03 Jul

Guest Post: Ruth Dennison, Black Mothers and Breastfeeding

Ruth Dennison will be giving a presentation at our conference in October, entitled “Supporting black women who breastfeed”. In this guest blog, she explains why it’s so important to support women in the black community to breastfeed, and how their needs may be different to those from other ethnicities or cultures.

Everyday a mother gives birth. Everyday a mother would attempt to breastfeed her newborn.

Everyday a mother successfully breastfeeds her baby and everyday a mother struggles to breastfeed her baby.

Why is this important, because in my 12 years of supporting mothers with breastfeeding, the rates of mothers reaching out for support in the black community is very low, why is this?

Do you know breastfeeding support is more likely to be effective if it is proactive, delivered face to face and provided on an ongoing basis.

Why do black mothers feel that they are just supposed to get it right on there own or supplement with artificial milk, do you know that within the black community most expectant mothers have already been told or have told themselves that breastfeeding is not always possible and that they may need to top up their baby.  So what do they do, they buy formula milk and bottles just in case they have breastfeeding difficulties.  Black mothers, do you know this is not the best solution and definitely not your only solution.  Learning about breastfeeding antenatally is the best approach to help you get breastfeeding off to the best start.  Yes, there are many books, videos, courses and workshops to help you get off to the best start and this is needed more than ever as the black community’s health is being affected by this.

Think…..If formula milk is just as good as breast milk, there would be no need for me to write this blog, no need for breastfeeding advocates, UNICEF and WHO trying to get the world to breastfeed their babies with something which is biologically made for their babies, the most natural food for your baby.  You know, when I have spoken to some black mothers about breastfeeding, they have many reasons why to stop breastfeeding but not many reason why they want to continue breastfeeding upto and beyond 6 months as recommended.  Many black mothers offer their babies solid food from around 3-4 months (Read when experts say babies are ready for solid food: here), why is this, is it because of family and culture influences or is it because you don’t see other women who look like you breastfeeding much more than 6 weeks.  Do you feel like you will be negatively judged? Is it the lack of support, social or media pressure?  Did you want or need extra support but wasn’t sure where to go? What is your reason why?

Have you ever asked your parents what they remember about breastfeeding. There are so many different stories and 2 of the popular reasons is that they either suffered in pain and swear never to put themselves through it again or that they believe that they never had enough milk.  Just my note to you, most of the time if you feel pain and have sore nipples/breast while breastfeeding, it is very likely that your baby wasn’t latched on correctly which can cause pain and with your baby not being latched on correctly your milk supply can drop, if you mix feed your baby this can also cause your milk supply to drop.  Over 90% of women can exclusively breastfeed their babies successfully with good support, encouragement and reassurance.  Breastfeeding is a skill that mother and baby are learning together and each day won’t always be the same but one thing is that you shouldn’t have sore nipples and if you do, you should consider getting support to help you breastfeed your baby comfortable.

How much do you know about breastfeeding? It would be good to know, because when I have spoken to families about breastfeeding they are amazed with the knowledge I share with them.

These links below can give you an idea of the breastfeeding rates in Africa and the caribbean which also have details on how many babies lives can be saved with improved breastfeeding rates.
Caribbean fails to fully meet recommend standards for breastfeeding.
The Wellbeing Foundation Africa is urging all mothers to breastfeed infants exclusively until they are at least 6 months old.

To hear more from Ruth, book tickets to our conference here: http://www.breastfeedingnetwork.org.uk/conference/

This post has been reproduced from Ruth’s blog, and was originally published here:
https://www.121doula.co.uk/breastfeeding/black-mothers-and-breastfeeding/

02 Jul

Exclusive expressing: your questions answered.

Sam is a volunteer with the Association of Breastfeeding Mothers, and runs a Facebook support group for exclusively expressing mums. There is unfortunately very little information or support dedicated to this subject online, so we asked her to write a guest blog post, explaining what exclusive expressing is, and giving some helpful information and pointers.

