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/

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.

04 Oct

Guest Blog by Smita Hanciles – The Power of Peer Support

Smita Hanciles works for Central & North West London NHS Foundation Trust and leads the Camden Baby Feeding Service. Here’s a taster of her presentation at our conference this Saturday (6th October), on the power of peer support. If you’ve been unable to get a ticket, follow #BfNConf18 on social media to catch our updates throughout the day.

There is evidence that establishing breastfeeding can be protective of maternal mental health and aids with bonding.  When establishing breastfeeding is challenging or even unsuccessful, particularly when a mother really wants to breastfeed, the mother can be left vulnerable and at increased risk of post-natal depression. At points of such vulnerability, does having access to a trained breastfeeding peer supporter in addition to her own network of relationships provide a source of emotional co-regulation and co-learning?  Does this help increase resilience and possibly decrease the risk of anxiety and depression and any negative impact on bonding?   These are the questions we have been asking in Camden as we introduced a group of new volunteer breastfeeding peer supporters into the Baby Feeding service.

We often think of support for breastfeeding and support for perinatal mental health separately and services generally focus on one or the other.  There are peer support projects for mothers who need help with feeding their baby and there are now separate peer support projects for mothers experiencing mild to moderate postnatal depression and anxiety. However, this way of delivering care doesn’t factor in that one impacts on the other and can’t easily be addressed separately.  What would happen if we supported new mothers in a much more holistic way?  Or maybe we already do this as peer supporters but just don’t describe it as such.

Having reflected on what we actually spend our time doing in the Baby Feeding drop-ins in Camden and on the stories of mothers we support, we recently decided that instead of describing ourselves as solely providing peer support for women experiencing difficulties with feeding or establishing breastfeeding, we would emphasize that we also provide listening support to those who had intended to exclusively breastfeed but were experiencing challenges or were not able to for various reasons.  We added the Baby Feeding service to the Camden Perinatal Mental Health services register under services for the ‘mild /moderate’ end of mental health concerns. We hoped this would help with the recognition of our role in providing emotional as well as practical feeding support and as a place from which referrals to more specialist help could be made if necessary.

I recently saw a poster with the words ‘I sat with my anger long enough, until she told me her real name was grief’. Mothers struggling to breastfeed can feel angry with services that failed to provide the right support or even at themselves or their baby. However, the anger could be borne from a sense of grief over the loss of the breastfeeding relationship they had wanted or looked forward to.  They are unlikely to seek help from other mental health services in this situation but still need to be listened to and for their feelings of loss to be acknowledged as a normal response and justified.  They don’t want to be told their feelings are unreasonable because they can always just give a bottle and as long as the baby is fed, it’s all ok.  They also need support to accept and embrace a different feeding relationship from the one they had anticipated whether it is mixed feeding or bottle feeding with EBM and /or formula.

We approached the Maternal Mental Health Alliance and began a discussion about how to join up different elements of support for new mothers and how we could best train and develop our volunteer peer supporters to work in a more holistic way. This resulted in a diverse and knowledgeable working group coming together including all the main voluntary sector organisation that train peer supporters to develop competencies for the Infant feeding workforce in relation to perinatal mental health.

We know from countless stories of mothers we have supported that breastfeeding peer support has the power to change a mother’s story and experience of care. Those of us who provide peer support have the privilege to hear a mother’s story, to become part of her story as we come alongside to help empower her to find the way forward that is right for her.  Can receiving peer support help a mum change the way she views her own story?  Providing peer support can often help reframe our own stories and see them differently.   If our story was one of painful experiences or even trauma, we can often realise the pain wasn’t in vain but has provided the backdrop to another mother feeling supported and empowered.

We are now looking for ways to collect evidence of the impact breastfeeding peer support has and how it contributes to perinatal mental health. We are still very much on a learning curve with this piece of work and I hope to share more during my presentation.

26 Jul

Breastfeeding and Mental Health

Wendy JonesDr Wendy Jones is the pharmacist on our Drugs in Breastmilk service, receiving around ten thousand contacts from breastfeeding mothers every year. 20% of these are queries about mental health medication.  Beth Chapman is her daughter and a Cognitive Behavioural Therapist. They will be speaking at our conference in October together on breastfeeding and mental health. Buy your tickets here.

“I am very proud to be presenting this session with my daughter Beth who is a Cognitive Behavioural Psychotherapist working within the NHS. It feels like a legacy that my passion for breastfeeding has passed to all my daughters – and my 4 grandchildren. Beth and I have spoken at conferences together before but never co-presented.

Peri natal mental health issues affect very many women, and this is apparent in the media regularly. Add in breastfeeding and worse still add in medication and you have a mass of mis-information and stress for mums trying to find their way through the maze.

One of the problems with society is that it is so easy to get caught up comparing ourselves with everyone else. How good a parent are we? Does your baby gain weight faster than mine? Is mine gaining too fast? What about sleep – shall we avoid the discussion?

When we give birth, we become hyper vigilant to dangers around our babies. It is all too easy for that to become anxiety about everything. Anxiety is horrible – it affects our thoughts, our moods and behaviours and that is where CBT (cognitive behavioural therapy) comes in. It recognises the vicious cycle and provides a way to break that. It isn’t easy, it takes time and perseverance, but it is possible.

Sometimes we need medicines to enable us to challenge the thoughts we have, be they within anxiety or the black dog of depression, the feeling that the Dementors, well known to Harry Potter fans, are nearby.

It is really sad that doctors don’t actually receive training at undergraduate level about breastfeeding and their knowledge tends to be accumulated by experience – possibly by mentors but also by personal and friend experiences. The licensing of medicines taken for any condition in a breastfeeding woman is complex and in our increasingly litigious country it is hard for them to draw the balance between the need to treat the mum and the need to keep the baby safe from the amount of drug passing through milk. I make these decisions multiple times every day and have both experience and expert databases. I also have time which they don’t in a busy surgery.

I’m not going to give away our presentation or you might not come to the conference. We don’t have all the answers, but we may have some solutions to offer and a safe forum for discussion.

See you in Birmingham

Wendy

PS 5-month-old baby Elodie will be with us!”

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

 

20 Oct

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Resources:

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

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

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

 

04 May

Breastfeeding and maternal mental health

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

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

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

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

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

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

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

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

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

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

Shereen Fisher is Chief Executive for the Breastfeeding Network @shereen_fisher