03 Jul

Guest Post: Ruth Dennison, Black Mothers and Breastfeeding

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

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

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

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

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

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

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

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

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

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

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

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

26 Jun

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

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

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

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

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

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

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

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

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

There is anger on both sides.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

04 Oct

Guest Blog by Smita Hanciles – The Power of Peer Support

Smita Hanciles works for Central & North West London NHS Foundation Trust and leads the Camden Baby Feeding Service. Here’s a taster of her presentation at our conference this Saturday (6th October), on the power of peer support. If you’ve been unable to get a ticket, follow #BfNConf18 on social media to catch our updates throughout the day.

There is evidence that establishing breastfeeding can be protective of maternal mental health and aids with bonding.  When establishing breastfeeding is challenging or even unsuccessful, particularly when a mother really wants to breastfeed, the mother can be left vulnerable and at increased risk of post-natal depression. At points of such vulnerability, does having access to a trained breastfeeding peer supporter in addition to her own network of relationships provide a source of emotional co-regulation and co-learning?  Does this help increase resilience and possibly decrease the risk of anxiety and depression and any negative impact on bonding?   These are the questions we have been asking in Camden as we introduced a group of new volunteer breastfeeding peer supporters into the Baby Feeding service.

We often think of support for breastfeeding and support for perinatal mental health separately and services generally focus on one or the other.  There are peer support projects for mothers who need help with feeding their baby and there are now separate peer support projects for mothers experiencing mild to moderate postnatal depression and anxiety. However, this way of delivering care doesn’t factor in that one impacts on the other and can’t easily be addressed separately.  What would happen if we supported new mothers in a much more holistic way?  Or maybe we already do this as peer supporters but just don’t describe it as such.

Having reflected on what we actually spend our time doing in the Baby Feeding drop-ins in Camden and on the stories of mothers we support, we recently decided that instead of describing ourselves as solely providing peer support for women experiencing difficulties with feeding or establishing breastfeeding, we would emphasize that we also provide listening support to those who had intended to exclusively breastfeed but were experiencing challenges or were not able to for various reasons.  We added the Baby Feeding service to the Camden Perinatal Mental Health services register under services for the ‘mild /moderate’ end of mental health concerns. We hoped this would help with the recognition of our role in providing emotional as well as practical feeding support and as a place from which referrals to more specialist help could be made if necessary.

I recently saw a poster with the words ‘I sat with my anger long enough, until she told me her real name was grief’. Mothers struggling to breastfeed can feel angry with services that failed to provide the right support or even at themselves or their baby. However, the anger could be borne from a sense of grief over the loss of the breastfeeding relationship they had wanted or looked forward to.  They are unlikely to seek help from other mental health services in this situation but still need to be listened to and for their feelings of loss to be acknowledged as a normal response and justified.  They don’t want to be told their feelings are unreasonable because they can always just give a bottle and as long as the baby is fed, it’s all ok.  They also need support to accept and embrace a different feeding relationship from the one they had anticipated whether it is mixed feeding or bottle feeding with EBM and /or formula.

We approached the Maternal Mental Health Alliance and began a discussion about how to join up different elements of support for new mothers and how we could best train and develop our volunteer peer supporters to work in a more holistic way. This resulted in a diverse and knowledgeable working group coming together including all the main voluntary sector organisation that train peer supporters to develop competencies for the Infant feeding workforce in relation to perinatal mental health.

We know from countless stories of mothers we have supported that breastfeeding peer support has the power to change a mother’s story and experience of care. Those of us who provide peer support have the privilege to hear a mother’s story, to become part of her story as we come alongside to help empower her to find the way forward that is right for her.  Can receiving peer support help a mum change the way she views her own story?  Providing peer support can often help reframe our own stories and see them differently.   If our story was one of painful experiences or even trauma, we can often realise the pain wasn’t in vain but has provided the backdrop to another mother feeling supported and empowered.

We are now looking for ways to collect evidence of the impact breastfeeding peer support has and how it contributes to perinatal mental health. We are still very much on a learning curve with this piece of work and I hope to share more during my presentation.

26 Sep

Guest Blog by Sally Etheridge: ‘I just really wanted to breastfeed’ – How stress affects how babies are fed, and how mums feel about it.

