06 Aug

Breastfeeding support during COVID-19 – A summary report in collaboration with Professor Amy Brown (Swansea University) and Dr Natalie Shenker (Imperial College & Human Milk Foundation)   

In May 2020, researchers from Swansea University and Imperial College conducted research in collaboration with the Breastfeeding Network to explore families’ experiences of breastfeeding support during COVID-19. 

 

Click the image to read the full report:

Covid Report Thumbnail

 

The following summary has been taken from the report, the full findings will be published in a journal later this year.

COVID-19 and lockdown has been a challenging time for breastfeeding families. Many have stopped sooner than they planned. Although this is unfortunately a common issue even outside of the pandemic3, many blamed a lack of support and lockdown experiences upon their decision to stop. 

We know that breastfeeding works best when women receive high quality practical and emotional support from professionals and peers including in the community1. This support had to change once lockdown was in place, with breastfeeding charity organisations making rapid alterations to the way they delivered their service.  

Some women were fortunate to be able to access this, evidenced by the multiple, varied queries they had answered during this time, covering both practical and emotional support needs. The majority of those who accessed this support found it useful and wanted it to stay, albeit alongside the benefits of face to face support once possible. For these women, their experience was positive, giving them easy and rapid access to support from the comfort of their homes. Notably, some women accessed this support over and above health professional support during the pandemic. It is clear that breastfeeding organisations provided a valued and needed service at this time – a finding reflected in similar previous research exploring the impact of the Australian Breastfeeding Association during this time4

Unfortunately, two further groups of women did not have the benefit of this support including those who did not realise it was available, and those who accessed it but either struggled or had a strong preference for face to face provision. These women found a lack of in person care challenging, struggling to convey issues or with technology, or simply wanted the reassurance of someone in the room. It is likely these experiences are not equal; those with more resources and fewer challenges at home will find accessing different sources of support in during difficult times easier.  

We found that women who did access charity support when they needed it were more likely to still be breastfeeding at the time of completing the survey compared to those who did not. To some extent their ability and willingness to seek support will in itself have supported these mothers’ ability to continue breastfeeding, most likely reflecting high motivation. However, given what we know about the impact of breastfeeding support for new families1, the range of queries posed to teams, and the positive experiences from some women in this survey, it is evidence that charity breastfeeding organisations have played an important role in ensuring mothers could continue breastfeeding through lockdown.  

In terms of where we go from here, the good news is that online breastfeeding support services are working well for many women, helping them to breastfeed for longer. However, many challenges and questions have been set, with some of the answers likely outside the control or remit of organisations offering support. Namely: 

  • How do we ensure better promotion of availability of online breastfeeding support so that more families know they can access it? 
  • How do we ensure these organisations are well funded to be able to meet the needs of more women? 
  • How to we enable all populations to access online support, including those who may not be able to afford technology or high-speed internet connections? 
  • What is needed to recommence face to face breastfeeding support, given other public spaces such as restaurants and public spaces are open?  

Given the known impact of breastfeeding upon population health5 and maternal wellbeing6, the government urgently needs to review its provision of care for new families, considering how it can ensure that more are protected in similar circumstances in the future. Although almost all mothers valued the option to receive online or phone support during lockdown, many expressed a wish for face to face support to continue. Recent press reports have stated that Health Secretary Matt Hancock wishes to encourage future virtual GP appointments unless clinical need, but caution must be urged in relying too heavily on a lack of in person support. It was clear mothers valued both the information they were being given, but also the warmth and connection from face to face support, and engagement with other mothers.  

Finally, the impact of breastfeeding charities in supporting mothers practically and emotionally through this stressful period should be celebrated. They have served a community of new mothers, whom without their support may have had a much more challenging breastfeeding experience and likely a premature end to breastfeeding altogether. Their value and contribution must be recognised.  

 

References 

1.     McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., … & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, (2). 

2.     Unicef UK (2020) Unicef UK Baby Friendly Initiative statement on infant feeding during the coronavirus (COVID-19) outbreak.  

