Anthea Tennant-Eyles, Research Lead and Breastfeeding Peer Supporter
New research published here by Cardiff University and The Breastfeeding Network highlights inequity of access to breastfeeding support for families across England and Wales, a pattern of decreased funding since 2015 across England and loss of funded peer support training across Wales. One peer supporter describes changes to local support as ‘a skeleton with all the flesh removed’.
This research looks at data from local authorities, CCGs, health boards, infant feeding leads, peer supporters and service-users on breastfeeding support services. The need to value breastfeeding support (including peer support) at all levels has been a key finding.
Good practice of this has been reported. One Infant Feeding Lead describes a maintained level of funding, with BFI accreditation, a staff team to support the infant lead role and a peer support service that is ‘fully integrated and offers comprehensive very high level support across all areas of maternity and health visiting services.’
High-level investments are needed across England and Wales to ensure that there is equity of access to breastfeeding support.
One peer supporter noted, “it was different in every local authority or health board … it was a post code lottery … until after you had your baby, you didn’t really realise how much that mattered in terms of what support you would get”.
So why is academic research on breastfeeding so important? To inform policy makers on the importance of providing dedicated breastfeeding support services to local families and that services are protected for the well-being of future generations.
This time last year, we published a joint statement with a number of other organisations, expressing our concern at the fragility of infant feeding support in the UK, exposed by the Covid-19 pandemic. Unfortunately, not a lot of progress has been made towards remedying this situation in the past year, and this new report only serves to highlight the continuing need for change. We stand by our statement and are still calling on the UK government to work towards reducing health inequalities and improving provision of adequate breastfeeding support for all. You can read our original statement here: https://www.breastfeedingnetwork.org.uk/2020statement/
Breastfeeding a baby with Down syndrome can sometimes present challenges, but with the right information and support, many can breastfeed successfully. As part of World Down Syndrome Day, here we present two pieces from mothers of children with Down syndrome. First, Sarah gives her tips on successfully breastfeeding a baby with Down syndrome. Then Alice gives some pointers to those supporting families of children with Down syndrome.
Sarah is a BfN peer supporter and mother to Zephaniah. Here she gives her ten top tips for breastfeeding a baby with Down syndrome. You can read more of Sarah and Zephaniah’s story on Sarah’s blog, Chromosomes and Curls.
So you have decided you would like to breastfeed your baby. There are so many benefits in breastfeeding and these can apply even more so to babies with Down Syndrome. Breast milk can boost your babies immune system and provide protection against numerous auto-immune disorders such as celiac disease, allergies and asthma to name a few. The act of breastfeeding itself will strengthen your babies tongue, lips and face which helps with future speech development.
Sadly there is a myth that babies with Down Syndrome cannot breastfeed and I’ve heard many stories of mums not being supported or being told their baby won’t breastfeed so not to bother trying by various healthcare professionals.
Whilst it’s absolutely possible for many babies with Down Syndrome to breastfeed efficiently and successfully, there are some factors that may arise which can impact on establishing feeding. Medical complexities, low muscle tone and lack of suck, swallow, breathe co-ordination are some of the additional challenges facing babies with Down Syndrome. As a result some mums will breastfeed with expressed breastmilk from a bottle/tube and others will move onto formula milk.
I have been a breastfeeding helper with the BFN (the Breastfeeding Network) for around 5 years and Zephaniah, my baby with Down syndrome, is my second breastfed baby. I had a pre natal diagnosis and one of my major fears and concerns was whether I would be able to breastfeed. Thankfully I was surrounded by wonderfully supportive people who reassured me that it would be hopefully be possible! We had a slightly rocky start and I had to express almost exclusively for the first 3 weeks whilst bottle feeding and using an ng tube whilst we were in the special care unit and in the first week or so at home. Zephaniah is now four years old and breastfed until he was 2.5.
Here are my top tips! I would love for any other breastfeeding mums (or dads) to share any of their top tips in the comments.