Sally Etheridge is an IBCLC who will be giving a presentation at our conference entitled “Breastfeeding Struggles”.  Here she gives some background to the subject and explores how stress can impact on feeding journeys. Come along to the conference on 6th October to hear more – information and tickets here.

As mother to mother breastfeeding supporters, we may often be especially aware of some of the personal challenges she is facing that are affecting how she feels about life, and becoming a mum, and how these might be affecting how breastfeeding is going – and her chances of achieving her goals around feeding her baby. While there has been a shift in understanding around maternal mental health issues, and better support offered to mothers with depression and anxiety, breastfeeding supporters may recognise that many mums face challenges that we can do little or nothing to change. We may recognise too that there are many mothers who never access our groups and who are much less likely to access breastfeeding support. Poorer communities, women from  different cultures and ethnicities, those for whom English is not their first language, women facing all manner of stressful situations that may be outside our experience. Yet as breastfeeding supporters, we want every mum and baby to be able to enjoy a loving relationship, and enjoy breastfeeding, especially those mothers who always expected to breastfeed.

Leicester has high numbers of mothers like this, and Mammas Community Breastfeeding Support Programme works hard to find innovative and low cost ways to support every mum whatever personal challenges she faces. My presentation focuses on a study I carried out, talking to a number of mums who faced high levels of stress, about how this impacted on how they fed their baby – and what helped most.

04 Sep

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

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

 

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

Some lessons for peer support design

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

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

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

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

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

What else do peer supporters do?

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

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

References

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

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

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

 

 

 

26 Jul

Breastfeeding and Mental Health

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

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

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

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

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

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

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

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

See you in Birmingham

Wendy

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

20 Jul

How to make public spaces more breastfeeding friendly

Aimee GrantAimee Grant, PhD, is a Wellcome Trust ISSF Fellow at the Centre for Trials Research, Cardiff University.  She will be speaking at our conference in October on what the evidence says helps and hinders breastfeeding in public spaces, like shops, cafes and public transport.  Here she gives a taster of what will be covered. Find out more about the full line up of speakers and buy your tickets to the conference.

“In 2012, I started doing research on infant feeding for the NHS.  I come from a British working class background and had never seen breastfeeding before my early twenties, so I can still recall wondering what all of the fuss was about; surely you pop the baby on the boob and everything just works.  How wrong I was about so much! 

Fast forward a few years, and last year, I published a small study where we spoke to mothers and grandmothers from south Wales about their experiences of feeding babies (you can find a blog with the findings here, and the full text here).  We found that mothers reported more intrusive looks and comments from strangers than their grandmothers had experienced.  I’ve also looked at how breastfeeding in public spaces is considered on social media and Mail Online reader comments (my advice is it’s best not to look at the Mail Online comments!), and found the public have a lot of misunderstandings about breastfeeding, and the legal right to breastfeed in England and Wales. 

So, how does this link to what I’ll be talking about?  Much of what the NHS does in relation to breastfeeding is aimed at trying to change individual mothers by giving them support.  My research (which has been confirmed by lots of other research in the UK and abroad) showed how difficult our society makes it for women to breastfeed outside of the home.  As I’m sure you all know, if a mum can’t breastfeed outside of the home, this is going to make life as a breastfeeding mother very difficult.  Because of this, I decided I wanted to focus my research on changing society, to make it more breastfeeding friendly. 

In October, I was fortunate to begin leading a Wellcome Trust funded project doing just that.  Myself and colleagues at Cardiff University have reviewed every academic paper for 10 years that looked at experiences or views of breastfeeding in public (38 of them in total!).  I will discuss our findings, the barriers and facilitators, and I hope that together we can think about ways to take these findings forward to change the UK for the better! 

As an aside, the second part of the Wellcome Trust project will be looking at existing programmes that try to make it easier for mums to breastfeed in public.  If you are aware of projects, programmes or interventions that aren’t published in the academic literature, I’d really appreciate it if you dropped me an email with details and any evaluation reports you have (my email address is:  GrantA2@cardiff.ac.uk ).  You can also find me on Twitter: @DrAimeeGrant”

12 Jul

How do we help families to trust responsive feeding?