3.     McAndrew, F., Thompson, J., Fellows, L., Large, A., Speed, M., & Renfrew, M. J. (2012). Infant feeding survey 2010. Leeds: health and social care information Centre2(1). 

4.     Hull, N., Kam, R. L., & Gribble, K. D. (2020). Providing breastfeeding support during the COVID-19 pandemic: Concerns of mothers who contacted the Australian Breastfeeding Association. medRxiv. [preprint] – doi 10.1101/2020.07.18.20152256  

5.     Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., … & Group, T. L. B. S. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. 

6.     Brown, A. (2018). What do women lose if they are prevented from meeting their breastfeeding goals? Clinical Lactation9(4), 200-207. 

7.     BBC (2020) ‘More Zoom medicine needed’ in NHS says Hancock https://www.bbc.co.uk/news/health-53592678

 

Download the Summary Report in PDF

07 Apr

Coronavirus update from BfN’s CEO

I was heartened to receive a tweet in the last week which read ‘the rest of the world has finally caught up with the way @NBHelpline and @BfN_Uk volunteers have been working for years! #Remoteworking’

BfN_CEO

It was in response to an image shared of our volunteers’ home work stations – places they shared where they take calls from mothers calling the National Breastfeeding Helpline. While I know not all of our volunteering and commissioned work is provided remotely, never more than now have I been thankful for BfN’s strong helpline and telephony skills, our vibrant online community of peer supporters, our established working from home culture and broad volunteer base that branches out across the whole of the UK – just the strength we have needed to call on during this pandemic.

It’s now more important than ever that we stay connected to each other, not only because sharing knowledge will help us plan and learn but because while stabilising immediate support for women and families we can also stay in touch about how we navigate the future.

All our lives have been turned upside down by the Coronavirus crisis – some of us may be finding ourselves closer to loved ones in our isolation, others may feel lost without the routine of social interaction. Without a doubt mothers looking for breastfeeding support will find their usual services drastically cut back or gone, they will find their feelings of worry and of being overwhelmed heightened as health care professionals struggle to meet demand. This is why at the Breastfeeding Network our immediate priority has been to stabilise our offer of remote support across our helplines and in communities by offering digital alternatives. In tandem we have been working with partners including – Scottish Government, Public Health England, NHS and with other third sector partners on sharing resources that will be a vital support line for women and families for many months to come.   

Responding to the crisis

I want to highlight a few things we have done to respond to the crisis – for mothers and families, for peer supporters – volunteers and paid staff, for our tutors and supervisors and for healthcare professionals in the front line or responding to the virus.

For mothers and families – we have strengthened the National Breastfeeding Helpline offer and secured additional resourcing in England. Against the usual opening hours, we have appealed to volunteers to help us respond to all calls, added in a voicemail option so any missed calls can be returned and we are doubling our remote supervision for volunteers. There is dedicated social media support that extends to enquiries on BfN’s Drugs in Breastmilk Information Service. At time of writing we are answering close to 100% of all calls to the helpline. I am so inspired and proud of what our volunteers on NBH have been able to achieve working with our sister organisation – Association of Breastfeeding Mothers, the strength of this long held partnership has been a rock of support.

With a lack of consistent reliable information being an often quoted issue from Mothers we knew that we had to develop our online resources for women and families in response to the crisis. A small team of writers mobilised quickly to develop FAQ’s that can be found here.  Content evolves in response to enquiries from the helpline and on social media and is quickly updated online.

In addition, third sector organisations working in infant feeding have come together to highlight the support that women and families can access during this time. The collaboration and generous offer of the third sector has been impressive, our combined effort can be found here.

When the Government moved from ‘manage’ to ‘contain’, it was with a heavy heart that we suspended our face to face support services including community drop-ins, training, events and home visits. Only exceptionally is face to face work continuing under the strictest of arrangements, only at the request of the local authority area or health board. It’s absolutely the right thing to do as the safety of our staff and volunteers comes first. Some of our volunteers are pregnant and with few exceptions have dependents on whom good health will be relied upon so we take this very seriously. Areas supported by a small central team are stabilising services locally through offering digital support and the charity has purchased Zoom licences to enable this to happen. Project areas are reporting that they are trialling helper training, supervision get-togethers, local team meetings and even 1-1 support with Mothers. We are learning fast and will look to test our digital capacity even further as we plan to hold our May BfN Directors’ Meeting by Zoom – strengthening our digital service offer is going to be an item of strategic importance.

