05 Aug

A little less conversation, a lot more action…

Shereen Fisher

Shereen Fisher, CEO,
The Breastfeeding Network

Just last week the Department of Health and Social Care (DHSC) together with the Cabinet Office published the long awaited Green Paper setting out proposals to tackle the causes of preventable ill health in England. It signals a new approach to public health that involves a personalised prevention model. It will mean the government, both local and national, working with the NHS to put prevention at the centre of decision-making.

In November last year, before the NHS Long Term Plan was launched, I wrote a blog that set out the case to explain why support for breastfeeding and wider infant feeding considerations are so relevant to the prevention agenda. Supporting and protecting breastfeeding is not just relevant, it’s essential for realising the NHS plan and bringing about a healthy society. With the UK holding one of the worst records for breastfeeding in the world it’s important that bold and clear action is taken. Does the prevention paper deliver on this?

The results are mixed.

On the plus side the Government’s commitment as part of the NHS long term plan to make all maternity services in England Unicef Baby Friendly accredited is a real win for parents and infant feeding in England (remember Scotland has already achieved this with strong results emerging in their breastfeeding rates). It means mothers and babies of the future will be experiencing maternity services with important cultural and clinical standards where mothers will be supported to feed their baby in a way they choose and loving relationships fostered from the start.

The paper includes an important commitment to an infant feeding survey (IFS). After the cancellation of the IFS in 2015 there has been a dangerous gap in data especially a population level survey which gives a voice for parent experience. The vision to commit to this, although presently undefined, represents an important step forward to help monitor breastfeeding rates and the breastfeeding environment.

The paper is strong on vision for mental health including a commitment to parity of esteem between mental and physical health “not just for how conditions are treated but for how they are prevented.” Specific mention of the crisis of maternal mental health would have been welcome along with the poor maternal treatment of black and ethnic minority women who experience an almost five-fold higher mortality rate compared with white women.

To round up the positives I would also add strong vision on early years emphasising importance of strong foundations, parent-infant relationships, infant feeding and development.

However, for the vision to be more than just paper talk the Government must address the public health budget with local authorities. This is where health visiting programmes and breastfeeding / infant feeding peer support programmes sit in England and cuts and reductions have been a reality impacting on available family support. What will be done about the services lost and the ones currently threatened?

In order to understand how much of the Green paper vision is achievable we have to know what will  be the future of the public health grant and be clear on local governments commitment to realise the plan.

Importantly, the Green paper and its proposals are open for consultation. The closing date for responses is 14 October 2019. The Government is asking us how can we do more to support mothers to breastfeed?

This is such an important question. By knowing what kind of support can be provided to help mothers with breastfeeding, we can help mothers to solve any problems and continue to breastfeed for as long as they want to, wherever they live. We know that stopping breastfeeding early can cause disappointment and distress for women and health problems for themselves and their infants.

The Breastfeeding Network (BfN) have over 20 years of experience supporting women and families. We know that support can come in many forms including giving reassurance, skilled help, information, and the opportunity for women to discuss problems and ask questions as needed – for us it’s about being present when everyone else has gone and you are left holding the baby.

This is what we know helps women with breastfeeding:

  • organised skilled support for mothers
  • trained volunteers, nurses, doctors working as a team to UNICEF UK BFI standards
  • face – to – face contact
  • confidential, evidence-based, independent telephone support from trained peer supporters
  • trained and supervised peer support is effective especially when contact is frequent, pro-active and sustained over several sessions, including the early days with a new baby.

In summary providing women with extra organised support helps them breastfeed their babies for longer. Breastfeeding support is more effective where it is predictable, scheduled, and includes ongoing visits with trained health professionals including midwives, nurses and doctors, or with trained volunteers.

BfN intends to publish its full response. Don’t miss your opportunity to do the same!

https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

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

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.

02 Apr

“A lifeline when no one else gives you an answer”: Evaluation of drugs in breastmilk service launched today

2nd April 2019

A new report is published today evaluating the impact of the Breastfeeding Network’s Drugs in Breastmilk Information Service. This service provides evidence based factsheets and one to one support about taking medications or having medical procedures while breastfeeding to over 10,000 parents and professionals each year.

