26 Sep

Guest Blog by Sally Etheridge: ‘I just really wanted to breastfeed’ – How stress affects how babies are fed, and how mums feel about it.

Sally Etheridge is an IBCLC who will be giving a presentation at our conference entitled “Breastfeeding Struggles”.  Here she gives some background to the subject and explores how stress can impact on feeding journeys. Come along to the conference on 6th October to hear more – information and tickets here.

As mother to mother breastfeeding supporters, we may often be especially aware of some of the personal challenges she is facing that are affecting how she feels about life, and becoming a mum, and how these might be affecting how breastfeeding is going – and her chances of achieving her goals around feeding her baby. While there has been a shift in understanding around maternal mental health issues, and better support offered to mothers with depression and anxiety, breastfeeding supporters may recognise that many mums face challenges that we can do little or nothing to change. We may recognise too that there are many mothers who never access our groups and who are much less likely to access breastfeeding support. Poorer communities, women from  different cultures and ethnicities, those for whom English is not their first language, women facing all manner of stressful situations that may be outside our experience. Yet as breastfeeding supporters, we want every mum and baby to be able to enjoy a loving relationship, and enjoy breastfeeding, especially those mothers who always expected to breastfeed.

Leicester has high numbers of mothers like this, and Mammas Community Breastfeeding Support Programme works hard to find innovative and low cost ways to support every mum whatever personal challenges she faces. My presentation focuses on a study I carried out, talking to a number of mums who faced high levels of stress, about how this impacted on how they fed their baby – and what helped most.

04 Sep

Guest Blog by Heather Trickey – What sorts of breastfeeding peer support interventions should we be developing?

Heather TrickeyHeather Trickey is a researcher in parenthood and public health at DECIPHer, Cardiff University.  Here she writes about the importance of not just implementing peer support systems for breastfeeding mothers, but, crucially, ensuring that those systems are effective and fit for purpose.  She’ll be talking in more detail on the subject at our conference on 6th October – buy your tickets here.

 

Breastfeeding peer support is considered an important intervention for supporting women with breastfeeding and is recommended by the World Health Organisation, by NICE, and by UNICEF UK. The evidence for breastfeeding peer support in a UK context is mixed, UK experimental studies have tended to show little or no impact on breastfeeding rates. As Dr Gill Thomson (UCLAN) and I have discussed, are lots of reasons why that might be, these include poor intervention design and implementation failure under experimental conditions (Thomson and Trickey, 2013; Trickey 2013).

Some lessons for peer support design

Earlier this year we published a realist review of breastfeeding peer support interventions (Trickey, Thomson, Grant et al, 2018). We identified some key lessons for design. For example, we found intervention goals need to have a good fit with the goals of mothers, that the intervention needs to be linked into existing health care systems, that help won’t reach many mothers unless it is proactive and for UK mothers it needs to come soon after the birth, that peers need to be confident and friendly for mothers to feel comfortable, that relationships need to need to be warm and affirming, that peers supporters themselves need to feel valued, and the intervention needs to enhance rather than displace existing care.

But we also need think about peer support in the bigger picture…

The UK has one of the lowest breastfeeding rates in the world, and there are big differences in rates at area level depending on level of deprivation. Our review found that we need to develop better ideas about how changes in attitudes and behaviours happen at the level of a whole community. We concluded,

“In the absence of overarching theories of change for infant feeding behaviour at community level, it is difficult for intervention planners to target breastfeeding peer support interventions to maximum benefit”.

So, what is the longer term objective for society? And what needs to happen, where, why and for whom and in what order to meet that goal? Should the focus be on encouraging getting more mothers to initiate breastfeeding, or on helping mothers to continue for as long as they want? Should interventions pay more attention to the needs of mothers using formula milk, whose babies are most at risk of infection? Should we be measuring breastfeeding rates, or should we be considering women’s experiences or changes in wider societal knowledge and attitudes as a way of measuring ‘success’?

What else do peer supporters do?

We need to get smarter at understanding how peer support interventions can contribute to delivering the kind of big community-level changes that we will need in the UK if we are to ensure that all women’s decisions are respected and supported and that women who decide to breastfeed have a better time and can meet their feeding goals. This means thinking about all the things that peer supporters do alongside helping individual mothers. We need to develop different sorts of theories and outcome measures which can underpin more holistic, community-focused interventions.