We have a big network of volunteers and staff and communicating well, under pressure and accurately has called for a lot of focus. We are a small central team with contracted support on law and finance. We have managed to achieve a series of well-timed and high quality briefings that have included guidance on HR, IT, safeguarding, upskilling tools and tips on coping in isolation and remote working.  We are working hard to fast-track our online training offer and support our tutors and supervisors to feel able to offer tutoring over online means.

How we are supporting our healthcare professionals

Within a week of the social distancing measures coming in, BfN were invited to be part of the conversation with Government about what the voluntary sector can do to support the NHS. This conversation was held in the very real context that up to 30% of the NHS workforce will be undermined by the Coronavirus. Today with other organisations we submitted our collective response with the honest hope that third sector might get recognised as a vital part of society.

We are asking Governments in Scotland and England to help us raise even more awareness of the NBH, our online resources and of BfN’s Drugs in Breastmilk Information Service. These services directly support midwives and health visitors on the frontline of the healthcare response and many of these services do not rely on NHS staff. In project areas peer supporters are offering support remotely in their communities – maintaining a vital presence that health care professionals can call upon.

The longer term impact of the Coronavirus is still to be calculated but while it takes its toll on our relationships and erodes our traditional ways of communicating, social distancing is also offering us a choice, a choice to be curtailed by the measures or to be connected differently. There are concerns in the dash for digital – real concerns about inequalities and inclusion as well as our human rights like privacy. For now, our priority is to stabilise support and ensure that our combined efforts support mothers as well as possible while also looking after ourselves.

Heartfelt thanks to you all for your courage and commitment to supporting women and families and breastfeeding. You are a true inspiration!

Best Wishes

Shereen

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

09 Jan

Dr Wendy Jones, The Breastfeeding Network’s pharmacist, awarded MBE in Queen’s New Year’s Honours List

One of the founding members of the Breastfeeding Network (BfN), and our resident Pharmacist for over 20 years, Dr Wendy Jones, has been awarded MBE in Queen’s New Year’s Honours List for 2019.

Wendy set up the BfN drugs in breastmilk information service in 1997 after being asked to update an information pack about the safety of drugs in breast milk. Gradually the service grew and now she now leads a small team of volunteers who offer individual support to more than 10,000 families and healthcare professionals each year via email and social media.

Commenting on the award which Wendy receives for services to mothers and babies, Shereen Fisher, CEO of the Breastfeeding Network, said:

“We are delighted with the news that Wendy is receiving this award in recognition of her work. Wendy is an inspiration to us all.  She has dedicated the last twenty years to supporting mothers and families through the drugs in breastmilk service she founded.  Day in day out, she responds to phone calls, emails and now social media messages from parents and healthcare professionals who need reliable, evidence based information about the safety of medications and treatments while breastfeeding.  The work she does allows parents to make their own informed decisions and has undoubtedly saved lives.”

A soon to be published evaluation of the drugs in breastmilk information service was overwhelmed by responses from mums and healthcare professionals when they were asked for their thoughts on the service. A mum of four said: “Wendy has saved me and my daughters many times over. I can honestly say I would have committed suicide after my second baby was born had it not been for her support to keep taking my meds and to keep breastfeeding.”

A consultant paediatrician said: “Wendy’s information is presented in a way which is accessible to non-medical mothers to understand, but also written in a way that doctors who know little about breastfeeding will take seriously.”

Wendy said: “I couldn’t be more proud than I am today that I have been awarded an MBE in the New Year’s Honours List as Founder of the Breastfeeding Network Drugs in Breastmilk Service for services to Mothers and Babies.