The Drugs in Breastmilk information service was set up more than 20 years ago by the Breastfeeding Network and has been funded by the charity ever since. It was established in response to reports of many breastfeeding women receiving inconsistent or inaccurate advice from some health professionals when they were prescribed a medication or procedure. This service enables them to access the latest evidence-based information on risk, from an experienced pharmacist.

The research, led by Professor Amy Brown in the Department of Public Health, Policy and Social Sciences at Swansea University, will be presented at the All-Party Parliamentary Group for Infant Feeding and Inequalities in Westminster today. It explored the experiences of mothers, health professionals and mother supporters who had used the service.

The evaluation found that the majority of mothers who contacted the service were enquiring about every day medications and procedures, such as antidepressants or antihistamines, where there is an established evidence base that continuing to breastfeed whilst taking these medications is not harmful. Yet women had been told by their GP or pharmacist that they could not continue breastfeeding whilst taking it. On contacting the service, mothers were given the information that they could continue meaning that many had the confidence and reassurance to continue breastfeeding for longer.

Professor Amy Brown explained ‘The findings are a concern as we do not know how many women did not contact the service and stopped breastfeeding through incorrect advice from medical professionals. This service is clearly plugging a gap in the knowledge of some GPs which should urgently be tackled by considering how medical professionals are trained not only in the risks of medications and breastfeeding but also in the value of breastfeeding for many mothers. Mothers highly valued the information they were given by the service as it enabled them to continue breastfeeding and take the treatment they needed. But they also particularly valued the support and reassurance given by the service around making any decision. Mothers described how before contacting the service they often felt dismissed and that their desire to breastfeed did not matter, but after contacting the service they felt reassured and listened to for the first time, describing the service as ‘a lifeline’.

Indeed, the evaluation examined how mothers felt before and after contacting the service, highlighting a highly significant improvement in maternal wellbeing, Mothers reported they felt more informed, confident, reassured, supported and listened to after contacting the service, even if they were given the advice that they couldn’t breastfeed whilst taking a prescribed medication.  

Dr Gretel Finch, Research officer for the project noted ‘We expected to see that the service would be rated positively by those who used it but were struck by just how significant the impact was for maternal wellbeing. Even when mothers were told that they could not breastfeed and take a medication they reported feeling listened to and cared for, rather than simply being told they couldn’t breastfeed. Given what we know about the devastating impact not being able to breastfeed can have for maternal mental health, this service is playing a key role in helping alleviate that by providing women with answers and support, rather than a simple ‘no’.

The report found that for many mothers, if they had not received information from the service, they would have made the decision not to take their prescribed medication, rather than stop breastfeeding. GPs often assumed mothers would stop, but in reality, they valued breastfeeding so strongly that they would put their own health at risk in order to continue doing so.

Dr Heather Trickey, Research Fellow at the University of Cardiff School of Social Sciences explained ‘It is clear that breastfeeding women who are given incorrect information when prescribed a medication face a difficult choice. Many stated that they would decide to continue breastfeeding over taking the medication, putting their own health at risk when in fact there was usually evidence that it would not be harmful to continue breastfeeding. This is a common theme for new mothers when it comes to information about caring for their baby. Many are not given accurate information by health professionals about the real risks to them and their baby putting their physical and psychological wellbeing at risk. Women deserve the level of accurate information and support this service brings.’

The evaluation clearly shows the impact the service has and the gap that it is filling. As a result of the report the Breastfeeding Network are calling on the government to ensure that this gap is not left to a charity organisation to fund.

Shereen Fisher, Chief Executive of the Breastfeeding Network, who commissioned the evaluation, said ‘Many of the mothers who contacted the service stated that they were only able to continue to breastfeed because of the support and information they received. The service is vital for women yet we rely on funding from the charity, goodwill and fundraising appeals to provide it. Given the impact of the service upon maternal and infant health and wellbeing we are calling for the Government to reverse cuts to the Public Health Grant and to provide funding to support the continued work and expansion of the service’.

The BfN Drugs in Breastmilk Service can only continue with sufficient funding.  To donate to help keep the Drugs in Breastmilk Information service running, text BFNDIBM to 70085 to donate £3. This costs £3 plus a standard rate message. Alternatively, you can opt to give any whole amount up to £20 by texting BFNDIBM 5 to donate £5, BFNDIBM 15 to give £15.

