In the first of our #MakingItWork real-life case studies, Jade tells us about the issues she faced when returning to work, when her daughter was 9 months old.
“I returned to work at my local special needs school. During my back to work meeting, I discussed my need for expressing breaks and a place to go, I was told “I’m sure there is a bathroom you can use” by the assistant head teacher. Obviously I made her aware this is unacceptable and I require a private area to use. It was arranged that I use the medical room, my half hour expressing break was interrupted on more than 4 occasions, one of these times causing me to spill the milk I had spent time pumping. I then fought for 3 more months to find a room every day, despite there being a whole school full, I was told it was not possible to book out a meeting room, or have the same room each day. So on my lunch break every day I would traipse around the school, find an empty room, stick my “expressing mother” sign on the door and do my thing.”
Unfortunately, this isn’t an uncommon story. The law does not currently allow a simple, straightforward right to breastfeeding breaks, though employers are required to provide a place for breastfeeding mothers to rest. The Health and Safety Executive and guidance from the European Commission recommend that employers should provide:
access to a private room where women can breastfeed or express breast milk;
use of secure, clean refrigerators for storing expressed breast milk while at work, and
facilities for washing, sterilising and storing receptacles.
The ladies toilet for example is never a suitable place in which to breastfeed a baby or collect milk.
ACAS guidance also gives the following advice to employers when asked to consider additional breaks for breastfeeding:
“Employers should consider providing short breaks for breastfeeding or expressing milk, weighing it up against the likely impact it might have on the business. Employers should be careful not to discriminate against breastfeeding employees. If employers are unable to grant additional breaks, they could consider slightly extending normal breaks for the employee such as a mid-morning coffee break or leaving earlier in the day to minimise any disruption to the business.”
Each employee will need to have a discussion with their employer – preferably in advance of their return to work – but hopefully this guidance will be helpful in these negotiations, and helping your employer to understand your needs and their obligations.
To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:
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.
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.
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
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.
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:
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:
– 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.
Newly qualified BfN Helper Naomi Forbes writes about her experiences as a young mum, in particular her decision to breastfeed both of her children in tandem.
Breastfeeding is a big part of my everyday life. I currently tandem feed my one year old and my two and a half year old. Tandem feeding can be challenging for many reasons but it’s something I wanted to do. When I had my first child at the age of 19 and my second at 20, I noticed a lot of people around me did not expect me to breastfeed. I think there is a stigma around “young” mothers, people assume a lot of things, such as “they won’t be breastfeeding”, “they’ll leave their baby with others all the time”, “they’ll be lazy” etc. I found this difficult and hurtful at first as I did plan my pregnancy at a young age and even if I hadn’t it would not have been anyone else’s business.
It can be lonely tandem feeding especially if you don’t know many others in the same position as you, and I’m writing this to make people aware that it is perfectly normal. I assumed most people already knew that there’s nothing “strange” about it, however I spoke to many people during my pregnancy who had no idea that it was even possible to feed my new baby and continue to feed my older child. It’s often hard to do the things you want to do when the people around you are not as supportive as you had hoped they would be, I don’t think people mean to be hurtful I think it’s often down to a lack of education about the subject.
I feel extremely passionate about empowering women and helping them to achieve their breastfeeding/parenting goals just like I have achieved mine. I have recently started to train to become a breastfeeding helper with the Breastfeeding Network, I often focus on the negative responses I have had and not the positive because I want to help educate more people and it’s important to focus on the bad so I know what I have to try and change, but I have had so much support and I feel this is one way of giving something back.
I didn’t really give it much thought before I gave birth to my first child, I had a few conversations about it when I was pregnant and a lot of people told me “you might not be able to breastfeed” and “most women can’t breastfeed”. I just knew I wanted to but I had it in my head that so many women can’t breastfeed and I thought there was a high chance that I wouldn’t be able to. I just decided I was going to try it and see how it went. I’ve found out now that only a tiny percentage of mothers truly can’t breastfeed and that a lot of people say that rather than just admit that they made the choice not to, and of course that’s fine but I don’t think they should be trying to put other mothers off by giving false information, especially as first time pregnant women do tend to look up to people who are already mothers as they believe they will know better than them.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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/.
