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.

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