06 Nov

Guest Blog: Shared Parental Leave & Breastfeeding

Dr Ernestine Gheyoh Ndzi

As part of our #MakingItWork campaign, this guest blog by Dr Ernestine Gheyoh Ndzi (York St John University) explores the impact that shared parental leave can have on breastfeeding.

Introduction

The reduction of maternity leave by way of shared parental leave raises the question of what impact it could have on breastfeeding. The WHO recommends two years breastfeeding with exclusive breastfeeding for the first 6 months of the baby’s life. Since the introduction of shared parental leave, the uptake has been low (2%), and the question is whether breastfeeding could be one of the reasons for the low uptake.

I am a mother of two, I breastfed my first daughter for 10 months and stopped because she just wouldn’t take it anymore. I felt bad because I wanted to be able to breastfeed for longer. I breastfed my second daughter for 15months. The bond and the emotional attachment to the baby when breastfeeding could not be the same if I had to bottle feed. Breastfeeding my first daughter was so hard at the beginning because I was very ill after giving birth, but the support my husband gave me helped me to carry on. I recognise the importance of breastfeeding and I recognise the importance of dads being there to support the mother and bond with the baby (which was what happened in my case). I was super excited when shared parental leave was introduced but questioning how it might impact on breastfeeding. I then set how to investigate which I here present the key findings.

The research was conducted through an online survey to investigate the impact of shared parental leave on breastfeeding. The survey was restricted to mothers who were pregnant or had babies after the 5th of April 2015 (when shared parental leave started). The survey was designed to collect qualitative data on mother’s experience and opinion on shared parental leave and breastfeeding. The survey retained 460 responses with rich qualitative data.

Key findings:

  • 95% of the mothers agreed that breastfeeding was the preferred choice for young babies and were aware of the benefits
  • 72.7% breastfed or planned to breastfeed for 49 weeks which is still less than the recommended two years by the WHO.
  • 96.1% of the mothers breastfed their babies on demand in the first 6 months.
  • 88.5% of the mothers knew what shared parental leave was
  • 17.2% had heard of shared parental leave from their employers
  • 59.7% said they had a workplace policy on shared parental leave
  • 43.6% of the mothers felt they would have to stop breastfeeding if they took shared parental leave.
  • 24.9% of the mothers took shared parental leave
  • 57.4% of the mothers were happy to express breastmilk at work
  • 42.6% of the mothers said they were not happy to express
  • 34% of the mothers said they were supported in the workplace to breastfeed
  • 48.9% of the mothers were not provided with any resources at work to encourage breastfeeding.
  • 47% said they were provided with a private room and sockets but no fridge

Key themes:

  • Most employers are not supporting breastfeeding mothers at work. Consequently, some mothers stop breastfeeding after returning to work.
  • Mothers who are not happy to express breastmilk will not take shared parental leave
  • Mothers who are happy to express breastmilk at work would take shared parental leave if the employer is supportive of breastfeeding at work.
  • Some mothers thought that shared parental leave and breastfeeding had no impact on each other. However, the thoughts were slightly limited to the first six months because most of the mothers (85.6%) were on maternity leave for at least the first six months and breastfed their babies exclusively in the first six months as recommended by WHO.
  • Most of the mothers who took shared parental leave or went back to work after 6 months massively reduced breastfeeding frequency and some stopped breastfeeding altogether.
  • Mothers who placed more value on breastfeeding dismissed the idea of shared parental leave entirely especially if they wanted to breastfeed for longer than 48 weeks.
  • Some mothers felt they were put under pressure to be to express breastmilk because if shared parental leave.
  • Societal pressure and ‘unacceptance’ of breastfeeding make some mothers not to breastfeed and shared parental leave was viewed as one of such ‘unacceptance’ of breastfeeding.

Conclusion

Breastfeeding is a contributory factor to the low uptake of shared parental leave and shared parental leave is also contributing to the low rate of breastfeeding in the UK.


To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:

25 Oct

BfN Central Evaluation 2019 – Results Highlights

Nina White, BfN Programme Manager

Every year, BfN release a survey to help us see what we are doing well, where we can improve and also give us the evidence we need to help secure future funding. 

This year, the survey was live throughout March 2019 and we received 572 responses.  Thank you to everyone who shared the survey link and encouraged people to complete the survey.  We were pleased to be able to send BfN travel mugs to 10 lucky winners from the prize draw.

Responses to the survey came from:

Survey responses

– 89% mothers
– 5% health professionals
– 6% others

Of these, 36% were supported by the BfN Drugs in Breastmilk Service and 12% from the National Breastfeeding Helpline. 

