04 Sep

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

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

 

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

Some lessons for peer support design

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

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

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

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

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

What else do peer supporters do?

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

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

References

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

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

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

 

 

 

24 Aug

Guest Post by Ruth Dennison – Why Black Breastfeeding Week?

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

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

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

Event Information

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

12 Jul

How do we help families to trust responsive feeding?

Emma PickettEmma Pickett, IBCLC and Chair of the Association of Breastfeeding Mothers, will be speaking at our conference in October about responsive feeding, and the dangers of focussing on feeding intervals. Here she gives us a little taste of what her session will be about. If you’d like to hear her speak, you can buy tickets to the conference here

“I first started talking about responsive feeding because I was angry. I was angry when I read about breastfeeding mothers who were successfully caring for their babies by every definition, but they were being told they were ‘doing it wrong’. Babies were healthy and putting on weight. Everyone was getting enough sleep – just about. Mums, and their partners, were feeling good until someone told them their baby was feeding too often.

“Does he really need to feed again?”

“But you only just breastfed him!”

“Shouldn’t you be stretching him between the feeds a bit now?”

“He shouldn’t be waking up for milk that many times, surely?”

I was angry about the mum who had asked me how to stretch a feed because ‘that’s what she was supposed to do’ and it was making her and her baby miserable, and the mums that doubted their milk supply when it didn’t seem to be possible.   I was angry about the mothers on an internet forum who again and again were ending exclusive breastfeeding – when they didn’t want to – to chase this idea of the ‘perfect interval’ between feeds. I’m talking about the mother who is at home and it’s 1pm and she’s in tears because her baby last fed at 11am and she was hoping to make it to 2pm. Artificial. Nonsensical. Depressing. And sometimes literally depressing.

‘Watch the Baby not the clock’ has been said for a long time. We’ve all been saying it. But it’s important to understand WHY it matters and what can happen if we try and stretch artificially. It’s important to understand that we can say it, but it doesn’t mean it gives mums the confidence to believe it. Watch your baby and not the clock is what science and biology tells us. Science says breastfeeding is so much more than a milk delivery system. And if we try and stretch the intervals between feeds some mums will reduce their milk supply – the last thing they were intending to do.

The message that very young sleepy babies – perhaps with jaundice or after birth complications – ideally have around 8 feeds in 24 hours as a minimum has very often become twisted to mean that 3hrly feeds is the norm. This is the misunderstanding we must work against. And the myth that a baby who is feeding more frequently must have a mum with a low milk supply is common.

Research from the 1990s in Australia transformed our understanding of how breasts work and the concept of storage capacity. While breasts ARE streams or rivers not reservoirs, and production happens constantly, the flow slows down as the breast empties and there is an element of storage going on.

The massive variation in storage capacity between women doesn’t impact on 24-hour intake for the baby provided the mother with the smaller storage capacity feeds more frequently. But if a mother was to try and ‘wait’ or ‘stretch the intervals’ her breasts would reach maximum storage capacity, her prolactin receptors become distended, she will accumulate that polypeptide protein known as feedback inhibitor of lactation. She will send messages to her body to reduce milk supply. Some women might never have a baby who goes ‘3-4 hours’ between feeds, while her mate with larger storage capacity might. It doesn’t mean that she has low supply or that her baby gets less milk overall provided she can feed responsively.

So, women ‘stretching babies to a magic interval between feeds’ are doing what we know works to decrease milk supply. They are sending messages to reduce production. 3-4 days of desperately trying to ‘get to 3 or 4 hours’ and ‘waiting for the breast to feel full’ could be harming their ability to meet their baby’s needs in the long term.

We can say to new mums if you want to count something, instead of counting minutes, count poo. Reassurance comes from mums knowing the relationship between effective breastfeeding and frequent pooing for the first few weeks. Let’s ensure mums know that for the first 4-6 weeks a breastfed baby should be pooing at least twice in 24 hrs and ideally more and only after that might it slow down.

Is it helpful to count minutes and record them on your app? What are the positives and what are the negatives of doing that? Is it helping you to count the millilitres you can pump and think that tells you all you need to know about your supply? Instead, what is your baby telling you? With their nappies and their weight gain.

But of course, breastfeeding is only a bit about milk. You don’t always have to know why a baby wants to come to the breast. It’s useful to know what milk transfer looks like but you can lose the plot if you focus on feeds as simply being about milk delivery.

“He’s using you like a dummy!!!” can be something to celebrate too. Because breastfeeding is meant to be about comfort and safety and reassurance and relaxation.

In antenatal classes, we sometimes say to expectant couples count all the times you eat and drink in 24 hours. Look how often you’re doing it and you aren’t trying to double your weight! Let’s also say to them, what about counting all the expressions of affection and love and communication? That’s what you are trying to do when you count breastfeeds.

