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.

05 Feb

A new year’s revolution: take time to enjoy the stillness.

Kirsty Cummins is one of our National Breastfeeding Helpline Link Workers. She has written this post about changing the perception of new year as a time to make huge changes or rush to achieve unrealistic goals. Instead, she’s championing a more laid back approach, taking cues from nature to rest, reflect and prepare for the excitement of warmer months ahead – a near-perfect analogy for the sometimes intense experience of new parenthood.

A New year makes me uneasy. I dread all the slimming programmes on TV, the ‘how to get yourself in shape’ articles, whether physically or mentally. I struggle in January and February and the last thing I need is more media making me feel I am doing a bad job of it. That the left over 12 boxes of mince pies (yes I DO bulk buy my favourite winter treat) cannot be touched because I should no longer be indulging, and that I should be making health choices (whatever they are) or else I am failing. I feel it unfair that it is the end of January that heralds the release of the small chocolate gooey filled eggs that are my favourite treat, when the guilt of having done nothing still lingers. Why is it now that I feel I am being told to don a stretchy outfit and be physical when I would much rather do that when the nights are lighter and I feel more alive? My head, if I let it, can be so full of what I am not achieving in this murky, dank, cold time that I forget what IS actually going on.

I have always dreaded that certain time in September when you know the summer is over. I would feel bereft that the summer was all but lost to me and all I had ahead was winter and cold and having to pretend that I love Christmas and New Year, when I would much rather carry on enjoying the warmth and the hope that truly fills my soul in summer. I would ignore the beauty of autumn because it heralded the coming of the cold.  I would tell anyone that would listen about my woes in winter. I did exactly this to a lovely lady who was treating me with acupuncture last January. And her reply has turned things upside down. She mentioned the Chinese, as she often does with little snippets of Chinese beliefs and said quite simply that January really should be a time to slow down and make things as simple as possible and really enjoy the stillness before the spring slowly starts to sneak its way in. In that pause you might think about what it is you wish to achieve over the whole of the coming year.

Thinking about it now I am guessing this would be connected to Chinese New Year which is sometime between 21st January and 20th February, depending on the New moon and building up to the New Year in the quiet, sleepy weeks gives you time to reflect. Perhaps it was her own ideas and not Chinese beliefs but either way I listened and remembered what she said to me.  It seemed important to remove the need to take quick, drastic action in January and the guilt that I hadn’t done that sulking away to itself in the corner in February.

She was suggesting that if I stopped hating the supposed emptiness of this time of year I might start to find the time to reflect and truly listen to what I do want and what I do appreciate.

Whilst simple and glaringly obvious somehow it was a jolt to my own beliefs and I decided to really try very hard to do just that. To find the beauty in the weather and the land and the lack of much to do. I decided to remove things from my life that made me unhappy and to think what would really make my life feel better all year round.

 I really took time to ponder that the earth beneath my feet and all around me is resting. That the trees and other such magical beings are sleeping, conserving their energy for greater moments when the Sun begins to linger for a little longer each day in the sky. This whole hemisphere is on a well-earned break from the busy busy of ‘getting it on’ except it would seem us humans.

Over the coming months I acted upon those things I had fully absorbed and appreciated during my rest and reflection.

 I am doing the same again this year without the feelings of dread and despair I have suffered in the past. I am enjoying the dark evenings while I can so I can prepare myself for an energy boost and throwing some shapes in the warmer months, when I don’t mind leaving the house after the kids are tucked up because it is still warm and light out there. I always aim for the clocks changing because then I know things are really on the move – including me!

I am using this time to think about what I would like to give to others. I am not failing if I am not giving now – I am preparing myself to do it the right way for me. Volunteering has a huge part to play in our lives but it has to ebb and flow like the seasons and we should never beat ourselves up when our own lives get too full to support others. Perhaps for you this quiet time IS your time to support. When the busy of the world slows, is it that you have more space to hear the thoughts of others. In the stillness of these months can you can give others the wisdom of the benefits of slowing down, listening to themselves and what their instinct is telling them, that it is ok to take time to make decisions or to practice rather than be immediately perfect?

