Helen Ball has been researching the sleep of infants and their parents for 25 years. She conducts research in hospitals, the community, and her lab, and she contributes to national and international policy and practice guidelines on infant care. She is a Board Member of ISPID (the International Society for the Study and Prevention of Infant Deaths), Chair of the Scientific Committee for the Lullaby Trust, and Assessment Board member for Unicef UK Baby Friendly Initiative. In 2018 Durham University received the Queen’s Anniversary Prize for Further and Higher Education for Helen’s research and outreach work.
In her talk at this year’s BfN Conference, Helen will provide an overview of her latest project to develop and trial a support intervention for parents who may be struggling with infant-related sleep disruption or post-partum fatigue. Here is a brief abstract of the project to whet your appetite!
Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants’ needs while supporting their own sleep-related well-being throughout their infant’s first year.
Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program, developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach.
Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both.
The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant’s needs, offers parents strategies for supporting the development of their babies’ biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The ‘Sleep, Baby & You’ discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback.
Practitioners reported the ‘Sleep, Baby & You’ materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention.
‘Sleep, Baby & You’ is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating ‘Sleep, Baby & You’ into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.
Ready to hear more? Get your ticket for the conference here:
Dr Lisa J. Orchard is a Senior Lecturer at The University of Wolverhampton. Lisa specialises in cyberpsychology and specifically the psychology behind social media use. Here she discusses the subject of her talk for our conference in October – the impact of social media on breastfeeding.
A recent trend on Tik Tok sees the reaction of breastfeeding infants and toddlers when shown the sight of their mother’s breast. Their eyes light up in glee, as they crawl or toddle over for a snuggle and feed. An adorable sight; but what are the implications of the clip being shared on social media? Perhaps the video will attract a series of likes, shares and comments. Will this make the mother feel supported and empowered? Will she receive any negative comments, which could be detrimental to her confidence? What happens when a teenage girl stumbles upon the video? Perhaps she’s never encountered breastfeeding before. Will this be a positive introduction to seeing how a baby is fed?
The hashtag “normalisebreastfeeding” has been used over the last decade across social media to counteract some of the negativities surrounding breastfeeding. This cyberactivism demonstrates that there was always a hope that social media could be used in a positive manner to benefit breastfeeding promotion and support. This makes sense – social media is our ‘go to’ when finding new information or looking for someone to talk to, which is exactly what new parents need. The “new normal” of COVID-19 has meant an even stronger reliance on technology than ever before. However, to make the most out of social media, we need to take stock of content in order to understand its effect. We also need to consider who is using social media, as this will determine what content is seen.
Let’s start with the breastfeeding mother, who may actively search for breastfeeding support groups and information pages. How does she decide what group to look at? What kind of information does she see? What does she find useful? How accurate is the information? Now let’s consider other users, who may only encounter breastfeeding incidentally, through the sharing of a newspaper article or the viewing of a breastfeeding social media influencer. How often do they encounter breastfeeding content? Do negative comments impact on their opinion of breastfeeding? Do they learn about the benefits of breastfeeding from infographics and memes shared by friends?
Dr Wendy Nicholls and I have embarked on a research project to try and answer some of these questions. In our first study we conducted a review of research already looking at social media and breastfeeding to see what has already been found. The research so far suggests that breastfeeding families enjoy social media and find it useful for information and support. However, social media support does not always result in improved breastfeeding rates. Within our research we consider why this may be and suggest that it could be due to the content being seen. From looking across the studies so far, we can make suggestions about ways to improve this content. For instance, it is important for breastfeeding mothers to feel that information is credible and trustworthy. Furthermore, having relatable role models is important. People want to see other people like them breastfeeding.
Our second study is looking at one specific type of content – the breastfeeding selfie, aka the brelfie! We have been interviewing breastfeeding mothers who share brelfies to better understand what mothers think about brelfies and why they feel they are important to share. By finding this information we can hopefully understand the impact of this content and think about how we can use them more effectively.
Social media undoubtedly poses risks for breastfeeding, and not all content will be positive. However, if we understand the types of content available and how they may impact perceptions of breastfeeding, we can work on improving positive content, and minimising the risk of negative content.
We look forward to hearing more at our virtual conference on 24th October. Got your ticket? Click here:
In May 2020, researchers from Swansea University and Imperial College conducted research in collaboration with the Breastfeeding Network to explore families’ experiences of breastfeeding support during COVID-19.
Click the image to read the full report:
The following summary has been taken from the report, the full findings will be published in a journal later this year.
