04 Sep

Guest Blog by Heather Trickey – What sorts of breastfeeding peer support interventions should we be developing?

Heather TrickeyHeather Trickey is a researcher in parenthood and public health at DECIPHer, Cardiff University.  Here she writes about the importance of not just implementing peer support systems for breastfeeding mothers, but, crucially, ensuring that those systems are effective and fit for purpose.  She’ll be talking in more detail on the subject at our conference on 6th October – buy your tickets here.

 

Breastfeeding peer support is considered an important intervention for supporting women with breastfeeding and is recommended by the World Health Organisation, by NICE, and by UNICEF UK. The evidence for breastfeeding peer support in a UK context is mixed, UK experimental studies have tended to show little or no impact on breastfeeding rates. As Dr Gill Thomson (UCLAN) and I have discussed, are lots of reasons why that might be, these include poor intervention design and implementation failure under experimental conditions (Thomson and Trickey, 2013; Trickey 2013).

Some lessons for peer support design

Earlier this year we published a realist review of breastfeeding peer support interventions (Trickey, Thomson, Grant et al, 2018). We identified some key lessons for design. For example, we found intervention goals need to have a good fit with the goals of mothers, that the intervention needs to be linked into existing health care systems, that help won’t reach many mothers unless it is proactive and for UK mothers it needs to come soon after the birth, that peers need to be confident and friendly for mothers to feel comfortable, that relationships need to need to be warm and affirming, that peers supporters themselves need to feel valued, and the intervention needs to enhance rather than displace existing care.

But we also need think about peer support in the bigger picture…

The UK has one of the lowest breastfeeding rates in the world, and there are big differences in rates at area level depending on level of deprivation. Our review found that we need to develop better ideas about how changes in attitudes and behaviours happen at the level of a whole community. We concluded,

“In the absence of overarching theories of change for infant feeding behaviour at community level, it is difficult for intervention planners to target breastfeeding peer support interventions to maximum benefit”.

So, what is the longer term objective for society? And what needs to happen, where, why and for whom and in what order to meet that goal? Should the focus be on encouraging getting more mothers to initiate breastfeeding, or on helping mothers to continue for as long as they want? Should interventions pay more attention to the needs of mothers using formula milk, whose babies are most at risk of infection? Should we be measuring breastfeeding rates, or should we be considering women’s experiences or changes in wider societal knowledge and attitudes as a way of measuring ‘success’?

What else do peer supporters do?

We need to get smarter at understanding how peer support interventions can contribute to delivering the kind of big community-level changes that we will need in the UK if we are to ensure that all women’s decisions are respected and supported and that women who decide to breastfeed have a better time and can meet their feeding goals. This means thinking about all the things that peer supporters do alongside helping individual mothers. We need to develop different sorts of theories and outcome measures which can underpin more holistic, community-focused interventions.

My talk for the BfN conference will draw on findings from my PhD research. This builds on the findings of our review, drawing on conversations with groups of parents, peer supporters, health professionals and policy makers to ‘think outside the box’ and consider all the different ways that peer support makes a difference. I conclude that we need to develop interventions that reflect the potential for peer supporters to enhance existing social networks, counteract inadequate existing services, advocate for services, and diffuse attitudes, knowledge and skills within their social networks.

References

Trickey, H. 2013. Peer support for breastfeeding continuation: an overview of researchPerspective – NCT’s journal on preparing parents for birth and early parenthood (21), pp. 15-20.

Thomson, G. and Trickey, H. 2013. What works for breastfeeding peer support – time to get realEuropean Medical Journal: Gynaecology and Obstetrics 2013(1), pp. 15-22.

Trickey, H.et al. 2018. A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settingsMaternal and Child Nutrition 14(1), article number: e12559. (10.1111/mcn.12559)

 

 

 

24 Aug

Guest Blog by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

24 Aug

Guest Post by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

31 Jul

BfN Statement on Channel 4 Dispatches Programme 30/07/2018 – Breastfeeding Uncovered

Dispatches presenter breastfeeding her baby

Dispatches presenter Kate Quilton

Negative cultural attitudes towards breastfeeding are common place in the UK and often this is reinforced by media messages.

However, last night’s Dispatches programme demonstrated sensitive and robust journalism on the emotive and polarised issue that is breastfeeding.

The Breastfeeding Network is a charity that supports women and families in their choice to breastfeed in a culture that often treats women negatively for pursuing an unpopular choice.