Not many parents plan to exclusively express breastmilk. Indeed, most of us find us ourselves here, not quite sure how we got here, and often without a plan, or a certain end-date. Infant-feeding conversations tend to involve two well-mapped roads: breastfeeding or formula feeding. However, there is a slip road alongside breastfeeding, that some mums find themselves taking: exclusive expressing.  

What is exclusive expressing?

Exclusive expressing is the removal of milk from the mother’s breasts, usually with a breast pump, and feeding the milk to baby via a bottle, or more suitable method, such as nasogastric tube for premature or poorly babies.

Some mums express milk for each feed, and their routine consists of pumping, then feeding that milk to their baby. Other mums prefer to get ahead of their baby’s requirements and express to a schedule. This means they are able to warm breastmilk from their fridge, whenever baby needs feeding. Some mothers have an abundant supply, which means they can freeze extra milk. This milk can be stored for their own baby, or they may choose to donate it.

Why do mums choose to exclusively express?

Mostly, they don’t choose to!

A few will have chosen this method, researched how much time and effort is required, and concluded it is the right way to feed their baby.  However, the majority are expressing their milk because baby is unable to feed from the breast. These mums know how incredible breast milk is, and all it has to offer. Their driving force is wanting their baby to receive the amazing properties of breastmilk, even though their baby cannot nurse.

These mums are usually aware breastfeeding is not just about the milk, and many feel great sadness about not nursing and missing out on that special relationship. At the same time, they are also incredibly proud of providing breastmilk for their baby who would otherwise receive artificial milk.

Some mums are expressing whilst their baby is too small or sick to nurse, but hope to begin nursing once their baby is strong enough. Other mums may be expressing for longer-term, such as for babies with cleft lip and palates who cannot form a seal at the breast. Or some mums may be expressing for babies who continue to not latch at the breast.

What do mums exclusively expressing need to know?

  1. How milk supply is established. Removal of milk from the breasts drives milk production. See here for an excellent explanation.
    /
  2. The first few days and weeks after the birth are when prolactin receptors are switched on. This means the early days and weeks, are when the body is most responsive to building milk supply.

    Information about first feeds happening within (ideally) 1-2 hours of birth, and frequently thereafter, applies to expressing too. Hand-expressing is usually suggested for the first couple of days until the milk begins to come in, when mums may choose to start using a breast milk.
    /
  3. Your time is precious. You are a new mum with a small baby, recovering from birth. You need time to cuddle your baby, rest, sleep and recover. Using a double pump-halves the time required to express, compared to expressing one breast then the other. Breast pumps can be purchased online, hired from hospitals and children’s centres or direct from suppliers themselves for a monthly rental fee.
    /
  4. Hands-on expressing and massage help the milk flow and the breasts drain evenly and efficiently. Some mum’s find warm compresses or help too.
    /
  5. Responsive feeding and skin-to-skin are just as important for a bottle-fed baby as a nursing baby. Skin-to-skin has numerous benefits for mum and baby, and can help stimulate milk supply, even if baby cannot nurse.

    Paced bottle-feeding will help to ensure your baby takes just enough milk to fill their tummy. This means they are less likely to overfill their tummy and bring up any of your hard-earned milk.

    (See the image at the bottom of this post for more info on responsive bottle feeding.)
    /
  6. Don’t get complacent. As mentioned earlier, milk supply will ideally increase steadily within the first couple of weeks. Some mum’s will be expressing for a poorly or premature baby who only requires tiny amounts of milk. This means there could be a surplus of milk produced each day.

    A full-term, healthy baby consumes around 570-900ml with an average of 750ml per day, between 1-6 months of age. Therefore, this is good amount to keep in mind if you wish to feed your baby only breastmilk. A mum of twins will need twice this amount each day.
    /
  7. How often to express? Most sources will suggest 8-10 sessions of expressing in a 24 hour period. This could be every 3 hours round the clock.