Matching last year’s results exactly, 64% of this year of mothers contacted BfN because they were experiencing breastfeeding problems.

Once again – the most popular topic of discussion with BfN Peer Supporters was positioning and attachment for feeding, with more than half of mothers struggling with painful breasts and nipples.  The next three common topics were frequency of feeding, baby’s weight gain and expressing milk.  Nearly half of mothers asked for information about medication/medical intervention and impact on breast milk/ breastfeeding.  We hope we were able to ensure all these mothers were able to continue feeding their babies if they wished to, since many reported being told to stop breastfeeding unnecessarily.

We asked a variety of ‘before/after’ questions and were delighted with the answers, which proved the value of peer support:

61% agreed they had the information needed to make decisions about feeding their baby before contact with BfN, rising to 95% after support from BfN.

45% of mums could breastfeed without pain before contacting BfN, increasing to 80% after support from us. 

Once again, more than half of the mums questioned (54%) claimed BfN supported them to breastfeed for longer than they otherwise would have done.  Reasons given for this included evidence based information about medication, information about attachment, expressing milk, managing blocked ducts and mastitis, meeting other like-minded mums and knowing what is ‘normal’ newborn behaviour.  There were also lots of comments about general support, building confidence and encouragement.

90% of mums said they felt listened to, that their choices were respected, they were not pressured to do one particular thing and that the support/information they received was specific to them.

98% of mothers were satisfied with the support they received from BfN and 98.5% would recommend us to family or friends.

We feel that these results help to demonstrate how important the support we offer to families really is – and how appreciated our volunteers and staff are. 

09 Oct

“Advancing Our Health: Prevention in the 2020s” – BfN’s Response

BfN sees supporting women and families with breastfeeding as an important way to tackle some of the causes of preventable ill health in England. Here is BfN’s charity response to the Government’s Advancing Our Health: Prevention in the 2020s. Our response focuses on several themes important to the protection and promotion of breastfeeding, making a special call for early days support for all women and families. For our full response read on below. The consultation closes on 14th October so there is still time to submit an individual response. 


From Life Span to Health Span

Which health and social care policies should be reviewed to improve the health of people living in poorer communities or excluded groups?

Young, poor and less-educated women are less likely to breastfeed. This is also true of minority groups such as gypsy, traveller and Roma communities. Not breastfeeding widens the health inequalities gap for groups who already experience hardship and compromises maternal and infant health outcomes. The Healthy Start welfare food scheme needs an overhaul as eligibility has declined and it fails to catch the most vulnerable groups in society. Also, the scheme offers no breastfeeding support.

Improvements to breastfeeding support overall would make a difference, but targeted efforts to encourage and support these excluded groups to breastfeed needs investment and engagement with the voluntary sector as delivery partner as often charities have established local buy-in from communities.

More broadly, education policy doesn’t adequately address choices around infant feeding at primary or secondary level. It would be a great advantage to future generations if discussions around infant feeding could be introduced at an earlier age.

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Intelligent Health Checks

Do you have any ideas for how the NHS Health Checks programme could be improved?

Family culture and beliefs are passed through the generations within families and influence how an infant is then cared for. This includes infant feeding decisions where a family history and support network congruent with women’s infant feeding intentions has been shown to be important to women’s breastfeeding experience. This is reflected in breastfeeding rates where women who were not breastfed themselves are less likely to initiate and continue with breastfeeding. Given the importance of family infant feeding history in the initiation and duration of breastfeeding, and the limited ability of some families to provide support; it is unclear why infant feeding family history and support networks are not explored during pregnancy. There should be routine information collection on infant feeding history as part of family history data. An infant feeding genogram could be included as a time efficient tool to assist health professionals and support workers to stimulate discussions around breastfeeding and help design support interventions.

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Supporting Smokers to Quit

What ideas should the government consider to raise funds for helping people stop smoking?

Helping people to stop smoking is a fundamental part of preventative health work in the UK and should be funded by government without need for external funding. While BfN welcomes the steps the UK has taken to ban and control use of tobacco the loss of many local authority funded cessation services has been a retrograde step. We would like to see smoking cessation services be reinstated and include dedicated antenatal smoking cessation support.

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Eating a Healthy Diet

How can we do more to support mothers to breastfeed?

Women tell us they struggle to breastfeed because of pain, worries about milk supply and because there was no skilled support to help them. Women frequently report a lack of consistent information on feeding their babies given at the right time including on the safety of medication in breastmilk.