Ends

For more information:
Felicity Lambert, BFN Comms Officer felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk
www.facebook.com/BfNDrugsinBreastmilkinformation

21 Mar

Press release: The Breastfeeding Network’s Pharmacist, Dr Wendy Jones to receive MBE at Windsor Castle on Friday 22nd March

Wendy Jones MBE, BSc, MSc, PhD, MRPharmS

One of the founding members of the Breastfeeding Network (BfN), and their resident pharmacist for over 20 years, Dr Wendy Jones, will receive an MBE at Windsor Castle this Friday.

Wendy set up the BfN Drugs in Breastmilk information service in 1997 after being asked to update a basic information pack about the safety of drugs in breast milk. Gradually the service grew and now she now leads a small team of volunteers who offer individual support to more than 10,000 families and healthcare professionals each year via email and social media. 

Commenting on the award which Wendy receives for services to mothers and babies, Shereen Fisher, CEO of the Breastfeeding Network, said:

“We are delighted with the news that Wendy is receiving this award in recognition of her work. Wendy is an inspiration to us all.  She has dedicated the last twenty years to supporting mothers and families through the drugs in breastmilk service she founded.  Day in day out, she responds to phone calls, emails and now social media messages from parents and healthcare professionals who need reliable, evidence based information about the safety of medications and treatments while breastfeeding.  The work she does allows parents to make their own informed decisions, undoubtedly saving breastfeeding journeys.”

A soon to be published evaluation of the drugs in breastmilk information service was overwhelmed by responses from mums and healthcare professionals when they were asked for their thoughts on the service. A mum of four said: “Wendy has saved me and my daughters many times over. I can honestly say I would have committed suicide after my second baby was born had it not been for her support to keep taking my meds and to keep breastfeeding.”

A consultant paediatrician in the same evaluation said: “Wendy’s information is presented in a way which is accessible to non-medical mothers to understand, but also written in a way that doctors who know little about breastfeeding will take seriously.”

On hearing about the award, Wendy said: “I couldn’t be more proud that I have been awarded an MBE as Founder of the Breastfeeding Network Drugs in Breastmilk Service for services to Mothers and Babies.  In 1995 when I wrote the first information on drugs in breastmilk I could never in a million years have imagined this happening. I followed my dreams and the opportunities given, massively supported by my family and particularly my husband Mike who gave me the opportunity to leave paid work and develop my passion.

Nothing I can do would be possible if breastfeeding advocates didn’t spread the word that you can breastfeed as normal when you take most medication or there are ways around it. So, this MBE is for all of you too for all the hard work you do in groups, on the helplines, face to face, via social media and just at the school gate or supermarket checkout. You are all amazing.

Thank you everyone for your wonderful comments. I’m treasuring them in my heart and taking inspiration from them to keep challenging and to carry on supporting mums, dads, grandmas, peer supporters and everyone to keep breastfeeding these special precious babies. I’m hoping that this is the beginning of a year when breastfeeding and its support gets the recognition it deserves and just maybe some funding as a public health issue.”

Earlier this year Wendy was also awarded a Points of Light award by the Prime Minister.

The BfN Drugs in Breastmilk Service can only continue with sufficient funding.  To donate to help keep the Drugs in Breastmilk Information service running, text BFNDIBM to 70085 to donate £3. This costs £3 plus a standard rate msg. Alternatively, you can opt to give any whole amount up to £20 by texting BFNDIBM 5 to donate £5, BFNDIBM 15 to give £15, etc.

Wendy’s story

Over the past 40 years, Community Pharmacist Dr Wendy Jones has made a huge impact on the lives of thousands of families across the UK. In this time she has helped people manage issues such as weight loss, cardiovascular disease and smoking cessation alongside her general pharmaceutical duties, but her real impact has been felt by new mothers. Wendy has dedicated her life to researching the effects of medication and medical treatments on breastfeeding mothers and their babies.

In 1997 she was one of the founder members of national charity The Breastfeeding Network, and in 1999 she set up the Drugs in Breastmilk helpline. This telephone helpline was set up in response to the number of questions the charity was receiving from breastfeeding mums about prescribed medications. At that time there was no easily accessible, reliable information for mums who had been told to stop breastfeeding in order to take certain forms of medication. Wendy has singlehandedly filled this gap.

