20 Jul

How to make public spaces more breastfeeding friendly

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

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

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

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

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

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

12 Jul

How do we help families to trust responsive feeding?

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

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

“Does he really need to feed again?”

“But you only just breastfed him!”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

17 May

BfN Position statement on APPG on Obesity report May 2018

On 15th May the All Party Parliamentary Group on Obesity launched its report on the current landscape of obesity services.

‘With overweight and obesity costs in the UK estimated to be at least 27 billion every year and recent headline news that obesity is poised to overtake smoking as a key cause of cancer it is no wonder that national leaders are championing for change’, said Shereen Fisher, CEO of Breastfeeding Network who attended the event in Parliament.

She said, ‘We agree with the report’s key recommendation that “A national obesity strategy for both adult and childhood obesity should be developed and implemented by the Government, with input from key stakeholders. This should look to strengthen existing services and replicate best practice across the country. However we were disappointed to see there is no mention of how babies are fed anywhere in the report despite recognising “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.

A full list of studies related to obesity and breastfeeding can be found on the Unicef Baby Friendly site here (infant health): https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-obesity/ and here (maternal health): https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/maternal-health-research/maternal-health-research-obesity/

The Obesity report recognises that: “There needs to be a co-ordinated, whole-system approach to the prevention of obesity at both the local and national level considering the impact of the environments in which people live, including the total household income, as well as the amount and type of food they consume.” and so there is clearly understanding that how infants and children are fed has both an immediate and long term effect on their health.
With the role of the Obesity APPG being to consider prevention through to treatment for obesity it is vital that the evidence for nutrition and the role that breastfeeding plays is considered and understood. The long awaited SACN (Scientific Advisory Committee on Nutrition) draft report ‘Feeding in the First Year of Life’ will provide important review of the evidence affecting nutrition useful for the work of the APPG on Obesity.

Last year the Government published its childhood obesity strategy. The top line in this was the soft drinks industry levy. The Breastfeeding Network would like to see the Government go further in taking action to implement the recommendations of the Obesity APPG AND include evidence and support for breastfeeding which will go a long way to support better health outcomes for women and children regardless of their backgrounds.

‘With the effects of obesity disproportionately centred on poorer children and families the important role of breastfeeding, which offers the same health and emotional benefits to all babies regardless of background, needs important attention in any future obesity strategy that cares about narrowing inequalities‘ says Shereen.

While focus on the problem of pervasive junk food advertising at children and families is important we must not ignore the role of early years nutrition from pregnancy and beyond. As a recent tweet said ‘…the problem of obesity begins long before a child is able to eat crisps’.

10 May

‘BfN helped me through some tough times’

Loisa Hayward is one of the runners in our Mum’s Milk Run. This is her story.

‘I am running the 20km Mums Milk Run virtual race for the Breastfeeding Network to help raise funds to keep this amazing and much needed organisation going.

I am a mum of a beautiful 14 month old girl who I have proudly breastfed since birth. No one told me how tough it actually was to do what is supposed to be a perfectly natural thing for your baby. There were so many times at the start of our journey that I said enough was enough and it was time to stop. But it wasn’t the choice I wanted to make, I wanted to keep going.

We had a ventouse delivery which gave my little girl pain when feeding on a particular side, which led to three initial bouts of mastitis in about 8 weeks. We also had nipple blisters, lack of confidence in feeding out in public, and poor latch (due to prematurity). It was very painful to feed at the start.

The Breastfeeding Network offered support, information and understanding. I was never coerced in to thinking bottle or breast. I was given the space and time to make my own decision and they helped me with that. They helped with positioning, techniques and with allowing me to feel compassion for myself and what I was trying to do.

Going to the group helped me feel reassured that what I was going through was normal for some women and that camaraderie got me through the hard times. What I have found so helpful is the local Facebook group which has gotten me through some very long nights, huge self-confidence issues, and all the other little bits that come up that completely throw you if you haven’t breastfed before.

The atmosphere of the group I attended was very relaxed and friendly. I remember turning up for the first time and my baby girl had a nappy explosion in her car seat; I’m a first-time mum and this sort of thing used to really throw me in to a wobble, but even this non-breastfeeding related issue was taken in its stride as just one of those things at the group, which instantly put me at ease. The volunteers were absolutely lovely, kind and empathetic.

Breastfeeding is one of the hardest things I’ve ever done and I am so happy that I made it through all of the tough early days, the endless nights, the tears and tantrums (from both mum and baby), and all of the happy bonding memories too.