How do we help families to feel safe and to really be able to trust responsive feeding and to stop it being just theory? Peer support is a big tool in helping this to happen. It’s as simple as connecting mums who don’t yet quite trust it with the mums who do this every day. It can be about the Facebook group where people have DONE this. It’s great to see the pregnant mum arriving at the Facebook group where everyone breastfeeds.  They are bombarded with the norm of every day breastfeeding and it works and even when people are struggling, answers are being found. That smartphone can be a life line when it’s not an app measuring feeding intervals. It enables you to join the sea of other mums out there who understand you don’t need to press a finger into their breast to ‘help baby to breathe’, who are finding ways to sleep safely, who have 8-month olds and older. Their milk is this colour. This is how they breastfed in public without a pillow. It’s normal to only get this much out when you pump? Yes! My son didn’t sleep longer than 4 hours until he was 6 months old. And me and me. 4 hours, you’d be lucky!

That feeling of it being just a little bit scary is eroded with ten minutes of Facebook browsing here and there in the last few weeks of pregnancy. And this is the team you come back to when you run into some problems in the early days. And if they are the right team, they signpost you to find the right help when you need it. They share the number for the National Breastfeeding Helpline (0300 100 0212) and they talk to you about finding a breastfeeding group. Because of course it’s not just the Facebook connections, it’s the real life connections beyond that. The drop-in group where you connect with mothers for whom breastfeeding is normal has a special power. The word ‘responsive’ means reacting positively. That comes from confidence.

I think the word ‘breastfeeding’ is doing us no favours.  It starts with a word that we’re not all comfortable saying and ends with a word that makes us think it’s just about feeding.

I don’t think the word ‘nursing’ quite works in the UK. That was originally about avoiding saying the word  <whispers> ‘breast’. It’s not the breast bit I have a problem with but the ‘feeding’ bit. In Germany, it’s ‘stillen’. It can mean calm, quieten, please, fill, satisfy.

At the moment we’ll have to stick with ‘breastfeeding – or rather ‘I wish it wasn’t called ‘breastfeeding’ because really it’s so much more than feeding’. All we can do until a new magic word is invented is explain that the word isn’t quite right. It’s only a bit about milk.

When we can get the message right, it can be magic. When you get stopped on the street by the woman holding the hand of a toddler and she thanks you for some conversations you had a year ago, or when you hear from the mum still breastfeeding her 20-month-old and she’s got a quick question from her cousin, there’s not much like it.

If we can connect women to other women and to the feeling that breastfeeding is not feeding and that’s not just OK and acceptable and the norm but that’s wonderful, we’ve done our job right.”

 

04 May

Breastfeeding was my lifeline while struggling with PTSD

I could barely hold the funnel to my breast. My hands, swollen and numb grasped as hard as they could, my body weak, hardly had the strength I needed to do this. I lay there, on the hospital bed, the noise of the machines sending me into a trance like slumber. Slowly the small drops of precious milk appeared, glistening in the light that flooded my room, and I felt relief relax my body. I closed my eyes, this, this was my lifeline, this was what was keeping me alive.

My baby lay in neonatal, she felt like a million miles away, this was all I could do, I couldn’t walk, couldn’t hold her or care for her, but I could do this, I could give her my milk. So, while my arms ached, the pain making my fingers tremble, my ravaged and traumatised body fought to give me what I needed, I would do this for her, for me.

While on HDU and then when I was well enough to go to the postnatal wards, pumping for my daughter became my lifeline. It kept me alive, because deep down I truly believed I was dying, so I would stare at the clock and will myself to live just a few hours longer, so I could pump again and provide another feed for my baby. It became my mission, my goal to live till the next time I had to express, and it felt like the last gift that my failing body could give her. The staff tried to make me stop, telling me that with the massive blood loss and a haemoglobin of 4.1 it was pointless. They told me I would never make any milk, let alone enough to feed her just breastmilk, but I wasn’t giving up that easy. I cherished every drop that my body gave me, like it was a magical potion that would keep my baby safe. Even after I was found unconscious in my room and at the brink of death, all I could think about was I needed to live, just a little longer to express my milk, I had to do this because soon I would be gone, and this was all I could do, all I could give her of me.

Every syringe, I sent to the unit was full of love, I couldn’t be there, to tell her I loved her, but my milk was like a message in a bottle. So, I would beg for the pump and even fetch it myself. It was such a sight, me in my wheelchair trying to also wheel the pump down the ward, but I was determined nothing would stop me. Gradually as the days passed my supply increased. It felt like a victory. I would prove them all wrong, I would do this, just wait and see.