COVID-19 and lockdown has been a challenging time for breastfeeding families. Many have stopped sooner than they planned. Although this is unfortunately a common issue even outside of the pandemic3, many blamed a lack of support and lockdown experiences upon their decision to stop.
We know that breastfeeding works best when women receive high quality practical and emotional support from professionals and peers including in the community1. This support had to change once lockdown was in place, with breastfeeding charity organisations making rapid alterations to the way they delivered their service.
Some women were fortunate to be able to access this, evidenced by the multiple, varied queries they had answered during this time, covering both practical and emotional support needs. The majority of those who accessed this support found it useful and wanted it to stay, albeit alongside the benefits of face to face support once possible. For these women, their experience was positive, giving them easy and rapid access to support from the comfort of their homes. Notably, some women accessed this support over and above health professional support during the pandemic. It is clear that breastfeeding organisations provided a valued and needed service at this time – a finding reflected in similar previous research exploring the impact of the Australian Breastfeeding Association during this time4.
Unfortunately, two further groups of women did not have the benefit of this support including those who did not realise it was available, and those who accessed it but either struggled or had a strong preference for face to face provision. These women found a lack of in person care challenging, struggling to convey issues or with technology, or simply wanted the reassurance of someone in the room. It is likely these experiences are not equal; those with more resources and fewer challenges at home will find accessing different sources of support in during difficult times easier.
We found that women who did access charity support when they needed it were more likely to still be breastfeeding at the time of completing the survey compared to those who did not. To some extent their ability and willingness to seek support will in itself have supported these mothers’ ability to continue breastfeeding, most likely reflecting high motivation. However, given what we know about the impact of breastfeeding support for new families1, the range of queries posed to teams, and the positive experiences from some women in this survey, it is evidence that charity breastfeeding organisations have played an important role in ensuring mothers could continue breastfeeding through lockdown.
In terms of where we go from here, the good news is that online breastfeeding support services are working well for many women, helping them to breastfeed for longer. However, many challenges and questions have been set, with some of the answers likely outside the control or remit of organisations offering support. Namely:
- How do we ensure better promotion of availability of online breastfeeding support so that more families know they can access it?
- How do we ensure these organisations are well funded to be able to meet the needs of more women?
- How to we enable all populations to access online support, including those who may not be able to afford technology or high-speed internet connections?
- What is needed to recommence face to face breastfeeding support, given other public spaces such as restaurants and public spaces are open?
Given the known impact of breastfeeding upon population health5 and maternal wellbeing6, the government urgently needs to review its provision of care for new families, considering how it can ensure that more are protected in similar circumstances in the future. Although almost all mothers valued the option to receive online or phone support during lockdown, many expressed a wish for face to face support to continue. Recent press reports have stated that Health Secretary Matt Hancock wishes to encourage future virtual GP appointments unless clinical need, but caution must be urged in relying too heavily on a lack of in person support. It was clear mothers valued both the information they were being given, but also the warmth and connection from face to face support, and engagement with other mothers.
Finally, the impact of breastfeeding charities in supporting mothers practically and emotionally through this stressful period should be celebrated. They have served a community of new mothers, whom without their support may have had a much more challenging breastfeeding experience and likely a premature end to breastfeeding altogether. Their value and contribution must be recognised.
1. McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., … & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, (2).
2. Unicef UK (2020) Unicef UK Baby Friendly Initiative statement on infant feeding during the coronavirus (COVID-19) outbreak.
3. McAndrew, F., Thompson, J., Fellows, L., Large, A., Speed, M., & Renfrew, M. J. (2012). Infant feeding survey 2010. Leeds: health and social care information Centre, 2(1).
4. Hull, N., Kam, R. L., & Gribble, K. D. (2020). Providing breastfeeding support during the COVID-19 pandemic: Concerns of mothers who contacted the Australian Breastfeeding Association. medRxiv. [preprint] – doi 10.1101/2020.07.18.20152256
5. Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., … & Group, T. L. B. S. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490.
6. Brown, A. (2018). What do women lose if they are prevented from meeting their breastfeeding goals? Clinical Lactation, 9(4), 200-207.
7. BBC (2020) ‘More Zoom medicine needed’ in NHS says Hancock https://www.bbc.co.uk/news/health-53592678
Gemma Scott is a registered midwife and health visitor, and currently works for Plymouth City Council Public Health Team. Since her work focuses on children and young peoples’ health, she was familiar with some of the challenges she might face when returning to work as a breastfeeding mum – but what happens if you find it difficult to express milk when you’re away from your child? As she discovered, it needn’t spell the end of breastfeeding.