The BfN were a big part in my continuation of breastfeeding my baby. I want to do something to give back to this voluntary organisation by raising some money to help them train more amazing volunteers who give that community support to all parents.

If you would like to sponsor Loisa, please visit her Just Giving page

04 May

Breastfeeding was my lifeline while struggling with PTSD

I could barely hold the funnel to my breast. My hands, swollen and numb grasped as hard as they could, my body weak, hardly had the strength I needed to do this. I lay there, on the hospital bed, the noise of the machines sending me into a trance like slumber. Slowly the small drops of precious milk appeared, glistening in the light that flooded my room, and I felt relief relax my body. I closed my eyes, this, this was my lifeline, this was what was keeping me alive.

My baby lay in neonatal, she felt like a million miles away, this was all I could do, I couldn’t walk, couldn’t hold her or care for her, but I could do this, I could give her my milk. So, while my arms ached, the pain making my fingers tremble, my ravaged and traumatised body fought to give me what I needed, I would do this for her, for me.

While on HDU and then when I was well enough to go to the postnatal wards, pumping for my daughter became my lifeline. It kept me alive, because deep down I truly believed I was dying, so I would stare at the clock and will myself to live just a few hours longer, so I could pump again and provide another feed for my baby. It became my mission, my goal to live till the next time I had to express, and it felt like the last gift that my failing body could give her. The staff tried to make me stop, telling me that with the massive blood loss and a haemoglobin of 4.1 it was pointless. They told me I would never make any milk, let alone enough to feed her just breastmilk, but I wasn’t giving up that easy. I cherished every drop that my body gave me, like it was a magical potion that would keep my baby safe. Even after I was found unconscious in my room and at the brink of death, all I could think about was I needed to live, just a little longer to express my milk, I had to do this because soon I would be gone, and this was all I could do, all I could give her of me.

Every syringe, I sent to the unit was full of love, I couldn’t be there, to tell her I loved her, but my milk was like a message in a bottle. So, I would beg for the pump and even fetch it myself. It was such a sight, me in my wheelchair trying to also wheel the pump down the ward, but I was determined nothing would stop me. Gradually as the days passed my supply increased. It felt like a victory. I would prove them all wrong, I would do this, just wait and see.

As soon as I was well enough I would wheel myself down to the neonatal unit, placing the small bottles containing my milk, in the pocket of my dressing gown next to my heart. It was like carrying the most precious jewels, bringing my baby her gift. As I watched the nurses fill up the syringe and feed it through her nasal gastric tube, my heart would beat so fast, fit to burst. I had done that, I had provided her with what she needed, no one else just me. I was giving her life, giving her what she should have had from me, had she still been inside me, had my stricken body not failed her six weeks too soon. I would not fail again. My body would come good this time and provide her what she needed. As I looked at her small and fragile in the incubator, I willed my body to hold out and to keep going.

Soon my supply was increasing, and the nurses were amazed as I kept bringing down bottles full of milk. As my baby grew stronger they asked if they could start giving bottles, so they could wean her off the NG tube, but I made it clear that I wanted to feed her from my breast. Again, I was told we would never achieve breastfeeding but that I could try her at the breast and then they would offer her a top up in a bottle. However, this wasn’t good enough for me, we would prove them wrong again, because I knew that she could get this breastfeeding lark, we just needed time.

When I held her to my breast I felt calm, and safe. The terror went away, and the fear eased.

So, after two weeks I was discharged from the ward and my mission now was to be at the unit 24/7. The staff agreed to leave in the NG tube while I was trying to establish breastfeeding so that they could top up feeds if needed. So, I basically moved in. Every moment I could, I placed my tiny baby to my breast. It was terrifying, I had no idea what I was doing, she still had wires everywhere and the machines would beep and go crazy, but slowly I found a way to hold her and she would open her tiny mouth and latch. It filled me with the most amazing feeling, to know that I was caring for my baby this way. When most of her care was out of my hands, this was something I could do.

After two nights in the chair next to her cot, the staff knew I was going nowhere and I was given the tiny room on the unit that was only big enough to contain a bed and a tiny sink, but I was so grateful. I was just about able to walk very small distances, so it meant I had a place to rest at night till I was called to her bedside. I was watched by the staff like a hawk, and she was weighed daily. Many times the staff and family suggested I be kind to myself and take it easy and add in some formula. They said she wouldn’t gain weight as fast on breastmilk and it would take longer for us to go home. But I was determined and so was my little baby. She worked so hard, and she would open her eyes and gaze at me like she was willing me on and telling me she could do this.