My talk for the BfN conference will draw on findings from my PhD research. This builds on the findings of our review, drawing on conversations with groups of parents, peer supporters, health professionals and policy makers to ‘think outside the box’ and consider all the different ways that peer support makes a difference. I conclude that we need to develop interventions that reflect the potential for peer supporters to enhance existing social networks, counteract inadequate existing services, advocate for services, and diffuse attitudes, knowledge and skills within their social networks.

References

Trickey, H. 2013. Peer support for breastfeeding continuation: an overview of researchPerspective – NCT’s journal on preparing parents for birth and early parenthood (21), pp. 15-20.

Thomson, G. and Trickey, H. 2013. What works for breastfeeding peer support – time to get realEuropean Medical Journal: Gynaecology and Obstetrics 2013(1), pp. 15-22.

Trickey, H.et al. 2018. A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settingsMaternal and Child Nutrition 14(1), article number: e12559. (10.1111/mcn.12559)

 

 

 

24 Aug

Guest Blog by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

24 Aug

Guest Post by Ruth Dennison – Why Black Breastfeeding Week?

Ruth Dennison
Ruth Dennison is a Doula and breastfeeding supporter in London.  She has kindly shared this blog with us to celebrate the first ever Black Breastfeeding Week in the UK.  The original version of this blog can be found here.

.
Black Breastfeeding Week starts 25th – 31st August, we will celebrating Black Breastfeeding Week for the first time in the UK.

 .
There has been a look into what has been happening in the breastfeeding community of black families.  It has been documented in the UK showing that black women have the highest breastfeeding rates of 1-3% .  Many are questioning this, as there are many factors within the black community which causes black women to not exclusively breastfeed their babies until 6 months and beyond as recommended by UNICEF and WHO.  Evidence shows that Black families suffer the highest infant mortality in the UK and it is strongly believed breastfeeding could help reduce the numbers.  Breastfeeding/breastmilk have countless health benefits for mother and child, it can help prevent many illnesses, infections, diseases and reduce the risk of SIDS (Sudden infant death syndrome).
 .
In the black community it is very common for mothers to offer their babies alternatives from early, 2-4months, if not earlier.  The top on the list is introducing water, why? because baby has a bad tummy.  Black families have a culture of introducing solid foods from as early as 3- 4 months, why? because their milk is not satisfying baby, because baby is looking at the dinner plate and trying to grab the food off, she is now ready to eat, because granny said baby keeps crying, because your breast milk is not enough, mum needs to rest and let someone else feed baby (this can be done with expressed breast milk and breastfeeding actually makes mothers have to sit their busy bodies down, bond, heal and nurture their babies while they rest), because you never knew what to expect, because no one told you, because you never had any breastfeeding support, because breastfeeding is painful (which it should not be).  I would say I have listed a good few things on why many black women don’t exclusively breastfeed their babies in the early stages of their babies life and there is so much more to this which will be high lighted at the “Why Black Breastfeeding Week?” event.
 .
Do you know there is a history of breastfeeding trauma which has passed down through generations in the black community, this may still be hindering breastfeeding in the black community today, many black women tend to not seek breastfeeding education, they tend to listen to their family elders, especially grandparents, as they are placed as the veterans in parenting.  Learn more about the history of breastfeeding trauma within the black community here: Slavery, Wet-Nursing, and Black
 .
This table below shows research on the reasons why breastfeeding mothers in the Caribbean introduce supplements to their babies, this also effects black mothers in the UK.
The most common reason was that water was given as it was felt the babies were too hot, baby was constipated or have grip (wind), to wash baby’s tongue, to settle baby, supplements were started in the hospital nursery or when mothers was ill, to prevent baby getting gas from the breastmilk, or on doctor’s orders.
 .
How many black women do you see in your local community breastfeeding support groups?
A qualitative study of baby cafe services was carried out in the UK, within this it states, older, more highly educated mothers are more likely to seek help with breastfeeding difficulties.  Which ethnicity/colour do you think these mothers are?
 .
I do get a lot of hate when I speak on colour and breastfeeding, especially on my BBW Youtube video I made last year, it did get to me to begin with but now I do not worry about the negative comments, because those who don’t want to learn about the issues which lay in the black breastfeeding community, don’t really care and to be honest that is life, you can’t please everyone no matter how much you try.  BBW is not a race war, it is a call for action as evidence show black babies die at a higher rate than any other race.
 .
Yes, we all know the world needs major improvements in breastfeeding, but when working within breastfeeding, noticing how badly this is effecting the black community more than any other race, it is only right that someone waves the red flag and alerts the UK breastfeeding community.
 .
Yes, black mothers may have a higher initiation of breastfeeding, but it is also very common for black mothers to introduced their babies to alternatives from early days, weeks and months due to culture influences, social pressures and lack of skilled breastfeeding support.
 .
Here I have attached a link of 3 black breastfeeding mothers stories, with hope that you see it through the mothers eyes.
 .
There are many risk factors contributing to infant mortality such as birthweight, mother’s age at birth of child, and the parents’ socio-economic status, some of these same factors are also what contributes to the high drop off breastfeeding rates in the black community.
 .
Black African origin in the UK, had the highest infant mortality rate at 54.1 deaths per 1,000 live births, you can learn more here.
 .
Black Breastfeeding week isn’t just an issue in USA, it is an issue in the UK and other parts of the world.
My name is Ruth Dennison, I am a Doula who specialises in breastfeeding.  I have been supporting families in breastfeeding since 2007 in the NHS and privately.
 .
On Friday August 31st 2018, I will be hosting the ‘Why Black Breastfeeding Week’ event,  because many don’t understand why we need it and it is important for families, breastfeeding practitioners and organisations to learn the reasons why.  When we learn the reasons why, is when we can then help make a change, help reduce infant mortality and better the health within the black community as evidence shows breastfeeding has long term health benefits for mother and child and this lengthens the longer you breastfeed.
 .
After speaking with Kimberly Seals Allers Author of The Big Letdown and Mars Lord from Abuela Doulas, at the Birth and Breastfeeding While Black UK event, it made me more determined to host this event.  I know it may not be everyone’s cup of tea but neither is it mine when I know how much improvements need to be made for black families and breastfeeding.
 .
Together we can make a change!
Event Information