Some of the most common questions I see mothers asking about returning to work are,
How much breastmilk should I leave with my child?
How often should I pump?
I don’t have enough expressed breast milk, do I need to switch to formula?
My own experiences of returning to work whilst both my children were still feeding (around the clock!) and both around 9 months old, suggest these issues might not matter as much as you would think
Personally, I could never pump a huge amount of milk no matter how hard I tried. I have spent a whole week pumping a measly 100 mls for my daughter! And do you know how much of that precious liquid gold she drank? ZERO, choosing instead to have cups of water, solid food and cuddles with her nanny instead. I’ve tried, pumping and hand expressing religiously in office spaces, cafes, supermarkets, the car and everywhere else in between, terrified that my supply will dwindle whilst away from child, all to no avail. So, as you can gather, none of this stuff worked for me, …but something did, as we continued through our breastfeeding journey well into their toddler years.
Instead, I’ve learned that some good questions might be,
Who or what is my support system?
How can my support system adapt to support me on my return to work?
So, who or what was my support system? Well, it was completely a team effort and it began well before the babies came along.
Preparing my employer and particularly my immediate colleagues for the fact that I would be breastfeeding on my return to work was so important. The ‘what’ of course, was an HR policy which supported me as a breastfeeding mother – so do find yours and if there isn’t one, start asking some questions! Alongside this, during pregnancies I made sure that my work mates knew how important breastfeeding was to me, and how I might need to manage that on my return. In my case I did make it very clear that I would need to go out of the office to either express or feed my baby during regular breaks.
I kept in touch with my colleagues during maternity leave. I took opportunities to bring baby in to work to for events and occasional meetings when I could and so, my children became part of my work identity. I believe that this made it easier for my work system to adapt around me and be empathetic to my needs as a parent. I can recall a number of corporate events where I attended with baby in a sling, who was of course then passed continuously around everyone in the room. I mean, who doesn’t love a cuddle with a baby?!
It wasn’t only my employer who was prepared for the need to adapt and support us, but my partner’s also. By asking to flex his hours around our family well before baby arrived, he was able to work a shorter week and to be at home more as needed. By being provided with the necessary IT and diary considerations, he was supported in supporting me. On his days at home if I wasn’t able to get away from the office for some reason, he would often bring baby to me for a breastfeed. Working in a fairly male dominated sector, he was initially reluctant to request this change to his schedule presuming that it would not be approved or, that it wouldn’t be a priority; but of course it was, so do ask!
By also having additional childcare close to work, I was able to organise my day around visits for breastfeeds, never being further than a 5 minute drive away. There were times when I would arrive and baby would be too busy to be interested in feeding, or fast asleep, but to arrive and see that they were happy and settled that was always good enough for me. It wasn’t long before myself and baby were ready to be separated for a little longer, but the transition felt like a process that we were both very much in control of.
Of course looking back, I was very lucky! I had good relationship with my employer, as did my husband. We had childcare from someone we knew and trusted. We had choices. I know unfortunately that this is not the case for lots of families, but some of the questions we asked and the steps we put in place, might be just a bit easier than the challenges women like me face with pumping, storing milk and being physically away from baby for the day.
We know that given the right support baby and mum will adapt around each other, it’s actually up to everyone around us to make sure it happens.
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, Emma Pickett (IBCLC and chair of the Association of Breastfeeding Mothers) gives her take on the process of returning to work as a breastfeeding mum – from the practical to the more emotional aspects.
The first few weeks are often a blur for new mums. The learning curve is steep and you survive day to day – remembering to shower and put food in the fridge for yourself if you are lucky. For those mums still in the middle of that blur, the thought of the eventual return to work can be one that provokes anxiety.
You can’t imagine how it will feel to leave this new special person in your life.
How do you people cope with drop-offs to childcare and getting back to work after potentially several night-wakings?
What do you do if you don’t want to give up breastfeeding?
As a breastfeeding counsellor and lactation consultant, I’ve been supporting breastfeeding mums on their return to work for the last 6 years and there are a few things that are worth bearing in mind.
Here are my SIX top tips for returning to work as a breastfeeding mum.
1. Don’t think about it.
OK, now I don’t mean that too literally. My message is just that if you are going to take 6 months, 8 months or a year off work and you spend several months of that stressing about the return to work, you will be seriously missing out.