The vast majority of the issues women raise as barriers are amenable to good support and the following actions would help:

  • Develop a National Infant Feeding Strategy Board with all relevant government departments, health and third sector stakeholders driven by appropriate leadership.
  • In a national infant feeding strategy/plan include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • Implement the Unicef UK Baby Friendly Initiative across all relevant services.
  • Protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law.
  • Commission and fund universal, evidence-based breastfeeding support programmes and services delivered by peer supporters with accredited qualifications and specialist/lead midwives and health visitors.
  • Maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline.
  • Deliver universal health visiting services and the Healthy Child Programme (including the 5 mandated contacts, plus an additional review before the 10-day visit to resolve early feeding issues)
  • Establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.

We support the commitment to undertake an Infant Feeding Survey and this should build on the data previously collected in the 2010 cancelled IFS.

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How can we better support families with children aged 0 to 5 years to eat well?

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. Recent government policy on obesity has failed to address the importance of how we feed our babies and early years nutrition. The Government should improve the legal protection and support for breastfeeding, improve availability of caregiving / parental education around introduction of solid foods and feeding responsively.

Where babies are not breastfed, given formula and commercial foods there should be strong legislation in place to regulate nutritional composition and tight regulation of labelling and marketing of commercial foods in line with Public Health recommendations and WHO Europe with implementation of WHO Code.

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Support for individuals to achieve and maintain a healthier weight

How else can we help people reach and stay at a healthier weight?

Children who are obese are likely to become obese adults. More should be done to help prevent children from becoming overweight or obese in the first place. Breastfeeding has a very significant effect on childhood obesity, with some studies indicating that breastfeeding to a year or more could reduce rates by 25-50%. Support for breastfeeding, particularly breastfeeding to 12 months or more, must be part of any obesity reduction strategy.

For some women breastfeeding makes it easier to lose weight, since additional calories are used. This can help some women to return to pre-pregnancy weight more quickly. The role that breastfeeding can play in managing maternal weight should be discussed with a health care professional or peer support worker.

The Department of Education should ensure that all young people learn about the importance of healthy body weight and good diet before and after pregnancy.  Breastfeeding as a normal human behaviour should be more thoroughly explained as part of the curriculum to remove stigma.

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Taking care of our mental health

How can we support the things that are good for mental health and prevent the things that are bad for mental health, in addition to the mental health actions in the green paper?

Up to 20% of women are affected by mental illness either during pregnancy or in the 12 months after giving birth. A woman’s risk of postnatal depression can be lowered by successful breastfeeding. On the contrary, when women who wanted to breastfeed are unable to meet their goals, their mental health can be adversely affected. Given that 8 out of 10 mothers stop breastfeeding before they wanted to, one means of safeguarding the mental health of new mothers is to improve breastfeeding support and protection. This is particularly important soon after birth. https://www.breastfeedingnetwork.org.uk/breastfeeding-ad-perinatal-mental-health/

Being born in a Unicef UK Baby Friendly accredited hospital and supported to breastfeed there has been linked to improvement in child emotional development and maternal mental health.

Data from the Millennium Cohort Study found that term children breastfed for four months or longer had lower odds of abnormal scores on a strengths and difficulties questionnaire compared with never breastfed children. There is also evidence that breastfeeding for less than 6 months compared with 6 months or more is an independent predictor of mental health problems, both internalised and externalised through childhood and into adolescence. Reviews of many studies linking breastfeeding with mental health of mothers and children can be found here https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/infant-health-research/infant-health-research-mental-health-and-emotional-development/.

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Sleep

We recognise that sleep deprivation (not getting enough sleep) is bad for your health in several ways. What would help people get 7 to 9 hours of sleep a night?

New parents or parents of young children will rarely get 7-9 hours’ of unbroken sleep a night. New parents should be supported to understand that normal infant sleeping patterns involve frequent night waking. New parents should be able to access advice and support to cope with lack of sleep and tiredness from their health care professional, peer supporter or maternity support worker. It is also useful to highlight that exclusively breastfeeding mothers report sleeping for longer than mothers who mix feed or formula feed as a positive effect of hormones. Therefore actions to better support and protect breastfeeding may also have benefits for sleep among new parents.

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Prevention in the NHS

Have you got examples or ideas for services or advice that could be delivered by community pharmacies to promote health?