Event Information

“Why Black Breastfeeding Week?” event coming Friday 31st August 2018, learn more or purchase tickets here.

31 Jul

BfN Statement on Channel 4 Dispatches Programme 30/07/2018 – Breastfeeding Uncovered

Dispatches presenter breastfeeding her baby

Dispatches presenter Kate Quilton

Negative cultural attitudes towards breastfeeding are common place in the UK and often this is reinforced by media messages.

However, last night’s Dispatches programme demonstrated sensitive and robust journalism on the emotive and polarised issue that is breastfeeding.

The Breastfeeding Network is a charity that supports women and families in their choice to breastfeed in a culture that often treats women negatively for pursuing an unpopular choice.

The programme highlighted the progress that science and medical experts have made in acknowledging the make-up of breastmilk and the impact breastfeeding can have on infant and maternal health. It also looked at the marketing of breastmilk substitutes and how much care has to be taken to ensure breastfeeding is not undermined in health care settings. The lack of evidence-base for formula products’ claims to resolve sleep and colic problems is clearly misleading parents, exploiting families’ tight financial budgets and failing to resolve the problem.

The programme also highlighted the shocking truth that investment in health even where the evidence-base is strong does not always follow, nor can it compete with a multi-billion pound industry that seeks to dominate the choices of parents and families. Protection and scaling up of breastfeeding can only be truly tackled where we work together to create the environment to enable women and their families to choose it.

The programme spoke directly with breastfeeding women and allowed them to voice their concerns around the lack of support for breastfeeding – an issue that BfN are all too aware of – many of our face-to-face peer support services have seen significant cuts in recent months and years, meaning many families are no longer able to access good quality peer support in their local areas.