BfN and National Breastfeeding Helpline supporter Katrona Templeton writes about the unique challenges faced by breastfeeding mothers with disabilities, and the ways that they may be supported to achieve their goals.
Can a mother with a thyroid problem feed?
Does having a colostomy bag affect feeding?
Does an autistic mother need different support and information than a non-autistic mother?
The answer to these questions is yes.
Hi, my name is Katrona, I am a 39 year old mother of two beautiful and very ‘lively’ daughters, aged 3 and 4. I have been a BfN helper for around three years and recently became a helpline supporter.
I am autistic and also have epilepsy and dyslexia. It was when I began to look for support and information about breastfeeding with these conditions that I realised that there seemed to be a gap in knowledge in this area. There is little information when it comes to supporting people with disabilities who wish to breastfeed.
Many mothers with disabilities and/or long term conditions face unique challenges when breastfeeding. For example:
Low milk supply and medication worries for thyroid problems.
The practicalities of feeding with a colostomy bag, does it need changing during a feed? Ensuring enough calories are consumed and absorbed by the mother for her baby and her own needs.
Dealing with a mother who may have read every article on breastfeeding known to mankind and can bring up obscure facts, but wants to feed even through the sensation of the baby latching and suckling makes her feel as if every inch of her skin is crawling with fire ants.
Disabilities, like mothers, come in many forms. Some difficulties are easily solved: sign posting to drugs in breast milk page; getting creative with positioning; discussing distraction techniques to bring the mother’s focus away from the feeding.
The biggest challenge faced is the resistance from health care professionals to support these mothers, with many seeing formula as the easiest option. This may be due to time constraints, a lack of general information about how conditions can affect breastfeeding, or concern that breastfeeding will put extra pressure on a mother who, in their eyes, already has enough to cope with, with their own health.
A lot of these mothers are more resilient that they seem at first glance, willing to put up with pain, reducing or temporarily stopping some medicines, constantly dislocating shoulders to name a few.
Breastfeeding can be a lot easier for these mothers than bottle feeding. It’s a lot easier to lift a baby, feed it and go back to sleep, than getting out of bed, into a wheelchair, to kitchen, make up the bottle, feed the baby, get out of wheelchair and back to bed.
For some mothers the mechanics of making up a bottle can be daunting, the ability to even screw on the lid can be a hurdle in itself. Reading the instructions on the tin can be hard or impossible for some, as not many formula tins have Braille on them. The anxiety of asking yourself questions like, “Have I put the right amount of formula to water in the bottle?”, “Is it too hot or too cold?”, “Has the baby had enough?”, “Is the bottle sterilised?” can be overwhelming for some mothers.
Breastfeeding can have extra advantages for some mothers and babies: staving off flares of Crohn’s disease; reducing the amount of time a baby cries helping with sensory disorders; helping the baby wean off the medication they were exposed to within the womb.
So what can be done to support these mothers and enable them to meet their breastfeeding aims? The most basic help is just listening to them, empathising with their problems, and talking through different ideas and methods to support them – from different positions, to ways of finding others with their condition who may have breastfed before and can give them tips and ideas.
Also helping them to face the reality that, in some cases, they may not be able to meet their breastfeeding goals, and may need to consider combi feeding or formula feeding. Supporting and guiding them through their decisions can be invaluable to the person concerned.
When mothers face these difficulties, breastfeeding will often give a sense of achievement for being able to do something that others thought was impossible. Empowerment from doing what they feel is right for themselves, their child and their family situation. A high percentage of these mothers will still breastfeed until the child naturally weans themselves, after fighting so hard in the first place to establish a breastfeeding relationship.
At the end of the day, mothers with disabilities or long term conditions are just like any other mother who is trying their best for their child. To be there for them, to listen to them and empathise with them is what they need. That and maybe some out of the box thinking.