Pharmacists have a key role to play in promoting and protecting breastfeeding in the community. Women contacting us through BfN’s Drugs in Breastmilk Service for information and support on the effects of medication on their breastfeeding tell us that pharmacists in their community lack sufficient knowledge and understanding of breastfeeding and the effects of medication on it. This means families in the community struggle to get advice on breastfeeding and how to maintain breastfeeding through illness of mother or baby. Often we see that this leads to breastfeeding ending unnecessarily or a mother denying herself medication so she can continue to breastfeed her child. See ‘A lifeline when no one else wants to give you an answer’ An evaluation of the Breastfeeding Network drugs in breastmilk service Professor Amy Brown, March 2019 https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf

Unicef’s infant feeding learning outcomes for pharmacy students set a standard for the level of knowledge and understanding that could be reasonably expected of a newly qualified pharmacist; see: https://www.unicef.org.uk/babyfriendly/accreditation/universities/learning-outcomes/learning-outcomes-pharmacy-students/. Pharmacists should also be aware of local breastfeeding support services and be able to signpost accordingly.

Worryingly, many pharmacists receive information about breastmilk substitutes (BMS) from sponsored materials provided by the BMS industry. This is a clear conflict of interest and means that advice provided by a pharmacist may be inconsistent with advice from other health workers. All pharmacists should be encouraged to work within the WHO Code of Marketing of Breastmilk Substitutes.

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What could the government do to help people live more healthily: in homes and neighbourhoods, when going somewhere, in workplaces, in communities?

Supporting women to breastfeed and for as long as they choose requires societal action and support. All too often responsibility is placed on women to breastfeed when so much more can be done in communities, work, health and education settings to support breastfeeding.

To improve community support for new and young families the Government should provide all Local Authorities with ring-fenced funding to establish, re-establish or support the development of universal Children’s Centres. These should focus on areas of deprivation, with Centres able to offer a range of support services including breastfeeding peer support. Building community support encourages breastfeeding to be more visible. This is key to changing attitudes in the UK to breastfeeding and improving all parents to feel more comfortable when out and about with their infants. Whilst the Equalities Act means that women have the right to breastfeed in public, many women remain anxious about feeding their baby outside the home. Consistent efforts are needed to normalise and support breastfeeding anywhere that a baby needs to be fed.

The Department of Education should ensure all young people, boys and girls, learn in school that breastfeeding is a normal human activity should be explained and de-stigmatised. Government should also follow initiatives in the London Food Strategy implementation plan which aim to improve breastfeeding across London, including looking at how Transport for London can better support women travelling with infants on the network.

Often returning to work or education is seen as a barrier to breastfeeding and a reason for women to stop before they want to.

The current protection for breastfeeding when a women returns to work is inadequate and the burden is placed on the individual mother to negotiate arrangements with her employer, at a time when she is feeling vulnerable and not entitled to ask for support. Explicit protections for breastfeeding protection are missing in the current legislation. Protection should also extend to provision of adequate storage for her expressed milk. Clarity through the policy on storage will be useful to women and employers alike in navigating the practical arrangements that are needed to continue breastfeeding and giving breastmilk.  

Question: What more can we do to help local authorities and NHS bodies work well together?

To ensure that women’s intentions and efforts to breastfeed are upheld and supported following initiation good breastfeeding support needs to be available at every step of a mother’s journey. As a charity that has been involved in delivering peer support services for over 20 years working in communities and also alongside health care professionals in a complimentary way we have learned that moving breastfeeding peer support services from the NHS to local authorities has not only been damaging for families accessing quality breastfeeding support but it has also damaged relationships. Many community services have been lost and an increased burden has been placed on an already struggling health visiting workforce. Supporting breastfeeding requires dedicated skills, time and patience often supporting a Mum for several hours on several occasions.

Many services funded through local authority structures are operating on reduced budgets or have been de-commissioned because of cuts. Previously, many of these services worked well because relationships with health professionals were strong and an engaged local volunteer base was supported. Going forward it is vital that breastfeeding peer support services are protected and there is a close contact between local authorities and NHS services. 

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Question: What are the top 3 things you’d like to see covered in a future strategy on sexual and reproductive health?

Just one thing from BfN’s perspective. There is good research that suggest that attitudes to infant feeding are shaped long before individuals become parents. We would like to see all children and young people learning about breastfeeding and early nutrition at school so that they have the information they need about their bodies years before they become parents. Working with school age children helps open up space to start conversations at home and help normalise breastfeeding in the wider community. To help shift attitudes and future generations to breastfeed the Department of Education should ensure all young people learn about breastfeeding as a normal human activity. This will help explain normal functions of the body and help to de-stigmatise it. The following resources are available for use in schools on breastfeeding https://www.breastfeedingnetwork.org.uk/breastfeeding-information-for-children-and-young-people/ and https://abm.me.uk/resources-for-schools/.

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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