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.
    /
  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.
26 Apr

Breastfeeding after a Caesarean Birth

Photo: Ashley Marston

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

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

About caesareans & breastfeeding: Zoë Chadderton

There are three types of C-sections:

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

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

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

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

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

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

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

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Alyson & Charlie’s Story

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

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

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

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

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

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

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

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

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

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

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

25 Apr

Breastfeeding Mothers Returning to Work – Top 5 Tips

Law firm Slater and Gordon recently published a report on the rights of breastfeeding mothers returning to work, highlighting the fact that many employers are unaware of the law. Slater and Gordon have written the following guest blog for us, explaining the top five things you need to know about returning to work whilst continuing to breastfeed.

1. Plan your discussion with your employer in advance of your return

Take time to consider the support and facilities you need to help you breastfeed or express at work before you go back to work and plan to have a conversation with your manager or HR, ideally well in advance of your return date. You may wish to use one of your KIT days to arrange a meeting.

The support you need will very much depend on your own personal circumstances. Some mothers would like to visit their baby during the working day and others plan to express breastmilk. 

Check whether your employer has a breastfeeding policy, or a return to work policy outlining the type of support they provide or what you need to do to request support. Most good employers will.

2. Know your rights

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.

In terms of breastfeeding support, 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.”

3. Consider a request for flexible working, such as for reduced hours

If you have worked for your employer continuously for 26 weeks, you have the right to make a request for flexible working. You are likely to qualify to ask as maternity leave counts as continuous service.

You might want to reduce your hours, change which hours you work (to start later or finish earlier) or work the same number of hours but over fewer days. You may also want to work from home or as a job share, or return part-time. Your employer must agree to flexible working where it can accommodate the request, but can turn it down on business grounds defined in flexible working regulations (there are 8 grounds including inability to meet client demand and detrimental impact on performance). However, it must make sure it does not discriminate and cannot simply refuse a request without fair process or reasons.

Employers are obliged to deal with requests in a reasonable manner. If your employer refuses your request you should have a right to appeal your employer’s decision so that you have an opportunity to clear up any misunderstandings or explore other options. If you do not appeal there is a risk that this implies you accept the decisions made.

If it is still refused you should seek legal advice, as you may have claims for discrimination, including indirect discrimination if your employer for example has a policy or practice which disadvantages women and which cannot be justified by the employer.

For example, an employer might require all posts to be full time. If a breastfeeding employee asked for a temporary alteration in her hours in order to continue breastfeeding and she would be disadvantaged if this was refused (because she would be unable to breastfeed), her employer should grant her request unless there are good business reasons for refusing.

4. Consider whether there is a health and safety risk to you and your baby, and know your rights

Is there a risk to your health or safety or that of your baby from your working conditions or hours?

All employers have a duty to protect the health and safety of their employees. While you are breastfeeding, you and your baby have special health and safety protection under the same regulations that give protection to pregnant employees.

Employers of women of childbearing age employers must also carry out a ‘specific’ risk assessment of risks to new and expectant mothers arising from ‘any processes, working conditions, physical, biological and chemical agents’.

Some hazardous substances can enter breastmilk and might pose a risk to your baby. If your work brings you into contact with a dangerous substance, your employer should take appropriate steps to make the job safe, remove that risk or if that is not possible they may have to explore temporarily changing your working conditions or hours, such as working shorter shifts, giving regular shifts or avoiding night work or overnight stays.

Reasonable action to protect your health and safety while you are breastfeeding could include adequate rest breaks to ensure proper nutrition, access to water and washing facilities. Your employer should ensure that the environment is not too hot or too cold. Employers should also consider levels of fatigue, stress and changes in posture.

If adjustments to your working hours or conditions would not remove identified risks, then you should be given a temporary transfer to alternative work, or suspended, without loss of pay.