Katrona runs a Facebook support group for breastfeeding mums with disabilities or long term conditions – click here if you’d like to check it out.
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.
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!
Ruth Dennison will be giving a presentation at our conference in October, entitled “Supporting Black women who breastfeed”. In this guest blog, she explains why it’s so important to support women in the black community to breastfeed, and how their needs may be different to those from other ethnicities or cultures.
Everyday a mother gives birth. Everyday a mother would attempt to breastfeed her newborn.
Everyday a mother successfully breastfeeds her baby and everyday a mother struggles to breastfeed her baby.
Why is this important, because in my 12 years of supporting mothers with breastfeeding, the rates of mothers reaching out for support in the Black community is very low, why is this?
Do you know breastfeeding support is more likely to be effective if it is proactive, delivered face to face and provided on an ongoing basis.
Why do Black mothers feel that they are just supposed to get it right on their own or supplement with artificial milk, do you know that within the Black community most expectant mothers have already been told or have told themselves that breastfeeding is not always possible and that they may need to top up their baby. So what do they do, they buy formula milk and bottles just in case they have breastfeeding difficulties. Black mothers, do you know this is not the best solution and definitely not your only solution. Learning about breastfeeding antenatally is the best approach to help you get breastfeeding off to the best start. Yes, there are many books, videos, courses and workshops to help you get off to the best start and this is needed more than ever as the Black community’s health is being affected by this.
Think…..If formula milk is just as good as breast milk, there would be no need for me to write this blog, no need for breastfeeding advocates, UNICEF and WHO trying to get the world to breastfeed their babies with something which is biologically made for their babies, the most natural food for your baby. You know, when I have spoken to some Black mothers about breastfeeding, they have many reasons why to stop breastfeeding but not many reason why they want to continue breastfeeding up to and beyond 6 months as recommended. Many Black mothers offer their babies solid food from around 3-4 months (Read when experts say babies are ready for solid food: here), why is this, is it because of family and culture influences or is it because you don’t see other women who look like you breastfeeding much more than 6 weeks. Do you feel like you will be negatively judged? Is it the lack of support, social or media pressure? Did you want or need extra support but wasn’t sure where to go? What is your reason why?
Have you ever asked your parents what they remember about breastfeeding. There are so many different stories and 2 of the popular reasons is that they either suffered in pain and swear never to put themselves through it again or that they believe that they never had enough milk. Just my note to you, most of the time if you feel pain and have sore nipples/breast while breastfeeding, it is very likely that your baby wasn’t latched on correctly which can cause pain and with your baby not being latched on correctly your milk supply can drop, if you mix feed your baby this can also cause your milk supply to drop. Over 90% of women can exclusively breastfeed their babies successfully with good support, encouragement and reassurance. Breastfeeding is a skill that mother and baby are learning together and each day won’t always be the same but one thing is that you shouldn’t have sore nipples and if you do, you should consider getting support to help you breastfeed your baby comfortable.
How much do you know about breastfeeding? It would be good to know, because when I have spoken to families about breastfeeding they are amazed with the knowledge I share with them.
Sam is a volunteer with the Association of Breastfeeding Mothers, and runs a Facebook support group for exclusively expressing mums. There is unfortunately very little information or support dedicated to this subject online, so we asked her to write a guest blog post, explaining what exclusive expressing is, and giving some helpful information and pointers.
Not many parents plan to exclusively express breastmilk. Indeed, most of us find us ourselves here, not quite sure how we got here, and often without a plan, or a certain end-date. Infant-feeding conversations tend to involve two well-mapped roads: breastfeeding or formula feeding. However, there is a slip road alongside breastfeeding, that some mums find themselves taking: exclusive expressing.
What is exclusive expressing?
Exclusive expressing is the removal of milk from the mother’s breasts, usually with a breast pump, and feeding the milk to baby via a bottle, or more suitable method, such as nasogastric tube for premature or poorly babies.