1. Find your support during pregnancy This is so important when pregnant with any baby. It’s something I learnt in hindsight after I had my first baby. The immediate post partum period can leave a woman feeling vulnerable, emotional, hormonal, physically in pain and sometimes the thought of trying to seek out where you can get support from can feel overwhelming. During pregnancy pop along to your local breastfeeding support group or La Leche League meeting and have a chat. Ask what support is available in hospital in the immediate post natal period. Have the breastfeeding helpline numbers to hand.
2. Colostrum Harvesting Speak to your midwife about harvesting some colostrum in the last few weeks of pregnancy. This is expressing and collecting colostrum. They can show you a correct technique and provide you with syringes to collect the drops in. This will be beneficial in the early hours/days if your baby struggles to latch straight away or needs expressed milk/supplementation.
3. Donor Milk Policies Talk to your hospital about their policies and availability of donor milk/milk bank if this is something you would prefer your baby to have over formula should you be required to supplement your baby with milk. Hospitals have different guideline that they follow so if you have something in place with them it will make things easier when the time comes.
4. Be prepared to pump There are many reasons you may need to express breastmilk for your baby. It could be that your baby is struggling to latch or it could be due to a nicu/scbu stay, or baby being too sleepy to feed. If you baby has a heart condition or other medical issues going on then they might tire easily. Whilst you are in hospital you should be able to access a good hospital grade double pump. There are some companies that hire out hospital grade pumps at home or you can use a high street brand electric or manual pump. Some babies with Down Syndrome will breastfeed with no problems from the beginning, others, like any baby, may take longer to establish effective, successful feeding. Some mums will decide to pump exclusively for their babies for whatever timeframe they choose to. I pumped for around 3 weeks with Zephaniah before he was effectively feeding at the breast. I know a mum who pumped for 5 months before getting her son to feed directly at the breast.
5. Be wary of the phrase ‘It’s a Down Syndrome issue’ Don’t assume or allow anyone to dismiss problems you are facing as being ‘a Down Syndrome issue’. As a breastfeeding helper I have seen many women with typical babies facing all sorts of difficulties when establishing breastfeeding. Position and attachment, tongue tie, sleepy babies, being pushed into formula top ups, and mis information and awareness of typical newborn behaviour patterns are common reasons for struggling and all of these same things can apply to you and your baby with Down Syndrome as well as some additional challenges your babies may face. The main additional challenges your baby may face is difficulty latching and feeding due to low muscle tone, taking longer to establish a breathe, suck, swallow routine, being more sleepy or tiring easily. If your baby has complex medical issues such as a heart defect or anything else requiring surgery then there may be pressure for your baby to gain a certain amount of weight in a specific timeframe and sometimes this can make establishing breastfeeding a challenge.
6. Comfort and support Low muscle tone in a baby can often make the baby feel heavier or floppy and more of a challenge to hold whilst breastfeeding. It’s important for your comfort, and your baby’s, that you are both well supported with good position and attachment. A suitable chair, a supportive breastfeeding pillow or your own cushions can help with this. Babies with low muscle tone will often brace their feet against something such as the arm of the chair to stabilise themselves and this can lead to arching which can impact on the positioning of the feeding. You may also want to give additional support to the babies head whilst making sure you aren’t restricting their movement.
7. Dancer Hand Position. This is a technique that can assist when a baby has low muscle tone. You start by holding the breast in the C-hold (thumb on top and 4 fingers underneath) but support the breast with only 3 fingers leaving your index finger and thumb free to hold the baby’s cheek on either side, forming a U shape with the baby’s chin in the bottom of the U. This keeps the weight of the breast off the baby’s chin and helps keep the head steady. This can really help your baby to maintain a good latch. In the early days of feeding Zephaniah he really struggled to maintain a latch and without adequate chin support he would slip off the latch frequently. I would always have to feed him with a muslin cloth underneath as he leaked so much milk out of his mouth. As he got bigger and stronger so did his latch.
8. Skin to skin. Make lots of time for skin to skin contact with your baby. This will help establish your milk supply and raise oxytocin levels. Whether you have a prenatal or post natal diagnosis, the immediate time after birth can often be traumatic and confusing. Your baby may be in the nicu or scbu where it can sometimes be more of a challenge to easily have skin to skin with your baby so it will need to be intentional. You may be feeling a variety of emotions and some mums may struggle to initially bond with their baby after having a surprise diagnosis. It’s normal to go through a range of emotions from sadness,to grief, to guilt, to anger and everything else in between. It’s also normal to not feel any negative emotions and have no issues with bonding, everyone is different and all feelings are normal.