Winter (especially that January panic) sounds a bit like a new mother doesn’t it? In that scary time when all is new and we are expected to do so much in the right way when actually perhaps what a new mum needs to hear is bed down, listen, reflect and trust that life as you knew it will return in some recognisable form at some point in the future but it doesn’t have to be now. That the early unfurlings of motherhood is a time to slow and snuggle and make choices without all the background noise of life.

The comfort of knowing things are ever changing, like the seasons, can bring comfort to us whether we are new parents or volunteers choosing our next adventure or women going about our ever changing lives from maiden to mother to grandmother. Sometimes the still bits are just what we need.

And now we are in February and every snowdrop lifts my heart.

31 Jan

BfN in the news: Shereen Fisher appears on BBC Woman’s Hour

Shereen Fisher, our CEO, featured in a panel discussion on BBC Woman’s Hour this week, on infant feeding experiences and how they made women feel. Shereen was joined by GP Dr Ellie Cannon and maternity matron Gill Diskin. The discussion covered all aspects of infant feeding, and addressed some of the challenges faced by new mums, as well as the health care professionals and organisations who aim to support them. Here’s what Shereen had to say about the experience.

I was thrilled to be invited to be part of the panel for BBC Radio 4’s Woman’s Hour this week, representing BfN. The opportunity was unique and the feature would be part of a 3 day-long focus on infant feeding – no flash in the pan for women’s stories about breastfeeding this time, but 3-plus hours of national radio air time devoted to getting the triumphs and heartache across – and for me – the injustice of women who don’t get the support they so deserve.

Invitation accepted then the worry began, as the facts of the show and angle the producers were aiming for were slow to emerge, along with details of the other panel members. I liken the experience of preparation to that of ‘getting a genie into a bottle’ – I am not a doctor or Public Health specialist, so a fair amount of reading and revising ensued (taking me back to my Law degree finals, when I promised myself that I’d never put myself through it again), as did heartfelt conversations with some sound, strong and sensible minds – you know who you are.

The challenge was, when the cork was taken off the bottle, to make sure that at least five clear messages were unleashed and not just a mist of vapour … The preparation, guidance from others and commitment I have held to this issue for over six years came good in the end and I was calm and relaxed in the studio (broom cupboard!), waiting to hear Jenni Murray say my name and invite me to speak.

Predictably the slant has been somewhat focused on the problems and the negatives of breastfeeding, but the presence that BfN was afforded has given me hope that all voices are valid and with a concerted effort we will be able to improve support for all women to pursue their choices and reach their own individual goals. That, I am certain, will be the secret to happy mums and babies.

To hear the full podcast featuring Shereen Fisher, Chief Executive, visit:
https://www.bbc.co.uk/programmes/m00027ml

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.

20 Oct

Supporting positive conversations about feeding choice and mental health in the perinatal period

The relationship between how a woman feeds her baby, and her perinatal mental health is a complex one.

Our emotional state and mental health in the perinatal period may affect how we decide to feed our baby. Choosing how we feed our little one may be based on many things such as how our own mum fed us, advice from professionals and what we have seen friends and family do. Our emotional wellbeing – factors such as how we feel about ourselves, our bodies and our relationships – can also influence this decision.

For women with a diagnosed mental health problem, feeding decisions may be influenced by considerations about how best to manage their condition during the perinatal period. This is particularly true for women who take medication. With the right advice and support, it should be possible for most women to find and use medication that is compatible with breastfeeding if they desire to do so. However, sadly, approximately 15% of calls to the Drugs in Breastmilk Information service are from those who have received inconsistent or negative advice on breastfeeding whilst taking medication for their mental health. Mothers contacting the service regularly tell us of their confusion and hesitancy in combing breastfeeding and their medication. It is a worry that there so many women who may unnecessarily stop breastfeeding or attempt to limit their exposure to medication because they have not received evidence-based consistent information and skilled support about mental health and breastfeeding.  The need for evidence based services such as the independent Drugs in Breastmilk information service that professionals and women can access for advice is so important if we are to create a culture where feeding choice can be respected and supported.

How we feed our baby may also affect our mental health. Research shows that breastfeeding releases hormones which can help reduce stress in mothers, and some women report that it can reduce the symptoms of postnatal depression. A large study found that, for mothers who showed signs of depression before the birth, four weeks exclusive breastfeeding (for those who had intended to breastfeed), exercised a protective effect. For the women who had not been depressed in pregnancy there was no such protection.