Some mums express milk for each feed, and their routine consists of pumping, then feeding that milk to their baby. Other mums prefer to get ahead of their baby’s requirements and express to a schedule. This means they are able to warm breastmilk from their fridge, whenever baby needs feeding. Some mothers have an abundant supply, which means they can freeze extra milk. This milk can be stored for their own baby, or they may choose to donate it.
Why do mums choose to exclusively express?
Mostly, they don’t choose to!
A few will have chosen this method, researched how much time and effort is required, and concluded it is the right way to feed their baby. However, the majority are expressing their milk because baby is unable to feed from the breast. These mums know how incredible breast milk is, and all it has to offer. Their driving force is wanting their baby to receive the amazing properties of breastmilk, even though their baby cannot nurse.
These mums are usually aware breastfeeding is not just about the milk, and many feel great sadness about not nursing and missing out on that special relationship. At the same time, they are also incredibly proud of providing breastmilk for their baby who would otherwise receive artificial milk.
Some mums are expressing whilst their baby is too small or sick to nurse, but hope to begin nursing once their baby is strong enough. Other mums may be expressing for longer-term, such as for babies with cleft lip and palates who cannot form a seal at the breast. Or some mums may be expressing for babies who continue to not latch at the breast.
What do mums exclusively expressing need to know?
How milk supply is established. Removal of milk from the breasts drives milk production. See here for an excellent explanation. /
The first few days and weeks after the birth are when prolactin receptors are switched on. This means the early days and weeks, are when the body is most responsive to building milk supply.
Information about first feeds happening within (ideally) 1-2 hours of birth, and frequently thereafter, applies to expressing too. Hand-expressing is usually suggested for the first couple of days until the milk begins to come in, when mums may choose to start using a breast milk. /
Your time is precious. You are a new mum with a small baby, recovering from birth. You need time to cuddle your baby, rest, sleep and recover. Using a double pump-halves the time required to express, compared to expressing one breast then the other. Breast pumps can be purchased online, hired from hospitals and children’s centres or direct from suppliers themselves for a monthly rental fee. /
Responsive feeding and skin-to-skin are just as important for a bottle-fed baby as a nursing baby. Skin-to-skin has numerous benefits for mum and baby, and can help stimulate milk supply, even if baby cannot nurse.
Paced bottle-feeding will help to ensure your baby takes just enough milk to fill their tummy. This means they are less likely to overfill their tummy and bring up any of your hard-earned milk.
(See the image at the bottom of this post for more info on responsive bottle feeding.) /
Don’t get complacent. As mentioned earlier, milk supply will ideally increase steadily within the first couple of weeks. Some mum’s will be expressing for a poorly or premature baby who only requires tiny amounts of milk. This means there could be a surplus of milk produced each day.
A full-term, healthy baby consumes around 570-900ml with an average of 750ml per day, between 1-6 months of age. Therefore, this is good amount to keep in mind if you wish to feed your baby only breastmilk. A mum of twins will need twice this amount each day. /
How often to express? Most sources will suggest 8-10 sessions of expressing in a 24 hour period. This could be every 3 hours round the clock.
Or it could be more often in the day, and one longer stretch of 4-5 hours overnight, meaning you only needs to get up once in the night to express. This could be at the same time baby wakes to feed, or it could mean setting an alarm if your baby is in hospital.
You may find 8 times isn’t quite enough to meet baby’s milk requirements. Some mums choose to ‘power pump’ which mimics cluster feeding behaviour of young babies. Power Pumping involves one full expressing session, following by several short sessions of 5-10 minutes expressing, with 10 minutes rest breaks in between. /
How long to express? When building supply the aim is to express until the milk stops flowing, even when adding in compressions and massage. Then keep going for a few minutes longer, to ‘ask for more.’ Some mum’s like to finish off with some hand-expression.
Your breasts are never empty, milk is continuously produced, and you will always be able to express more with your hands. Becoming familiar with your own breasts, will mean you’ll get to know when they are suitably soft and drained, and you have reached the end of your expressing session. /
Breast storage capacity varies from woman to woman. Breasts are not storage devices, they are designed to continuously produce milk, and for this milk to be regularly removed.