So, it began, my breastfeeding journey, my lifeline. When we both finally went home, 5 weeks after her birth, my baby was fully breastfeeding, to the amazement of the staff. Together we overcame a traumatic, premature birth that nearly cost us both our lives, massive blood loss that should have robbed me of my milk and transitioning to fully breastfeeding when no one said we would. Even when we got home it wasn’t easy and we battled oversupply, awful colic, mastitis and tongue tie. But together we made it; for 15 months I fed and nourished my baby and she thrived, she put on weight and despite me being told to expect her to be behind in developmental milestones, to everyone’s amazement she was instead ahead. In fact, my little girl, even though only tiny, was walking at nine months.

For me breastfeeding kept me alive. On the days I lay in hospital when I had no idea if I would make it, I lived to express for my baby. When I went home, when I was battling flashbacks and nightmares from the birth, when I was scared and worried about my baby, breastfeeding was my lifeline. When I held her to my breast I felt calm, and safe. The terror went away, and the fear eased. Close to me, she was mine, I could protect her, nothing could harm her or take her from me. My body that had failed her, was now keeping her alive once more, giving her everything she needed. It was also saving me, keeping me from losing myself to the terrors that sought to take over my mind. In the night, when I woke and heard her crying, I could run to her, take her in my arms and place her to my breast, unlike all those nights in hospital when I couldn’t be with her, couldn’t care for her.

While everyone tried to get me to stop they didn’t understand that it was a vital part of my healing from birth trauma and also that it was helping me while struggling with undiagnosed PTSD. It was so important to me, my vital connection to my baby but also helping me to cope with everything that we had been through. It was my journey that years later moved me to train with the BFN so that I could offer others the support that I didn’t receive. To help other Mums like me who wanted to breastfeed and so they too could experience the joy I had. Those early weeks were hard, and I know how much I would have valued having someone by my side to offer encouragement and hope.

I now support others who have had a traumatic birth. It’s so important that we understand how birth can impact on maternal mental health and breastfeeding. That we listen and support women in their choices giving them accurate information and support, but also that we understand the emotional side and how kindness, encouragement and just being with them can make such a difference.

For me breastfeeding was a beautiful gift. It is a gift that I cherish because it was a battle no one said we could win. But win we did, and I will forever be grateful for the fact that we achieved what was seemly impossible, given all the odds – a lifeline in the darkest of times.

Emma Sasaru

Emma is a mother to two beautiful daughters. Her passion is to improve support for women and their families that have experienced birth trauma, had a premature baby and the difficult journey of neonatal. She is also a volunteer breastfeeding supporter with BfN.

Twitter: @emmajanesas

Beyondbirthtrauma.com

Finding breastfeeding support

Getting help with breastfeeding, at the time you need it, is really important. We know the relationship between breastfeeding and mental health is a complex one. Whatever our decision is to feed our little one, and however our mental state is affected during this time, we should expect to feel supported and respected in our feeding decision, and with our mental wellbeing. We are here to offer all families independent, non judgemental support with breastfeeding for as long as they choose.

Please don’t be afraid to ask for help. BfN Registered Volunteers want to help you with breastfeeding. It is why they have done training and offer their time.
Call the National Breastfeeding Helpline on 0300 100 0212

You may not need to venture beyond your front door to get breastfeeding support. BfN Registered Breastfeeding Supporters are trained to give support and information by telephone.

Drugs in Breastmilk Information Service

For enquiries in relation to taking medication whilst breastfeeding contact our Drugs in Breastmilk team.

Find a Drop-In Group

It can be helpful to get face-to-face help with breastfeeding and to meet other breastfeeding mums. There may be a Breastfeeding Drop-In Group in your area that can help you do this (we list groups on our website where there is a BfN Registered Breastfeeding Volunteer attending). Also it can be really helpful to have someone who knows about breastfeeding to sit with you as you feed your baby. If the person helping you can be there from before you start a breastfeed until your baby has finished feeding, this is most helpful. The drop-in group can help you with this or you can ask your midwife or health visitor if they are able to do this.