However, conversely, some mothers feel that breastfeeding can exacerbate feelings of depression or anxiety. The following quotes show the very different ways in which women feel that breastfeeding affects their mental state:

“I possibly breastfed for longer – it felt like one of the few things I was getting right as a mother.”

“My mental health issues played a significant role in stopping. Once I decided to stop my mental health issues got significantly worse.”

“I think my inability to breastfeed caused the PND.”

“Breastfeeding had a positive impact on my mental health, helping me with sleep & anxiety.”

Women who struggle to feed their baby, or stop breastfeeding before they intended to, are particularly vulnerable to a decline in their mental health. Discomfort, pain or concern about supply, can lead to stress and anxiety for women. Any feeding difficulties, whether breast or bottle, can cause worry and distress. The research cited above showed that there was a particularly high risk of postnatal depression amongst women who planned to breastfeed and then stopped before they intended to, demonstrating both the importance of supporting women to breastfeed their baby, but also of support if this is not successful.

How we feed our baby is such a personal choice, and can, for some people, leave a lasting impact on our lives. Older women who did not feed their child in the way they may have wished to can recount their feeding history to young mothers often with sadness and regret. Our feelings about our feeding decisions can also be influenced by societal pressures. Some women report having felt pressured to breastfeed or feel unsupported to formula feed. We hear of women feeling guilt and judged for formula feeding; women feeling isolated because they are afraid to breastfeed in public; and far too many stopping breastfeeding because there was a failure to support them with practical skills to increase their physical comfort and supply.

All of the evidence and arguments outlined above reinforce the importance of enabling all mothers to access positive conversations, good information and support to enable them to feed their baby the way they wish to, and to do so in a way that is as pain-free, low stress and rewarding as possible.

Support can and should come in many forms; from close family or friends, it may involve a specific breastfeeding supporter or helpline, or a midwife, family nurse, doctor or health visitor.  This should be non-judgemental, encouraging, patient and kind.  The complex and multifactorial reasons for lower breastfeeding rates among women with depressive illness (Pope & Mazmanian, 2016) suggests there may be an opportunity to link the perinatal mental health professionals with those working to support infant feeding.  As part of the developing pathways of care locally, this interdisciplinary working seems like relationship worth nurturing so that professionals are equipped and women can receive evidence based and supportive care whatever their feeding choice and whatever their mental state.

We need to offer a safe place for mothers to discuss their choices around infant feeding. We need to listen to mothers and offer them options, allowing them to make their own informed decisions.

Mothers should be able to get the support that they need when they need it. Their decisions should be respected and honoured and women should feel listened to rather than bombarded with conflicting advice.

Whether breastfeeding, formula feeding or doing a bit of both, all mothers need consistent support.  This might be in getting breastfeeding established, continuing as long as they and baby choose, or in stopping – whenever that may be– without judgement. Support may also need to be in how to make a formula feed up correctly and safely, or how best to position your baby with a bottle.

Whatever our decision is to feed our little one, and however our mental state is affected during this time, we should expect to feel supported and respected in our feeding decision, and with our mental wellbeing.  With many support services for mothers cut to the bone we are all going to need to understand mental health and breastfeeding better – partners, grandparents, friends of new mothers will need better information to offer support. It’s vital that we share information and research on the relationship between breastfeeding and maternal mental health.

By Shereen Fisher, Chief Executive of The Breastfeeding Network and Wendy Jones , Pharmacist and registered Supporter and Trainer with the Breastfeeding Network. Also Beckie Lang, Interim Strategic Lead, Mothers and Babies in Mind at the Maternal Mental Health Alliance.

This blog was previously posted on The Maternal Mental Health Alliance website, here

Resources:

http://www.rcgp.org.uk/clinical-and-research/toolkits/-/media/B789CC91113D4FB3816D11C5C99BB2B4.ashx

Explore MABIM’s tools for leaders working in perinatal mental health: www.maternalmentalhealthalliance.org/mumsandbabiesinmind/mabim-tools

Mums and Babies in Mind supports local leaders in four areas of England to improve care and quality of life for mums with mental health problems during pregnancy and the first year of life, and their babies. 