As soon as I was well enough I would wheel myself down to the neonatal unit, placing the small bottles containing my milk, in the pocket of my dressing gown next to my heart. It was like carrying the most precious jewels, bringing my baby her gift. As I watched the nurses fill up the syringe and feed it through her nasal gastric tube, my heart would beat so fast, fit to burst. I had done that, I had provided her with what she needed, no one else just me. I was giving her life, giving her what she should have had from me, had she still been inside me, had my stricken body not failed her six weeks too soon. I would not fail again. My body would come good this time and provide her what she needed. As I looked at her small and fragile in the incubator, I willed my body to hold out and to keep going.

Soon my supply was increasing, and the nurses were amazed as I kept bringing down bottles full of milk. As my baby grew stronger they asked if they could start giving bottles, so they could wean her off the NG tube, but I made it clear that I wanted to feed her from my breast. Again, I was told we would never achieve breastfeeding but that I could try her at the breast and then they would offer her a top up in a bottle. However, this wasn’t good enough for me, we would prove them wrong again, because I knew that she could get this breastfeeding lark, we just needed time.

When I held her to my breast I felt calm, and safe. The terror went away, and the fear eased.

So, after two weeks I was discharged from the ward and my mission now was to be at the unit 24/7. The staff agreed to leave in the NG tube while I was trying to establish breastfeeding so that they could top up feeds if needed. So, I basically moved in. Every moment I could, I placed my tiny baby to my breast. It was terrifying, I had no idea what I was doing, she still had wires everywhere and the machines would beep and go crazy, but slowly I found a way to hold her and she would open her tiny mouth and latch. It filled me with the most amazing feeling, to know that I was caring for my baby this way. When most of her care was out of my hands, this was something I could do.

After two nights in the chair next to her cot, the staff knew I was going nowhere and I was given the tiny room on the unit that was only big enough to contain a bed and a tiny sink, but I was so grateful. I was just about able to walk very small distances, so it meant I had a place to rest at night till I was called to her bedside. I was watched by the staff like a hawk, and she was weighed daily. Many times the staff and family suggested I be kind to myself and take it easy and add in some formula. They said she wouldn’t gain weight as fast on breastmilk and it would take longer for us to go home. But I was determined and so was my little baby. She worked so hard, and she would open her eyes and gaze at me like she was willing me on and telling me she could do this.

So, it began, my breastfeeding journey, my lifeline. When we both finally went home, 5 weeks after her birth, my baby was fully breastfeeding, to the amazement of the staff. Together we overcame a traumatic, premature birth that nearly cost us both our lives, massive blood loss that should have robbed me of my milk and transitioning to fully breastfeeding when no one said we would. Even when we got home it wasn’t easy and we battled oversupply, awful colic, mastitis and tongue tie. But together we made it; for 15 months I fed and nourished my baby and she thrived, she put on weight and despite me being told to expect her to be behind in developmental milestones, to everyone’s amazement she was instead ahead. In fact, my little girl, even though only tiny, was walking at nine months.

For me breastfeeding kept me alive. On the days I lay in hospital when I had no idea if I would make it, I lived to express for my baby. When I went home, when I was battling flashbacks and nightmares from the birth, when I was scared and worried about my baby, breastfeeding was my lifeline. When I held her to my breast I felt calm, and safe. The terror went away, and the fear eased. Close to me, she was mine, I could protect her, nothing could harm her or take her from me. My body that had failed her, was now keeping her alive once more, giving her everything she needed. It was also saving me, keeping me from losing myself to the terrors that sought to take over my mind. In the night, when I woke and heard her crying, I could run to her, take her in my arms and place her to my breast, unlike all those nights in hospital when I couldn’t be with her, couldn’t care for her.

While everyone tried to get me to stop they didn’t understand that it was a vital part of my healing from birth trauma and also that it was helping me while struggling with undiagnosed PTSD. It was so important to me, my vital connection to my baby but also helping me to cope with everything that we had been through. It was my journey that years later moved me to train with the BFN so that I could offer others the support that I didn’t receive. To help other Mums like me who wanted to breastfeed and so they too could experience the joy I had. Those early weeks were hard, and I know how much I would have valued having someone by my side to offer encouragement and hope.

I now support others who have had a traumatic birth. It’s so important that we understand how birth can impact on maternal mental health and breastfeeding. That we listen and support women in their choices giving them accurate information and support, but also that we understand the emotional side and how kindness, encouragement and just being with them can make such a difference.

For me breastfeeding was a beautiful gift. It is a gift that I cherish because it was a battle no one said we could win. But win we did, and I will forever be grateful for the fact that we achieved what was seemly impossible, given all the odds – a lifeline in the darkest of times.

Emma Sasaru

Emma is a mother to two beautiful daughters. Her passion is to improve support for women and their families that have experienced birth trauma, had a premature baby and the difficult journey of neonatal. She is also a volunteer breastfeeding supporter with BfN.

Twitter: @emmajanesas

Beyondbirthtrauma.com

Finding breastfeeding support

Getting help with breastfeeding, at the time you need it, is really important. We know the relationship between breastfeeding and mental health is a complex one. 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. We are here to offer all families independent, non judgemental support with breastfeeding for as long as they choose.

Please don’t be afraid to ask for help. BfN Registered Volunteers want to help you with breastfeeding. It is why they have done training and offer their time.
Call the National Breastfeeding Helpline on 0300 100 0212

You may not need to venture beyond your front door to get breastfeeding support. BfN Registered Breastfeeding Supporters are trained to give support and information by telephone.

Drugs in Breastmilk Information Service

For enquiries in relation to taking medication whilst breastfeeding contact our Drugs in Breastmilk team.

Find a Drop-In Group

It can be helpful to get face-to-face help with breastfeeding and to meet other breastfeeding mums. There may be a Breastfeeding Drop-In Group in your area that can help you do this (we list groups on our website where there is a BfN Registered Breastfeeding Volunteer attending). Also it can be really helpful to have someone who knows about breastfeeding to sit with you as you feed your baby. If the person helping you can be there from before you start  a breastfeed until your baby has finished feeding, this is most helpful. The drop-in group can help you with this or you can ask your midwife or health visitor if they are able to do this.

Your local Infant Feeding Co-ordinator, Community Midwife or Health Visitor may have details of local support. Their contact details  might be in the discharge pack you were given when you had your baby. If you live in England or Wales you can find contact details for your nearest maternity unit on the NHS Choices Website.

 

 

30 Apr

The Breastfeeding Network and Support for Mothers with Mental Health Issues

Wendy Jones is  BfN’s Pharmacist for our Drugs in Breastmilk Service. Here she talks about how we support mums with mental health issues, and points to some of the research, statistics, and useful resources about maternal mental health that inform her work.

wendy-300x300The Breastfeeding Network Drugs in Breastmilk Service has around ten thousand contacts with breastfeeding mothers annually. Some 20% of these queries relate to issues around mental health. We are passionate about supporting these mothers in accessing therapy and medication which enables them to continue to breastfeed if that is what they choose. As everyone who works within the service is a trained BfN helper or supporter we are also able to offer information on breastfeeding difficulties either on line, by using links or referring on to the National Breastfeeding Helpline.
A survey monkey questionnaire we sent out last year showed that the dilemmas for mothers fell into several categories;

•  Problems with breastfeeding was making the mother anxious or depressed
•  Breastfeeding was a positive part of the mother’s relationship with her baby, but she needed medication to support her mental health issues
•  Mothers for whom breastfeeding was going well but whose doctors or mental health team said that they couldn’t be prescribed medication unless they stopped breastfeeding
•  Situations where mothers chose not to discuss their infant feeding with their professionals to avoid expected censure or debate, and where a drug had been prescribed with the doctor unaware that the mother was breastfeeding
•  Mothers who were desperate not to take medication, but were struggling with mental health issues
• Decisions made the mother to stop breastfeeding to take medication

ieso bethSome of you may know that my second daughter Beth is a CBT (Cognitive Behavioural Therapy) psychotherapist working for IAPT in the NHS and through IESO; a service which is also available for online support in some areas through the NHS. It isn’t surprising that often our conversations veer towards breastfeeding and mental health (we are mutually influential!). One of the points I have taken from her is the concept of being a “Good Enough Mum”.

So many of us strive to be the perfect mum, reading lots of books, watching social media, running ourselves ragged to be at every group in order to give our children the best start. This not unsurprisingly leads to tiredness, depression and anxiety. It is something I remember doing 30 odd years ago with my babies. They must do Tumble Tots, must learn signing, must learn nursery rhymes leading to rhythm and pitch a precursor to music lessons, must learn to swim, must learn to share, must ………. Actually, what they remember now is being loved and happy. Some of the best times I spend with my grandbabies involves playing in the sand or sploshing in puddles etc.

Does social media add to the pressure and engender more depression and anxiety?
Our Drugs in Breastmilk service operates through Facebook. People can message me, and a team of other trained volunteers, and ask their medication and breastfeeding questions and we get back to them with an evidence based answer. However, the relationship between social media and mental health is a complex one. Professor Amy Brown, Associate Professor for Child Public Health at Swansea University, has shown some fascinating insights

Other research links Facebook use per se with depression 

But social media can be a lifesaver in the middle of the night when you ask your trusted group for advice – or the opposite. Google searches can make you decide that you and/or your baby have some rare condition the outcome of which is terrible. Google (other search engines are available!) is not selective of evidence-based materials. If you look long enough you can find any viewpoint you want – it can reassure, and it can terrify.

Most of the contacts to the Drugs in Breastmilk service now come via social media – not just from the UK but across the world. We are continuing to develop fact sheets to answer the frequently asked questions. Nevertheless, many mums need reassurance that their personal situation is covered by the sheet be that in terms of dose, age of baby, other medications and we are happy to answer those questions. We also increasingly supply more in-depth information to healthcare professionals.

Relevant Statistics

Taken from “The costs of perinatal health problems
• Between 10 and 20% of women develop a mental illness during pregnancy or within the first year after having a baby

• Perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK.

• About half of all cases of perinatal depression and anxiety go undetected and many of those which are detected fail to receive evidence-based forms of treatment.

• Suicide is a leading cause of death for women during pregnancy and in the year after giving birth.
Prevalence of mental health conditions

• Antenatal depression; 7.4% in the 1st t trimester rising to14.8% in the 3rd trimester.

• Postnatal depression. 7.4 -11.0% in the first 3 months after childbirth, 7.8 – 12.8% in the 3rd to 6th months and 8.5 -12.0% in the 6th to 9th months

• Anxiety 11.8% – 15.3% during pregnancy and 8% in the period after birth

• Psychosis (refers to bipolar disorder, schizophrenia or very severe forms of depression). 0.2%. There are some developing studies that the condition may reach another peak following weaning (unpublished data reviewed)

• Obsessive Compulsive Disorder. 2.1% during pregnancy and 2.4% during the postnatal period compared with 1.1% in the general female population suggesting that pregnancy and giving birth might trigger the onset of the condition.

• Birth Trauma (Post Traumatic Stress Disorder (PTSD) that occurs after childbirth) 1.9-9% of births

Provision of mental health services

The provision of specialised support services and in particular the availability of mother and baby units varies widely across the country. Access to CBT and other talking therapies may involve leaving the baby with another carer which may not always be possible. To deal with mental health issues isn’t easy in some areas! According to data released April 2018 by the Maternal Mental Health Alliance “24% of pregnant women and new mums in the UK still have no access to specialist perinatal mental health services

Insights from mothers experiencing maternal mental health issues

The Boots Family Trust wrote a fascinating report on Perinatal mental health experiences of women and health professionals 2013, which gives us some perspectives from the mothers themselves.

insights from mumsOne of the findings is that mothers may be reluctant to discuss their in depth feeling of depression and anxiety for fear that they will be judged as not good enough and have their baby removed by social services. It is actually most unlikely that this will happen but may be far more likely in fact open up other means of support.

 

 

symptomsSymptoms described vary widely as shown in this image. Recently I shared a post to Facebook
“How many of you have had a night out planned or arranged coffee with friends and suddenly the 4 walls you inhabit seem the only haven because it’s the only place you don’t have to pretend you are ok, so you cancel. Or when you are invited out you tell them how terribly sorry you are, but you’re already booked up that weekend, when you are actually just really busy holding it together in your safe box. And so, the first problem starts, all by itself. People stop asking you and the isolation that at first wasn’t true becomes your only truth”.
Several people who the outside world would see as confident and outgoing readily identified with the statement. Feeling socially anxious or in a place where you don’t want to go out is normal – let’s not stigmatise the feeling.

Mindfulness may help

Just before Christmas I was whiling away half an hour before catching a train, in a bookstore on Waterloo station. I bought a copy of “Frazzled” by Ruby Wax and devoured its contents. She felt like she was in my brain and understood ME. She is so honest about the stresses of life that crowd into our head – the buzzing in the brain which never ceases.

Tonight, I was listening to a radio 4 podcast by her and another lightbulb moment for me. “I wake up at 3 in the morning” she said, “and start doing emails frenetically, when I run out I check the spam box just in case then press refresh!” Oh, that is so what I do! She went on to say it is ok to rest, to watch a blackbird in the garden, to read poetry, to just be in the moment. I am currently trying to learn and practice the skill of mindfulness regularly. To be present in the moment, not the one which has just passed, not the one to come but just to be present at that instant. To accept thoughts but let them pass and not dwell on them.

This is a technique being more and more widely advocated for depression and anxiety. It isn’t easy as a mother to have as the wonderful story book my children loved “Five Minutes Peace” but just one minute can be enough to calm the brain, lower the adrenaline, stop the panic. I posted this guided mindfulness exercise on my own Facebook page recently which maybe some of you may find helpful. Keep going, don’t judge yourself, it isn’t a test it’s just being Mindful.

I have no financial link with any of these resources but have used and valued them myself.

Mental health and breastfeeding

Perinatal mental health issues affect many mothers. Some issues are caused by breastfeeding difficulties – the solution is to make more evidence-based, well-informed breastfeeding support available or to help mothers come to terms with why breastfeeding may not be for them in a positive, mother-centred, empathetic manner. Some issues need medical interventions which can be used during breastfeeding if the mother so wishes. Support of breastfeeding to the age of 2 years and beyond by all health professionals should be implicit. This is unlikely until breastfeeding is covered as a health promotion intervention in all undergraduate courses.

Mothers need to be listened to and their choices valued – whether that be in infant feeding choice or use of medication. Every one of us is an individual – that is what makes the human race so special, we are diverse and special.

What does the Breastfeeding Network do to support mothers with mental health issues in May 2018?

1. We have Drugs in Breastmilk fact sheets specifically written about:
•  depression

anxiety 

OCD

Bi-polar disorder 

2. We provide additional information via social media and emails about the drugs used for mental health disorders

3. We are working with other organisations to support perinatal mental health

4. We are looking at how peer breastfeeding supporters can signpost to information on mental health

5. I deliver presentations to peer supporters and professionals normalising mental health conditions and looking at the safety of the drugs used to treat these conditions during breastfeeding

6. We are always striving to make links with other organisations supporting mothers and to work with them

7. We have made links with fathers who have mental health issues after the birth of their children

This was a comment on social media recently which I hope is exactly what I strive to do “Thank you so much. You provide a wonderful service and so much more than just drug knowledge “

Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

I will be fully engaged with Maternal Mental Health Matters Awareness Week 30th April – 6th May 2018

Tuesday 1 May Facebook Live session 7.30 pm Perinatal Mental Health Partnership

Friday 4th May Facebook live session from Mama Conference Glasgow, where BfN have been nominated as breastfeeding champions and I have been nominated as individual breastfeeding champion

 

03 Apr

6 Top Tips for New Mums who want to Start Running

trainers on fallen leavesIf you’ve recently had a baby, or even not so recently, getting back into exercise once you are a mum can seem like a big hurdle. Being active is good for physical and mental health, but taking your time and waiting until you feel ready to get back to running or any other exercise you enjoy is very important.

In preparation for our Mums’ Milk Run 2018 we asked some of BfN’s volunteers for their tips on getting active after childbirth. All are mums and have taken that first step back into exercising themselves, so they speak from personal experience alongside their breastfeeding support training. Thank you, Lindsay Cook, Sally Carter, Erica Harris, and Joy Jones for your tips!

1. Take it easy at first

Don’t expect too much from yourself. Pregnancy, childbirth, and beyond put your body through a lot and it takes time to recover. Every mum is different so make sure you wait until you feel ready, some mums are keen to get back to exercising quite quickly and others find they have other priorities once their baby arrives.

Lindsay and Sally advise that walks with the pram, or whilst babywearing, will be enough for most mums in the first few months. If you want to go to an exercise class maybe try and find one where the instructor is post-natally trained so you don’t over-do things.

2. Find a good sports bra

Lindsay says “Get a proper supportive sports bra (or even two layered up), there is nothing worse than trying to run with breastfeeding boobs bouncing around!”

For most breastfeeding mums the best choice will be a non-wired sports bra to reduce the risk of mastitis. It may be worth going to a store that offers a bra-fitting service and getting yourself measured to make sure you get the best fit, and the most support for your size

3. Planning is keycropped-milk-run-189x300

For Lindsay, planning was the key to actually getting out and running: “I have 3 children, the youngest is 3, and I found it hard to get back into exercise, I think it was because I was so tired and the windows for getting exercise in are so few and far between. I recommend planning ahead to make the most of any small opportunity you may get. I always fed mine immediately before exercise to maximise the time I had”.

4. Get into the habit

Another good planning tip from Lindsay: Have some time that is yours for exercise and stick to it, once the habit is formed then it is easier to stick to it.

5. You don’t need to feel guilty

Erica says “Taking time to run (or any activity that takes you away from your baby) does not make you selfish. I think some mums can feel that somehow they are. In fact exercise provides an invaluable space to be “you”. It’s restorative and is a form of self care, which is vital for all, especially parents!”

“And you’re modelling great behaviour for your kids – both because you are keeping fit, and because you are practicing self-care”, adds Joy.

6. Express!

Feeding your baby, or expressing before you go running will make it much more comfortable.

And when you’re ready for entering your first event, take Lindsay’s advice. “Express before you take part, I have a not very fond memory of expressing in the portaloos at the start of the London Marathon…I sterilised the equipment about 5 times afterwards!”.

Mums Milk Run 2018

mumsMilkRun]If you would like to start running, registration is now open for our Mums Milk Run 2018. It is a 20km virtual run challenge open to everyone, raising much needed funds for BfN’s work providing independent evidence-based support about breastfeeding.

A virtual run is a run done in your own time, you can run (or walk/cycle/swim) at your own pace and you can do the run in one go or over several smaller runs spread over the month.  You can complete your virtual race at the gym on a treadmill or running round your local area and you can do it by yourself or with your family and friends. There are four Saturdays in May so you could do the 20km by going along to your local Parkrun each week. There is no time pressure, this is all about raising funds and having FUN, plus you will get a unique BfN medal at the end!

23 Feb

BFN Statement on the Scottish maternal and infant health survey

baby's feetThe Breastfeeding Network (BfN) welcomes the publication of the Scottish Maternal and Infant Nutrition Survey.  It offers a useful insight into maternal and infant nutritional health in Scotland and this research is desperately needed since the cancellation of the UK-wide Infant Feeding Survey in 2010.

The Scottish survey shows that most women do want to breastfeed their babies, and that most babies receive some breastmilk, but, it also shows that there are big drop off rates, particularly in the first eight weeks.

With more than 20 years of experience supporting families, BfN understands that many women do find breastfeeding challenging, especially in the early days, and this is highlighted in the report. Breastfeeding is a skill that has to be learnt and most mothers and babies usually need a bit of practice to get it to work for them – it is completely normal in our society for women to need support with breastfeeding and our experience tells us that many of the challenges mentioned in the report can be overcome with access to good quality information and support.

The report shows that voluntary peer support for breastfeeding is difficult to access for many families, but that it is wanted (almost a fifth of mums felt having access to voluntary support would have been helpful), and where it is available, it is very helpful.  The report suggests that dedicated peer support is very important to parents, in addition to support offered from healthcare professionals.

Scotland continues to face persistent health inequalities amongst the population and BfN believes that creating an enabling environment to support all families regardless of background or social standing to breastfeed could help reduce this ever-widening gap. The report highlights that babies in more deprived areas are less likely to receive any breastmilk at all (65% of babies in the most deprived areas received any breastmilk vs 86% in the least deprived areas).

Overall, it is encouraging to read that nearly three quarters of babies were receiving some breastmilk at six weeks old and 57% at six months – cautious comparison with the 2010 Infant Feeding Survey suggests that mothers who breastfeed now are doing so for longer than they did in 2010. The high intention rate to breastfeed amongst women is also an important opportunity that requires Scottish Government, working with others, to act responsibly to address the support needs, so those intentions can be fulfilled, and Scottish women and babies can be supported in achieving optimal health.

As a voluntary organisation working in Scotland, this report will help us to target even further the work we do, and we hope that the longer term impact of the report is that all families across Scotland will be equally able to access good quality, evidence based support to enable them to make informed choices about how they feed their babies.

If you would like to read the full results of the survey, you can view them online here

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

14 Nov

From new mum to Peer Supporter: BfN volunteer stories

Children wearing 'ask my mum about breastfeeding' topsAs part of our 20th anniversary parliamentary reception in Westminster tonight, two of our breastfeeding supporters will be sharing their breastfeeding journeys from new Mum, to qualifying as Breastfeeding Supporters for BfN. We like their stories so much, we want to share them with you too! So here they are.

Gosia’s story
I’ve always liked to think about breastfeeding in two ways. First one, more personal, related to my own experience and second more social.

I think I’m blessed to have breastfed my children for as long as I wanted. My older daughter for 50 months and going strong with my 15 month old boy.

There were a couple of factors that had an impact on fulfilling my breastfeeding wishes. I gave birth to my babies in this country, which at least partially implemented protective law for breastfeeding couples. Moreover, all women in my family breastfeed and this prepared me for the idea that breastfeeding can be associated with some pain in the beginning, although it shouldn’t be. Also my husband and sister were a great support when I most needed it. Possibly this support was the most important part.

On the social level I hope for every child to be healthy and content. This wish pushed me to take action and promote, protect and support breastfeeding.

A lot of supporters are using the comparison of bike riding and breastfeeding. You don’t know how to ride a bike unless you see someone doing it and then practising. So often I feel like a caring tutor who shows women how to ride, shows which path may be less bumpy, gives options for balancing wheels or a bar and most of all encourages and motivates.

I am grateful for volunteering with BfN, making a difference to individuals and the future generation.

A baby's hand pulling at a mother's topMarion’s story

I became a mother at the young and tender age of 41. Medically, I was considered a geriatric mum. However I thought of myself as a lazy mum because I wanted to breastfeed. There was no way I was going to get up in the middle of the night to prepare a bottle or sterilize equipment when all I had to do was lift my top up and feed my baby. My younger sister prepared me – go through the pain and after 3 weeks it will be fine. I never knew that I could access support.

What I did learn was that my newborn baby cried when I put her down and stopped crying when I put her to my chest. It just made sense to keep her close whilst I was also recovering from the birth. A quiet life in the early days whilst I rest and recover.

I have also read that some cultures stay at home for 40 days and 40 nights, partly to recover from the birth and to build a baby’s immune system. I decided that’s exactly what I should do. I was in no hurry to meet the world.  My world was with me, feeding and sleeping safely together.

I read so many baby books but my maternal instinct kicked in. What do animals do? They keep their young close – cuddly and warm, what I now know as skin to skin. Allow them to feed as often and as much as they want . Babies, when they have access to food can not only feed themselves but control how much they want to eat. All I had to do was to sit and learn how to maximize the best feeding position so that I was comfortable and my baby fed efficiently. In fact that can take from 2-3 days up to several weeks to learn.

I found out that there was a local breastfeeding drop-in run by The Breastfeeding Network a charitable organisation that I could attend on a weekly basis, which I did.

What I never realized at the time was how many other women struggle with breastfeeding and that I could help and support them. After a while I took a course to become a breastfeeding helper, and I was soon helping out at my local breastfeeding drop-in.

I live in Islington and I feel lucky that the London borough of Islington commissioned the Breastfeeding Network to run local breastfeeding drop-ins.  I volunteered for 2 and half years. Soon I found myself on another course training to become a Breastfeeding Peer Supporter and I was then paid to support mothers in both UCLH and Whittington hospital. I was trained to visit mothers at home and qualified to run my own breastfeeding drop-in in Islington.


 

 

08 Nov

Invite your MP to our 20th birthday reception

shereen on stageNext week the Breastfeeding Network is celebrating our 20th anniversary with a parliamentary reception in Westminster. This will be held after an All Party Parliamentary Group meeting on Infant Feeding and Inequalities on Tuesday 14th November. We would like to ask you to invite your MP to these two events, which are an important opportunity for us to campaign for breastfeeding support services in the midst of severe cuts to services this year.

An anniversary is always a time for great pride and celebration, and we’re looking forward to telling MPs about how our charity was founded by a group of empowered women with a desire to improve things for breastfeeding mums like themselves. BfN was set up by a group of breastfeeding peer supporters who, in their experience of supporting families, saw a need for truly independent breastfeeding support, free from commercial funding and influence.

That was 20 years ago, and we still have their founding vision at our core – we provide independent, evidence-based information and support to help build awareness of breastfeeding to individuals and organisations, and to support mums in their choice to breastfeed. The parliamentary reception is a chance to tell MPs about all we’ve achieved over those 20 years:

  • we have established projects in over 17 areas of the UK, with staff and volunteers supporting mums before birth, on hospital wards and at home in communities
  • supported hundreds of thousands of callers to the National Breastfeeding Helpline (with Welsh and Polish options) and Supporterline
  • grown a network of over 1000 trained volunteers
  • offered a unique Drugs in Breastmilk information service for parents and health professionals which has answered tens of thouands of queries

But perhaps more importantly, the APPG and the reception also provide an opportunity to talk to MPs about the devastating cuts to services that breastfeeding support is facing this year. A UNICEF survey of infant feeding leads across England in 2017 revealed that over half of breastfeeding support services had seen cuts. Further research done by Cardiff University found that breastfeeding peer supporters were available in only 56% of NHS regions. The impact of all this is that families aren’t receiving the support they need to continue to breastfeed. 80% of mums who stop breastfeeding in the early days do so before they want to. And of course you will probably have heard that the UK has the lowest breastfeeding rates in the world.

We too have been personally affected by these cuts, in 2017 we were told that there was no funding available to continue breastfeeding peer-support in Blackpool, a scheme we have been running with great success for 10 years. 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 has been forced to close.

The APPG and the reception are a great opportunity for us to influence MPs, to show them just how important breastfeeding support is to families in their constituencies, and to make the case that if we want breastfeeding rates in the UK to rise then we need to adequately resource support services.

MPs need to know how their constituents feel about these issues, and so we are asking you to please write to your MP and ask them to attend the All Party Parliamentary Group on Infant Feeding and Inequalities and The Breastfeeding Network Parliamentary reception. You can find guidance on how to contact your MP, and some sample text you could use to invite them to these events in this Guide for contacting your MP.