Your local Infant Feeding Co-ordinator, Community Midwife or Health Visitor may have details of local support. Their contact details might be in the discharge pack you were given when you had your baby. If you live in England or Wales you can find contact details for your nearest maternity unit on the NHS Choices Website.

30 Apr

The Breastfeeding Network and Support for Mothers with Mental Health Issues

Wendy Jones is BfN’s Pharmacist for our Drugs in Breastmilk Service. Here she talks about how we support mums with mental health issues, and points to some of the research, statistics, and useful resources about maternal mental health that inform her work.

The Breastfeeding Network Drugs in Breastmilk Service has around ten thousand contacts with breastfeeding mothers annually. Some 20% of these queries relate to issues around mental health. We are passionate about supporting these mothers in accessing therapy and medication which enables them to continue to breastfeed if that is what they choose. As everyone who works within the service is a trained BfN helper or supporter we are also able to offer information on breastfeeding difficulties either on line, by using links or referring on to the National Breastfeeding Helpline.
A survey monkey questionnaire we sent out last year showed that the dilemmas for mothers fell into several categories;

• Problems with breastfeeding was making the mother anxious or depressed
• Breastfeeding was a positive part of the mother’s relationship with her baby, but she needed medication to support her mental health issues
• Mothers for whom breastfeeding was going well but whose doctors or mental health team said that they couldn’t be prescribed medication unless they stopped breastfeeding
• Situations where mothers chose not to discuss their infant feeding with their professionals to avoid expected censure or debate, and where a drug had been prescribed with the doctor unaware that the mother was breastfeeding
• Mothers who were desperate not to take medication, but were struggling with mental health issues
• Decisions made the mother to stop breastfeeding to take medication

Some of you may know that my second daughter Beth is a CBT (Cognitive Behavioural Therapy) psychotherapist working for IAPT in the NHS and through IESO; a service which is also available for online support in some areas through the NHS. It isn’t surprising that often our conversations veer towards breastfeeding and mental health (we are mutually influential!). One of the points I have taken from her is the concept of being a “Good Enough Mum”.

So many of us strive to be the perfect mum, reading lots of books, watching social media, running ourselves ragged to be at every group in order to give our children the best start. This not unsurprisingly leads to tiredness, depression and anxiety. It is something I remember doing 30 odd years ago with my babies. They must do Tumble Tots, must learn signing, must learn nursery rhymes leading to rhythm and pitch a precursor to music lessons, must learn to swim, must learn to share, must ………. Actually, what they remember now is being loved and happy. Some of the best times I spend with my grandbabies involves playing in the sand or sploshing in puddles etc.

Does social media add to the pressure and engender more depression and anxiety?
Our Drugs in Breastmilk service operates through Facebook. People can message me, and a team of other trained volunteers, and ask their medication and breastfeeding questions and we get back to them with an evidence based answer. However, the relationship between social media and mental health is a complex one. Professor Amy Brown, Associate Professor for Child Public Health at Swansea University, has shown some fascinating insights

Other research links Facebook use per se with depression

But social media can be a lifesaver in the middle of the night when you ask your trusted group for advice – or the opposite. Google searches can make you decide that you and/or your baby have some rare condition the outcome of which is terrible. Google (other search engines are available!) is not selective of evidence-based materials. If you look long enough you can find any viewpoint you want – it can reassure, and it can terrify.

Most of the contacts to the Drugs in Breastmilk service now come via social media – not just from the UK but across the world. We are continuing to develop fact sheets to answer the frequently asked questions. Nevertheless, many mums need reassurance that their personal situation is covered by the sheet be that in terms of dose, age of baby, other medications and we are happy to answer those questions. We also increasingly supply more in-depth information to healthcare professionals.

Relevant Statistics

Taken from “The costs of perinatal health problems”
• Between 10 and 20% of women develop a mental illness during pregnancy or within the first year after having a baby

• Perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

• About half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

• Suicide is a leading cause of death for women during pregnancy and in the year after giving birth.
Prevalence of mental health conditions

• Antenatal depression; 7.4% in the 1st t trimester rising to14.8% in the 3rd trimester.

• Postnatal depression. 7.4 -11.0% in the first 3 months after childbirth, 7.8 – 12.8% in the 3rd to 6th months and 8.5 -12.0% in the 6th to 9th months

• Anxiety 11.8% – 15.3% during pregnancy and 8% in the period after birth

• Psychosis (refers to bipolar disorder, schizophrenia or very severe forms of depression). 0.2%. There are some developing studies that the condition may reach another peak following weaning (unpublished data reviewed)

• Obsessive Compulsive Disorder. 2.1% during pregnancy and 2.4% during the postnatal period compared with 1.1% in the general female population suggesting that pregnancy and giving birth might trigger the onset of the condition.