The programme highlighted the progress that science and medical experts have made in acknowledging the make-up of breastmilk and the impact breastfeeding can have on infant and maternal health. It also looked at the marketing of breastmilk substitutes and how much care has to be taken to ensure breastfeeding is not undermined in health care settings. The lack of evidence-base for formula products’ claims to resolve sleep and colic problems is clearly misleading parents, exploiting families’ tight financial budgets and failing to resolve the problem.

The programme also highlighted the shocking truth that investment in health even where the evidence-base is strong does not always follow, nor can it compete with a multi-billion pound industry that seeks to dominate the choices of parents and families. Protection and scaling up of breastfeeding can only be truly tackled where we work together to create the environment to enable women and their families to choose it.

The programme spoke directly with breastfeeding women and allowed them to voice their concerns around the lack of support for breastfeeding – an issue that BfN are all too aware of – many of our face-to-face peer support services have seen significant cuts in recent months and years, meaning many families are no longer able to access good quality peer support in their local areas.

Many women featured in the programme also spoke out about their concerns around breastfeeding in public.  Many women tell us that they worry about feeding out and about, feeling intimidated and worried about being treated negatively. The presenter Kate Quilton said she sometimes felt like a ‘social outcast’ – women tell us this all the time and that is why having peers in your community to support you is so critical for many women.

We were pleased to see the portrayal of the issues and the balanced journalism presented by Dispatches that reinforces the high quality evidence in the field of infant feeding helps us to continue to change the conversation around breastfeeding and move to its normalisation, so that more parents can feel they can choose to breastfeed.

If you are affected by any of the issues raised please contact the National Breastfeeding Helpline on 0300 100 0212 – open 9.30am-9.30pm 365 days a year.

The programme is available for 30 days on C4 catch up.  If you only do one thing to celebrate World Breastfeeding Week, please share this link with your local councillor and MP.

26 Jul

Breastfeeding and Mental Health

Wendy JonesDr Wendy Jones is the pharmacist on our Drugs in Breastmilk service, receiving around ten thousand contacts from breastfeeding mothers every year. 20% of these are queries about mental health medication.  Beth Chapman is her daughter and a Cognitive Behavioural Therapist. They will be speaking at our conference in October together on breastfeeding and mental health. Buy your tickets here.

“I am very proud to be presenting this session with my daughter Beth who is a Cognitive Behavioural Psychotherapist working within the NHS. It feels like a legacy that my passion for breastfeeding has passed to all my daughters – and my 4 grandchildren. Beth and I have spoken at conferences together before but never co-presented.

Peri natal mental health issues affect very many women, and this is apparent in the media regularly. Add in breastfeeding and worse still add in medication and you have a mass of mis-information and stress for mums trying to find their way through the maze.

One of the problems with society is that it is so easy to get caught up comparing ourselves with everyone else. How good a parent are we? Does your baby gain weight faster than mine? Is mine gaining too fast? What about sleep – shall we avoid the discussion?

When we give birth, we become hyper vigilant to dangers around our babies. It is all too easy for that to become anxiety about everything. Anxiety is horrible – it affects our thoughts, our moods and behaviours and that is where CBT (cognitive behavioural therapy) comes in. It recognises the vicious cycle and provides a way to break that. It isn’t easy, it takes time and perseverance, but it is possible.

Sometimes we need medicines to enable us to challenge the thoughts we have, be they within anxiety or the black dog of depression, the feeling that the Dementors, well known to Harry Potter fans, are nearby.

It is really sad that doctors don’t actually receive training at undergraduate level about breastfeeding and their knowledge tends to be accumulated by experience – possibly by mentors but also by personal and friend experiences. The licensing of medicines taken for any condition in a breastfeeding woman is complex and in our increasingly litigious country it is hard for them to draw the balance between the need to treat the mum and the need to keep the baby safe from the amount of drug passing through milk. I make these decisions multiple times every day and have both experience and expert databases. I also have time which they don’t in a busy surgery.

I’m not going to give away our presentation or you might not come to the conference. We don’t have all the answers, but we may have some solutions to offer and a safe forum for discussion.

See you in Birmingham

Wendy

PS 5-month-old baby Elodie will be with us!”

20 Jul

How to make public spaces more breastfeeding friendly

Aimee GrantAimee 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 PickettEmma 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.

Front+page+of+obesity report

 
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.

Loisa running for BfN‘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.