    Or it could be more often in the day, and one longer stretch of 4-5 hours overnight, meaning you only needs to get up once in the night to express. This could be at the same time baby wakes to feed, or it could mean setting an alarm if your baby is in hospital.

    You may find 8 times isn’t quite enough to meet baby’s milk requirements. Some mums choose to ‘power pump’ which mimics cluster feeding behaviour of young babies. Power Pumping involves one full expressing session, following by several short sessions of 5-10 minutes expressing, with 10 minutes rest breaks in between.
    /
  8. How long to express? When building supply the aim is to express until the milk stops flowing, even when adding in compressions and massage. Then keep going for a few minutes longer, to ‘ask for more.’ Some mum’s like to finish off with some hand-expression.

    Your breasts are never empty, milk is continuously produced, and you will always be able to express more with your hands. Becoming familiar with your own breasts, will mean you’ll get to know when they are suitably soft and drained, and you have reached the end of your expressing session.
    /
  9. Breast storage capacity varies from woman to woman. Breasts are not storage devices, they are designed to continuously produce milk, and for this milk to be regularly removed.

    Having said that, some breasts are physically able to contain more milk at any one time, and others simply don’t have room. This is nothing to do with breast size or shape – size is all to do with fat within the breast, and fat does not produce milk!

    Once milk supply is established, typically 6 weeks plus after birth, some mums are able to lengthen the time between expressing sessions, and this minimally impacts the amount of milk they produce overall. Other mum’s find they need to continue to express very regularly to maintain their output. Breast storage capacity is further explained here – you can use this information to identify whether your own capacity is average, large or small. This link explains why all capacities can work perfectly to feed your baby.

Take-home message: exclusively expressing is not a simple option. In many ways it combines the worst of both worlds – the washing and sterilising of bottles and equipment, storage and labelling of milk, and you don’t escape the potential problems that can sometimes affect lactating breasts (sore nipples, thrush, blocked ducts and mastitis etc).

For many mums, exclusively expressing is a temporary solution, whilst they work towards feeding their baby at the breast. With the right information and support, most mums and babies will manage this transition. For others, exclusive expressing can become a way of life for months or even years. It’s a journey they likely never intended to embark on yet could end up being one of their proudest achievements. If you’re part of the breastfeeding community, please extend your welcome to these exclusively expressing mums, they are probably some of the biggest advocates of breastfeeding around.

UNICEF Baby Friendly Initiative guidelines on responsive bottle feeding.
26 Jun

Guest post: Lisa Creagh’s thoughts on Holding Time – overcoming the cultural stigma of breastfeeding.

Holding Time” is an exhibition of breastfeeding photographs by Lisa Creagh, which “offers a creative reinterpretation of our concept of Time and how this influences our experience of Motherhood generally and breastfeeding in particular.” It aims to challenge the cultural stigma attached to breastfeeding, and how motherhood can make women feel that normal rules of time and space do not apply. In this post from her blog, Lisa talks about her experience of exhibiting her project, which raised some interesting issues relating to breastfeeding and motherhood.

Lisa will be talking more about her project at our conference in October – more information and tickets here: https://www.breastfeedingnetwork.org.uk/conference/

Over the past few weeks I have been at the gallery every day. Sometimes I just sat on the beanbags and enjoyed the quiet. Other days I had others to join me: Lucila came almost every day. Many mothers came with their children. But also quite a few fathers. And others who had never had children; young women interested in the subject with their boyfriends, mothers whose babies had grown, mothers who had not breastfed, mothers who were still breastfeeding their four year old, mothers with newborns still struggling with the adjustment to motherhood.

In every case we sat or stood and held the conversation open: this is not an exhibition about how to breastfeed, or why you should breastfeed, or condemning those who do not.

I had some criticisms. For example, why no suffering women? When the cultural landscape is so empty, with so little work on this subject, what is there becomes a beacon and needs to fulfill every demand: to promote breastfeeding, to speak for those who could not breastfeed, to address the social inequalities, to represent every class. Although I had gone to some lengths to ensure the portraits were representative of a broad population of the UK, I recognised the impossibility of fulfilling such demand.

