05 Feb

A new year’s revolution: take time to enjoy the stillness.

Kirsty Cummins is one of our National Breastfeeding Helpline Link Workers. She has written this post about changing the perception of new year as a time to make huge changes or rush to achieve unrealistic goals. Instead, she’s championing a more laid back approach, taking cues from nature to rest, reflect and prepare for the excitement of warmer months ahead – a near-perfect analogy for the sometimes intense experience of new parenthood.

A New year makes me uneasy. I dread all the slimming programmes on TV, the ‘how to get yourself in shape’ articles, whether physically or mentally. I struggle in January and February and the last thing I need is more media making me feel I am doing a bad job of it. That the left over 12 boxes of mince pies (yes I DO bulk buy my favourite winter treat) cannot be touched because I should no longer be indulging, and that I should be making health choices (whatever they are) or else I am failing. I feel it unfair that it is the end of January that heralds the release of the small chocolate gooey filled eggs that are my favourite treat, when the guilt of having done nothing still lingers. Why is it now that I feel I am being told to don a stretchy outfit and be physical when I would much rather do that when the nights are lighter and I feel more alive? My head, if I let it, can be so full of what I am not achieving in this murky, dank, cold time that I forget what IS actually going on.

I have always dreaded that certain time in September when you know the summer is over. I would feel bereft that the summer was all but lost to me and all I had ahead was winter and cold and having to pretend that I love Christmas and New Year, when I would much rather carry on enjoying the warmth and the hope that truly fills my soul in summer. I would ignore the beauty of autumn because it heralded the coming of the cold.  I would tell anyone that would listen about my woes in winter. I did exactly this to a lovely lady who was treating me with acupuncture last January. And her reply has turned things upside down. She mentioned the Chinese, as she often does with little snippets of Chinese beliefs and said quite simply that January really should be a time to slow down and make things as simple as possible and really enjoy the stillness before the spring slowly starts to sneak its way in. In that pause you might think about what it is you wish to achieve over the whole of the coming year.

Thinking about it now I am guessing this would be connected to Chinese New Year which is sometime between 21st January and 20th February, depending on the New moon and building up to the New Year in the quiet, sleepy weeks gives you time to reflect. Perhaps it was her own ideas and not Chinese beliefs but either way I listened and remembered what she said to me.  It seemed important to remove the need to take quick, drastic action in January and the guilt that I hadn’t done that sulking away to itself in the corner in February.

She was suggesting that if I stopped hating the supposed emptiness of this time of year I might start to find the time to reflect and truly listen to what I do want and what I do appreciate.

Whilst simple and glaringly obvious somehow it was a jolt to my own beliefs and I decided to really try very hard to do just that. To find the beauty in the weather and the land and the lack of much to do. I decided to remove things from my life that made me unhappy and to think what would really make my life feel better all year round.

 I really took time to ponder that the earth beneath my feet and all around me is resting. That the trees and other such magical beings are sleeping, conserving their energy for greater moments when the Sun begins to linger for a little longer each day in the sky. This whole hemisphere is on a well-earned break from the busy busy of ‘getting it on’ except it would seem us humans.

Over the coming months I acted upon those things I had fully absorbed and appreciated during my rest and reflection.

 I am doing the same again this year without the feelings of dread and despair I have suffered in the past. I am enjoying the dark evenings while I can so I can prepare myself for an energy boost and throwing some shapes in the warmer months, when I don’t mind leaving the house after the kids are tucked up because it is still warm and light out there. I always aim for the clocks changing because then I know things are really on the move – including me!

I am using this time to think about what I would like to give to others. I am not failing if I am not giving now – I am preparing myself to do it the right way for me. Volunteering has a huge part to play in our lives but it has to ebb and flow like the seasons and we should never beat ourselves up when our own lives get too full to support others. Perhaps for you this quiet time IS your time to support. When the busy of the world slows, is it that you have more space to hear the thoughts of others. In the stillness of these months can you can give others the wisdom of the benefits of slowing down, listening to themselves and what their instinct is telling them, that it is ok to take time to make decisions or to practice rather than be immediately perfect?

Winter (especially that January panic) sounds a bit like a new mother doesn’t it? In that scary time when all is new and we are expected to do so much in the right way when actually perhaps what a new mum needs to hear is bed down, listen, reflect and trust that life as you knew it will return in some recognisable form at some point in the future but it doesn’t have to be now. That the early unfurlings of motherhood is a time to slow and snuggle and make choices without all the background noise of life.

The comfort of knowing things are ever changing, like the seasons, can bring comfort to us whether we are new parents or volunteers choosing our next adventure or women going about our ever changing lives from maiden to mother to grandmother. Sometimes the still bits are just what we need.

And now we are in February and every snowdrop lifts my heart.

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.

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)