“In 1995 when I wrote the first information on drugs in breastmilk I could never in a million years have imagined this happening. I followed my dreams and the opportunities given, massively supported by my family and particularly my husband Mike [pictured above with Wendy] who gave me the opportunity to leave paid work and develop my passion.

“Nothing I can do would be possible if breastfeeding advocates didn’t spread the word that you can breastfeed as normal when you take most medication or there are ways around it. So, this MBE is for all of you too for all the hard work you do in groups, on the helplines, face to face, via social media and just at the school gate or supermarket checkout. You are all amazing.

“Thank you everyone for your wonderful comments today. I’m treasuring them in my heart and taking inspiration from them to keep challenging and to carry on supporting mums, dads, grandmas, peer supporters and everyone to keep breastfeeding these special precious babies. I’m hoping that this is the beginning of a year when breastfeeding and its support gets the recognition it deserves and just maybe some funding as a public health issue.”

Earlier this year Wendy was also awarded a Points of Light award by the Prime Minister.

Wendy’s story

Over the past 40 years, Community Pharmacist Dr Wendy Jones has made a huge impact on the lives of thousands of families across the UK. In this time she has helped people manage issues such as weight loss, cardiovascular disease and smoking cessation alongside her general pharmaceutical duties, but her real impact has been felt by new mothers. Wendy has dedicated her life to researching the effects of medication and medical treatments on breastfeeding mothers and their babies.

In 1997 she was one of the founder members of The Breastfeeding Network, and in 1999 she set up the Drugs in Breastmilk helpline. This telephone helpline was set up in response to the number of questions the charity was receiving from breastfeeding mums about prescribed medications. At that time there was no easily accessible, reliable information for mums who had been told to stop breastfeeding in order to take certain forms of medication. Wendy has single-handedly filled this gap.

In many cases where a mum is told to stop breastfeeding, there is no evidence to support the need for this. The mum can be left feeling she has no choice but to stop breastfeeding (even if she wants to continue), or she may choose not to take the medication prescribed. The impact of having to make a decision like this can be far reaching for some mums. In a very few cases, evidence shows the mum does need to stop breastfeeding, and then, being able to understand the reasons behind this may help the mum with this process. In most cases, the evidence shows the mum can continue breastfeeding safely and for many, to know this is possible is a huge relief.

Over the years, the service Wendy provides has grown – she now leads a small team of volunteers who offer individual support to more than 10,000 families each year via email and social media.  She is contacted by mums and families, as well as health care professionals.

She has also written more than 50 information sheets about the most common medications breastfeeding mums ask about – these infosheets cover everything from postnatal depression and anxiety to cold and cough remedies, to contraception, hayfever, headlice and norovirus.

She was awarded a PhD in 2000 and has written several books on this topic, as well as speaking at numerous national and international conferences, study days and other events.

She is extremely well known and highly regarded by breastfeeding supporters across the world. Her knowledge, patience, understanding and support has been felt and appreciated by thousands of families.

With her unending, selfless commitment and passion Wendy is an inspiration to many. Her work is so far reaching, it is impossible to measure the difference she has made.

 

For more information/press enquiries:
Contact Felicity Lambert, BfN Comms Officer felicity.lambert@breastfeedingnetwork.org.uk / 07979872301

https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/

https://www.facebook.com/BfNDrugsinBreastmilkinformation/

17 Dec

Peace on Earth, goodwill to all relatives: surviving the holidays as a breastfeeding mum.

Victoria Davies, aka Mum In Make-Up, writes about how to get through the holidays even when your family’s views on breastfeeding don’t quite match up with your own.

The festive season. It means something different for everyone, but for new (and not so new) breastfeeding mums it can spell an entirely new level of stress. This year I’ll be celebrating my third Christmas as a breastfeeding mother. My little boy might not be a cluster-feeding newborn any more, but he’ll certainly be demanding boob fairly regularly nonetheless. It’s his way of reconnecting with me when things get a bit much, when he’s tired or just wants some uninterrupted time with me. If you’re new to this, unless you are spending the whole two weeks staying at home with just your little family, you’re likely to be wondering how whipping the girls out regularly is going to go down. After all, you’re going to be seeing various assorted extended family and friends and Jane-from-number-ten who always comes to the Boxing Day buffet. Here are a few things to consider before you decide to come down with a mysterious seasonal illness.