Having said that, some breasts are physically able to contain more milk at any one time, and others simply don’t have room. This is nothing to do with breast size or shape – size is all to do with fat within the breast, and fat does not produce milk!
Once milk supply is established, typically 6 weeks plus after birth, some mums are able to lengthen the time between expressing sessions, and this minimally impacts the amount of milk they produce overall. Other mum’s find they need to continue to express very regularly to maintain their output. Breast storage capacity is further explained here – you can use this information to identify whether your own capacity is average, large or small. This link explains why all capacities can work perfectly to feed your baby.
Take-home message: exclusively expressing is not a simple option. In many ways it combines the worst of both worlds – the washing and sterilising of bottles and equipment, storage and labelling of milk, and you don’t escape the potential problems that can sometimes affect lactating breasts (sore nipples, thrush, blocked ducts and mastitis etc).
For many mums, exclusively expressing is a temporary solution, whilst they work towards feeding their baby at the breast. With the right information and support, most mums and babies will manage this transition. For others, exclusive expressing can become a way of life for months or even years. It’s a journey they likely never intended to embark on yet could end up being one of their proudest achievements. If you’re part of the breastfeeding community, please extend your welcome to these exclusively expressing mums, they are probably some of the biggest advocates of breastfeeding around.
“Holding Time” is an exhibition of breastfeeding photographs by Lisa Creagh, which “offers a creative reinterpretation of our concept of Time and how this influences our experience of Motherhood generally and breastfeeding in particular.” It aims to challenge the cultural stigma attached to breastfeeding, and how motherhood can make women feel that normal rules of time and space do not apply. In this post from her blog, Lisa talks about her experience of exhibiting her project, which raised some interesting issues relating to breastfeeding and motherhood.
Over the past few weeks I have been at the gallery every day. Sometimes I just sat on the beanbags and enjoyed the quiet. Other days I had others to join me: Lucila came almost every day. Many mothers came with their children. But also quite a few fathers. And others who had never had children; young women interested in the subject with their boyfriends, mothers whose babies had grown, mothers who had not breastfed, mothers who were still breastfeeding their four year old, mothers with newborns still struggling with the adjustment to motherhood.
In every case we sat or stood and held the conversation open: this is not an exhibition about how to breastfeed, or why you should breastfeed, or condemning those who do not.
I had some criticisms. For example, why no suffering women? When the cultural landscape is so empty, with so little work on this subject, what is there becomes a beacon and needs to fulfill every demand: to promote breastfeeding, to speak for those who could not breastfeed, to address the social inequalities, to represent every class. Although I had gone to some lengths to ensure the portraits were representative of a broad population of the UK, I recognised the impossibility of fulfilling such demand.
For example, it was very difficult and time consuming to recruit successful breastfeeders for the project. Those in great pain, in the early days of breastfeeding were off limits to me. I promised to represent their experience through the interviews.
I am certainly lining up interviews with women who have struggled, as I did, to breastfeed. They are closest to my heart. It is the struggle that started this. The struggle that both Lucila and I had in the first instance, to manage to feed (see Mother stories) and then, later on the struggle to understand the place of breastfeeding, both within motherhood and within society.
We hear from so many women that their struggle felt lonely, they felt abandoned. The question over why one woman would continue alone, when another went straight out to buy formula is a complex one. Some women were pressured to do so. Others were pressured to continue trying.
There is anger on both sides.
Some felt they had amazing support from the hospital, the health workers, the midwives. Others complained of poor advice: GPs failing to understand the basics, midwives advising unnecessary processes, being constantly asked if they were ‘still’ breastfeeding. Being left alone for hours after delivering their child with no advice or help, being unable to fathom an avalanche of conflicting information from different sources.
The lack of a single authoritative active voice seemed a constant. Those who struggled, either paid for a Lactation Consultant or gave in. There was nobody who had overcome their struggle alone. Everyone who had problems and eventually found their way through them had access to a trained source of help via a LC at a drop in, or by paying a LC.