STOP yourself thinking about it too much. If you stare at your gorgeous three month old and think fleetingly, “How can I ever leave you?” (which is how nature very much wants you to feel), that is fair enough. But if you spend chunks of your maternity leave feeling anxious and worrying about practicalities, you will be wasting the special times you do have together.
This time is precious. Your baby now is not going to be the same person when you return back to work. They will sleep differently, feed differently, and interact differently. You will not be leaving THIS baby but an older one. So get your childcare sorted (which you may well have thought about in pregnancy anyway) and other than that, there’s not too much more to do! If you intend to express milk at work, it’s a good idea to write to your employer about 2 months before you go back to work to talk about arrangements. And then just carry on as normal. If your 4 month old baby won’t take a bottle and that starts you panicking because you have to go back to work at 8 months, don’t think about it. An 8 month old baby can breastfeed when you are with them in the morning and evening, take a sippy cup, drink from an open cup – you will have options. And a four month old baby that refuses a bottle may not if you try again after leaving it for a few weeks. It’s very easy to set yourself into a panic when the truth is that things usually work out with the right information and the right support.
2. As mentioned, speak to your employer.
The recommendation is that you inform them that you will be returning to work as breastfeeding mum so they have a chance to assess your health and safety and what provisions you may need. Your employers are required to keep you safe. They also have a legal requirement to allow you to ‘rest’ as a breastfeeding mother. Sadly, in the UK, there is not a clearly established legal right to express breastmilk at work and it’s important you talk to your employer so they have advanced warning and you can come to an arrangement. Some women need to have break times re-organised or a room found. Although there is no ‘legal right’ the VAST majority of employers understand that it is in their interests to try and meet your needs and provide you with facilities. Your morale matters and a baby receiving breastmilk is less likely to suffer from illness meaning less time off work for you. There are health and safety executive recommendations and many employers understand the benefits of supporting you as much as possible. However, employers will be more likely to be accommodating if you give them warning and explain your needs clearly.
3. Talk through your schedule with a breastfeeding counsellor or lactation consultant.
Drop-ins are not just for people with problems with positioning and attachment. It’s really common for a mum to come along a few weeks before their return to work to talk about how they hope to organise their feeding and pumping schedule and how to organise things practically. I’ve included some typical scenarios later on.
4. Practise pumping.
Is the breast pump you are using a home something you are familiar with? Do you have a backup if you need to pump at work? Is it worth sourcing a double pump if time is an issue or even hiring a hospital grade electric breast pump for a few months which can just stay at work? You’d be looking at paying around £45 a month (http://www.ardobreastpumps.co.uk/breastpumps_for_hire)
There are tricks such as preparing the breast using massage and warm compresses. And we know that women who finish a pumping session using hand expression techniques can increase their output considerably.
It’s also not a bad idea to build up a bit of a freezer stash before you go back. If you start pumping for one extra session each day and storing that in a freezer bag (store them flat and build up layers of thin flat bags which defrost more easily and take up less space), you will have some wiggle room if you need it. It’s not entirely predictable how pumping will go at work and some women find that their pumping output decreases towards the end of the week and then a weekend of normal breastfeeding boosts it back up again. If you have that freezer stash, it will take away some of their anxiety.
5. Get your kit.
So you need a pump and some bottles and some breastmilk storage bags. What else? Surprisingly not much. You don’t need to store freshly expressed breastmilk in the fridge at work if you don’t want to. You can have a freezer block and an insulated bag and put any expressed milk in there. It is fine in that for 24 hours. So if you store it like that at work, put it in the fridge when you get home, then that milk can be given to your baby’s carer for the next day.
It’s also really important to note, you don’t need to wash and sterilise the pump between pumping sessions. Breastmilk is fine at room temperature for up to 6 hours. So you certainly don’t need to wash a pump between your 11am pumping session and your 2pm one. Lots of working mums use a technique called ‘wet-bagging’, putting a pump in a plastic bag between sessions and then putting it back in the fridge. Then simply take it out next time and wipe any wet parts with paper kitchen towel if you don’t fancy cold drips against you! This also saves precious time.
6. Breastfeed when you can.
Your supply is more likely to be maintained if you breastfeed when you get the chance. Is your childcare near work or home? Could you visit your baby at lunchtime? Could you work from home for one day a week for the first few weeks? You could breastfeed early in the morning, then once more at drop-off, once more at pick-up and again at home later in the evening. Those 4 feeds would be enough breastmilk overall for a baby of 8 months or more. You may not need to be carrying bottles back and forth. And breastfeeding at the weekends and during holidays will help to boost your supply.