Get some boob buddies
Chances are if you’re staying somewhere for a few days there will be a few others there too. Who can you trust to have your back? If you have a partner, they should be the first person you drag onto your cheerleading team, but there are bound to be others who will get you a glass of water, plump the cushions for you and glare at anyone who dares to utter that time-honoured line “Are you still breastfeeding?” Give those people a quick message before you see them. Something like “Please help, I’m breastfeeding and Uncle Martin thinks my five-month-old should be eating steak” should do the trick. 

Dealing with nosy parkers
Chances are nobody will make a peep. After all, drawing attention to the fact your boobs are out just isn’t cricket, and most people will be polite. If, however, there are people there who haven’t seen you breastfeed yet and don’t observe the usual social boundaries, you might find yourself inundated with a barrage of questions and interest. If you feel so inclined you can discuss your choice to breastfeed, telling your audience all about current recommendations from the NHS and the World Health Organisation, and that things may have changed significantly since they had their own babies, in regard to when and how children are weaned from the breast. If someone is genuinely curious it can be nice to impart some of your gems of wisdom.

However, you don’t actually have to do any of this. It’s not your job to be Google, and if you don’t want to be drawn into a conversation about breastfeeding, especially if you’re dealing with truculent people who feel they have the right to question your choices, you absolutely don’t have to. Being asked repeatedly “But when are you going to stop?” can get incredibly wearing after a while, especially if “when we’re ready” isn’t quite cutting it with people who want some kind of detailed timeline.  After two years of breastfeeding, I’ve found the most helpful phrase to shut down anyone who is challenging me beyond my boundaries is “It’s working for us and we’re really happy.” It lets the person know that your choices are not up for debate. After all, this is your child. Don’t feel undermined or threatened for a second.

Do what you normally do
Does your partner usually give a bottle in the evening? Go ahead and stick to that. Perhaps Granny would like to do it; after all, some of the complaints tend to be about extended family members not getting enough cuddle time. Do you usually use a cover or scarf to feed? Keep going with that, especially if it gives you the confidence to feed whenever and wherever. Do you and your partner like to curl up together on the bed for a feed with your baby? (I ask because this is our favourite thing to do). Keep on keeping on, and enjoy that little ritual together.

Take a break
Particularly when babies are very young and going through a cluster-feeding stage, having to breastfeed almost constantly in front of everyone gathered at the Christmas celebrations can feel a bit much. Smiling at your in-laws through gritted teeth as one of them pipes up “Are you feeding her again?!” is probably not what you need right now. And here is where breastfeeding gives you the perfect excuse to take a break. Take your child off to the bedroom or to another quiet space, put your feet up and enjoy the peace and quiet. You don’t have to worry about anyone else right now; this is more important. It’s also a brilliant excuse to get away from your dad’s more strident views on politics, or to avoid eating yet another slice of Granny’s horrible cake. Breathe and enjoy the time with your baby. Barricade the door if you have to.

A breastful of milk
This is the time of year when, at its heart, we’re celebrating the birth of a baby. A baby who would have been fed from his mother’s breast. Hey, it’s even mentioned in the carols we sing every year! Every time someone questions your decision or makes you feel on edge, just take a few deep calming breaths and remember that you are part of something beautiful. So many women have done what you are doing, and have experienced that magical bond created by breastfeeding. At one time, the entire community would have helped a new mother and encouraged her. If you’re struggling, remember that you’re not alone, and you will always have help and support online or on the phone from organisations like The Breastfeeding Network. If it was good enough for Mary and Jesus, it’s good enough for you and your baby.

Merry Christmas, you brilliant woman. Well done.

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

06 Nov

Prevention is better than cure

Shereen Fisher, BfN’s CEO, responds to Health and Social Care Secretary Matt Hancock’s vision for prevention released yesterday, and how it relates to investment in breastfeeding support.