• Birth Trauma (Post Traumatic Stress Disorder (PTSD) that occurs after childbirth) 1.9-9% of births

Provision of mental health services

The provision of specialised support services and in particular the availability of mother and baby units varies widely across the country. Access to CBT and other talking therapies may involve leaving the baby with another carer which may not always be possible. To deal with mental health issues isn’t easy in some areas! According to data released April 2018 by the Maternal Mental Health Alliance “24% of pregnant women and new mums in the UK still have no access to specialist perinatal mental health services”

Insights from mothers experiencing maternal mental health issues

The Boots Family Trust wrote a fascinating report on Perinatal mental health experiences of women and health professionals 2013, which gives us some perspectives from the mothers themselves.

One of the findings is that mothers may be reluctant to discuss their in depth feeling of depression and anxiety for fear that they will be judged as not good enough and have their baby removed by social services. It is actually most unlikely that this will happen but may be far more likely in fact open up other means of support.

Symptoms described vary widely as shown in this image. Recently I shared a post to Facebook
“How many of you have had a night out planned or arranged coffee with friends and suddenly the 4 walls you inhabit seem the only haven because it’s the only place you don’t have to pretend you are ok, so you cancel. Or when you are invited out you tell them how terribly sorry you are, but you’re already booked up that weekend, when you are actually just really busy holding it together in your safe box. And so, the first problem starts, all by itself. People stop asking you and the isolation that at first wasn’t true becomes your only truth”.
Several people who the outside world would see as confident and outgoing readily identified with the statement. Feeling socially anxious or in a place where you don’t want to go out is normal – let’s not stigmatise the feeling.

Mindfulness may help

Just before Christmas I was whiling away half an hour before catching a train, in a bookstore on Waterloo station. I bought a copy of “Frazzled” by Ruby Wax and devoured its contents. She felt like she was in my brain and understood ME. She is so honest about the stresses of life that crowd into our head – the buzzing in the brain which never ceases.

Tonight, I was listening to a radio 4 podcast by her and another lightbulb moment for me. “I wake up at 3 in the morning” she said, “and start doing emails frenetically, when I run out I check the spam box just in case then press refresh!” Oh, that is so what I do! She went on to say it is ok to rest, to watch a blackbird in the garden, to read poetry, to just be in the moment. I am currently trying to learn and practice the skill of mindfulness regularly. To be present in the moment, not the one which has just passed, not the one to come but just to be present at that instant. To accept thoughts but let them pass and not dwell on them.

This is a technique being more and more widely advocated for depression and anxiety. It isn’t easy as a mother to have as the wonderful story book my children loved “Five Minutes Peace” but just one minute can be enough to calm the brain, lower the adrenaline, stop the panic. I posted this guided mindfulness exercise on my own Facebook page recently which maybe some of you may find helpful. Keep going, don’t judge yourself, it isn’t a test it’s just being Mindful.

I have no financial link with any of these resources but have used and valued them myself.

Mental health and breastfeeding

Perinatal mental health issues affect many mothers. Some issues are caused by breastfeeding difficulties – the solution is to make more evidence-based, well-informed breastfeeding support available or to help mothers come to terms with why breastfeeding may not be for them in a positive, mother-centred, empathetic manner. Some issues need medical interventions which can be used during breastfeeding if the mother so wishes. Support of breastfeeding to the age of 2 years and beyond by all health professionals should be implicit. This is unlikely until breastfeeding is covered as a health promotion intervention in all undergraduate courses.

Mothers need to be listened to and their choices valued – whether that be in infant feeding choice or use of medication. Every one of us is an individual – that is what makes the human race so special, we are diverse and special.

What does the Breastfeeding Network do to support mothers with mental health issues in May 2018?