Here are the stories of three mothers I have supported (names and some details have been changed):
Carla is going back to work full-time at 6 months. Her son is an enthusiastic exclusive breastfeeder and she’d like to avoid using formula if she can. When her son is 4 months old, she writes to her boss (she is a PA in a law firm) and explains she would like to express her milk at work. Her boss explains the company procedure of having a small office set aside for pumping and there is also a fridge available. Carla explains she intends to express around 3 times in the working day and one of those times will be during her lunch break. Her boss is fine with that. She has a double electric pump which she starts using from 4 months and she gives her son a bottle every other day to get him used to it. She finds he prefers to sit a bit more upright and usually takes 3-4oz from the bottle.
She starts solids around 10 days before she goes back to work and he takes small amounts initially and Carla knows his breastfeeding schedule will remain unaffected for a while. The week before she starts work, they visit the nursery together and he has a few hours there. He then has two trial days where Carla practises her expressing schedule and the nursery workers give him a bottle and some solids.
On her working day, she breastfeeds him as normal at 6am. She drops him off at nursery at 7.45am and offers again and he takes a small feed. At work she expresses at 11am, 1.30pm and 3.30pm. She collects her son from nursery at 6pm. He is keen to breastfeed when she arrives and they breastfeed at nursery. She breastfeeds him again at home at around 10pm as a dreamfeed. He wakes once at around 2am and she breastfeeds him again.
While he is at nursery, the carers give him bottles and offer solids and he usually takes around 12oz in total while they are separated. As he has 3 good breastfeeds in addition to that in 24 hours, Carla isn’t worried. Carla expresses more milk at work than her son takes in a bottle at the moment. Over the next few weeks, she moves to expressing only twice. Carla ends up offering exclusive breastmilk until 12 months and then she gradually introduces cow’s milk.
Phoebe is returning to work at 10 months. She is a graphic designer and works from home with some client visits necessary around London. Her daughter breastfeeds around 4 times in 24 hours and enjoys solids which she started at 6 months. Phoebe doesn’t enjoy pumping and finds it difficult so would rather avoid it if possible. She finds a child-minder who lives near her home. Phoebe breastfeeds at 8.30am and drops her daughter at the child-minder. If she is working from home she visits at lunchtime for another breastfeed. She then collects her daughter at around 4pm and takes her home to breastfeed at 6pm and around 11pm. While her daughter is at the child-minder, she eats solid food and drinks water. The child-minder doesn’t give her milk. When Phoebe has a client visit, she sometimes hand expresses for a few minutes into a plastic bag when she can grab a private moment. This is just to stay comfortable when she feels particularly engorged. This will help to reduce her risk of blocked ducts and mastitis and help to maintain her supply. She doesn’t keep the milk. Phoebe continues breastfeeding her daughter until she is 18 months old. At the end she is only breastfeeding in the morning and evening and Phoebe doesn’t feel the need to use any hand expression when they are separated.
Catherine is returning to work at 8 months. Her son breastfeeds around 6 times in 24 hours. He started solids at 6 months. He doesn’t particularly like bottles and usually only takes around 2oz max. Catherine finds that he will take more milk from an open cup called a doidy cup. He will also more likely to take it if she mixes the breastmilk with ripe banana and makes a smoothie! Catherine gets through a lot of bananas! She works 4 days a week (and at 12 months will go back to being full time). Catherine is a teacher. Her headteacher has struggled to find her a private room for pumping but has given her the key to the medical room and if that is in use, she uses a stock cupboard and she has told staff that when her scarf is on the door, please knock! Usually the medical room is empty. Her colleagues have agreed to relieve her of playground duty while she is breastfeeding. She breastfeeds her son at 5.45am and again at 7.45am at the child-minder. She arrives at school at 8.15am. She expresses at 10.45am during morning break. She expresses for 10 minutes. She expresses again at lunchtime for 15 minutes and at around 4pm for another 10 minutes. She has to use a double pump as her pumping time is restricted. She remains at school for meetings and lesson preparation and collects her son at around 6pm. She breastfeeds him at 7pm and 10pm. He wakes to feed between 1-2am and Catherine is happy for that to continue for the time being as he feeds and goes back to sleep quickly.