The future of health in the UK is dependent on us all getting really serious about prevention[1]. Currently the NHS spends £1 in every £5 on health problems that are a direct result of our lifestyle such as obesity and poor diet[2]. We are told that not only will prevention help reduce the strain on the NHS but it will also improve all our health.

Getting serious about prevention must include getting serious about community level investment to enable all mothers who choose to breastfeed to do so, given the substantial evidence that links breastfeeding with improved health.

The Lancet[3] series on breastfeeding offers the most comprehensive review of all the evidence on breastfeeding to date and highlights breastfeeding’s role in the UK prevention agenda.

The authors state: “…how important breastfeeding is for all women and children, irrespective of where they live … Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media [ear infections]. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancers and diabetes [Type 2] in mothers.”

Importantly UK women and babies offer policy and health leaders an attractive opportunity. While breastfeeding rates in the UK are the lowest in the world the rates of initiation – women starting to breastfeed – have been increasing for the last 20 years (81%)[4].

Scotland’s infant feeding statistics[5] (November 2018) show signs of positive change – no happy accident but consequence of national leadership, strategic planning, partnership and sustained investment.

Women’s intention to breastfeed offers an important opportunity for health and wellbeing both for babies (next generation) and women themselves. However, individual will has to be met with support that effectively improves a mother’s breastfeeding experience and helps sustain her choice to breastfeed. Peer support can make a big difference here especially as over time it offers the chance for areas to recreate a culture where breastfeeding is familiar.  We also know that choice isn’t made in a vacuum but is heavily influenced by family members, hospital care, health care professional advice and societal views. Patient empowerment is an important theme in the vision of healthcare for the future yet women feel constantly disempowered in their efforts to breastfeed through the lack of support available to them.

With the NHS celebrating a landmark anniversary alongside £20 billion a year in extra cash now announced[6] NHS leaders will be putting forward a 10-year plan that will make crucial decisions about how the service will spend the money.

In the planning no doubt demands will be high, as cancer survival rates, mental health support, health inequalities and an aging population all vie for consideration, how should we use the government’s cash boost to tackle the priorities that matter most to us?

In the debate let’s remember the substantial benefits to health in breastfeeding for mother and baby as well as the sheer economic and environmental sense that breastfeeding makes.

In 2012 UNICEF UK[7] reported that just a moderate increase in breastfeeding rates could save the NHS millions. In 2016 the Lancet[8] series calculated that the overall savings would actually be in the order of billions, not millions, of pounds. Moreover, the measures required to support breastfeeding are relatively inexpensive and soon pay for themselves. Keith Hansen of the World Bank said …

“In sheer, raw bottom-line economic terms, breastfeeding may be the single best investment a country can make.[9]

The potential savings into the billions are important here because we all know that the cash boost being offered by government to the NHS and social care isn’t going to be enough. While the additional £20 billion a year (in five years) has already been welcomed, the Kings Fund has pointed out, that this does not come close to the amount required to improve services after years of underfunding[10]. On social care, the budget announcements will not be able to undo the cuts in services and underfunding of local government that has already occurred. These cuts that have caused losses to breastfeeding support services, many of which are located in areas of low breastfeeding rates and run by volunteers and supported by charities[11].

Knowing how the money works to support breastfeeding is essential and it is currently hard to know this in England. What we do know is that funding for community-led breastfeeding peer support has been cut because it sits within a shrinking public health budget devolved to local authorities. Despite excellent evidence-based commissioning guidance on infant feeding for local authorities[12] breastfeeding support services in communities is entirely optional.

This has led to mothers who choose to breastfeed being unable to access local services and leaves them failed and let down. This is just too precarious a situation for a public health priority as important as breastfeeding that if better funded and supported could serve us well in the prevention of infant mortality, obesity, type 2 diabetes, ovarian and breast cancer ….

If we are going to get serious about prevention in health then there needs to be a clear strategy and leadership for breastfeeding. Government’s role is key here in taking responsibility for building an environment that promotes, protects and supports breastfeeding[13], not just for the next year but for the next 20 years.