5. If your employer is not supportive and you have concerns about harm to you or your baby or in relation to possible discrimination of harassment, know your options

If support is not forthcoming, then it may be concerns need to be raised. It’s usually best to raise concerns informally initially with your manager or HR, and if that isn’t successful, it may be necessary to raise concerns more formally in writing through a grievance process.  If the concerns relate to working hours, you may wish to firstly consider making a formal flexible working request. If support is still not forthcoming, you have to consider a more formal route again, such as exploring potential legal claims. You should seek support from your trade union or seek legal advice in these circumstances.

Do keep a record of the requests being made, the experiences you’ve had and the responses received.

It is worth noting that if you consider your situation is serious enough to merit taking legal action, there are strict time limits and you only have three months less one day from the date the last act of discrimination took place to lodge a start the compulsory ACAS Early Conciliation process with a view to bringing an Employment Tribunal claim.

It is important to take advice quickly and you should seek support from your trade union or take specialist advice if you find yourself in this situation.  

You can find information on returning to work, discrimination and flexible working on the Slater and Gordon website, and on the ACAS and gov.uk websites.

10 Apr

Guest post: Breastfeeding through pregnancy and beyond

Emma Pickett is the chair of the Association of Breastfeeding Mothers, and also works as a lactation consultant. Here we share her article on breastfeeding through pregnancy, and potentially continuing to breastfeed two (or more!) children, known as tandem nursing.

Let’s imagine you are breastfeeding your toddler and you discover you’re pregnant. It’s a much wanted pregnancy but perhaps you weren’t expecting that positive test quite so quickly. And now here you are, pregnancy test still drying, teeny tiny new person inside you and less teeny person on the outside, very much still in love with breastfeeding.

By still feeding your toddler, you’ve already been up against it in terms of what most modern cultures find comfortable and acceptable. Now you’re ticking the box for another misunderstood area of breastfeeding: one full of myths and nonsense and one lots of uneducated people claim to be experts about.

A useful starting point is finding a group online of mothers who have breastfed through pregnancy and beyond. That can be reassuring and immensely helpful but it’s worth remembering that every woman’s experience is different and it’s very hard to make predictions about how things will go for you.

I’m going to guess that when many people are looking at the drying pregnancy test, their thoughts shift to the consequences for their current nursling. Then soon, you wonder about the baby-to-be. Is breastfeeding during pregnancy ‘safe’?

What does the research say?

Let’s look at this study from 2012: A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes. Madarshahian F, Hassanabadi M. The study looked at 320 women in Iran, some breastfed during pregnancy and some did not. It showed that, “Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group.”

So, breastfeeding during pregnancy didn’t ‘take nutrition away from the baby’ and it did not cause prematurity.

Another study of 57 Californian women from 1993: Breastfeeding during pregnancy. Moscone SR, Moore MJ. Just under half continued to breastfeed through pregnancy and after the new baby arrived. The new babies were healthy and appropriately sized.

However, it’s not all clearly positive. Another research study on 133 women in Peru found a link between breastfeeding through pregnancy and 125g on average less weight gain for the new baby in the first month. (Postpartum consequences of an overlap of breastfeeding and pregnancy: reduced breast milk intake and growth during early infancy. Marquis GS, Penny ME, Diaz JM, Marín RM. 2002)

Another study looked at 540 women in Egypt with sub-standard nutrition. Effect of pregnancy-lactation overlap on the current pregnancy outcome in women with substandard nutrition: a prospective cohort study. Shaaban OM, Abbas AM, Abdel Hafiz HA, Abdelrahman AS, Rashwan M, Othman ER (2015). This was not all positive news with increased risk of maternal anaemia and issues with infant growth. BUT there was NOT an increase in miscarriage risk when women breastfed through pregnancy.

How’s your nutrition and how are your iron levels? If you are a mother with access to good nutrition, it appears you have less reason to be concerned.

Does breastfeeding trigger early labour? Even for those women who were struggling with other issues, it doesn’t appear so.