9. Weight chart and red book. In the UK all babies are issued with a red book at the hospital which contains medical information and growth charts/developmental information. Make sure you are given the green Down Syndrome insert which contains specific weight/growth charts as babies with Down syndrome can grow at a different/slower rate to typical children. Your baby may seem to be on a lower centile on the typical graph which can lead to some health care professionals recommending top ups of either expressed breast milk or formula when it’s unnecessary.
10. Go easy on yourself and enjoy your baby Having a baby is a major event in anyone’s life and having a baby with additional needs adds an entirely different dimension on to that. Do what is best for you and your baby. Make informed choices. If you want to breastfeed and are struggling, try and find the right support and be patient as it can take time to establish.
If you are a mum who desperately wanted to breastfeed and have been unable to, know that you did your absolute best for your baby and you are amazing for giving it a go!
Alice works for the Portsmouth Down Syndrome Association, and is mother to Teddy. Here she writes about their experience, and gives some information on how best to sensitively support the families of children with Down syndrome on their breastfeeding journey.
I feel it’s important to start by explaining that I am not an expert in breastfeeding! I am a Social Worker and had chosen to specialise my career in working with people with Learning Disabilities. It wasn’t until my second son, Teddy was born, and then diagnosed with Down syndrome that I realised just how important and powerful language and knowledge is for everyone involved in supporting a family. I reached out to my local support group Portsmouth Down Syndrome Association (PDSA) when Teddy was diagnosed, and they supported my family from his diagnosis and throughout our journey to the cheeky 4-year-old he is now. I started to volunteer with PDSA and now provide education and training for Health and Social Care practitioners on all aspects of Down syndrome. It is important that families of people with Down syndrome have access to the support that they need and that this is delivered holistically.
Teddy was born by an elective c-section due to being breech. We had a blissful hour of skin to skin and Teddy was great at feeding, he latched straight away and ‘just got it’. After 24 hours in hospital recovering, both Teddy and I were discharged home (his diagnosis was missed) and we were eager to start life as a family of four. Teddy was brilliant at feeding and on day 3, we were rewarded with the fantastic news that he had gained 40g! However, Teddy’s subsequent weight gains were ‘static’, and he only gained 20g a day. Due to extended jaundice at 2-weeks-old we were seen in hospital by a doctor and consultant who suggested some screening and tests. I was grateful as had some feelings that all was not as expected with Teddy. One of these tests diagnosed Teddy as having polycythaemia (a high concentration of red blood cells in your blood). We were admitted to hospital the next day for ‘failure to thrive’. There was a suggestion that Teddy may be having difficulties getting milk, and that he may not manage with a bottle so would need a Nasogastric tube (NG). I was clear with the team that I wanted to continue breastfeeding, and so would express the ‘bottle top ups’ that they felt Teddy needed. As I had fed Teddy’s older brother successfully, I was quite confident in my ability to provide milk for him. I didn’t know what a NG tube was – but they weren’t doing that to my baby if we could avoid it!! We started the gruelling 3-hour cycle of alarms, feeding, expressing, and topping up. One nursery nurse was incredibly supportive. She sat next to me on the bed late in the evening and told me to ‘stand by my guns, and that if I wanted to feed, that I could and should’.
Slowly but surely, Teddy continued to gain weight, and so we were discharged 4 days later. At 3 weeks old, Teddy’s genetic bloodwork came back, and he was diagnosed with Down syndrome.
A few days later at a baby weigh clinic, I asked for support from a breastfeeding volunteer, I wanted to see if there was anything more I could do to help Teddy. I remember the volunteer asking my husband and I ‘how she could help’. It was the first time, that I had to tell anybody outside of our family, and health professionals that Teddy had Down syndrome. I was so very aware of the other mothers feeding their babies close by and found it difficult to speak. The volunteer was lovely and tried to support me but referred to Teddy as a ‘Downs baby’. I didn’t know how to tell her that Teddy’s diagnosis was only part of him – it didn’t define him. He was (and is) so much more than his diagnosis.