The social pressures of breastfeeding and motherhood were equally expressed across the days. In particular, pressure from mother in laws, their own mother, or close family members to leave a baby to cry, to cover up more when feeding or to stop feeding before the mother or child was ready.
Pressure to stop feeding also seemed to come from GPs. Who had little awareness of the benefits of ‘full term’ breastfeeding.
Superstition around this area and sleep was rife. Women talked of their fears about babies developing excessive dependency as a result of being picked up, sleeping in the same room or being breastfed beyond six months. Women were overwhelmed with unwanted and unnecessary pointers from well meaning family, friends and strangers. Regardless of their choices they felt judged, accused and tried on an hourly basis – on the bus, at home, at the library, everywhere except for baby centred places such as play groups and get-togethers.
The prevalence of advice seemed in exact inverse proportion to the amount of accuracy, based on current research. Authors like Gina Ford came up over and over as a source of extreme anxiety and frustration. Fathers talked of their confusion at the minute by minute instructions; the bewildering threats and promises of a bad or good baby depending on their ability to follow these instructions.
At the Breastfeeding in Public workshop, Lucila and I were interested to discover that the social pressure of the immediate family and friends was far greater than the anxiety about breastfeeding in public. Most women spoke of struggling more with overcoming the taboo of breastfeeding in front of in in-laws, parents and siblings. Once this had been mastered, the act of breastfeeding in public was merely seen as a step into the unknown. Nobody had a negative story or experience about a stranger, only about family and friends.
It may be that this is peculiar to Brighton, (an overwhelmingly accepting and liberal place) but the idea of breastfeeding as taboo rang clear. Women’s struggle was largely with their kith and kin. Their experience of breastfeeding felt as though it was in opposition to social norms that they had always, otherwise obeyed. They experienced conflict around this: struggling to reconcile their certainty of the benefits of breastfeeding with the determination of others to maintain the status quo.
Education of the older generation: specifically those aged 55-75 seemed relevant. It was noted that many older women in their late seventies and eighties were extremely supportive and vocally so. We guessed these were the last of the generation who breastfed before the wholesale introduction of formula in the 1960s. For those who had children later, and who experienced the full impact of the formula take over of maternity wards in the 60s there was a sense of affront: to insist on breastfeeding, even when it was a struggle was an accusation that they had not tried hard enough, or had made the wrong choices.
Women came to the exhibition and expressed their gratitude for being shown and honoured with such beautiful pictures. They stood and looked, they sat and watched the film, then went downstairs to watch the videos. Many returned at least once. Some didn’t have time to see everything but took a card and promised to go to the website, to stay in touch, to tell their friends. The exhibition was shared widely on Facebook, by email and WhatsApp. Most women had heard about it from more than one place. Many said they had been sent details from a friend who thought they would find it interesting.
Many professionals also came. Zoe and Claire from the NHS support team in Brighton came, the Post Natal ward manager of the local hospital, a party from the NHS support team in Hampshire came along with photographer Paul Carter who has done a wonderful project with them called , ‘We do it in Public’. Many midwives came. One commented that the abstract concepts behind the work were too complex for ordinary women. Another, from Spain invited me to bring the work to their newly created birthing centre.
A GP from the GP Infant Feeding Network came to watch the videos twice. Another doctor, one of the mothers photographed, told us of discovering the inaccuracies in doctors exam questions regarding breastfeeding (how long does the who recommend breastfeeding? Answer: 1 year – the correct answer is at least two years) and we despaired at the levels of medical ignorance and absence of proper training for GPs on all aspects – not just breastfeeding but infant feeding generally and other issues such as sleep issues and weaning.
The weeks flew by quickly and were intense from start to finish. It was the first time to test out a safe space for conversation in this way. The gallery noted that the audience numbers grew during the exhibition and that the demographic was broader than usual. I was particularly struck by the draw of the work across society and professions. I revised my assumption that this was a project made for women. I realised that motherhood is a universal theme and the broad reaching ideas concerning Time and Motherhood make this work accessible to everyone.
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