In many cases where a mum is told to stop breastfeeding, there is no evidence to support the need for this. The mum can be left feeling she has no choice but to stop breastfeeding (even if she wants to continue), or she may choose not to take the medication prescribed. The impact of having to make a decision like this can be far reaching for some mums. In a very few cases, evidence shows the mum does need to stop breastfeeding, and then, being able to understand the reasons behind this may help the mum with this process. In most cases, the evidence shows the mum can continue breastfeeding safely and for many, to know this is possible is a huge relief.

Over the years, the service Wendy provides has grown – she now leads a small team of volunteers who offer individual support to more than 10,000 families each year via email and social media.  She is contacted by mums and families, as well as health care professionals.

She has also written more than 50 information sheets about the most common medications breastfeeding mums ask about – these infosheets cover everything from postnatal depression and anxiety to cold and cough remedies, to contraception, hayfever, headlice and norovirus.

She was awarded a PhD in 2000 and has written several books on this topic, as well as speaking at numerous national and international conferences, study days and other events.

She is extremely well known and highly regarded by breastfeeding supporters across the world. Her knowledge, patience, understanding and support has been felt and appreciated by thousands of families.

With her unending, selfless commitment and passion Wendy is an inspiration to many. Her work is so far reaching, it is impossible to measure the difference she has made.

Ends

Notes to editors:

For more information:
Contact Felicity Lambert, BFN Comms Officer
felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk
https://www.facebook.com/BfNDrugsinBreastmilkinformation

09 Jan

Dr Wendy Jones, The Breastfeeding Network’s pharmacist, awarded MBE in Queen’s New Year’s Honours List

One of the founding members of the Breastfeeding Network (BfN), and our resident Pharmacist for over 20 years, Dr Wendy Jones, has been awarded MBE in Queen’s New Year’s Honours List for 2019.

Wendy set up the BfN drugs in breastmilk information service in 1997 after being asked to update an information pack about the safety of drugs in breast milk. Gradually the service grew and now she now leads a small team of volunteers who offer individual support to more than 10,000 families and healthcare professionals each year via email and social media.

Commenting on the award which Wendy receives for services to mothers and babies, Shereen Fisher, CEO of the Breastfeeding Network, said:

“We are delighted with the news that Wendy is receiving this award in recognition of her work. Wendy is an inspiration to us all.  She has dedicated the last twenty years to supporting mothers and families through the drugs in breastmilk service she founded.  Day in day out, she responds to phone calls, emails and now social media messages from parents and healthcare professionals who need reliable, evidence based information about the safety of medications and treatments while breastfeeding.  The work she does allows parents to make their own informed decisions and has undoubtedly saved lives.”

A soon to be published evaluation of the drugs in breastmilk information service was overwhelmed by responses from mums and healthcare professionals when they were asked for their thoughts on the service. A mum of four said: “Wendy has saved me and my daughters many times over. I can honestly say I would have committed suicide after my second baby was born had it not been for her support to keep taking my meds and to keep breastfeeding.”

A consultant paediatrician said: “Wendy’s information is presented in a way which is accessible to non-medical mothers to understand, but also written in a way that doctors who know little about breastfeeding will take seriously.”

Wendy said: “I couldn’t be more proud than I am today that I have been awarded an MBE in the New Year’s Honours List as Founder of the Breastfeeding Network Drugs in Breastmilk Service for services to Mothers and Babies.

“In 1995 when I wrote the first information on drugs in breastmilk I could never in a million years have imagined this happening. I followed my dreams and the opportunities given, massively supported by my family and particularly my husband Mike [pictured above with Wendy] who gave me the opportunity to leave paid work and develop my passion.

“Nothing I can do would be possible if breastfeeding advocates didn’t spread the word that you can breastfeed as normal when you take most medication or there are ways around it. So, this MBE is for all of you too for all the hard work you do in groups, on the helplines, face to face, via social media and just at the school gate or supermarket checkout. You are all amazing.