Emma PickettEmma Pickett, IBCLC and Chair of the Association of Breastfeeding Mothers, will be speaking at our conference in October about responsive feeding, and the dangers of focussing on feeding intervals. Here she gives us a little taste of what her session will be about. If you’d like to hear her speak, you can buy tickets to the conference here

“I first started talking about responsive feeding because I was angry. I was angry when I read about breastfeeding mothers who were successfully caring for their babies by every definition, but they were being told they were ‘doing it wrong’. Babies were healthy and putting on weight. Everyone was getting enough sleep – just about. Mums, and their partners, were feeling good until someone told them their baby was feeding too often.

“Does he really need to feed again?”

“But you only just breastfed him!”

“Shouldn’t you be stretching him between the feeds a bit now?”

“He shouldn’t be waking up for milk that many times, surely?”

I was angry about the mum who had asked me how to stretch a feed because ‘that’s what she was supposed to do’ and it was making her and her baby miserable, and the mums that doubted their milk supply when it didn’t seem to be possible.   I was angry about the mothers on an internet forum who again and again were ending exclusive breastfeeding – when they didn’t want to – to chase this idea of the ‘perfect interval’ between feeds. I’m talking about the mother who is at home and it’s 1pm and she’s in tears because her baby last fed at 11am and she was hoping to make it to 2pm. Artificial. Nonsensical. Depressing. And sometimes literally depressing.

‘Watch the Baby not the clock’ has been said for a long time. We’ve all been saying it. But it’s important to understand WHY it matters and what can happen if we try and stretch artificially. It’s important to understand that we can say it, but it doesn’t mean it gives mums the confidence to believe it. Watch your baby and not the clock is what science and biology tells us. Science says breastfeeding is so much more than a milk delivery system. And if we try and stretch the intervals between feeds some mums will reduce their milk supply – the last thing they were intending to do.

The message that very young sleepy babies – perhaps with jaundice or after birth complications – ideally have around 8 feeds in 24 hours as a minimum has very often become twisted to mean that 3hrly feeds is the norm. This is the misunderstanding we must work against. And the myth that a baby who is feeding more frequently must have a mum with a low milk supply is common.

Research from the 1990s in Australia transformed our understanding of how breasts work and the concept of storage capacity. While breasts ARE streams or rivers not reservoirs, and production happens constantly, the flow slows down as the breast empties and there is an element of storage going on.

The massive variation in storage capacity between women doesn’t impact on 24-hour intake for the baby provided the mother with the smaller storage capacity feeds more frequently. But if a mother was to try and ‘wait’ or ‘stretch the intervals’ her breasts would reach maximum storage capacity, her prolactin receptors become distended, she will accumulate that polypeptide protein known as feedback inhibitor of lactation. She will send messages to her body to reduce milk supply. Some women might never have a baby who goes ‘3-4 hours’ between feeds, while her mate with larger storage capacity might. It doesn’t mean that she has low supply or that her baby gets less milk overall provided she can feed responsively.

So, women ‘stretching babies to a magic interval between feeds’ are doing what we know works to decrease milk supply. They are sending messages to reduce production. 3-4 days of desperately trying to ‘get to 3 or 4 hours’ and ‘waiting for the breast to feel full’ could be harming their ability to meet their baby’s needs in the long term.

We can say to new mums if you want to count something, instead of counting minutes, count poo. Reassurance comes from mums knowing the relationship between effective breastfeeding and frequent pooing for the first few weeks. Let’s ensure mums know that for the first 4-6 weeks a breastfed baby should be pooing at least twice in 24 hrs and ideally more and only after that might it slow down.

Is it helpful to count minutes and record them on your app? What are the positives and what are the negatives of doing that? Is it helping you to count the millilitres you can pump and think that tells you all you need to know about your supply? Instead, what is your baby telling you? With their nappies and their weight gain.

But of course, breastfeeding is only a bit about milk. You don’t always have to know why a baby wants to come to the breast. It’s useful to know what milk transfer looks like but you can lose the plot if you focus on feeds as simply being about milk delivery.

“He’s using you like a dummy!!!” can be something to celebrate too. Because breastfeeding is meant to be about comfort and safety and reassurance and relaxation.

In antenatal classes, we sometimes say to expectant couples count all the times you eat and drink in 24 hours. Look how often you’re doing it and you aren’t trying to double your weight! Let’s also say to them, what about counting all the expressions of affection and love and communication? That’s what you are trying to do when you count breastfeeds.