Many women featured in the programme also spoke out about their concerns around breastfeeding in public.  Many women tell us that they worry about feeding out and about, feeling intimidated and worried about being treated negatively. The presenter Kate Quilton said she sometimes felt like a ‘social outcast’ – women tell us this all the time and that is why having peers in your community to support you is so critical for many women.

We were pleased to see the portrayal of the issues and the balanced journalism presented by Dispatches that reinforces the high quality evidence in the field of infant feeding helps us to continue to change the conversation around breastfeeding and move to its normalisation, so that more parents can feel they can choose to breastfeed.

If you are affected by any of the issues raised please contact the National Breastfeeding Helpline on 0300 100 0212 – open 9.30am-9.30pm 365 days a year.

The programme is available for 30 days on C4 catch up.  If you only do one thing to celebrate World Breastfeeding Week, please share this link with your local councillor and MP.

04 Oct

Mothering the mother – a vital part of increasing breastfeeding rates 

Amy BrownDr Amy Brown is Associate Professor in Child Public Health at Swansea University. She is also the author of Breastfeeding Uncovered, a book which aims to highlight normal breastfeeding, challenge barriers and call on society to support breastfeeding. She will be the key note speaker at our conference on Saturday, and has written this guest blog for us ahead of her speech.

 

“Mothering the mother is a phrase often heard during pregnancy and birth. Look after the mother, care for her, support her emotional needs … and she will feel more empowered to grow, birth and care for her baby. A phrase (and actions)  that makes so much sense and is seen in many cultures across the world.

But might this form of love and care also be a key part of increasing our breastfeeding rates too? Of course, education, guidance and support directly about breastfeeding are vital parts of ensuring new mothers are knowledgeable and equipped to breastfeed. But if we really want to stand a chance of making this work, we must look outside of breastfeeding too.

Having a baby is hard, especially the first time. It is life changing and can be so overwhelming. Suddenly you have a brand new person to care for who is reliant on you for all their needs. And they communicate this well – after all, if they didn’t they wouldn’t survive. We aren’t baby giraffes who can get up and walk shortly after birth; we are entirely reliant on our caregivers for warmth, protection and food. Our babies need us, and we are hardwired to need to respond to them.

But as normal and natural as it is for babies to want to be kept close, this can understandably often feel exhausting and all consuming for new mothers. Many have gone from having freedom (and lots of sleep) one minute to having a baby who wants to feed often, chat at night and certainly doesn’t want to be put down. It can feel like all they do is hold, soothe and feed on repeat. Many weren’t prepared for it and start to worry that something is wrong. Might feeding him again create bad habits? Am I spoiling him? Is he manipulating me? What is this rod for my back people keep talking about?

But babies aren’t broken. They can’t manipulate. And it’s impossible to spoil them. In fact responding to, caring for and simply loving a baby is one of the best things you can do to ensure your baby grows into a happy, confident and loving adult. But society doesn’t recognize how valued just sitting and feeding your baby should be. Get your life back it shouts! Get back to work! The gym! At least get out of the house… and what about your poor partner? You must keep them happy too! And whilst I mention it … have you seen the dust? Your home isn’t looking like that celebrity new baby spread is it … oh and those nails… how on earth haven’t you managed to fit in a manicure? Priorities…

New mothers don’t need to get their lives back. That old life has gone and a whole new world has begun. But what they do need is support. In many cultures mothers are cared for and looked after for at least 6 weeks after the birth. Their meals are cooked, the housework is done and they are nurtured and supported. It isn’t a coincidence that rates of breastfeeding are low and levels of postnatal depression high.  Meanwhile when I recently googled ‘six weeks rest after the birth’ I got back a series of articles on avoiding heavy exercise.

In Western culture mothers often don’t have that support after the birth. Many live hundreds of miles away from home. Families are smaller and dispersed and many grandmothers will be working. Mothers are now often left to care for their babies alone, which we are simply not designed to do. No wonder the frequent needs of a baby feel overwhelming, especially for breastfeeding mums who might feel they do nothing but feed, day and night. And that’s before the pressure to get back in shape and regain your social life comes into play.