At home, we continued to ‘top’ Teddy up with expressed bottles of milk, but Teddy gained weight rapidly and so we limited these. Teddy was able to switch effortlessly between breastfeeding and bottle feeding – he wasn’t particularly bothered where his milk came from – as long as he had milk!
Breastfeeding was especially important to me. It gave Teddy and I a ‘closeness’, it helped me feel that despite a world of unfamiliar health appointments, invaded by complex health professionals and new medical language that I was doing something ‘important and normal’. Breastfeeding helped remind me that first and foremost, Teddy just needed love and milk- like all babies.
My tips to anyone supporting a family of a child with Down syndrome:
See the child first. Use positive, person first language, Teddy has Down syndrome rather than Down syndrome baby/child.
Congratulate that family on their newborn, as you would any baby – all babies deserve a warm welcome!
Signpost a family to resources like Julia’s way and their local Down syndrome support group for more guidance.
Encourage a family to advocate for how they wish to feed their child.
Many mothers of children with Down syndrome who had early issues report that their baby was breastfeeding successfully by 3-4 months of age.
Be aware that health conditions, a child’s tone or coordination may impact on their feeding, but different feeding positions may support baby better. For babies which may tire easily, it may help if milk let down happens before the baby latches. Ensure liaison with SLT if there are any concerns regarding aspiration.
Ensure that the family have a PCHR insert in their red book and so the baby is being plotted on a graph for children with Down syndrome.
In June 2020, against the backdrop of the worldwide protests advocating for an end to racial inequality on a mass scale, the Breastfeeding Network shared a statement on Black Lives Matter in solidarity against racism. It felt especially relevant for BfN to do this given our work with all mothers and our knowledge of the deep inequalities that exist for Black and Asian women in our maternity services highlighted in the MBRRACE report.
Here is that statement again:
Black breastfeeding matters
We stand alongside all Black mothers and families, and are willing to do anything we can to ensure mothers and babies get real change for the better.
At the heart of BfN’s values is empowerment of women, and none of us can feel empowered if we are raising our children with threat from racism.
As a charity we have always believed in social justice for mothers and babies, but often we have felt limited in what to do, in part due to our own ignorance – which is our responsibility to correct.
We hear our fellow Black mothers and families and we are committed to doing more – using our core values of empowerment, empathy and actively listening.
We are committed to learning and educating ourselves.
We will share and amplify Black women’s voices. We are here for you.
Since we made that statement, what have we done?
We have made the commitment publicly to push for anti-racism within infant feeding and across maternity and the early years agenda. We have done this through becoming a more visible ally to the people and organisations who give voice to anti-racism, including providing monetary support for Black Breastfeeding Week and promotion and awareness raising of the FIVEXMORE campaign in our communications.
Across the charity we have questioned ourselves and heard from others to understand our responsibilities to drive up equality and eliminate racist behaviour. While we, like many other breastfeeding support organisations, don’t consider ourselves to be racist, by virtue of the UK’s shocking inequalities we recognise that by remaining passive on these issues we perpetuate the same behaviours that allow racism to flourish. We all need to do more and given what we know about the inequalities that persist within breastfeeding we in particular actually need to do more than most to help correct this. We aim to drive up racial equality in breastfeeding by further committing to supporting ALL families to feel comfortable accessing our support, training, volunteering and working for us. This is at the heart of our work and we know that we can only truly achieve it by becoming a more representative and diverse charity.
So, informed by early work undertaken by volunteers on a working group in 2018/19, we have been asking ourselves …
What are the changes that we need to make?
Last summer we heard from many of our peer supporters out in communities who knew more than we did to understand how we can implement a lasting inclusion and diversity action plan for the charity.
Where we are now and, and what actions must we take?
