01 Oct

Breastfeeding with a disability

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.

26 Apr

Breastfeeding after a Caesarean Birth

Photo: Ashley Marston

As part of caesarean awareness month in April, we’re sharing some information on breastfeeding after a caesarean section. Your caesarean may be planned or unplanned, but either way it needn’t derail your breastfeeding journey – the key is to be informed so you can be as prepared as possible.

First, BfN Supporter Zoë Chadderton shares some information on caesarean births, how they can affect breastfeeding, and steps you can take to help get feeding established – with links to a factsheet by BfN pharmacist Dr Wendy Jones. Then we’ll hear from Alyson, a BfN peer supporter, on her experience of breastfeeding after a C-section.

About caesareans & breastfeeding: Zoë Chadderton

There are three types of C-sections:

  • Planned (also called elective) – this is planned ahead of time, and may be for a number of reasons, e.g. placenta praevia. 
  • Emergency – this takes place during labour, normally because of  slow or no progress in labour  or baby/mum in distress. Despite the term “emergency”, the actual surgery is performed in much the same way as a planned section, it just hasn’t been planned ahead of time.
  • Crash – an actual emergency, mainly if the baby is in danger and needs to be born very quickly.

Most sections happen under local anaesthetic – an epidural or spinal block. General anaesthetics are rare, but can occur.

Generally speaking, a caesarean birth can cause breastfeeding to be a little delayed compared to a vaginal birth because mum doesn’t get the natural surge of oxytocin that can help with her milk supply. However, that absolutely doesn’t mean that you can’t breastfeed after a C-section – just that you need to be aware of the issues that may arise, and how to deal with them to help get feeding successfully established.

Planned sections can be better in some respects because mum isn’t exhausted from the stresses and strains of labour, and she can plan what she would like to happen such as skin to skin in theatre, immediately after birth. Mums who are planning a section can also think about hand expressing colostrum before the birth (antenatal expressing), which may help if baby is delayed in going to the breast, and more importantly helps the mum be secure in her technique in a non-stressful situation (it can be quite stressful learning how to hand express because you HAVE to, because your baby isn’t feeding, rather than relaxed “I’m learning a useful skill” antenatal expressing). Even if you are not planning a caesarean birth, it can be a good idea to learn how to hand express before your baby is born – you can start after 37 weeks, and information on technique can be found here*.

Pain can be an issue – many mums worry about baby kicking their scar – and you may struggle to sit up for a while after surgery, so there are several feeding positions you can try to work around these issues. Lying down on your side with your baby beside you on the bed; underarm (also called rugby hold); and in some cases laid back feeding (also, confusingly, called upright hold or biological nurturing) can be really useful. Try out a few positions and see what works for you (see here for some tips). Check out BfN pharmacist Dr Wendy Jones’ factsheet for information on your pain relief options while breastfeeding – there are many options which are perfectly safe for you and your baby. Don’t be a hero – take that pain relief.

Get some skin to skin contact with your baby as soon as you are able – preferably in theatre immediately after birth. Mention it to the midwives, even in an emergency – it can make a real difference to baby’s instinctive behaviour at the breast by getting hormones flowing for both of you and allowing both you and baby time to get to know each other and start your feeding journey. Finally, be patient. Take your time, baby might not feed as quickly as you expect (this applies to all babies!), but skin to skin, hand expressing and help from the ward staff or breastfeeding peer supporters will all help. Good luck!