“Thank you everyone for your wonderful comments today. I’m treasuring them in my heart and taking inspiration from them to keep challenging and to carry on supporting mums, dads, grandmas, peer supporters and everyone to keep breastfeeding these special precious babies. I’m hoping that this is the beginning of a year when breastfeeding and its support gets the recognition it deserves and just maybe some funding as a public health issue.”

Earlier this year Wendy was also awarded a Points of Light award by the Prime Minister.

Wendy’s story

Over the past 40 years, Community Pharmacist Dr Wendy Jones has made a huge impact on the lives of thousands of families across the UK. In this time she has helped people manage issues such as weight loss, cardiovascular disease and smoking cessation alongside her general pharmaceutical duties, but her real impact has been felt by new mothers. Wendy has dedicated her life to researching the effects of medication and medical treatments on breastfeeding mothers and their babies.

In 1997 she was one of the founder members of The Breastfeeding Network, and in 1999 she set up the Drugs in Breastmilk helpline. This telephone helpline was set up in response to the number of questions the charity was receiving from breastfeeding mums about prescribed medications. At that time there was no easily accessible, reliable information for mums who had been told to stop breastfeeding in order to take certain forms of medication. Wendy has single-handedly filled this gap.

In many cases where a mum is told to stop breastfeeding, there is no evidence to support the need for this. The mum can be left feeling she has no choice but to stop breastfeeding (even if she wants to continue), or she may choose not to take the medication prescribed. The impact of having to make a decision like this can be far reaching for some mums. In a very few cases, evidence shows the mum does need to stop breastfeeding, and then, being able to understand the reasons behind this may help the mum with this process. In most cases, the evidence shows the mum can continue breastfeeding safely and for many, to know this is possible is a huge relief.

Over the years, the service Wendy provides has grown – she now leads a small team of volunteers who offer individual support to more than 10,000 families each year via email and social media.  She is contacted by mums and families, as well as health care professionals.

She has also written more than 50 information sheets about the most common medications breastfeeding mums ask about – these infosheets cover everything from postnatal depression and anxiety to cold and cough remedies, to contraception, hayfever, headlice and norovirus.

She was awarded a PhD in 2000 and has written several books on this topic, as well as speaking at numerous national and international conferences, study days and other events.

She is extremely well known and highly regarded by breastfeeding supporters across the world. Her knowledge, patience, understanding and support has been felt and appreciated by thousands of families.

With her unending, selfless commitment and passion Wendy is an inspiration to many. Her work is so far reaching, it is impossible to measure the difference she has made.

 

For more information/press enquiries:
Contact Felicity Lambert, BfN Comms Officer felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

https://www.facebook.com/BfNDrugsinBreastmilkinformation/

14 Nov

MBRRACE-UK Report, “Saving Lives, Improving Mothers’ Care” – BfN Response

Shereen Fisher, BfN CEO

MBRRACE–UK released their 5th report ‘Saving Lives, Improving Mothers’ Care’. It describes the lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity from 2014-2016. Here’s The Breastfeeding Network’s response. 

The Breastfeeding Network (BfN) welcomes the report. While the research has found that the number of women dying as a consequence of complications during or after

Wendy Jones

Wendy Jones, lead pharmacist, BfN Drugs in Breastmilk service

pregnancy remains low in the UK – with fewer than 10 out of every 100,000 pregnant women dying in pregnancy or around childbirth, the report highlights the unacceptable disparity in care for black and ethnic minority women. Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘The almost five-fold higher mortality rate amongst black women compared with white women requires urgent explanation and action. BfN welcome further exploration into this unacceptable disparity to ensure there is real change for black and ethnic minority women’.

A key concern, is the tragic case of a mother dying several weeks after her baby was born (Commencing treatment, dose and compliance page 39). There were delays in prescribing thromboprophylaxis because of concerns over  breastfeeding.

Dr Wendy Jones, lead pharmacist for the BfN Drugs in Breastmilk Information service, said ‘I have long feared such a scenario.  Physicians need to be aware how to check that a drug treatment is compatible with breastfeeding quickly, using evidence-based sources. The drugs in this case are widely used in the immediate postnatal period yet emergency medicine teams are often unable to access readily available evidence-based information on medication and breastfeeding as quickly as they need. The information should have been readily available in guidelines or a reference source including specialist information. The wording of the BNF: “Due to the relatively high molecular weight and inactivation in the gastro-intestinal tract, passage into breast-milk and absorption by the nursing infant are likely to be negligible, however manufacturers advise avoid” needs to be updated where the manufacturer is merely not taking responsibility in licensing the product. The removal of the words “manufacturer advises avoid” makes the information read very differently to a busy practitioner’.

Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘This sad case highlights the need for mothers to be able to access skilled support in their local communities, with staff alert for symptoms needing attention; the mother in question had multiple ‘fainting’ episodes postnatally that were not investigated until day 44. This emphasises the need for health care professionals in all front-line services to understand how to treat pregnant and breastfeeding mothers – until this happens women will continue to be exposed to risk and potentially loss of life. It feels that no-one listened to the mother or observed her and her baby as a dyad as closely as they should have done, possibly because breastfeeding was seen as a barrier to medication. Women should not be disadvantaged in the management of acute illness just because they are pregnant or breastfeeding, and communication needs to be improved throughout the multidisciplinary team.’

To read more you can download the full report, lay summary and the infographic here: https://www.npeu.ox.ac.uk/mbrrace-uk/reports

06 Nov

Prevention is better than cure

Shereen Fisher, BfN’s CEO, responds to Health and Social Care Secretary Matt Hancock’s vision for prevention released yesterday, and how it relates to investment in breastfeeding support.

The future of health in the UK is dependent on us all getting really serious about prevention[1]. Currently the NHS spends £1 in every £5 on health problems that are a direct result of our lifestyle such as obesity and poor diet[2]. We are told that not only will prevention help reduce the strain on the NHS but it will also improve all our health.

Getting serious about prevention must include getting serious about community level investment to enable all mothers who choose to breastfeed to do so, given the substantial evidence that links breastfeeding with improved health.

The Lancet[3] series on breastfeeding offers the most comprehensive review of all the evidence on breastfeeding to date and highlights breastfeeding’s role in the UK prevention agenda.

The authors state: “…how important breastfeeding is for all women and children, irrespective of where they live … Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media [ear infections]. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancers and diabetes [Type 2] in mothers.”

Importantly UK women and babies offer policy and health leaders an attractive opportunity. While breastfeeding rates in the UK are the lowest in the world the rates of initiation – women starting to breastfeed – have been increasing for the last 20 years (81%)[4].

Scotland’s infant feeding statistics[5] (November 2018) show signs of positive change – no happy accident but consequence of national leadership, strategic planning, partnership and sustained investment.

Women’s intention to breastfeed offers an important opportunity for health and wellbeing both for babies (next generation) and women themselves. However, individual will has to be met with support that effectively improves a mother’s breastfeeding experience and helps sustain her choice to breastfeed. Peer support can make a big difference here especially as over time it offers the chance for areas to recreate a culture where breastfeeding is familiar.  We also know that choice isn’t made in a vacuum but is heavily influenced by family members, hospital care, health care professional advice and societal views. Patient empowerment is an important theme in the vision of healthcare for the future yet women feel constantly disempowered in their efforts to breastfeed through the lack of support available to them.

With the NHS celebrating a landmark anniversary alongside £20 billion a year in extra cash now announced[6] NHS leaders will be putting forward a 10-year plan that will make crucial decisions about how the service will spend the money.

In the planning no doubt demands will be high, as cancer survival rates, mental health support, health inequalities and an aging population all vie for consideration, how should we use the government’s cash boost to tackle the priorities that matter most to us?

In the debate let’s remember the substantial benefits to health in breastfeeding for mother and baby as well as the sheer economic and environmental sense that breastfeeding makes.

In 2012 UNICEF UK[7] reported that just a moderate increase in breastfeeding rates could save the NHS millions. In 2016 the Lancet[8] series calculated that the overall savings would actually be in the order of billions, not millions, of pounds. Moreover, the measures required to support breastfeeding are relatively inexpensive and soon pay for themselves. Keith Hansen of the World Bank said …

“In sheer, raw bottom-line economic terms, breastfeeding may be the single best investment a country can make.[9]

The potential savings into the billions are important here because we all know that the cash boost being offered by government to the NHS and social care isn’t going to be enough. While the additional £20 billion a year (in five years) has already been welcomed, the Kings Fund has pointed out, that this does not come close to the amount required to improve services after years of underfunding[10]. On social care, the budget announcements will not be able to undo the cuts in services and underfunding of local government that has already occurred. These cuts that have caused losses to breastfeeding support services, many of which are located in areas of low breastfeeding rates and run by volunteers and supported by charities[11].