This should include at a minimum the following very important steps many of which are recommended by National Institute for Clinical Excellence:

  • Appoint a national multidisciplinary infant feeding board or committee with strong leadership to ensure evidence on infant feeding is understood and enshrined in policy
  • Ensure that Baby Friendly accreditation becomes a minimum requirement for all maternity settings (achieved in Scotland and Northern Ireland) (NICE recommended)
  • Ensure that all mothers regardless of where they live, receive skilled evidence-based breastfeeding support, making this provision a mandatory responsibility by protecting the public health budget that protects health visiting and breastfeeding peer support workers (NICE recommended)
  • Protect all families from aggressive marketing of formula companies by enacting into UK law the International Code of Marketing of Breastmilk Substitutes and subsequent relevant resolutions (NICE recommended).
  • Require employers to provide breaks to breastfeeding mothers to allow them to breastfeed or express milk at work.

With careful, long term thinking and action the prevention agenda offers great focus to help us plan the health and wellbeing of the UK for the future. The health of women and babies will be stronger still for joined-up planning and provision of quality breastfeeding support. Let us not forget all our responsibilities in supporting breastfeeding and ensuring that its role in the prevention agenda is fully acknowledged.

 

 Footnotes:
[1] https://publichealthmatters.blog.gov.uk/2018/11/05/matt-hancock-my-vision-for-prevention/

[2] Anita Charlesworth, Chief Economist, The Health Foundation interviewed for Healthy Visions BBC Podcast / https://www.health.org.uk/Running-to-stand-still-why-20-5bn-is-a-lot-but-not-enough

[3] Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect (30 January 2016), Victora, CG et al, The Lancet Volume 387, Issue 10017, 475-490 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

[4] Infant Feeding Survey 2010 (2012), Fiona McAndrew et al, Health and Social Care Information Centre https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010

[5] Scottish Government Infant Feeding Statistics 2017/18 http://www.isdscotland.org/Health-Topics/Child-Health/Publications/index.asp#2275

[6] NHS funding: Theresa May unveils £20bn boost https://www.bbc.co.uk/news/health-44495598 17/06/18

[7] Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK (October 2012), Renfrew, M et al, Unicef UK https://www.unicef.org.uk/babyfriendly/about/preventing-disease-and-saving-resources/

[8] Why invest, and what it will take to improve breastfeeding practices/ (30 January 2016), Nigel C Rollins et al, The Lancet Volume 387, No. 10017, 491-504 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext

[9] The Power of Nutrition and the Power of Breastfeeding (2015), Keith Hansen, Breastfeeding Medicine, Volume 10, Number 8

[10] The Kings Fund, NHS Funding: What we know, what we don’t know and what comes next https://www.kingsfund.org.uk/blog/2018/06/nhs-funding-what-we-know

[11] Open Letter on the crisis in UK breastfeeding https://ukbreastfeeding.org/open-letter/

[12] https://www.gov.uk/government/publications/infant-feeding-commissioning-services

[13] https://www.unicef.org.uk/babyfriendly/about/call-to-action/

26 Oct

What Breastfeeding Looks Like

We recently appealed for photographs showing what breastfeeding looks like in your everyday lives. The response has been immense, and the photos are so wonderful and varied, showing breastfeeding anywhere and everywhere…often in some quite comical situations!

Everyone has a small part to play in normalising breastfeeding and removing the stigma that can be attached to something that should be as commonplace as eating a sandwich. This might be by feeding your child in public, or by supporting others who you see feeding, with a kind word or just a smile. Thank you so much to everyone who contributed photos for this project, it is our hope that they will be shared and seen widely and will also do their bit to help make breastfeeding the norm.

Here’s a full round up of all of the photos we received – click on each one to view the full image, and hover to see accompanying captions and comments. Unfortunately we are only a small team and are unable to accept any further submissions for this page or the original Facebook album – however if you’d like to share your image, you can do so by adding it as a comment to the Facebook album.