1. We have Drugs in Breastmilk fact sheets specifically written about:
• depression

• anxiety

• OCD

• Bi-polar disorder

2. We provide additional information via social media and emails about the drugs used for mental health disorders

3. We are working with other organisations to support perinatal mental health

4. We are looking at how peer breastfeeding supporters can signpost to information on mental health

5. I deliver presentations to peer supporters and professionals normalising mental health conditions and looking at the safety of the drugs used to treat these conditions during breastfeeding

6. We are always striving to make links with other organisations supporting mothers and to work with them

7. We have made links with fathers who have mental health issues after the birth of their children

This was a comment on social media recently which I hope is exactly what I strive to do “Thank you so much. You provide a wonderful service and so much more than just drug knowledge “

Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

I will be fully engaged with Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

Tuesday 1 May Facebook Live session 7.30 pm Perinatal Mental Health Partnership

Friday 4th May Facebook live session from Mama Conference Glasgow, where BfN have been nominated as breastfeeding champions and I have been nominated as individual breastfeeding champion

27 Apr

The non-runners guide to our Mum’s Milk Run 2018

The beauty of our virtual run is that you can complete it any way you like. You don’t have to run it at all if running is not your thing. To give you a bit of inspiration for our Mums Milk Run 2018, we have interviewed two of our supporters who did the Mums Milk Run a different way last year

Sukie is Vice-Chair of the BfN board, and last year did the Mums Milk Run through spinning.

I don’t like running, I’m not built to run, and I find it boring! But I’m a member of my local YMCA gym, and they do spinning classes every day, which I love. I do six of those a week. So last year, I decided to do 20 spins in a week for the Mums Milk Run.

I really wanted to be part of the Mums Milk Run because I’m the Vice-Chair of the BfN board, and the longer I’m involved with the organisation, the more I see the inequalities in breastfeeding support, and I really want to help do something about that. I did it because I know we need the funding, and we need to raise awareness.

So I decided on 20 spins in a week, because that seemed like a good challenge compared to my usual six, and I thought it was something people might give me money for. And last year was the 20^th anniversary of BfN so 20 seemed like a good amount.

The main challenge was that I couldn’t wash my gym kit quickly enough! It’s an average of three spinning classes a day. Towards the end I was wearing really unflattering mis-matched cobbled together outfits!

I felt extra fit by the end of it. My clothes started to feel loser, and I felt so good about myself, it really helped my self-esteem.

I definitely would recommend spinning to others – I think it is great fun. The music is great, there are some great instructors, and we have a laugh, it’s not too serious. And it’s a great community of all ages. There’s a couple who regularly sit next to me who are 82. They always save me the bike they know I like! I always say I see more of my spinning friends than I see of my husband!

Nina is Programme Manager for BfN and last year did part of her Mums Milk Run in Lake Windermere!

I am a keen runner, I’ve been running for a long time, and I love long distance running. I’ve done marathons and ultra-marathons. Last year I had to have a knee operation, and by the time the Mums Milk Run came around, the doctors said I could only do a short slow run – 1 mile at the most – because I had to build back up slowly. So I thought ‘OK I will do my Mums Milk run in 20 short little physio runs, getting my strength back’. I really wanted to be part of the Mums Milk Run if I could, because I’ve received so much support from BfN, and I want other people to be able to experience that support.

When all my other running friends were doing spring marathons, for me it was getting back to running after the operation. It could have been quite a lonely time for me, as running is a big part of my social life. But instead of feeling like I was missing out on all the long runs, I became part of such a lovely group of BfN ladies supporting each other through the Mums Milk Run.

That year I even swam part of the Mums Milk Run. I always enjoyed swimming before I was a runner, particularly outdoor swimming. That May I was supposed to run a marathon around Lake Windermere, but I had to defer. I still went anyway to cheer my friends on. Whilst they ran around Windermere, I went and swam the last mile of my 20 miles across the lake. As I was swimming I could see the runners running by, it was lovely, and I felt like I’d achieved something that day.

I do love outdoor swimming. It’s peaceful and calm. When you’re running you can hear other runners, chatting, pounding of footsteps, panting and grunting. In the lake it’s absolutely quiet and peaceful. I regularly just stop and float on my back, because it’s not about the swimming for me, it’s about the quiet and the beautiful views. It’s invigorating. You come out the other end and feel amazing.

Registration is still open for our Mums Milk Run 2018. If you fancy doing it, but don’t like running, why not do some exercise you do like. It all counts and every registration raises much needed funds for BfN’s work providing independent evidence-based support about breastfeeding. This is all about raising funds and having FUN, plus you will get a unique BfN medal at the end!

17 Apr

Why I do the Mums Milk Run

Ahead of the Mums Milk Run 2018, we interviewed some of our regular fundraisers to find out what they get out of doing our bi-annual 20k virtual run. Clare Farquhar is BfN’s Central Support Manager and she got into running recently. Here’s her story.