Guided by the insights from the volunteer working group, Black, Asian and Ethnic Minority peer supporters from BfN, and colleagues from BRAP, we have mapped the areas and actions that we want to work on. Our Board-approved Inclusion and Diversity Action Plan will document change in the following areas:-
People we support
We have always recognised that some women face higher barriers to breastfeeding support. This is why we have and will continue to keep our training for mothers free. We have also always targeted our work in areas where breastfeeding rates are at their lowest. We routinely collect ethnicity data on our helplines and across our commissioned services but we don’t have a complete picture for our volunteers across the charity. We believe that increasing access to our training is key to building a more diverse charity. However, we recognise that even the act of volunteering is problematic for individuals and communities who are not able to afford to volunteer.
We provide a universal service meeting mothers on-wards, and we know that our home visits reach a diverse community, but many services are based at our community groups and attendance at groups is not representative. Through our action plan we are seeking partnerships with others to help us build representation across our community groups and drop-ins. We recognise that with a few exceptions the majority of the people we support across our helplines and in our commissioned services are white and we want to change this through encouraging wider access to our training. The charity has a tradition of offering minority language lines. We proactively maintain specific helpline support for Welsh, Polish, Bengali/Syheti women and families – and are able also to offer helpline support in various other languages, because of the diversity and strength in languages that our networks possess. While we see this as a strength it can also be a practical weakness as language lines rely on volunteers. We will proactively report on the take-up of our language lines and develop less volunteer-reliant ways of supporting families who require support in a different language.
While progress had been made to engage younger mothers with lived experience of breastfeeding on the Board as Directors there has been a clear lack of diverse ethnic representation on our Board of Directors for some time. In November 2020 we were pleased to welcome two new board members and there is an ongoing commitment to ensure strong representation on the Board to support effective decision-making.
Workforce and volunteers
BfN attracts a diverse range of candidates for jobs but we need to do more work to see if the people who get offered jobs are also representative and diverse. We commit to doing an employee survey in 2021 and benchmarking with other appropriate organisations.
We will also explicitly recruit staff from diverse backgrounds for a range of specialist and skilled roles across the organisation.
Training and Supervision
We are working with a partner to undertake a review of our Helper training and resources to ensure equality, diversity, inclusion and accessibility. This will be complete by February 2021 and then we will look to extend the review across the rest of our training resources over the course of the year.
Our commissioned work in Cheshire and Merseyside, where some trainees were recruited through the Black Mum Magic Project, will provide invaluable ongoing learning for our training. As the vast majority of our trainees are white, attracting, training and retaining women from more diverse ethnic backgrounds is a key focus of our work in many communities. We intend to offer targeted training to these communities independently or in collaboration with a partner.
We recognise that we have not done enough to help our workforce adopt and implement inclusive and diverse practices and to build knowledge and cultural sensitivity. In early 2021 we are training our tutors and supervisors in inclusion and diversity, we are doing this with two external providers – BRAP, an equality charity, and Vanisha Virgo, Mama and Me, who has trained with BfN. We will extend training on inclusion and diversity to all staff by the end of 2021.
We have reviewed our mandatory training requirements to cover training that is important to our volunteers and staff and this now includes inclusion and diversity training.
We are committed to diversity and inclusion being on all agendas – wherever we meet we will actively discuss and invite feedback and learning on diversity and inclusion. This includes our Board, manager meetings and meetings of our project leads, tutors and supervisors.
We are collecting and updating resources, policies and documents on inclusion and diversity and we will make these available for all staff and volunteers as part of the induction process.
The working group in 2019 guided us on changes that have largely been implemented but we want to do more. Our website requires an overhaul both in design, images and content and this is a goal to achieve in 2021/22.
Marketing and Communications
Our communications team do and will continue to ensure that our values around diversity and inclusivity are publicly demonstrated. This covers our newsletters, all social media channels, blogs, campaigns and printed materials.
Next Steps …
We are committed to taking lasting and ongoing action and progressing our plans publicly. We will share progress. We have dedicated resources within our team and a commitment from the charity to implement real change. We will work with partners and agencies to help guide us as we bring on these changes to ensure that the impact of the changes we make is evaluated and prove to be effective.