Share this post:

 

 

Share this post:

 

 

This project was originally inspired by this post:
https://www.romper.com/p/what-does-breastfeeding-look-like-these-photos-celebrate-the-diversity-of-experiences-9926018

 

19 Oct

Facing Fears

Kirsty Cummins is one of our National Breastfeeding Helpline Link workers, who has written this post about her own experience of anxiety and how she is beginning to overcome it in her role as a breastfeeding supporter.  

Fear. It’s a funny thing isn’t it. Most of us live in fear of something. Chest squeezing, breath taking fear tucked away inside our breast, kept on a low burn as much as possible it can rear up and get you when you least expect it. Taking the wind out of your sail and putting you firmly in your place.

I have lived in fear nearly all my life. From small person wobbles such as the squirmy, unknown feel of the sea bed under my feet when my Mum forced me to paddle, to the terror I felt when I happened upon “Jaws” being viewed in a neighbour’s living room in all its terrifying splendour at the age of 5. (I haven’t been able to watch it since.)

As I grew older I developed an anxiety disorder. I didn’t know that’s what it was.  I just thought I was mad and panicked all the time that I couldn’t control life. Would someone die if I didn’t turn the light on and off a certain number of times, would something terrible happen to a loved one if I didn’t wash my hands in a certain way? What I didn’t realise at the time was that in trying to control life and death, stuff that I actually couldn’t control, I was unable to deal with the things that were my responsibility, such as study and relationships and other such teen angst. I would never socialise and talking on a phone has always been difficult because of the fear of the unknown and the need to keep myself tiny and unnoticed.

I have had treatment. I sought help when I couldn’t look after myself any more. And that was and is a long term project but also a wonderful thing. Through years of up and downs, undiagnosed post natal depression and other such low jinx I wished of a way to take control.

This insight into a life of worry and nervousness has made me wonder often about our fears. What fears we have as parents and how our modern life affects those to a lesser or greater degree, with instant access to answers or opinions that we used to have to seek in other ways. The need for us all to go back to trusting our instincts, hidden under a huge pile of ‘other’. The voices that live inside us, and the knowledge passed down from Grandmothers and from inside the cells in our bodies, carried through the generations, is still there but no longer encouraged in quite the same way.

Recently I have been pondering the fears we carry as volunteers supporting other parents through times of worry or uncertainty. What makes some people fearless and certain they can make a difference, whilst others hide their knowledge and instincts, terrified they might get it wrong?

My reluctance to be a helpline volunteer has always been based around fear. The fear that I am not good enough to support another person. That if I get it wrong something terrible might happen. In a bid to avoid manic light switching or some such antic aimed at being the high master of control, I avoid. Avoid. Avoid. In talking to people who wish me to support I feel unable to be honest, with them or myself and have always talked vaguely about my true feelings out of embarrassment.

A plethora of excuses may come up that loosely express my fear, but not enough to convey just how terrified I am. Our greatest defence in the fight against fear is, more often than not, knowledge. If we know more we may fear less. When the terrified abseiler is gently guided through moving themselves down the rock face passing the rope through their hands, they are guided by the words of the instructor. That knowledge from another gets them down and the feelings of elation when reaching the bottom make it all worthwhile.

When I look down into the pit of worry and feelings that I am not good enough, I don’t believe in my knowledge, or intuition or listening skills. They don’t feel good enough to guide me.

Someone very brilliant recently talked to me about voicing those helpline fears out loud. As I said how I felt it made total sense. “It sounds so silly but it isn’t silly” I said as I expressed my fear that it felt like a baby’s life was in my hands if I took a call. The ugly face of not good enough was there again, taking control and making me feel useless. But actually as I said it I realised that I do have the tools to support and with that added bonus of modern tech allowing us to signpost instantly, we have so much to give.

Fear, my old nemesis, can be thwarted if I use my greatest weapon. Honesty. Being truthful to myself about my fears and using the support I know I have available could actually get me past this block.

The warm hand of support from a helpline volunteer can and does make all the difference to new families. And that is possible over the phone. Your love, warmth and ingrained desire to be part of the supportive community – the grandmother full of wisdom just for ten minutes in someone’s life – is what you have control of and what changes lives. Yours and theirs.