Unfortunately industry has jumped on this vulnerability and recognized a gap in the market for isolated, exhausted mothers looking for a solution (and a good nights sleep).  Despite the fact that research shows that breastfeeding mothers often get more sleep overall, the subtle and not so subtle messages coming out of formula promotion are that it will help your baby sleep (nope) or that someone else can feed the baby (missing the fact that they rarely want to do this at 3am). But these messages are pervasive and you can see why many an exhausted mother considers a bottle at that 3am feed. Unfortunately many make this move, it doesn’t affect sleep and they can feel even worse.

But it’s wider than just messages to move to formula. Baby care books promise to get your baby into a sleep and feeding routine and countless devices are arriving on the market promising hands free feeding or to rock your baby to sleep for you. These products are not the answer. Following a strict routine for feeding is linked to stopping breastfeeding, often due to problems with milk supply, as it interferes with everything we know about the importance of responsive feeding for building a good milk supply.  It’s unsurprising that routines often don’t work and sadly leave many mothers feeling even worse than when they began, even tipping them into postnatal depression.

So what is the solution? Simple. We need to care for our new mothers better. Mother them. Love them. Invest in giving them the time and support they need after the birth and throughout those early months and years. Think wider than breastfeeding and ensure that new mothers are as rested, supported and yes, cherished, as much as possible.

Work with partners and grandmothers where possible to explain why new mothers need to be mothered and what that might look like. And no, it doesn’t look like a bottle, even though that might seem like the perfect solution when your partner or daughter is exhausted and desperate for a break. Do some housework. Cook her a meal. Sit with her. If she’s happy to let you, take the baby for a walk between feeds, perhaps in a sling – but always check first. Separating her from her baby might make her feel anxious.

To really make this work though government must step up and ensure that mothers, babies and families are truly invested in. After all, they are our future and ensuring the best possible start in life reaps rewards for all of us. Mothers (and partners) need and deserve extended well-paid maternity and paternity leave and flexible working on return. Promote the importance of men taking time off and being there for their partner. No one should need to go back to work for financial reasons when they are still nourishing and caring for a baby.

Where family cannot be there, invest in creating networks and support groups for new mothers. Enhance access to doulas and invest in high quality support from professionals throughout pregnancy and after the birth, from professionals who have the time to sit and support. Caring for mothers should be seen as a public health responsibility and not something that simply happens if they are lucky.

Having a baby will always be life changing and exhausting but it needn’t be so overwhelming to the point where breastfeeding feels incompatible. With the right support and investment we can nurture a generation of new families and show them just what a valuable role they play. And with it, create an environment and support network that really supports new mothers to breastfeed. Mother the mother and she has the time, energy and peace of mind to get breastfeeding off to the best possible start.

27 Jun

Feeding baby out and about in the UK?  What’s the fuss?