Hilary Flower is the go-to person on the subject of breastfeeding during pregnancy. Her book, “Adventures in Tandem Nursing” is considered the bible on this subject. It was first written in 2003 and is now out-of-print but a second edition is currently being worked on. Her focus was on bringing the facts to pregnant mothers and she looked at this idea of triggering contractions or early labour in detail. She reminds us that we need oxytocin to trigger a milk ejection reflex (the letdown reflex) and this is also the hormone that can trigger uterine contractions. However, this doesn’t mean that breastfeeding in pregnancy triggers risky contractions and there are several safeguards in place. We need hormone receptor sites to exist before hormones get acted on by the uterus and they remain small in number until around 38 weeks of pregnancy. And even the hormone receptors that are in place can’t really do their job of causing contractions as there are oxytocin blockers in place like progesterone (made by the placenta) and proteins missing which would act as special agents to help the oxytocin do their job. Triple protection! So, oxytocin can carry on doing its breastfeeding jobs while baby remains protected in the uterus.

I think we can say science is on our side. Which makes sense when you think that throughout history women have been breastfeeding older babies and having sex and getting pregnant.

Do you know anything about the history of pregnancy testing? Today, we might know we are pregnant days after conception. For generations, it was based on guess work, someone examining your urine’s appearance and something about rabbits (early 20th century pregnancy tests involved injecting urine into a rabbit and observing a change in their ovaries). A lot of breastfeeding women couldn’t rely on whether they had missed a period as periods may only just be settling in or may not have even appeared yet. Some breastfeeding mums get pregnant without yet having a period. They ‘catch the first egg’. Then they go and see their doctor and the doctor brings out the chart that predicts due date based on last menstrual period, “errr…2015?”

Nature isn’t daft. If breastfeeding during pregnancy was hazardous, I doubt you nor I would be here. Hilary Flower mentions that if you have a high-risk pregnancy, you should talk to your health care providers about your specific situation but if you are safe to continue sexual intercourse, breastfeeding is very very likely to be fine too.

Science might say that breastfeeding during pregnancy is safe but that doesn’t mean you have to do it, or that it’s super easy for everyone. There is a wide range of experience and you need to reflect on what feels right for you.

The age of your current nursling might be a factor in your decision. If they are 7 months, you might feel differently than if they were 4 years old and you were getting a bit tired of breastfeeding a plastic truck several times a day.

If your baby is 7 months, or at any age where milk is still a significant proportion of their nutrition, you’ll need to do some thinking. It’s likely they will need an alternative source of milk (still doesn’t mean breastfeeding needs to end). Most women who are breastfeeding when they are pregnant do notice a decrease in milk supply – often a very significant one. This can start as early as the first few weeks after that positive pregnancy test. Whatever you do, your body will be resetting in its lactation story and you will go back to making colostrum during your pregnancy. It happens at different times and some mums might go through a period of feeling like they have virtually nothing and their child is ‘dry nursing’ before colostrum then appears and quantities seem to increase again.
Nurslings behave differently during the changes of pregnancy. Some self-wean as the quantities drop. Some self-wean when things seem to taste a bit different. Some care not a jot that changes are happening and would carry on breastfeeding whatever was coming out or if nothing was.  Word of warning: colostrum has a laxative effect. That’s one of the reasons it’s so great for newborns as it helps them to pass meconium. Potty training a toddler? Brace yourself.

What else can you expect? For some women, not much else. Pregnant and breastfeeding felt a lot like not pregnant and breastfeeding. You’ve just got to worry about the bump being in the way towards the end. (This was my experience).

Other women struggle with sore nipples from increased sensitivity that probably has something to do with hormonal changes and sometimes aversion to breastfeeding can be a problem.