How do we help families to feel safe and to really be able to trust responsive feeding and to stop it being just theory? Peer support is a big tool in helping this to happen. It’s as simple as connecting mums who don’t yet quite trust it with the mums who do this every day. It can be about the Facebook group where people have DONE this. It’s great to see the pregnant mum arriving at the Facebook group where everyone breastfeeds.  They are bombarded with the norm of every day breastfeeding and it works and even when people are struggling, answers are being found. That smartphone can be a life line when it’s not an app measuring feeding intervals. It enables you to join the sea of other mums out there who understand you don’t need to press a finger into their breast to ‘help baby to breathe’, who are finding ways to sleep safely, who have 8-month olds and older. Their milk is this colour. This is how they breastfed in public without a pillow. It’s normal to only get this much out when you pump? Yes! My son didn’t sleep longer than 4 hours until he was 6 months old. And me and me. 4 hours, you’d be lucky!

That feeling of it being just a little bit scary is eroded with ten minutes of Facebook browsing here and there in the last few weeks of pregnancy. And this is the team you come back to when you run into some problems in the early days. And if they are the right team, they signpost you to find the right help when you need it. They share the number for the National Breastfeeding Helpline (0300 100 0212) and they talk to you about finding a breastfeeding group. Because of course it’s not just the Facebook connections, it’s the real life connections beyond that. The drop-in group where you connect with mothers for whom breastfeeding is normal has a special power. The word ‘responsive’ means reacting positively. That comes from confidence.

I think the word ‘breastfeeding’ is doing us no favours.  It starts with a word that we’re not all comfortable saying and ends with a word that makes us think it’s just about feeding.

I don’t think the word ‘nursing’ quite works in the UK. That was originally about avoiding saying the word  <whispers> ‘breast’. It’s not the breast bit I have a problem with but the ‘feeding’ bit. In Germany, it’s ‘stillen’. It can mean calm, quieten, please, fill, satisfy.

At the moment we’ll have to stick with ‘breastfeeding – or rather ‘I wish it wasn’t called ‘breastfeeding’ because really it’s so much more than feeding’. All we can do until a new magic word is invented is explain that the word isn’t quite right. It’s only a bit about milk.

When we can get the message right, it can be magic. When you get stopped on the street by the woman holding the hand of a toddler and she thanks you for some conversations you had a year ago, or when you hear from the mum still breastfeeding her 20-month-old and she’s got a quick question from her cousin, there’s not much like it.

If we can connect women to other women and to the feeling that breastfeeding is not feeding and that’s not just OK and acceptable and the norm but that’s wonderful, we’ve done our job right.”

 

07 Oct

20th Anniversary Conference live blog

We’ll be live blogging the conference throughout the day here, scroll down and see the live updates below. Here’s the programme so you know what to look out for:

09:30-09:45 Shereen Fisher (CEO) Opening remarks and welcome
09:50-10.35 Dr Amy Brown  

Who really decides how we feed our babies?

10:40-11.25 Dr BJ Epstein  

Supporting LGBTQ families

11:25-11:45                                                          Break
11:50-12:30 Dr Katie Hinde, supported by Professor Sophie Scott What we don’t know about mothers’ milk – video, pre-recorded keynote speech, microbiome, followed by Q&A session.
12:35-13:05 Dr Kirsty Darwent The Infant Feeding Genogram: A tool for exploring family infant feeding narratives and identifying support needs
13:05-13:45 Lunch: including an informal session with Lorna Hartwell and some other founder members looking back at the early days of BfN – sharing their memories and taking you back to where it all began 20 years ago!
13:50-14:50 Small group discussion/training sessions  

Dr BJ Epstein – Supporting LGBTQ families

Lynn Timms – Tongue-tie: how can YOU support these babies with their feeding?
Dr Kirsty Darwent – The Infant Feeding Genogram: Supporting Women and Families in Practice
Walk and Talk – a walk (or run) round Birmingham city centre while chatting about mental health and breastfeeding #RunChatCake
14:55-15:35 Mairi Hedderwick Author & illustrator, Katie Morag (banned artwork)               – The Fuss Katie Morag caused
15:40-15:50 Felicity Lambert  

The National Breastfeeding Helpline Awards

15:50-16:00 Shereen Fisher Closure