14 Nov

MBRRACE-UK Report, “Saving Lives, Improving Mothers’ Care” – BfN Response

Shereen Fisher, BfN CEO

MBRRACE–UK released their 5th report ‘Saving Lives, Improving Mothers’ Care’. It describes the lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity from 2014-2016. Here’s The Breastfeeding Network’s response. 

The Breastfeeding Network (BfN) welcomes the report. While the research has found that the number of women dying as a consequence of complications during or after

Wendy Jones

Wendy Jones, lead pharmacist, BfN Drugs in Breastmilk service

pregnancy remains low in the UK – with fewer than 10 out of every 100,000 pregnant women dying in pregnancy or around childbirth, the report highlights the unacceptable disparity in care for black and ethnic minority women. Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘The almost five-fold higher mortality rate amongst black women compared with white women requires urgent explanation and action. BfN welcome further exploration into this unacceptable disparity to ensure there is real change for black and ethnic minority women’.

A key concern, is the tragic case of a mother dying several weeks after her baby was born (Commencing treatment, dose and compliance page 39). There were delays in prescribing thromboprophylaxis because of concerns over  breastfeeding.

Dr Wendy Jones, lead pharmacist for the BfN Drugs in Breastmilk Information service, said ‘I have long feared such a scenario.  Physicians need to be aware how to check that a drug treatment is compatible with breastfeeding quickly, using evidence-based sources. The drugs in this case are widely used in the immediate postnatal period yet emergency medicine teams are often unable to access readily available evidence-based information on medication and breastfeeding as quickly as they need. The information should have been readily available in guidelines or a reference source including specialist information. The wording of the BNF: “Due to the relatively high molecular weight and inactivation in the gastro-intestinal tract, passage into breast-milk and absorption by the nursing infant are likely to be negligible, however manufacturers advise avoid” needs to be updated where the manufacturer is merely not taking responsibility in licensing the product. The removal of the words “manufacturer advises avoid” makes the information read very differently to a busy practitioner’.

Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘This sad case highlights the need for mothers to be able to access skilled support in their local communities, with staff alert for symptoms needing attention; the mother in question had multiple ‘fainting’ episodes postnatally that were not investigated until day 44. This emphasises the need for health care professionals in all front-line services to understand how to treat pregnant and breastfeeding mothers – until this happens women will continue to be exposed to risk and potentially loss of life. It feels that no-one listened to the mother or observed her and her baby as a dyad as closely as they should have done, possibly because breastfeeding was seen as a barrier to medication. Women should not be disadvantaged in the management of acute illness just because they are pregnant or breastfeeding, and communication needs to be improved throughout the multidisciplinary team.’

To read more you can download the full report, lay summary and the infographic here: https://www.npeu.ox.ac.uk/mbrrace-uk/reports

13 Dec

BfN statement on Financial Incentives for Breastfeeding research

A breastfeeding babyBfN statement on the ‘Effects of Financial Incentives for Breastfeeding’ research

The Breastfeeding Network welcomes this new research to explore cash incentives to encourage breastfeeding, targeted in areas where breastfeeding is unlikely to happen.

With such a substantial body of evidence showing the benefits of breastfeeding for both mothers and babies, we believe everyone should have the right to make an informed decision about how they feed their baby – and to receive support, if they need it, to make it work for them.  Just because a family may happen to live in an area where there is little or no culture of breastfeeding, it shouldn’t mean they should be overlooked – and this study aimed to test what might make a difference in those areas.

We should remember that the availability of good quality breastfeeding support is lacking in many, if not most communities across the UK and we know that support is what makes the difference for many families on their breastfeeding journeys.  We should also be mindful that if more mothers were to choose to initiate breastfeeding, for whatever reason, there would be an even greater need to provide additional support services for all families.

For latest news about this research study, see the UNICEF Baby Friendly website and this BBC News video and article

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.

22 Aug

Can a man breastfeed? Supporting breastfeeding LGBTQ families

Dr BJ Epstein is Senior Lecturer in Literature at University of East Anglia and a Counsellor on our National Breastfeeding Helpline. In this guest blog post she talks about her experience breastfeeding in a two-Mum family.

Hand on topIf you’re a two-mum family, can you both breastfeed? Does your daughter get confused about whose breasts to latch on to? Is your wife jealous of your breastfeeding relationship?”

These are just some of questions that I’ve frequently been asked in the 34 months of my daughter’s life. Despite the obvious point that they’re rather personal subjects to discuss with people I often don’t know very well, the topic of breastfeeding and LGBTQ families is an extremely important one.

World Breastfeeding Week has recently passed, but the week is intended to raise awareness of issues surrounding the encouragement and support of breastfeeding all weeks of the year. Strangely, though, few people talk about supporting LGBTQ individuals/families with regard to breastfeeding.

You might think this is a very niche subject, but in fact more and more LGBTQ people are having children. Although figures vary, there are estimates that 1-10% of the population is LGBTQ, and that nearly 10% of LGBTQ people have children. That’s not an insignificant number. Considering how much thought and effort (and expense!) has gone into getting those children, LGBTQ families are often equally thoughtful about how to feed their babies. We need to know where to turn when we need help with breastfeeding, and we need to know we will be treated fairly and equally.

While many of the concerns regarding breastfeeding are the same for all families – what positions work? What if there’s pain? How much should the baby be feeding? How do you know if the baby is healthy? – There are some issues that are specifically relevant to LGBTQ people.

For example, can both mothers in a two-mother family breastfeed? What would be required to induce lactation? And how would that affect supply? And what if the baby was conceived through IVF? Does that affect breastfeeding? What if the breastfeeding mother wants to try to get pregnant again through IVF while continuing to breastfeed? And, also, if you’re talking to a two-mum family, should you call them both mothers or is only the one who gave birth the mother? (Here’s a hint: use whatever terms the parents want to use! And don’t judge!)

What about a situation where a trans man has given birth? Is he a “mother” or a “father”, a “she”, a “he”, a “they”, or something else altogether? (Again: employ whatever terms people use to refer to themselves!) Will a man be able to feed if he has had chest surgery? If he’s taking hormones, can they influence his milk supply? Should you even call it “breastfeeding” or might the man you’re talking to prefer “chestfeeding” or “nursing”?

In some LGBTQ families, donor milk might be used. Where can they find it? Is it safe? How do they use a supplementer system?

This is all quite practical so far. Then there are the more psychological or theoretical points. Is feeding a baby likely to induce or increase dysphoria in a trans man? Will one mother breastfeeding cause sadness in the other mother if she was unable to conceive or breastfeed herself? How will the men in a two-dad family feel about not being physically able to provide breastmilk for their child? Do LGBTQ families feel represented in literature about breastfeeding? Is someone’s queerness recognised and acknowledged by health professionals? Are they getting equal treatment from midwives, health visitors, doctors, and others?

These are just some of the things that LGBTQ individuals/families and those who want to support them on their feeding journeys need to consider. And yet there is little written about or for this group of people, and few breastfeeding support workers get education about it.

This needs to change. As all the events and publications that stemmed from World Breastfeeding Week pointed out, all families deserve knowledge and support when it comes to breastfeeding their children. We need to do better when it comes to LGBTQ families in particular.

Note: I’ll be speaking about this in more detail at the Breastfeeding Network Conference in October.’

 

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