Why do you run for BfN?

I have been doing the Mums Milk Run virtual run for BfN since the first event in 2017. I used to volunteer as a breastfeeding supporter, but I find I don’t have time for that now, so this is my way of supporting BfN on top of the job I do as BfN Central Support Manager.

I think there are a lot of similarities between running and breastfeeding in terms of things that help make them successful. Being single minded, determined, not caring what others think or say (no one did say anything, but I was worried) are all factors that helped me get into running and into breastfeeding. There’s also the physical and mental health benefits, of both activities, and the sense of achievement when you reach your own goals. They’re both free, you can do them as a group or on your own, at home or out and about. Mentally, breastfeeding and running have a lot of the same challenges, so running for BfN makes so much sense to me.

How did you get started?

I’m from Newcastle, and that’s where the Great North Run starts. Every year I would see the run on TV and wish I could do it, but I never thought I could. Then one year, I don’t know why, I just thought ‘this year I’m going to do it’. That was in 2016, and I was so determined that when I didn’t get a place in the ballot, I signed up to run for a charity – I did it for Mind.

I had never run before, I always hated running at school, and wasn’t really very active at all. I’d just done a bit of netball. But I got a free training plan from the Great North Run website, which was for beginners, and I stuck to it rigidly.

The race was brilliant, and also very emotional for me. It was held on my Dad’s birthday that year, and I wasn’t to know but it ended up being his last birthday. It was held in the September and he died in the January.

I think it was my Dad that motivated me to do the Great North Run in the first place. My sister did it a long time ago, and he’d always said he was proud of her, and I wanted him to be proud of me too. When I look back on it, it’s strange that that year I was suddenly so determined to do the run. My sister did it that day too, although she was a lot faster than me, and I think he was very proud of us both when we came back with our medals.

I completed it in 3 hours and 22 minutes and I did the whole thing on a run/walk basis, which means I ran for a couple of minutes, then walked for a couple of minutes repeatedly.

Since then, running has really helped me get through the bereavement. I think it’s so good for your physical and mental health. When I go running I get to clear my head, and I don’t really think about anything else other than how I’ll get through the next half mile.

What do you like about running?

I like going running on my own, it’s time to myself, and I enjoy listening to my music while I run. Some people like running groups, but they’re not really for me. It’s the peace and quiet I like – being able to go out under my own steam and leaving the house with just a front door key and a bottle of water – it’s quite liberating!

How do you keep going when you really don’t feel like it?

It’s determination that really got me through the tough times when I first started running. I wanted to do it, and so I just did it. Initially I felt a bit self-conscious and was worried what people might think – a woman in her 40s running around, and not having the right gear. But eventually I just decided, I don’t care what other people think. I actually got a lot of support from family and friends, and still do. Occasionally someone will beep their horn at me, and I nearly always automatically assume it is someone having a laugh at my expense, only to find out later it was someone I know beeping to wish me well!

Running for charity really helps, because I get lots of encouragement from friends and family who sponsor me and that gives me added motivation to get out when I really don’t feel like it.

What are your running goals?

I recently completed my first 5k event where I ran the whole way. I was pretty slow but I did it! I’m now working on being able to run the whole way for a 10k. I’ve signed up for the Great Womens Run in Glasgow in June, which is a 10k, so the BfN virtual run will be perfect as part of my training. For me it is all about achieving my own goals and not worrying about what anyone else is doing.

03 Apr

6 Top Tips for New Mums who want to Start Running

If you’ve recently had a baby, or even not so recently, getting back into exercise once you are a mum can seem like a big hurdle. Being active is good for physical and mental health, but taking your time and waiting until you feel ready to get back to running or any other exercise you enjoy is very important.

In preparation for our Mums’ Milk Run 2018 we asked some of BfN’s volunteers for their tips on getting active after childbirth. All are mums and have taken that first step back into exercising themselves, so they speak from personal experience alongside their breastfeeding support training. Thank you, Lindsay Cook, Sally Carter, Erica Harris, and Joy Jones for your tips!

1. Take it easy at first

Don’t expect too much from yourself. Pregnancy, childbirth, and beyond put your body through a lot and it takes time to recover. Every mum is different so make sure you wait until you feel ready, some mums are keen to get back to exercising quite quickly and others find they have other priorities once their baby arrives.

