfN’s Drugs in Breastmilk factsheets (as well as her own determination and self-advocacy), she was in fact able to continue safely feeding both of her children throughout. Here’s her story.

I’m Hannah. I trained as a breastfeeding peer supporter with Home Start in Sheffield in 2017 (though this centre has sadly now closed). I breastfeed both of my children (aged 4 and 1). I had come to hear about the Breastfeeding Network early on in my parenting journey – I was on various breastfeeding support forums on Facebook, and BfN’s drugs factsheets were shared a lot whenever someone had a question about breastfeeding and medicines.

In late 2020, I was diagnosed with bowel cancer after waiting 5 months on a waiting list due to the pandemic. I always thought I had bowel cancer but doctors had convinced me it was IBD. I walked into the room for my colonoscopy and said “I think it’s cancer.” The doctor replied, “That’s very unlikely at your age.” But sure enough, within a few minutes of starting the procedure, the atmosphere in the room changed. I was in agony, I knew something was wrong. I was wheeled into recovery and left on my own. I glanced at the report lying out on the table next to me, where under the findings heading, it said Colorectal cancer, 40mm. My heart sank. It’s a horrible feeling to be right all along. It was devastating as my youngest child was only 7 months old, and I feared I would have to wean her.

After that, things moved quickly. Scans confirmed the good news that it was operable and contained in the bowel, and I met with the surgeon the following week. I had to make a difficult decision to remove 80% of my colon to prevent future cancers. I used the BfN fact sheets to check that it was safe to feed after my CT scan, since staff in the CT unit had no idea what was ok for breastfeeding. At my surgeon’s appointment he mentioned I’d have to stop breastfeeding for 24 hours after surgery – thanks to the detailed factsheet on anaesthesia, I knew it was safe to feed after general anaesthetic. So I proudly stood up and told him he was wrong.

When my letter came through for admission, the anaesthetist had also written a note to say I should stop breastfeeding after surgery. I was a bit disappointed that yet another member of staff had asserted incorrect information. I printed off all the factsheets on anaesthesia and pain relief and brought them with me, so I was fully armed to defend myself when I was admitted for surgery a few weeks later. I was very lucky that I didn’t need them, as a different anaesthetist greeted me that morning, and told me it was perfectly safe to breastfeed after surgery. He discussed options for pain relief and had designed postoperative pain relief that lessened the need for morphine in my blood stream. Despite covid restrictions and worsening case numbers, the hospital kindly allowed my then 8 month old baby and husband to stay in the hospital with me. I pumped a sippy cup of milk before I went to theatre and returned 7 hours later free of cancer. Baby survived on snacks but hopped straight back on the boob as soon as I returned. I was discharged 4 days later but I was back in hospital 6 days later.

This is where the factsheets really came to my rescue. I ended up in back in hospital with extreme stomach pain and high fever. The new join in my bowel had leaked gas into my abdomen and it had caused a huge infection. I needed antibiotics. When the doctor arrived with the antibiotics, I asked if they were safe for breastfeeding, and thankfully he answered honestly “I don’t know”. I said “let’s check then”, pulled out my phone and went to the factsheet on antibiotics. We scrolled the sheet together and identified both drugs and verified within seconds they were both safe. Thus I was able to start treatment quickly.

I was discharged after a week without need for further surgery and whilst in hospital received the good news that I was stage 2 bowel cancer and chemo would not be beneficial. Unfortunately I was separated from my baby for a lot of that time, due to a covid case on the ward, where I wasn’t allowed visitors for the last 3 days. Baby survived on artificial milk and food as well as expressed milk when I was well enough to pump. She never took a bottle, but drank from sippy cups and open cups, only taking around 30ml at a time. My supply was very low when I got home, but with the help of my milk loving 4 year old and the baby, my supply returned to normal after a week or so. 

Things I learnt about breastfeeding and medical issues:

  • If a healthcare professional tells you that you can’t breastfeed due to a medicine or medical procedure, don’t just take it at face value.
  • Do your own research, and check facts from reputable sources such as the Breastfeeding Network.
  • Ask for details of exactly what medicines or substances are being used on your body, you have a right to know and to verify their safety for breastfeeding.
  • If something isn’t safe, ask what other options there are. There are always options in medicine, even if one is clearly the best one. You have a right to choose what happens to your body.
  • Doctors and healthcare professionals are experts in their field but they are not often trained in breastfeeding. Do listen to their advice on your treatment, they only want the best outcomes for you, and sometimes stopping breastfeeding for treatment is the right choice.

I am eternally grateful to the Breastfeeding Network and their factsheets. They have saved me from much worry and uncertainty around all of my treatment and surgery, enabling and empowering me to keep doing the thing that gives me the most joy in my life (breastfeeding) during an extremely traumatic time.


You can find the Drugs in Breastmilk Information Service factsheets here:
https://www.breastfeedingnetwork.org.uk/drugs-factsheets/

If the medication or treatment you need isn’t listed, or you have questions, please contact the service directly. Email druginformation@breastfeedingnetwork.org.uk, or send a private message to the Drugs in Breastmilk Facebook page, and one of our team of volunteers will be in touch.


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02 Aug

Why does academic research have an important role in protecting breastfeeding?

Anthea Tennant-Eyles, Research Lead and Breastfeeding Peer Supporter

New research published here by Cardiff University and The Breastfeeding Network highlights inequity of access to breastfeeding support for families across England and Wales, a pattern of decreased funding since 2015 across England and loss of funded peer support training across Wales. One peer supporter describes changes to local support as ‘a skeleton with all the flesh removed’.

Click here to read the full report.

This research looks at data from local authorities, CCGs, health boards, infant feeding leads, peer supporters and service-users on breastfeeding support services. The need to value breastfeeding support (including peer support) at all levels has been a key finding.

World Breastfeeding Week 2021 has a fitting theme ‘Protect Breastfeeding: a shared responsibility’.

Good practice of this has been reported. One Infant Feeding Lead describes a maintained level of funding, with BFI accreditation, a staff team to support the infant lead role and a peer support service that is ‘fully integrated and offers comprehensive very high level support across all areas of maternity and health visiting services.’

High-level investments are needed across England and Wales to ensure that there is equity of access to breastfeeding support.

One peer supporter noted, “it was different in every local authority or health board … it was a post code lottery … until after you had your baby, you didn’t really realise how much that mattered in terms of what support you would get”.

So why is academic research on breastfeeding so important?
To inform policy makers on the importance of providing dedicated breastfeeding support services to local families and that services are protected for the well-being of future generations.


This time last year, we published a joint statement with a number of other organisations, expressing our concern at the fragility of infant feeding support in the UK, exposed by the Covid-19 pandemic. Unfortunately, not a lot of progress has been made towards remedying this situation in the past year, and this new report only serves to highlight the continuing need for change. We stand by our statement and are still calling on the UK government to work towards reducing health inequalities and improving provision of adequate breastfeeding support for all. You can read our original statement here:
https://www.breastfeedingnetwork.org.uk/2020statement/


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