We are grateful to the many peer supporters in BfN from Black, Asian and other Minority Ethnic backgrounds who took the time to talk with us about their lived experience of our support, training and volunteering. BfN at its heart is a listening organisation and we believe that it is really only through listening that we can fully understand the needs of the women and families whom we serve. However, it is through action that we can really build trust and confidence. We welcome any other feedback, especially where you think we could do better. Please contact us email@example.com
In this blog, Kirsty and Geraint Davies explain how they used shared parental leave so Kirsty could return to work while continuing to breastfeed their son, Evan.
My son Evan was born in May 2015. I went back to work January 2016 as a deputy headteacher when he was 8 months old.
My husband is in the military (he was actually featured in Baby London a couple of years ago talking about SPL [shared parental leave]!) We confused everyone I think within our work places as we were one of the first to use SPL, as it came in for babies born from April 2015, however it was very easy to sort.
Evan was exclusively breastfed from birth and he never took a bottle or drank milk from any other source. To be honest, I did worry when I returned to work but I needn’t have. I use to breastfeed him before work (sometimes waking him up – much to my husband’s annoyance!), I would feed as soon as I got home and overnight as he normally would, whenever he woke up. On the days I didn’t work, weekends and holidays, I fed as ‘normal’ and responded to his and my own needs. Although Evan did not drink the milk, I did pump at work for my own comfort and as it could be used for food etc.
Evan breastfed until he was 22 months old, tandem feeding with his brother for a couple of months. We have since had two more children, both exclusively breastfed and I am now only feeding my youngest (8 months old). We have not done SPL again, not because we didn’t enjoy it or it didn’t work out, but just because of how timings of various things panned out. My husband loved having the opportunity to be at home with Evan. He says, “With SPL we got time to bond. It brought me and my wife closer; I saw things from her perspective and, similarly, it showed her life from my perspective. It made us more rounded parents.”
It’s great to hear of a family who have been able to continue their breastfeeding journey, and have used shared parental leave to their advantage.
Unfortunately there are no additional obligations for employers to make allowances for breastfeeding mothers returning to work as part of shared parental leave – breastfeeding employees are entitled to have somewhere to rest, and the HSE suggests it’s best practice to provide a private room for expressing breastmilk, but this is not a requirement. For more information on shared parental leave and breastfeeding from Maternity Action, click here: https://maternityaction.org.uk/2018/06/shared-parental-leave-and-the-right-to-breastfeed-on-return-to-work/
What’s it like being a student and a new parent at the same time? In this #MakingItWork real life story, Jenni tells us how she juggled study, part time work and breastfeeding.
“I was 20 when I got pregnant, 21 when I had my little girl and began our breastfeeding journey! I was in the middle of my foundation degree which I was going to night classes to finish – I was also working full time in Burger King while doing placements for my course, and moving house! I found that there wasn’t much support on breastfeeding and I went into it pretty blind. When my baby was 2 months old I returned to night classes, I had a bottle refuser so was actually bringing my little girl to class with me and then leaving her with my mum when possible and running over every 3 hours to feed her so I ended up missing out on a lot of course content. Then when she was 7 months I went back to work in Burger King, returning home on my lunch break to fill my little one with her favourite drink! I passed my course however! I was able to graduate from Stranmillis and get myself a new job in a day nursery, little one is now able to take a cup, however still nurses to sleep every night.”
It’s brilliant that Jenni was able to complete her course, and that she was sometimes able to bring her daughter to class in order to continue breastfeeding. But it may not always be a straightforward process – many student parents feel that they are, at best, overlooked by their college or university, and that more adjustments and allowances could be made. This article in the Guardian states that “Sixty per cent of student parents have considered leaving their course, a number which rises to 65% for single parents.”
Education institutions should make the same types of provisions as employers for women who are returning to study and wish to continue breastfeeding. A good first step is to talk to your place of study as soon as possible, telling them that you intend to continue breastfeeding after your return. For more information on the types of allowances that should be made, check out this blog post: https://www.breastfeedingnetwork.org.uk/breastfeeding-mothers-returning-to-work-top-5-tips/
“The law protects students against maternity discrimination. This means that you are protected against unfavourable treatment because you have given birth in the last 26 weeks or are breastfeeding a baby under 26 weeks. Your course provider must not treat you unfavourably because you are breastfeeding. Unfavourable treatment could include refusing to allow you to take part in the course, refusing certain benefits or services or treating you differently. If your baby is over 26 weeks old it is likely to be direct sex discrimination if you are treated less favourably than you would have been treated if you were not breastfeeding.”