For example, it was very difficult and time consuming to recruit successful breastfeeders for the project. Those in great pain, in the early days of breastfeeding were off limits to me. I promised to represent their experience through the interviews.

I am certainly lining up interviews with women who have struggled, as I did, to breastfeed. They are closest to my heart. It is the struggle that started this. The struggle that both Lucila and I had in the first instance, to manage to feed (see Mother stories) and then, later on the struggle to understand the place of breastfeeding, both within motherhood and within society.

We hear from so many women that their struggle felt lonely, they felt abandoned. The question over why one woman would continue alone, when another went straight out to buy formula is a complex one. Some women were pressured to do so. Others were pressured to continue trying.

There is anger on both sides.

Some felt they had amazing support from the hospital, the health workers, the midwives. Others complained of poor advice: GPs failing to understand the basics, midwives advising unnecessary processes, being constantly asked if they were ‘still’ breastfeeding. Being left alone for hours after delivering their child with no advice or help, being unable to fathom an avalanche of conflicting information from different sources.

The lack of a single authoritative active voice seemed a constant. Those who struggled, either paid for a Lactation Consultant or gave in. There was nobody who had overcome their struggle alone. Everyone who had problems and eventually found their way through them had access to a trained source of help via a LC at a drop in, or by paying a LC.

The social pressures of breastfeeding and motherhood were equally expressed across the days. In particular, pressure from mother in laws, their own mother, or close family members to leave a baby to cry, to cover up more when feeding or to stop feeding before the mother or child was ready.

Pressure to stop feeding also seemed to come from GPs. Who had little awareness of the benefits of ‘full term’ breastfeeding.

Superstition around this area and sleep was rife. Women talked of their fears about babies developing excessive dependency as a result of being picked up, sleeping in the same room or being breastfed beyond six months. Women were overwhelmed with unwanted and unnecessary pointers from well meaning family, friends and strangers. Regardless of their choices they felt judged, accused and tried on an hourly basis – on the bus, at home, at the library, everywhere except for baby centred places such as play groups and get-togethers.

The prevalence of advice seemed in exact inverse proportion to the amount of accuracy, based on current research. Authors like Gina Ford came up over and over as a source of extreme anxiety and frustration. Fathers talked of their confusion at the minute by minute instructions; the bewildering threats and promises of a bad or good baby depending on their ability to follow these instructions.

At the Breastfeeding in Public workshop, Lucila and I were interested to discover that the social pressure of the immediate family and friends was far greater than the anxiety about breastfeeding in public. Most women spoke of struggling more with overcoming the taboo of breastfeeding in front of in in-laws, parents and siblings. Once this had been mastered, the act of breastfeeding in public was merely seen as a step into the unknown. Nobody had a negative story or experience about a stranger, only about family and friends.

It may be that this is peculiar to Brighton, (an overwhelmingly accepting and liberal place) but the idea of breastfeeding as taboo rang clear. Women’s struggle was largely with their kith and kin. Their experience of breastfeeding felt as though it was in opposition to social norms that they had always, otherwise obeyed. They experienced conflict around this: struggling to reconcile their certainty of the benefits of breastfeeding with the determination of others to maintain the status quo.

Education of the older generation: specifically those aged 55-75 seemed relevant. It was noted that many older women in their late seventies and eighties were extremely supportive and vocally so. We guessed these were the last of the generation who breastfed before the wholesale introduction of formula in the 1960s. For those who had children later, and who experienced the full impact of the formula take over of maternity wards in the 60s there was a sense of affront: to insist on breastfeeding, even when it was a struggle was an accusation that they had not tried hard enough, or had made the wrong choices.

Women came to the exhibition and expressed their gratitude for being shown and honoured with such beautiful pictures. They stood and looked, they sat and watched the film, then went downstairs to watch the videos. Many returned at least once. Some didn’t have time to see everything but took a card and promised to go to the website, to stay in touch, to tell their friends. The exhibition was shared widely on Facebook, by email and WhatsApp. Most women had heard about it from more than one place. Many said they had been sent details from a friend who thought they would find it interesting.

Many professionals also came. Zoe and Claire from the NHS support team in Brighton came, the Post Natal ward manager of the local hospital, a party from the NHS support team in Hampshire came along with photographer Paul Carter who has done a wonderful project with them called , ‘We do it in Public’. Many midwives came. One commented that the abstract concepts behind the work were too complex for ordinary women. Another, from Spain invited me to bring the work to their newly created birthing centre.

A GP from the GP Infant Feeding Network came to watch the videos twice. Another doctor, one of the mothers photographed, told us of discovering the inaccuracies in doctors exam questions regarding breastfeeding (how long does the who recommend breastfeeding? Answer: 1 year – the correct answer is at least two years) and we despaired at the levels of medical ignorance and absence of proper training for GPs on all aspects – not just breastfeeding but infant feeding generally and other issues such as sleep issues and weaning.

The weeks flew by quickly and were intense from start to finish. It was the first time to test out a safe space for conversation in this way. The gallery noted that the audience numbers grew during the exhibition and that the demographic was broader than usual. I was particularly struck by the draw of the work across society and professions. I revised my assumption that this was a project made for women. I realised that motherhood is a universal theme and the broad reaching ideas concerning Time and Motherhood make this work accessible to everyone.

For tickets to our conference, where Lisa will be speaking more about her work, click here: https://www.breastfeedingnetwork.org.uk/conference/

16 May

Breastfeeding and Obesity

Breastfeeding Network CEO Shereen Fisher responds to the recent press coverage on the link between breastfeeding and reduced chances of childhood obesity.

Late April saw a flurry of articles from the Guardian covering breastfeeding. It’s useful to see the media give attention to the subject but especially so when it highlights robust research alongside the very sorry state we are in when it comes to supporting women and families with breastfeeding.

The standout piece for me was the article of April 30th, ‘Breastfeeding reduces child obesity risk by up to 25%’. This article gives new evidence to the very real contribution that breastfeeding makes in reducing child obesity while at the same time supporting a wide range of improved health outcomes for women regardless of their backgrounds.

The data came from nearly 30,000 children monitored as part of the WHO Childhood Obesity Surveillance initiative (COSI). Launched in 2007, COSI is continuously being updated and now receives data from about 40 countries on children aged six to nine. But rather awkwardly not the UK. With one in five children in the UK already overweight or obese before they start school, the measures offered by the UK at 4 and 11 seem too little – too late.

In a society that struggles to accept breastfeeding as a universal norm, the contribution that independent evidence can make to help shape public opinion is powerful. However, it must be used proactively by Governments to invest in measures to protect breastfeeding and invest in the support services that enable mothers and families to carry out their choices.

We have a problem in the UK in that we fail to support a woman’s intention to breastfeed.

Here’s the story. In the UK most women start to breastfeed, (initiation rates are over 70%). However, many women reduce or stop breastfeeding in the first few days and weeks. The majority of mothers want to carry on. Many mothers say that they stopped because of lack of support – no time or skilled guidance was around to help them learn to do it. For many women who want to breastfeed but struggle to do it through lack of support this becomes a personal failure. The injustice of it is that they are being failed. The rapid drop off rates in breastfeeding represent feelings of crashing disappointment for many women who tell us they carry the pain of their breastfeeding struggles for years. Lack of timely, quality and consistent early days support leaves them ill-equipped to deal with the challenges of coping with a newborn, they then return home to struggle on in communities where breastfeeding culture varies widely and support around them may exist or not, and may not be easy to access.

We agree with Kate Brintworth, head of maternity transformation at the Royal College of Midwives, who said the study reinforced the need to put more resources into supporting women to breastfeed: “We need both more specialist breastfeeding support for women after the birth and more time for midwives to offer the support women are telling us they need. It is important that we respect a woman’s infant feeding choices, and that if a woman chooses not to breastfeed, for whatever reason, she will need to be supported in that choice.”