The reduction in milk supply can also be upsetting for some. It can come at a time when we might already have mixed feelings about giving birth to another child. We know what positives a new sibling can bring for your toddler but there’s sometimes a feeling of loss or even guilt as we’re concerned how their life is going to change – especially in the first few months. And when milk seems to be going too – that can feel doubly hard. Unfortunately, there isn’t much you can do to increase milk supply in pregnancy when changes are starting. All the usual stuff doesn’t work: pumping, herbs, just feeding more frequently. Many herbs that we might consider when we want to increase production are not thought to be safe in pregnancy. It appears that milk storage is affected for almost all women (only a small minority don’t feel their supply has diminished). You might want to consider using a supplementary feeding system at the breast, so baby can remain attached and get other milk through a lightweight tube.

It’s important to remember though (and this is engraved on the heart of many of us in breastfeeding support) that BREASTFEEDING IS NOT JUST ABOUT MILK. Your little bloke with the plastic truck might not care a jot if supply diminished and milk tastes different because this is only partially about milk. It’s also about connecting to you, relaxation, safety and contentment. That big world out there is only getting bigger and breastfeeding is home.

If you are happy to continue with that, breastfeeding is still working.

You might also be wondering what life is going to be like when the new baby arrives. How does breastfeeding work when there is a newborn and a toddler? Pretty much like it did the last time there was a newborn – nature gets on with it. While breastfeeding during pregnancy doesn’t ‘use up’ colostrum, during in the first few days after the birth, it’s sensible to let the newborn do their thing first before the older nursling gets a turn. And once your mature milk transitions, you can make decisions based on how your newborn’s nappies and weight gain are getting on. Sometimes there is talk of restricting a baby to one breast and a toddler to another. Most lactation consultants agree that’s not sensible. Ideally you want the newborn to have the option of both and continue to have the option of both fully lactating as their breastfeeding experience continues. Toddlers feeding after newborns are very effective at helping a milk supply to develop and tipping into oversupply is more of a worry than running out of milk. A toddler is also fabulous at relieving engorgement in the early days post-partum. Flashback to my 3-year-old son announcing proudly to his grandmother (not entirely on board with natural term breastfeeding) that he ‘helped mummy because her milkies were really full’!

Does the toddler feel jealous of the baby having ‘their milk’? I have yet to meet a mother who feels that’s been a problem. In fact, many feel that it can help in the arrival of a new member of the family. Toddlers are likely to need some extra support, but breastfeeding is still there for them. The thing that has always provided comfort and reassurance. And good news! It’s changing back to regular milk and there’s lots more of it! What might not be sensible is weaning a toddler in the last few weeks of pregnancy so if you are thinking tandem breastfeeding really isn’t for you, it might be wiser to wean sooner rather than just prior to baby arriving. If that’s you, I wrote an article on weaning an older child which you might find helpful:
http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/weaning-toddler-bob-and-pre-schooler-billie-how-do-you-stop-breastfeeding-an-older-child

It sometimes happens that an older child who hasn’t breastfed for a while asks to do so again when a new baby is on the scene. That might be because they weren’t a fan of the colostrum. Or there might be some other things going on in their head. Are they ‘testing’ whether they still get to be your baby? Are they just curious? Some resume breastfeeding at this point. Some are happy to have a taste of expressed milk in a cup. Some ask and run away giggling and don’t mention it again. There’s no right or wrong answer on how to deal with this but ideally, we’re looking for ways to minimise rejection and any refusal is done so as gently as possible.

Still think it’s a bit hippy and ‘risky’? This is the American Academy of Family Physicians (folks on the opposite end of the spectrum from hippy and risky):
“Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned.
Breastfeeding the nursing child during pregnancy and after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.”

We can’t guarantee it’s all smooth but breastfeeding through pregnancy and beyond is something mothers have been doing for millennia and there’s very little to fear and lots to embrace. Those of us who do it are often those who have taken the path of child-led weaning and it instinctively feels right to let the nursling make the call. But you’ll make the decision that’s right for you.