Lindsay and Sally advise that walks with the pram, or whilst babywearing, will be enough for most mums in the first few months. If you want to go to an exercise class maybe try and find one where the instructor is post-natally trained so you don’t over-do things.

2. Find a good sports bra

Lindsay says “Get a proper supportive sports bra (or even two layered up), there is nothing worse than trying to run with breastfeeding boobs bouncing around!”

For most breastfeeding mums the best choice will be a non-wired sports bra to reduce the risk of mastitis. It may be worth going to a store that offers a bra-fitting service and getting yourself measured to make sure you get the best fit, and the most support for your size

3. Planning is key

For Lindsay, planning was the key to actually getting out and running: “I have 3 children, the youngest is 3, and I found it hard to get back into exercise, I think it was because I was so tired and the windows for getting exercise in are so few and far between. I recommend planning ahead to make the most of any small opportunity you may get. I always fed mine immediately before exercise to maximise the time I had”.

4. Get into the habit

Another good planning tip from Lindsay: Have some time that is yours for exercise and stick to it, once the habit is formed then it is easier to stick to it.

5. You don’t need to feel guilty

Erica says “Taking time to run (or any activity that takes you away from your baby) does not make you selfish. I think some mums can feel that somehow they are. In fact exercise provides an invaluable space to be “you”. It’s restorative and is a form of self care, which is vital for all, especially parents!”

“And you’re modelling great behaviour for your kids – both because you are keeping fit, and because you are practicing self-care”, adds Joy.

6. Express!

Feeding your baby, or expressing before you go running will make it much more comfortable.

And when you’re ready for entering your first event, take Lindsay’s advice. “Express before you take part, I have a not very fond memory of expressing in the portaloos at the start of the London Marathon…I sterilised the equipment about 5 times afterwards!”.

Mums Milk Run 2018

If you would like to start running, registration is now open for our Mums Milk Run 2018. It is a 20km virtual run challenge open to everyone, raising much needed funds for BfN’s work providing independent evidence-based support about breastfeeding.

A virtual run is a run done in your own time, you can run (or walk/cycle/swim) at your own pace and you can do the run in one go or over several smaller runs spread over the month. You can complete your virtual race at the gym on a treadmill or running round your local area and you can do it by yourself or with your family and friends. There are four Saturdays in May so you could do the 20km by going along to your local Parkrun each week. There is no time pressure, this is all about raising funds and having FUN, plus you will get a unique BfN medal at the end!

02 Mar

Our dismay at report on marketing practices of formula companies

The Breastfeeding Network was dismayed to read the recent report ‘Don’t Push It’ from Save the Children, highlighting the marketing practices of formula milk companies around the world. The report looks at mainly practices in developing countries such as the Philippines and Myanmar where formula is aggressively marketed at healthcare professionals and families, and the cost of providing formula for a baby can make up a huge proportion of a family’s income. It also looks at the danger of making up formula safely in countries with limited access to sufficient, safe and affordable water and adequate sanitation.

The problem of aggressive marketing tactics is global, and while the report shows that those in developing countries suffer most, this isn’t just an issue in those countries, but also right here in the UK. We know that the families least likely to breastfeed are those living in the most deprived communities, and that the cost of formula is excessively high. Healthy Start vouchers are available, but if families have to use them to buy formula milk, they then can’t be used to buy other, healthy foods that all the family can access. The lack of a breastfeeding culture in the most economically deprived areas of the UK means that children born in those areas are subject to some of the worst health inequalities.

Baby Milk Action produce a report ‘Look at what they’re doing in the UK’ which highlights some of the ways in which marketing and claims of infant feeding products here in the UK cause parents and healthcare professionals to be misled. Conflicting ‘advice’ from commercial sources can cause confusion and anxiety amongst new parents eager to make the best choices for their children.

The Breastfeeding Network works to support all families and aims to target that support particularly in areas that have the lowest breastfeeding rates, which often are also the most economically deprived areas. By providing independent, unbiased, evidence based information for families, they are able to make their own informed choices about how they feed their babies.

We support the recommendations in the Save the Children report but we also urge the Government to consider better regulation and enforcement of current laws in the UK, as well as providing funding for good quality support for all families to ensure optimal health for all mothers and their babies.

Independent, unbiased information on formula milk products is available on the NHS Choices website and from First Steps Nutrition.

For independent, evidence based breastfeeding support and information, call the National Breastfeeding Helpline on 0300 100 0212.