In the UK, obesity costs are estimated to be at least £27 billion every year and obesity is poised to overtake smoking as a key cause of cancer. It’s critical that national leaders champion for change and for investment in obesity prevention and for support services to start much earlier. However, the UK government does not have a strong track-record in addressing infant feeding as part of the obesity agenda, despite there being a wealth of evidence about the importance of it. In the childhood obesity strategy published in 2016 the top line was introducing the soft drinks industry levy.

The Breastfeeding Network would like to see the Government go further. While focus on the problem of pervasive junk food advertising at children and families is essential, we must not ignore the role of breastfeeding in contributing to improved health outcomes for children and mothers and offering protection against obesity. The positive research from WHO is another crucial building block of evidence of the health protection benefits that breastfeeding offers, and it is one that Government should not ignore.

References:

UK breastfeeding rates are low. Although 81% of mothers in the UK begin to breastfeed, by six weeks that has fallen to 24% in England, 17% in Wales and 13% in Northern Ireland, 8 in 10 women said they gave up breastfeeding before they wanted to, according to the latest data, from 2010 Infant Feeding Survey: https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

A full list of studies can be found on the Unicef Baby Friendly site here (infant health) and here (maternal health).

Contact: Shereen Fisher, Chief Executive Breastfeeding Network

08 May

This Mum Runs: Breastfeeding at the London Marathon

This is Hannah – you may recognise her from recent social media posts, after she was interviewed while running the London Marathon last month. What’s so special about that, you might wonder? Well, not many runners had scheduled stops to breastfeed their eight-month-old daughter along the way. We were blown away by Hannah’s achievement – here’s what she had to say when we caught up with her for a chat.

I have previously run marathons before, Manchester marathon I had ran 3 times. I had run London once before in 2017 and had gained a ‘good for age’ place for 2018. However, I fell pregnant and deferred my entry to 2019. Once my daughter Skye came 2 weeks late (and via emergency c-section), I felt it took me a very long time to feel myself again and have energy and a want to run – or move any faster than walking! Being a first time mum who decided to exclusively breastfeed, I found myself exhausted. I spent the first 16 weeks still feeling battered and bruised. 

But I felt like this might be only chance to run the London marathon again, as it is so very hard to get in through the ballot. 

My training was non-existent, after about 5 months I managed to walk/run 5km. I used to really enjoy running pre-baby, but did not enjoy running these very few times I went out. I was slow, it was hard. I took Skye in her pram a couple of times – it wasn’t a running specific pram but I was going sooo slowly I decided it would be okay and tried to include it whilst she was sleeping. In March I did my local park run (5km) without baby and then 2 weeks later my partner and I did a 10km run. That was the first time I ran 8km without stopping. At the beginning of April I decided I was going to do the marathon. My partner, Max, is a teacher and I said I was going to use the Easter holidays to try to run, while he was around to look after Skye. In that time I managed about 4 runs, which got me up to 10 miles the weekend before the marathon. 

On the day of the marathon, I had planned for Max to come with me to the start of the race and I was going to give Skye a feed before I went in. However, I had fed her from 6am-7am and she was asleep as I continued to get ready to leave – so I made the tricky decision to leave her at home and just meet them both at our first meeting spot. We had arranged meeting points ahead of time, at around 13.1 miles, 21 miles, and finally at the end, where I fed her before starting our journey home. I had packed Skye some food for the day – cucumber, celery, green beans and baby corn. We started weaning a couple of months ago so I thought of things she may enjoy whilst waiting for feeds.

We didn’t make any special arrangements with the stewards or race organisers ahead of time. When I reached our designated feeding spots there were an awful lot of people, it was really crowded. For my first feed I came off the race course and sat behind the crowd on a little wall. Later on, a nice marshal said I could lean against the railing of the race and I sat down on the curb and fed her there. The marshal was really nice and offered me food and drinks, as well as another member of the public who passed by and gave me some blueberries.