In summary, returning to study shouldn’t be a barrier to breastfeeding, and vice versa. As one student stated in the article quoted above, “Student parents make fantastic students. You can’t balance a degree and the overwhelming job of parenting without being hardworking and resilient. I’m even more determined to succeed now I’m studying for my daughter’s future, as well as my own.”
To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:
In this #MakingItWork case study, Emma tells us how she went about discussing adjustments to her work pattern with her employer.
“My company weren’t really informed regarding my rights however they were so accommodating about whatever my needs would be that I initially didn’t have to think about what my rights were. I’m now into my sixth month of being back at work full time and still exclusively breastfeeding (baby is 14 months old). My employer makes time for me to pump through the day however the nature of my job requires me to be away from home. This is where I have had to do my own research regarding my rights whilst breastfeeding in full time employment as my company was expecting me to be away quite a few consecutive overnights which I couldn’t accommodate due to breastfeeding.”
It is down to each individual employer to decide what adjustments they will make for breastfeeding mums returning to the workplace, though there is guidance in place from the Health and Safety Executive (HSE) and European Commission, as well as organisations such as ACAS.
Employers have certain obligations towards their employees once they have been notified in writing that she is a new or expectant mother. When an employee provides written notification (regulation 18 of MHSW) to her employer stating that she is pregnant, or that she has given birth within the past six months or that she is breastfeeding, the employer should immediately take into account any risks identified in their workplace risk assessment. If that risk assessment has identified any risks to the health and safety of a new or expectant mother, or that of her baby, and these risks cannot be avoided by taking any necessary preventive and protective measures under other relevant health and safety legislation, then employers must take action to remove, reduce or control the risk.
If the risk cannot be removed employers must take the following actions:
Action 1 – Temporarily adjust her working conditions and/or hours of work; or if that is not possible
Action 2 – Offer her suitable alternative work (at the same rate of pay) if available, or if that is not feasible;
Action 3 – Suspend her from work on paid leave for as long as necessary, to protect her health and safety, and that of her child.
It can be argued that stopping breastfeeding before the mother and child are ready could present a risk to their health (since breastfeeding has a number of proven health benefits – see here, here and here), so if an employee wishes to continue breastfeeding her child, her employer should take action to adjust her working conditions to allow her to do so.
The employee may also wish to consider requesting flexible working in order to accommodate breastfeeding. More details on how to do so can be found here: https://www.gov.uk/flexible-working
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:
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.
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:
In the first of our #MakingItWork real-life case studies, Jade tells us about the issues she faced when returning to work, when her daughter was 9 months old.
“I returned to work at my local special needs school. During my back to work meeting, I discussed my need for expressing breaks and a place to go, I was told “I’m sure there is a bathroom you can use” by the assistant head teacher. Obviously I made her aware this is unacceptable and I require a private area to use. It was arranged that I use the medical room, my half hour expressing break was interrupted on more than 4 occasions, one of these times causing me to spill the milk I had spent time pumping. I then fought for 3 more months to find a room every day, despite there being a whole school full, I was told it was not possible to book out a meeting room, or have the same room each day. So on my lunch break every day I would traipse around the school, find an empty room, stick my “expressing mother” sign on the door and do my thing.”
Unfortunately, this isn’t an uncommon story. The law does not currently allow a simple, straightforward right to breastfeeding breaks, though employers are required to provide a place for breastfeeding mothers to rest. The Health and Safety Executive and guidance from the European Commission recommend that employers should provide:
access to a private room where women can breastfeed or express breast milk;
use of secure, clean refrigerators for storing expressed breast milk while at work, and
facilities for washing, sterilising and storing receptacles.
The ladies toilet for example is never a suitable place in which to breastfeed a baby or collect milk.