Fact: Feeding your baby out and about is protected by law. In Scotland breastfeeding is protected by the Breastfeeding etc. (Scotland) Act 2005, which says that it is an offence to stop someone in a public place from feeding their child, if under two, with milk. The legislation allows for fines for preventing breastfeeding in public places.
In England & Wales this protection comes from the Equality Act 2010 (EA 10), which states that it is sex discrimination to treat a woman unfavourably because she is breastfeeding.
Fact: Few people know the legal position. While the law is more explicit in Scotland, does it offer more protection?  We don’t yet know as the current EA 10 law has not been tested in court. All cases brought have been settled out of the courts. (Hogan Lovells, 2015)
What does this mean for parents breastfeeding out and about in the UK?  This could mean that although the law is protective, it has little cultural influence at a societal or individual level unless it is better understood and adhered to.
Fact: Many women are worried about feeding in public places. They are worried about feeling embarrassed, possible negative reactions from the public and the risk of confrontation.
Fact: Communities in the UK are generally not supportive of breastfeeding (Victora, 2016).
Fact: Worries about feeding in public are real for women and form a serious barrier to starting to breastfeed, or can mean a mum stops breastfeeding before she wants to.
Although infrequent, there have been several high profile cases of women being vilified in public for breastfeeding outside the home. The negative treatment of breastfeeding women in the media affects feeding decisions. One mum recently told me that her reason not to breastfeed was that she was worried about feeding in public; she had since questioned herself and felt guilty about her decision. She became less assertive as she reflected on her experience but I was sorry to hear her apologise for something that was not within her control.
Was her choice not to breastfeed based on freedom or the lack of it?  Who is responsible for that? The law? The media? Society? The influence of an industry that repeatedly and blatantly blurs the line between breastmilk and formula?
Many women tell us they worry that if they do decide to breastfeed they will end up isolated from their friends and family because they don’t feel welcome to breastfeed their baby when they are out and about.
So, you can understand any woman or concerned relative being worried that she might be treated badly, even though we know that breastfeeding happens all the time and largely goes unnoticed. Most women have a positive experience of breastfeeding, but this isn’t seen or shared with others. Only the negative stories make the press. Whether it’s just perception or reality, the worry stops breastfeeding happening.
We need to change the conversation about feeding out and about. This doesn’t mean pitching individual women against each other or suggesting women are more discreet or, indeed, by asking individual women to speak up alone for breastfeeding.
We collectively need to support communities to understand and value breastfeeding so it can be seen as just a normal thing to do. This is only achieved if we can bring it out of the closet or home and into the mainstream in an open and celebrated way. This requires conversations with others outside of the present breastfeeding movement.
We know what works. It is essential that breastfeeding protection and support is embedded in all maternity care and birthing facilities. This must be accompanied by consistent training of medical professionals.
Using a peer support model, through which women support each other, is a proven way for them to develop skills and confidence to rehearse breastfeeding out and about. This has a positive impact on breastfeeding choice and duration (Hoddinott 2006, Blake Stevenson 2016).
Designating places as breastfeeding-friendly is another way a community can act together to declare support for the value of breastfeeding, with the intention of changing local culture one place at a time.  The Breastfeeding Network has developed a scheme with information for parents, families, businesses and organisations to use. It is simple and accessible and can be used in a variety of contexts: single small businesses, retail parks or even airlines! The information is available for anyone who wants to help make places more breastfeeding-friendly by equipping them with information to help change the conversation around breastfeeding. The BfN scheme helps families feel confident breastfeeding out and about, offers communities and businesses a way to show that they welcome and support breastfeeding, and raises awareness about the benefits of and barriers to breastfeeding.
While some might see schemes like this as controversial or as a necessary evil, many women report positively that breastfeeding friendly schemes helped them cross the threshold from home to out and about and allowed them to see and feel that their community would support their decision to breastfeed their baby.
As one mother put it, seeing a breastfeeding friendly scheme in operation by a coffee shop owner made ‘…me feel like I was being held by my community while I was holding my baby…’.

Shereen Fisher, Chief Executive Officer, Breastfeeding Network
Useful resources and references
The National Breastfeeding Helpline (0300 100 0212), offers independent, confidential, mothercentred, non-judgmental breastfeeding support and information from volunteers with experience who trained by The Breastfeeding Network and the Association of Breastfeeding Mothers. Lines are open 9.30am – 9.30pm every single day of the year. Calls to the Helpline cost no more than calls to UK numbers starting 01 or 02 and are part of any inclusive minutes that apply to your mobile provider or call package.
Opinion on Breastfeeding Discrimination for Hogan Lovells International 2015
Hoddinott, P, et al (2006), One-to-One or Group-Based Peer Support for Breastfeeding?

Women’s Perceptions of a Breastfeeding Peer Coaching Intervention, Birth, 33: 139–146. http://onlinelibrary.wiley.com/doi/10.1111/j.0730-7659.2006.00092.x/abstract

Unicef Ten Steps to Successful Breastfeeding: http://www.unicef.org/newsline/tenstps.htm

Breastfeeding Network: Breastfeeding-Friendly Scheme: https://www.breastfeedingnetwork.org.uk/bfn-breastfeeding-friendly-scheme/

Evaluation of Breastfeeding Network peer support https://www.breastfeedingnetwork.org.uk/evaluation/
Victora, Cesar G. et al (2016), Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, Volume 387, Issue 10017, 475 – 490.

For further information contact Shereen Fisher, Chief Executive Officer, @shereen_fisher, ceo@breastfeedingnetwork.org.uk

A version of this blog first appeared on the UNICEF BFI website in August 2016