My tip to any other mums who are thinking about embarking on big fitness challenges would be, go for it! Get yourself a good bra that is supportive. Train when you can, don’t put any pressure on yourself. If you don’t feel like going for that run or doing that class, don’t, go later or rearrange. If you do it and you don’t enjoy it, stop. Be flexible and adaptable. 

I would definitely do the London marathon or a different marathon again. I will be shuffling my way through Hackney Half marathon in ten days, but I won’t need to feed Skye along the way, just before and after.  And then I’ll be putting my feet up for a while!

If Hannah has inspired you to get your trainers on, why not sign up for BfN’s Mums’ Milk Run? You can set your own challenge (it needn’t be a marathon, or even a run!) and any funds you raise will be used to help support breastfeeding families. The event runs throughout May – click here for more info and to register:
https://www.breastfeedingnetwork.org.uk/get-involved/fundraising/mums-milk-run/

08 May

Consensus Statement on Sustainable Funding for Public Health

We call on Government to increase investment in public health in England to prevent ill health, reduce health inequalities, and support a sustainable health and social care system.

Public health is facing a funding crisis. The NHS Five Year Forward View argues that “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health”.[i]Despite this, the Government has continued to cut the Public Health Grant year-on-year. Because of this, local authorities’ ability to provide the vital functions that prevent ill health are being severely compromised.

In the 2015 Budget, the Chancellor announced a £200 million in-year cut to the Public Health Grant, followed by a further real-terms cut averaging 3.9% each year (until 2020/21) in the 2015 Spending Review.[ii] Overall, the Public Health Grant is expecting to see a £700 million real-terms reduction  between 2014/15 and 2019/20—a fall of almost a quarter (23.5%) per person.[iii] In 2019/20, every local authority has less to spend on public health than the year before. According to analysis by the Health Foundation, almost all local authority public health services faced cuts between 2014/15 and 2019/20: for example, spending on stop smoking services and tobacco control are expected to fall by 45%; sexual health spending is expected to fall by 25% and specialist drug and alcohol services for young people is expected to be cut by over 41%.iii

Local authorities have made efficiencies through better commissioning, but cuts are nevertheless impacting frontline prevention services. As an example, research conducted by Action on Smoking and Health and Cancer Research UK shows that, following year-on-year reductions to the Public Health Grant since 2015, stop smoking services have been persistently cut across local authorities. Now, the majority (56%) of local authorities are no longer able to offer a stop smoking service to all smokers in their area.[iv]

Taking funds away from public health is a false economy. Unless we restore public health, our health and care system will remain locked in a ‘treatment’ approach, which is neither sustainable nor protects the health of the population as it should. In the UK, smoking caused an estimated 115,000 deaths in 2015,[v] whilst alcohol caused around 7,700 deaths in 2017.[vi] In England, there were around 617,000 hospital admissions where obesity was a factor in 2016/17.[vii] These preventable factors increase the risk of certain cancers, type 2 diabetes, lung and heart conditions, musculoskeletal conditions and poor mental health. Obesity alone is estimated to cost the NHS £5.1 billion every year, with wider costs estimated to be around three times this amount.[viii]

The Government must equip local authorities with adequate resources to provide vital public health functions. The Government currently plans to phase out the Public Health Grant by 2020/21, after which they propose to fund public health via a 75% business rates retention scheme. Whatever model is ultimately implemented, it must generate enough funding for local authorities to deliver their public health responsibilities, enable transparency and accountability, and be equitable so that areas with greater health needs receive proportional funding.

In her speech on 18 June 2018, the Prime Minister called for a renewed focus on the prevention of ill-health: “Whether it is cancer, heart disease, diabetes or a range of mental illnesses, we increasingly know what can be done to prevent these conditions before they develop – or how to ameliorate them when they first occur. This is not just better for our own health, a renewed focus on prevention will reduce pressures on the NHS too.”[ix]

We urge the Government to deliver on this promise by increasing investment in public health in England.