*(N.B. this video refers to small babies – however the technique remains the same for all babies, the only difference being that colostrum would more likely be collected in a syringe or cup rather than a spoon.)

~~~

Alyson & Charlie’s Story

I had always intended to breastfeed my baby, and throughout my pregnancy was hoping for as natural a birth as possible. I’d read about how breastfeeding often gets off to an easier start after a natural labour, so I felt I would be giving myself and my baby the best possible chance of success.

But apparently my baby hadn’t read the birth plan. I found out at 36 weeks that he was breech, and to top it off, his head measurement was (literally) off the charts…a trait he inherited from both me and my husband. We were told there was a 50/50 chance that he would turn head-down, but that if he didn’t and we tried for a breech birth, there was a high chance that his big head would get stuck and we’d have to have an emergency (or even a crash) C-section.

I was shattered by the news. I felt like the natural birth I’d planned for was disappearing before my eyes, and my chances of breastfeeding along with it. We decided to take a week, to see if the baby turned, and to fully research breastfeeding after a C-section so that we could be prepared. I was pleasantly surprised by what I found, and realised that a C-section needn’t spell disaster for breastfeeding – I just needed to be aware of what might happen and prepare for it. This was just as well. Despite me doing various bizarre exercises to try to spin him around, the baby remained resolutely breech, so we booked a C-section for 39 weeks…and suddenly everything seemed very real indeed!

I visited my local breastfeeding drop-in group before the birth, to speak to the peer supporters there and get some information. They were amazing. They showed me some positions (“laid back” feeding, and the rugby hold) that minimised the risk of the baby kicking my incision, and that would mean I wouldn’t have to completely sit up – since my core muscles would take a while to heal. They also explained how I wouldn’t experience the same hormonal changes that I would have done in labour, and how this might mean my milk was a little delayed in coming in. To combat this, they advised lots of skin to skin contact with the baby, starting immediately after birth and continuing throughout the first days and weeks. They explained that this would help to get the oxytocin flowing, and also give the baby a chance to follow his instincts and find his own way to the breast.

On the day of the birth, I discussed our plan with my midwife and surgical team. They were very helpful, and showed me how to put on my gown so it could be easily pulled down for skin to skin. When Charlie was born (complete with frankly enormous head), he was placed onto my chest almost straight away, and I held him like this, skin to skin, for the first couple of hours. I was amazed to see him start “rooting” for the nipple – it sounds unbelievable, but he did a sort of sideways shuffle/crawl until he was lined up, then latched himself on and stayed there for an hour. I had heard about this in my research and my visit to the breastfeeding group, so I knew I should just leave him to it as long as I wasn’t in pain, but it was still amazing to watch.

There was some concern from the midwives that he slept for a long time after this first feed, so we spent an hour trying to wake him up and persuade him to latch on, but he was absolutely zonked out. One midwife suggested we give him some formula, but my instinct (and everything I had read about getting breastfeeding established) was to avoid this if at all possible. While I was not against formula per se, I didn’t want to fill him up with it and therefore reduce the amount he needed from me, which would impact on my supply and potentially delay my milk coming in. Luckily another midwife suggested we express some colostrum into a syringe, so that we could feed him that. She showed me how to hand express, and I was delighted to see drops of thick, yellow colostrum coming out – the midwife told me this was a great sign that things were happening as they should. I’ll never forget her, she was so kind. I managed to express a couple of millilitres, which we carefully dropped into Charlie’s mouth and he lapped up without even waking up! About an hour later he woke up again and latched on for another feed – we were observed by a midwife, who told us that the latch looked good, and that she didn’t have any concerns about him feeding. This was very reassuring.

We were discharged from hospital after 36 hours, and went home to begin our lives as a family of three. Charlie spent the first night at home feeding A LOT. It was pretty constant from about 9pm to 4am, not wanting to be put down, and only really being content on the breast. If I hadn’t spoken to the peer supporters, I think I would have really panicked that the C-section had messed things up, that I didn’t have enough milk and that he was starving – but as it was, I’d been warned that this may happen, that he was just “putting his order in”, stimulating the breasts to kick-start my supply. I don’t know if this was more pronounced because of the C-section – it may well have happened anyway. It was pretty gruelling, but being prepared for it was key…I got comfy on the sofa with a mountain of snacks, drinks and a whole lot of Netflix. I felt very lucky to be facing this after a straightforward birth, rather than an exhausting labour, so that was a definite positive of the C-section for me. I also sent my husband off to get a bit of sleep, so he’d be refreshed and ready to tag in for a while later! Obviously he doesn’t have boobs, so did a lot of cuddling, bouncing and singing for an hour or so while I grabbed a quick nap. This really helped. It’s an absolute myth that dads can’t help or bond with their breastfed babies, there is so much that they can (and do) do.

My milk came in on day 3. I felt like I transformed into a Pamela Anderson lookalike overnight, which was both alarming and reassuring…this breastfeeding thing was really working! Charlie continued feeding like a trooper, and over the next few weeks my supply regulated and I felt more normal again. It was also really useful to use the hand expression technique I’d been taught in hospital, when I needed to keep things comfortable between feeds.

I found the “laid back” position really helpful, semi-reclined on the sofa/bed with Charlie lying diagonally across me. It felt very comfortable and seemed to give him the chance to follow his instincts without too much interference from me. Over time we adapted the position so I could feed him sitting more upright, with him straddling my leg. I found, with a bit of practice, I could feed like this in many situations – useful when we were ready to go out for a coffee! At night, his side-sleeper cot was a lifesaver – because of my incision, I found it really tricky to get in and out of bed in the first few days, so it was great to be able to just slide him towards me and feed in the laid back position.

I was lucky that Charlie took to breastfeeding pretty easily, and never had any real issues with latch etc. After a normal weight loss in the first few days, he gained weight well, and continued to breastfeed for almost a year. My C-section did have an impact on breastfeeding, but since I knew in advance, I was able to prepare and combat it – through immediate skin to skin, understanding frequent feeding (aka normal newborn behaviour!), avoiding unnecessary top-ups, and overall being led by my baby and feeding on demand, to let nature take its course. I was so pleased that we were able to breastfeed successfully, despite not having the natural birth we’d planned. I struggled for a while with the feeling that I hadn’t given birth “properly”, that my body had somehow failed me (I’ve now worked through this and know that any means of safely getting a person out of yourself is the “proper” way to do it, and is the opposite of failure), and breastfeeding really helped me to feel that something was working out the way I intended.

My advice to anyone intending to breastfeed would be to find out as much as you can before your baby is born, including the possible implications of a C-section, whether you’re planning to have one or not. As I discovered, birth plans are just a plan, and they don’t always work out the way you expect. Most of all, don’t assume you’re doomed before you even start – do your research, find a local group, ask your midwife, call the National Breastfeeding Helpline. They will be able to give you support and information, even before the birth, and help get breastfeeding established. You’ve got this!

02 Apr

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

2nd April 2019

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

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

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

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

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

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

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

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

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

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

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

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

Ends

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

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