ACAS guidance also gives the following advice to employers when asked to consider additional breaks for breastfeeding:
“Employers should consider providing short breaks for breastfeeding or expressing milk, weighing it up against the likely impact it might have on the business. Employers should be careful not to discriminate against breastfeeding employees. If employers are unable to grant additional breaks, they could consider slightly extending normal breaks for the employee such as a mid-morning coffee break or leaving earlier in the day to minimise any disruption to the business.”
Each employee will need to have a discussion with their employer – preferably in advance of their return to work – but hopefully this guidance will be helpful in these negotiations, and helping your employer to understand your needs and their obligations.
To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:
As part of our #MakingItWork campaign, this guest blog by Dr Ernestine Gheyoh Ndzi (York St John University) explores the impact that shared parental leave can have on breastfeeding.
The reduction of maternity leave by way of shared parental leave raises the question of what impact it could have on breastfeeding. The WHO recommends two years breastfeeding with exclusive breastfeeding for the first 6 months of the baby’s life. Since the introduction of shared parental leave, the uptake has been low (2%), and the question is whether breastfeeding could be one of the reasons for the low uptake.
I am a mother of two, I breastfed my first daughter for 10 months and stopped because she just wouldn’t take it anymore. I felt bad because I wanted to be able to breastfeed for longer. I breastfed my second daughter for 15months. The bond and the emotional attachment to the baby when breastfeeding could not be the same if I had to bottle feed. Breastfeeding my first daughter was so hard at the beginning because I was very ill after giving birth, but the support my husband gave me helped me to carry on. I recognise the importance of breastfeeding and I recognise the importance of dads being there to support the mother and bond with the baby (which was what happened in my case). I was super excited when shared parental leave was introduced but questioning how it might impact on breastfeeding. I then set how to investigate which I here present the key findings.
The research was conducted through an online survey to investigate the impact of shared parental leave on breastfeeding. The survey was restricted to mothers who were pregnant or had babies after the 5th of April 2015 (when shared parental leave started). The survey was designed to collect qualitative data on mother’s experience and opinion on shared parental leave and breastfeeding. The survey retained 460 responses with rich qualitative data.
95% of the mothers agreed that breastfeeding was the preferred choice for young babies and were aware of the benefits
72.7% breastfed or planned to breastfeed for 49 weeks which is still less than the recommended two years by the WHO.
96.1% of the mothers breastfed their babies on demand in the first 6 months.
88.5% of the mothers knew what shared parental leave was
17.2% had heard of shared parental leave from their employers
59.7% said they had a workplace policy on shared parental leave
43.6% of the mothers felt they would have to stop breastfeeding if they took shared parental leave.
24.9% of the mothers took shared parental leave
57.4% of the mothers were happy to express breastmilk at work
42.6% of the mothers said they were not happy to express
34% of the mothers said they were supported in the workplace to breastfeed
48.9% of the mothers were not provided with any resources at work to encourage breastfeeding.
47% said they were provided with a private room and sockets but no fridge
Most employers are not supporting breastfeeding mothers at work. Consequently, some mothers stop breastfeeding after returning to work.
Mothers who are not happy to express breastmilk will not take shared parental leave
Mothers who are happy to express breastmilk at work would take shared parental leave if the employer is supportive of breastfeeding at work.
Some mothers thought that shared parental leave and breastfeeding had no impact on each other. However, the thoughts were slightly limited to the first six months because most of the mothers (85.6%) were on maternity leave for at least the first six months and breastfed their babies exclusively in the first six months as recommended by WHO.
Most of the mothers who took shared parental leave or went back to work after 6 months massively reduced breastfeeding frequency and some stopped breastfeeding altogether.
Mothers who placed more value on breastfeeding dismissed the idea of shared parental leave entirely especially if they wanted to breastfeed for longer than 48 weeks.
Some mothers felt they were put under pressure to be to express breastmilk because if shared parental leave.
Societal pressure and ‘unacceptance’ of breastfeeding make some mothers not to breastfeed and shared parental leave was viewed as one of such ‘unacceptance’ of breastfeeding.
Breastfeeding is a contributory factor to the low uptake of shared parental leave and shared parental leave is also contributing to the low rate of breastfeeding in the UK.
To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.