This statement is supported by:

Action on Smoking and Health

Action on Smoking and Health Wales

Age UK

Alcohol Change UK (formally Alcohol Research UK)

Alcohol Health Alliance

Association of Breastfeeding Mothers

Association of Directors of Public Health

Association for the Study of Obesity

Beat Charity

Breast Cancer Care & Breast Cancer Now

Breastfeeding Network

British Association of Sexual Health and HIV

British Heart Foundation

British HIV Association

British Liver Trust

British Lung Foundation

British Medical Association

Brook

Cancer Research UK

Centre for Mental Health

Children’s Liver Disease Foundation

CLIC Sargent

Collective Voice

County Councils Network

Dementia UK

Diabetes UK

Faculty of Sexual and Reproductive Healthcare

First Steps Nutrition Trust

FPA

Health Action Campaign

Health Equalities Group

Health Foundation

Healthy Stadia

Helping Overcome Obesity Problems

HENRY

Hope UK

Institute of Alcohol Studies

Institute of Health Visiting

IPPR

IPPR North

Jo’s Cervical Cancer Trust

Kidney Research UK

La Leche League GB

LGBT Foundation

Local Government Association

Local Government Information Unit

Localis

Macmillan Cancer Support

Mayor, Greater Manchester

Mayor of London

Mayor, Sheffield City Region

Mental Health Foundation

Mental Health Research UK

Mentor

Metro Mayor, Liverpool City Region

Mind

NAM aidsmap

National AIDS Trust

New Local Government Network

NHS Clinical Commissioners

NHS Providers

Obesity Health Alliance

Positive East

Release

Royal College of Anaesthetists

Royal College of Emergency Medicine

Royal College of General Practitioners

Royal College of Nursing

Royal College of Physicians

Royal College of Surgeons

Royal Pharmaceutical Society

Royal Society for the Prevention of Accidents

Royal Society for Public Health

SANE

School and Public Health Nurses Association

Substance Misuse Management Good Practice

Sustain

Terence Higgins Trust

UK National Kidney Federation

Versus Arthritis

World Cancer Research Fund

YoungMinds


References

[i] NHS England. Five Year Forward View.

[ii] Public Health England. Annual budget allocations 2016/17.

[iii] The Health Foundation. Briefing: Taking our health for granted – plugging the public health grant funding gap.

[iv] Action on Smoking and Health & Cancer Research UK. A changing landscape: Stop smoking services and tobacco control in England.

[v] Peto R, Lopez A, Boreham J, et al. Mortality from smoking in developed countries 1950-2010.

[vi] Office of National Statistics. Alcohol-specific deaths in the UK: registered in 2017.

[vii] NHS Digital. Statistics on Obesity, Physical Activity and Diet – England, 2019.

[viii] House of Commons Health Committee. Childhood obesity – brave and bold action. 2015.

[ix] Prime Minister’s Office. PM speech on the NHS.

26 Apr

Breastfeeding after a Caesarean Birth

Photo: Ashley Marston

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

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

About caesareans & breastfeeding: Zoë Chadderton

There are three types of C-sections:

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

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

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

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

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

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

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

~~~

Alyson & Charlie’s Story

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

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

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

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

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

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

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

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

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

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

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

25 Apr

Breastfeeding Mothers Returning to Work – Top 5 Tips

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

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

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

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

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

2. Know your rights

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

18 Apr

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

Professor Amy Brown

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

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

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

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

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

1. In the early hours and days…

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

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

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

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

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

2. For more complex cases…

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

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

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

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

More research into unexplained low milk supply and other complications.

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

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

3. From friends and family…

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

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

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

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

4. In the community…

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

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

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

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

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

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

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

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

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

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

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

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

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


10 Apr

Guest post: Breastfeeding through pregnancy and beyond

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

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

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

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

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

What does the research say?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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