With the child-minder, her son takes around 3oz of breastmilk in his smoothie, 2oz mixed into a porridge and another 1-2oz from his doidy cup. She also makes sure his solids contain good sources of fats and calcium. Sometimes she struggles to pump in her breaks as she really needs to continue working. She finds herself dipping into her freezer stash and as time goes on, the child-minder sometimes uses formula to make up the porridge. On the weekends and on her day off, he breastfeeds more frequently.
There are many women who effortlessly combine breastfeeding and working. If it sounds hard, remember that in the USA there is no statutory maternity leave and women often return to work after just a few weeks. However they have 16% of babies exclusively receiving breastmilk at 6 months and the UK manages 1% (http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf).
Working and breastmilk are not incompatible. With modern electric breast pumps and using breastfeeding support available locally and through the National Breastfeeding Helpline, it’s never been easier. However if we could get the statutory right to pump at work it would certainly help. Contact your MP if you feel the right to express at work (as exists in 92 countries throughout the world) is something UK mums should be entitled to.
This article was originally published on Emma’s blog, here, and is reproduced here with her permission.
To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:
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.
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:
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.
- Hands-on expressing and massage help the milk flow and the breasts drain evenly and efficiently. Some mum’s find warm compresses or help too.
- 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.
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/
This is Hannah – you may recognise her from recent social media posts, after she was interviewed while running the London Marathon last month. What’s so special about that, you might wonder? Well, not many runners had scheduled stops to breastfeed their eight-month-old daughter along the way. We were blown away by Hannah’s achievement – here’s what she had to say when we caught up with her for a chat.
I have previously run marathons before, Manchester marathon I had ran 3 times. I had run London once before in 2017 and had gained a ‘good for age’ place for 2018. However, I fell pregnant and deferred my entry to 2019. Once my daughter Skye came 2 weeks late (and via emergency c-section), I felt it took me a very long time to feel myself again and have energy and a want to run – or move any faster than walking! Being a first time mum who decided to exclusively breastfeed, I found myself exhausted. I spent the first 16 weeks still feeling battered and bruised.
But I felt like this might be only chance to run the London marathon again, as it is so very hard to get in through the ballot.
My training was non-existent, after about 5 months I managed to walk/run 5km. I used to really enjoy running pre-baby, but did not enjoy running these very few times I went out. I was slow, it was hard. I took Skye in her pram a couple of times – it wasn’t a running specific pram but I was going sooo slowly I decided it would be okay and tried to include it whilst she was sleeping. In March I did my local park run (5km) without baby and then 2 weeks later my partner and I did a 10km run. That was the first time I ran 8km without stopping. At the beginning of April I decided I was going to do the marathon. My partner, Max, is a teacher and I said I was going to use the Easter holidays to try to run, while he was around to look after Skye. In that time I managed about 4 runs, which got me up to 10 miles the weekend before the marathon.
On the day of the marathon, I had planned for Max to come with me to the start of the race and I was going to give Skye a feed before I went in. However, I had fed her from 6am-7am and she was asleep as I continued to get ready to leave – so I made the tricky decision to leave her at home and just meet them both at our first meeting spot. We had arranged meeting points ahead of time, at around 13.1 miles, 21 miles, and finally at the end, where I fed her before starting our journey home. I had packed Skye some food for the day – cucumber, celery, green beans and baby corn. We started weaning a couple of months ago so I thought of things she may enjoy whilst waiting for feeds.
We didn’t make any special arrangements with the stewards or race organisers ahead of time. When I reached our designated feeding spots there were an awful lot of people, it was really crowded. For my first feed I came off the race course and sat behind the crowd on a little wall. Later on, a nice marshal said I could lean against the railing of the race and I sat down on the curb and fed her there. The marshal was really nice and offered me food and drinks, as well as another member of the public who passed by and gave me some blueberries.
My tip to any other mums who are thinking about embarking on big fitness challenges would be, go for it! Get yourself a good bra that is supportive. Train when you can, don’t put any pressure on yourself. If you don’t feel like going for that run or doing that class, don’t, go later or rearrange. If you do it and you don’t enjoy it, stop. Be flexible and adaptable.
I would definitely do the London marathon or a different marathon again. I will be shuffling my way through Hackney Half marathon in ten days, but I won’t need to feed Skye along the way, just before and after. And then I’ll be putting my feet up for a while!
If Hannah has inspired you to get your trainers on, why not sign up for BfN’s Mums’ Milk Run? You can set your own challenge (it needn’t be a marathon, or even a run!) and any funds you raise will be used to help support breastfeeding families. The event runs throughout May – click here for more info and to register: