Covid-19 Archives - The Breastfeeding Network

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:

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 families^1,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 Centre, 2(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 Lactation, 9(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

05 Aug

No experience needed, but prior knowledge advantageous: What I learned about breastfeeding second time around – by Alyson Spicer

“Mmm, you’re feeding him like a multip.”

The midwife preparing to discharge me gave a satisfied nod. I wasn’t sure what she’d said. “Like a what?”

“A multip. You’ve had a baby before, haven’t you?”

Oh Christ, was it that obvious? Had parenting a toddler really left me looking so noticeably haggard? Did I have Weetabix in my hair? But then I looked down. I was (slightly wonkily) cradling my not-quite-a-day-old son in one arm, while making notes with the other hand and occasionally pausing to guzzle more peppermint tea or tweak my top out of the way. He was doggedly cracking on and doing his thing.

It occurred to me that I hadn’t really paused in my conversation, and that it probably looked like I wasn’t paying much attention to what he was doing. It was pretty clear how this contrasted with my first days of learning to breastfeed three years before: constantly questioning, “Am I doing this right? How do I know?”; watching like a paranoid hawk for every possible feeding cue; requiring all body parts at exactly the right angle, precisely the right arrangement of pillows, no distractions…it was all a world away from the sort of casual lolling that baby number 2 and I were currently engaged in.

So I took her point.

But, previous time served in the breastfeeding trenches aside, I also had another secret weapon that she wasn’t aware of. When my first baby was a year old, I’d trained as a breastfeeding peer supporter, with the Breastfeeding Network. I’d volunteered at drop in groups for parents and their babies, offering information and support to help establish and maintain breastfeeding – everything from explaining how milk supply works to practical tips on positioning the baby at the breast…even ideas for gently handling well-meaning but clueless family members.

So when it comes to breastfeeding I should, on paper at least, have a fair idea what I’m doing.

Working as a peer supporter and then going back for another crack at breastfeeding myself has been an interesting experience. At almost 6 months in, it feels like it’s come easily this time. In some ways that’s definitely true – no cracked nipples, no worries about supply, no issues with baby’s weight, no mastitis. But there have also been times when it is the most challenging and frustrating thing in the world (Newsflash: being a trained peer supporter does not make you immune to all breastfeeding issues. Who knew?). Oversupply. Screaming baby. Sleepy baby. Uncomfortable boobs. Always being on call. Cluster feeding. Sleepless nights. Exhausting days.

Not to mention the fact that, when my baby was just nine weeks old, lockdown was announced thanks to COVID-19. The prospect of getting out to a breastfeeding cafe to get support or meet other mums – something I was particularly looking forward to, having just moved to a new area – disappeared faster than you could sing Happy Birthday (twice).

These were all challenges to push through, with the aid of hundreds of biscuits and gallons of tea (and a few glasses of wine along the way). Not because I’m supermum/a martyr/a masochist. At one point I found my hormone-addled brain thinking I must have been blessed with some sort of brilliant talent for breastfeeding (My calling at last! Are wet nurses still a thing?) – but that’s nonsense.

Why does it feel easy this time? Because I was armed with knowledge about breastfeeding. That’s all. So when I hit those challenging and frustrating times (which are so often just a normal part of getting breastfeeding established), I usually knew what I had to do to fix them. Or at least how to push through until they fixed themselves.

I knew that babies usually feed incessantly for the first few days, and I knew it didn’t mean I didn’t have enough milk. I knew the difference between a bad latch and a good one. I knew that a sore spot was a warning sign of a blocked duct, and I knew how to clear it before it got worse. And most crucially, if I didn’t know what to do, I knew where to go for support and information.

Sure, the local group was closed, but the breastfeeding community is an incredibly committed one, and nobody was going to see parents left in the lurch if they could help it.

Within days of restrictions being imposed, virtual support groups were set up on Zoom. Lactation consultants increased their Skype support offerings. Midwives posted how-to videos on hospital Facebook pages. Breastfeeding supporters on maternity wards donned layers of uncomfortable PPE and soldiered on. I even heard of peer supporters coming out of retirement to volunteer on the National Breastfeeding Helpline, where demand rocketed. Support was out there, even if it couldn’t always be offered face to face.

But what about first-time parents – not just those raising their babies under the shadow of a global pandemic, but anyone who doesn’t know what to expect or who to ask. Who have been told “breast is best” (a truly unhelpful phrase, but that’s a whole other essay) but not offered any follow up support, and have expected everything to just naturally fall into place.

Looking from that perspective – without the knowledge that it could and would get better, and working on the assumption that if this natural process didn’t come naturally, then it just wasn’t meant to be – there were many points where I could very easily have thrown in the towel, very quickly.

Even with the knowledge that I have, there have still been days when it’s bloody hard. It has become blindingly obvious to me why many parents have a tough time breastfeeding, and why breastfeeding rates aren’t higher (only 1% of babies in the UK are being exclusively breastfed at 6 months of age, as recommended by the World Health Organisation).

I’m not saying that every breastfeeding issue can be solved by reading a leaflet or spending half an hour with a peer supporter. Of course it’s never going to be that simple (and Professor Amy Brown explains the reasons for that far more eloquently than I ever could). But the right information and support can truly make the difference between having to stop breastfeeding, and being able to continue.

It allows every parent to make an informed choice about how to feed their baby (and if parents choose not to breastfeed, as is their right, at least that decision would be based on knowledge of the facts rather than an automatic adherence to prevalent bottle feeding culture). As a bonus, better breastfeeding support could save the NHS billions, through prevention of future health issues in both the child and the mother.

Information on breastfeeding isn’t a secret – but it’s not always easy to find, and not everyone has access to the same level of care. Every GP and midwife in the country will likely tell you the benefits of breastfeeding your baby and will encourage you to do so. Not all of them are able to support you to actually do it, or even point you in the direction of someone who can – usually because of cuts to local authority funding.

It’s cruel, when you think about it (Emma Pickett, chair of the Association of Breastfeeding Mothers, calls it “inhumane”): to dangle the carrot of how brilliant breastfeeding is, but then snatch it away again if you don’t live in the right postcode. This isn’t a criticism of GPs or midwives, who do a fantastic job – it’s just often the case that they don’t have enough time, resources or training to offer the support that is so badly needed.

So what can we do? If you’re about to have a baby, you’re probably (understandably) preoccupied with the matter of safely getting another human out of your body. But try to also focus a little further down the road – find out as much as you can about feeding your baby, as soon as you can. It can feel daunting, but even a little bit of knowledge of what to expect will help.

Follow the Breastfeeding Network and Association of Breastfeeding Mothers on social media, and check out their websites – they have so much amazing information available. They also jointly run the National Breastfeeding Helpline – save the number in your phone, and call them whenever you need to speak to a mum who’s been there, and has been trained to help you out.

There are some really helpful books out there – head to the library if you don’t want to buy your own copies. Ask your midwife or health visitor about support available in your area – make a note of where drop-in groups are held, which days they run and contact details for the organiser. Consider checking them out before the baby arrives – if it’s a face to face group, at least you’ll know where you’re going if you need to pop along again with a baby in tow.

As previously mentioned, under the current circumstances many groups are now online and are offering virtual support – from the comfort of your own sofa! Arm yourself with the knowledge that breastfeeding may be difficult in the beginning, but that most issues can be resolved. Perhaps most importantly, make it clear to your family and friends that breastfeeding is important to you and that you’ll need their support. Make sure everyone is on the same page.

We all have a part to play in creating a society that supports breastfeeding. Look out for your breastfeeding friends and family members. If they’re struggling, don’t reflexively tell them it doesn’t matter – ask them what support they need. You could also write to your MP, asking them to attend meetings of the APPG on Infant Feeding, to help make sure infant feeding support is on their agenda.

You don’t need to be an all-knowing guru, or be blessed with a magical talent for feeding babies. There’s no flashy product or clever gadget to buy. Just knowledge, kindness, support, perseverance.

For most of human history, it would have been passed to you by your mother, your sister, your aunt, your friends – cultural shifts mean that this is often no longer the case, so we can all step up to fill the gaps. A little information can go a long way towards helping to achieve breastfeeding goals – whether that’s feeding for a week, a month, a year, or longer.

As I finish writing this, I’m so grateful to everyone along the way who has supported my breastfeeding journey, and allowed me to reach a point where I can type with one hand while my baby nods off during his bedtime feed.

The midwives on day 1 in hospital; my husband helping me stick to my guns through the tough bits; my breastfeeding friends who gave me tips; the peer supporter who went above and beyond to help me; the tutors and supervisors who trained me and taught me so much (not just about breastfeeding!); and, through it all, my two sons who have somehow shown me the ropes even while learning alongside me.

I obviously couldn’t have done it without them, and I’m so proud of what we’ve achieved together. Even if they do leave Weetabix in my hair.

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’

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