 

04 May

Breastfeeding and maternal mental health

This week is maternal mental health awareness week and so it’s important that we speak up about the often misunderstood relationship between maternal mental health and breastfeeding. I hope this blog complements the fantastic offerings from Dr Wendy Jones’s live Facebook session in conjunction with the Perinatal Mental Health Partnership, and information offered by Dr Louise Santhanam of GP Infant Feeding Network (GPIFN). Both the Facebook session and GPIFN website are must-reads to any breastfeeding mother who is concerned about her mental health (that’s all of us by the way) or indeed for dads, partners or grandparents or anyone supporting a mother. It’s also the week BfN have been told that there is no funding available to continue breastfeeding peer-support in Blackpool. Since 2007 Blackpool Star Buddies have helped thousands of parents, babies and families to breastfeed against the odds and it is disappointing that such a high-performing scheme is being forced to close. Yet, still feeling the glow of BfN winning Charity of the Year award at the Mama Conference 2017, I am trying to work out how to feel about these highs and lows that are hitting the world of infant feeding, the charity sector and parents and families who are seeing services declining.

For those of you who had never thought about the connection between breastfeeding and maternal mental health or those who aren’t convinced, please read on. For those of you who are well versed in this you may want to make a friend a cup of tea.

The relationship between infant feeding and mental health is complicated, not least because a mother’s pre-natal mental state, pregnancy and birth experience can all result in stress and trauma – all of which can influence how a mother feels about breastfeeding. In other words the cause and correlation between breastfeeding and mental health isn’t a tidy one – it’s complicated.

There can be a lot of pressure on mothers to breastfeed fuelled by the ‘being the best’ campaigns, only slightly softened by the addition of ‘be the best you can be’. We know that pressure is not good for mental health so let’s just stop this rhetoric now!

What you may not know is that evidence suggests that ‘not breastfeeding’ can significantly increase the risk of postnatal depression, particularly if a mother wanted and intended to breastfeed. A 2014 study of over 10,000 mothers found that those who didn’t plan to breastfeed and who gave formula from birth were significantly more likely to become depressed than those who planned to breastfeed and who did so exclusively for at least four weeks. The same study found that those who planned to breastfeed, yet were unable to do so were at a higher risk of postnatal depression. This research tells us that breastfeeding is important to women and that good support is needed for women who want to breastfeed, but also good support is needed for women who intended to breastfeed but who find themselves unable to do so. So why are breastfeeding peer support services being closed down?

Supporting mothers for over 20 years we at BfN know that establishing pain-free, comfortable feeding makes for a good breastfeeding experience. So, we have to break down the culture of silence around pain and offer mothers as much support as they need, especially on positioning and attachment (typical cause of pain can be poor positioning of baby at the breast). Pain and injury are not acceptable characteristics of breastfeeding – if you are experiencing pain, don’t suffer in silence – talk to a mum who knows about breastfeeding. Call the National Breastfeeding Helpline on 0300 100 0212.

Scientists are trying to understand the relationship between breastfeeding and maternal mental health. Some theories say that the act of breastfeeding supports the hormonal surges of both oxytocin and prolactin which encourage a mother to feel more relaxed and reduce anxiety. Also breastfeeding helps to regulate / reduce the body’s inflammatory response – depression is associated with inflammation.

We know that some GPs lack time, training and opportunities to support a breastfeeding mother who is experiencing issues with her mental health. GPs can lack knowledge on breastfeeding and often are not sensitive to the needs of someone who is breastfeeding, unwittingly overlooking the issues or value the mother places on continuing to breastfeed. So, it is important to encourage awareness and better training for GPs. Information for GPs is available through the GP Infant Feeding Network and through the BfN’s Drugs in Breastmilk Information service.

Perhaps most importantly we should all be listening to mothers carefully. They know their baby more than anyone else and their experience is informed by instinct and regular contact. If something isn’t going well for them they are the best people to explain the situation and they shouldn’t feel worried about how it is coming across. A non-judgmental approach is essential.

With services to support breastfeeding cut to the bone we are all going to need to understand breastfeeding better – partners, grandparents, friends of new mothers will need better information to offer support. It’s vital that we share information and research on the relationship between breastfeeding and maternal mental health.

Shereen Fisher is Chief Executive for the Breastfeeding Network @shereen_fisher