Knowing how the money works to support breastfeeding is essential and it is currently hard to know this in England. What we do know is that funding for community-led breastfeeding peer support has been cut because it sits within a shrinking public health budget devolved to local authorities. Despite excellent evidence-based commissioning guidance on infant feeding for local authorities[12] breastfeeding support services in communities is entirely optional.

This has led to mothers who choose to breastfeed being unable to access local services and leaves them failed and let down. This is just too precarious a situation for a public health priority as important as breastfeeding that if better funded and supported could serve us well in the prevention of infant mortality, obesity, type 2 diabetes, ovarian and breast cancer ….

If we are going to get serious about prevention in health then there needs to be a clear strategy and leadership for breastfeeding. Government’s role is key here in taking responsibility for building an environment that promotes, protects and supports breastfeeding[13], not just for the next year but for the next 20 years.

This should include at a minimum the following very important steps many of which are recommended by National Institute for Clinical Excellence:

  • Appoint a national multidisciplinary infant feeding board or committee with strong leadership to ensure evidence on infant feeding is understood and enshrined in policy
  • Ensure that Baby Friendly accreditation becomes a minimum requirement for all maternity settings (achieved in Scotland and Northern Ireland) (NICE recommended)
  • Ensure that all mothers regardless of where they live, receive skilled evidence-based breastfeeding support, making this provision a mandatory responsibility by protecting the public health budget that protects health visiting and breastfeeding peer support workers (NICE recommended)
  • Protect all families from aggressive marketing of formula companies by enacting into UK law the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions (NICE recommended).
  • Require employers to provide breaks to breastfeeding mothers to allow them to breastfeed or express milk at work.

With careful, long term thinking and action the prevention agenda offers great focus to help us plan the health and wellbeing of the UK for the future. The health of women and babies will be stronger still for joined-up planning and provision of quality breastfeeding support. Let us not forget all our responsibilities in supporting breastfeeding and ensuring that its role in the prevention agenda is fully acknowledged.

 

 Footnotes:
[1] https://publichealthmatters.blog.gov.uk/2018/11/05/matt-hancock-my-vision-for-prevention/

[2] Anita Charlesworth, Chief Economist, The Health Foundation interviewed for Healthy Visions BBC Podcast / https://www.health.org.uk/Running-to-stand-still-why-20-5bn-is-a-lot-but-not-enough

[3] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (30 January 2016), Victora, CG et al, The Lancet Volume 387, Issue 10017, 475-490 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

[4] Infant Feeding Survey 2010 (2012), Fiona McAndrew et al, Health and Social Care Information Centre https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

[5] Scottish Government Infant Feeding Statistics 2017/18 http://www.isdscotland.org/Health-Topics/Child-Health/Publications/index.asp#2275

[6] NHS funding: Theresa May unveils £20bn boost https://www.bbc.co.uk/news/health-44495598 17/06/18

[7] Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK (October 2012), Renfrew, M et al, Unicef UK https://www.unicef.org.uk/babyfriendly/about/preventing-disease-and-saving-resources/

[8] Why invest, and what it will take to improve breastfeeding practices/ (30 January 2016), Nigel C Rollins et al, The Lancet Volume 387, No. 10017, 491-504 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext

[9] The Power of Nutrition and the Power of Breastfeeding (2015), Keith Hansen, Breastfeeding Medicine, Volume 10, Number 8

[10] The Kings Fund, NHS Funding: What we know, what we don’t know and what comes next https://www.kingsfund.org.uk/blog/2018/06/nhs-funding-what-we-know

[11] Open Letter on the crisis in UK breastfeeding https://ukbreastfeeding.org/open-letter/

[12] https://www.gov.uk/government/publications/infant-feeding-commissioning-services

[13] https://www.unicef.org.uk/babyfriendly/about/call-to-action/

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’.

02 Mar

Our dismay at report on marketing practices of formula companies

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

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

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

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

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

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

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