27 Nov

#MakingItWork – how shared parental leave worked for us

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.

Kirsty writes:

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/

For more information on how to arrange shared parental leave, click here:
https://www.gov.uk/shared-parental-leave-and-pay

For our guest blog by Dr Ernestine Gheyoh Ndzi on shared parental leave and breastfeeding, click here:
https://www.breastfeedingnetwork.org.uk/guest-blog-shared-parental-leave-breastfeeding/

To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:

22 Nov

#MakingItWork – breastfeeding as a student.

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/

It’s worth taking maternity and/or sex discrimination legislation into account too. The NHS/UNICEF Start4Life booklet, “Breastfeeding After Returning to Work or Study” states:

“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.”

You can find more information on this subject here (breastfeeding information starts on p.17): http://www.ecu.ac.uk/wp-content/uploads/external/student-pregnancy-and-maternity-implications-for-heis.pdf

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:

20 Nov

#MakingItWork – what adjustments can I expect to be made?

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.

The HSE states:

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

Employers can find more information and guidance on our website, including details of how to join BfN’s Breastfeeding Friendly Scheme. Click here: https://www.breastfeedingnetwork.org.uk/more-information-for-employers/

To read more about Making It Work, BfN’s campaign for breastfeeding mothers returning to work or study, click the image below:

15 Nov

#MakingItWork – what if expressing doesn’t work for me?

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?!

Gemma and her baby at work.

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:

12 Nov

Guest post: Emma Pickett on returning to work as a breastfeeding mum

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.

http://www.hse.gov.uk/mothers/faqs.htm#q14

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-back-to-work.aspx

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.

http://lllrochester.weebly.com/uploads/7/9/5/4/795404/marmet_technique_tearoff.pdf

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.

https://www.breastfeedingnetwork.org.uk/breastfeeding-help/expressing-storing/

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:

09 Nov

#MakingItWork – Expressing Breastmilk at Work

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:

06 Nov

Guest Blog: Shared Parental Leave & Breastfeeding

Dr Ernestine Gheyoh Ndzi

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.

Introduction

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.

Key findings:

  • 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

Key themes:

  • 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.

Conclusion

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:

05 Aug

A little less conversation, a lot more action…

Shereen Fisher

Shereen Fisher, CEO,
The Breastfeeding Network

Just last week the Department of Health and Social Care (DHSC) together with the Cabinet Office published the long awaited Green Paper setting out proposals to tackle the causes of preventable ill health in England. It signals a new approach to public health that involves a personalised prevention model. It will mean the government, both local and national, working with the NHS to put prevention at the centre of decision-making.

In November last year, before the NHS Long Term Plan was launched, I wrote a blog that set out the case to explain why support for breastfeeding and wider infant feeding considerations are so relevant to the prevention agenda. Supporting and protecting breastfeeding is not just relevant, it’s essential for realising the NHS plan and bringing about a healthy society. With the UK holding one of the worst records for breastfeeding in the world it’s important that bold and clear action is taken. Does the prevention paper deliver on this?

The results are mixed.

On the plus side the Government’s commitment as part of the NHS long term plan to make all maternity services in England Unicef Baby Friendly accredited is a real win for parents and infant feeding in England (remember Scotland has already achieved this with strong results emerging in their breastfeeding rates). It means mothers and babies of the future will be experiencing maternity services with important cultural and clinical standards where mothers will be supported to feed their baby in a way they choose and loving relationships fostered from the start.

The paper includes an important commitment to an infant feeding survey (IFS). After the cancellation of the IFS in 2015 there has been a dangerous gap in data especially a population level survey which gives a voice for parent experience. The vision to commit to this, although presently undefined, represents an important step forward to help monitor breastfeeding rates and the breastfeeding environment.

The paper is strong on vision for mental health including a commitment to parity of esteem between mental and physical health “not just for how conditions are treated but for how they are prevented.” Specific mention of the crisis of maternal mental health would have been welcome along with the poor maternal treatment of black and ethnic minority women who experience an almost five-fold higher mortality rate compared with white women.

To round up the positives I would also add strong vision on early years emphasising importance of strong foundations, parent-infant relationships, infant feeding and development.

However, for the vision to be more than just paper talk the Government must address the public health budget with local authorities. This is where health visiting programmes and breastfeeding / infant feeding peer support programmes sit in England and cuts and reductions have been a reality impacting on available family support. What will be done about the services lost and the ones currently threatened?

In order to understand how much of the Green paper vision is achievable we have to know what will  be the future of the public health grant and be clear on local governments commitment to realise the plan.

Importantly, the Green paper and its proposals are open for consultation. The closing date for responses is 14 October 2019. The Government is asking us how can we do more to support mothers to breastfeed?

This is such an important question. By knowing what kind of support can be provided to help mothers with breastfeeding, we can help mothers to solve any problems and continue to breastfeed for as long as they want to, wherever they live. We know that stopping breastfeeding early can cause disappointment and distress for women and health problems for themselves and their infants.

The Breastfeeding Network (BfN) have over 20 years of experience supporting women and families. We know that support can come in many forms including giving reassurance, skilled help, information, and the opportunity for women to discuss problems and ask questions as needed – for us it’s about being present when everyone else has gone and you are left holding the baby.

This is what we know helps women with breastfeeding:

  • organised skilled support for mothers
  • trained volunteers, nurses, doctors working as a team to UNICEF UK BFI standards
  • face – to – face contact
  • confidential, evidence-based, independent telephone support from trained peer supporters
  • trained and supervised peer support is effective especially when contact is frequent, pro-active and sustained over several sessions, including the early days with a new baby.

In summary providing women with extra organised support helps them breastfeed their babies for longer. Breastfeeding support is more effective where it is predictable, scheduled, and includes ongoing visits with trained health professionals including midwives, nurses and doctors, or with trained volunteers.

BfN intends to publish its full response. Don’t miss your opportunity to do the same!

https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

03 Jul

Guest Post: Ruth Dennison, Black Mothers and Breastfeeding

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

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

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

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

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

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

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

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

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

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

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

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

02 Jul

Exclusive expressing: your questions answered.

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?

  1. How milk supply is established. Removal of milk from the breasts drives milk production. See here for an excellent explanation.
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  2. 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.
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  3. 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.
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  4. 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.
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  5. 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.)
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  6. 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.
    /
  7. 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.
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  8. 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.
    /
  9. 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.

UNICEF Baby Friendly Initiative guidelines on responsive bottle feeding.