Guest blog by Rosalind Bragg, Director of Maternity Action
Maternity Action’s work centres on protecting the rights of pregnant women and new mothers in the workplace. As a member of the WBTi Core Group, Maternity Action was responsible for gathering most of the information on Indicator 4, “Maternity Protection in the workplace.” They have very kindly allowed us to republish their blog on the current status of breastfeeding in the workplace here during UK National Breastfeeding Weeks.
The original blog can be found on Maternity Action’s website here, along with a range of resources on maternity rights. Follow Maternity Action for updates on their campaigns on this and other important maternity rights.
The right to breastfeeding breaks and facilities is a gap in the policy framework to support new parents to balance work and family responsibilities. The current review of Shared Parental Leave policies is an opportunity to remedy this omission.
On May 15, we presented to the All Party Parliamentary Group on Infant Feeding focusing on Maternity Action’s campaigning against pregnancy and maternity discrimination and the particular challenges facing breastfeeding women in the workplace.
Women in the UK who wish to combine work and breastfeeding have very weak legal protections. Health and safety regulations provide breastfeeding women with the right to a place to rest and to a health and safety risk assessment. While some employers may offer regular breaks to breastfeed or express milk and a private space in which to do so, these are not required by law.
For most women, flexible working requests are the only legal avenue to seek adjustments to their working conditions to facilitate breastfeeding. Employers must seriously consider flexible working requests but can refuse them if they have a good business reason for doing so. On our advice line, we regularly hear from women struggling to negotiate flexible working arrangements on return to work. Employers can, and often do, reject reasonable requests for adjustments to working conditions.
Many of the UK’s trading partners have more constructive approaches to balancing breastfeeding and work. Germany provides paid breastfeeding breaks and facilities while the US provides unpaid breaks. Australia offers an alternative form of protection by prohibiting discrimination on grounds of breastfeeding. These are just a few examples. It is unsurprising that the recent World Breastfeeding Trends Initiative (WBTi) review rated the UK 67th out of 91 countries on its law, policy and programmes that support breastfeeding women.
The current review of the Shared Parental Leave scheme provides an opportunity for Government to reconsider its approach to breastfeeding and work. In 2013, when debates were underway on the new scheme, Maternity Action campaigned for a statutory right to breastfeed on return to work. While this did result in ACAS guidance on the issue, legal protections were not forthcoming.
It is extraordinary that a scheme to encourage parents to share leave from their child’s first weeks should pay so little attention to breastfeeding. The Department of Health recommends exclusive breastfeeding for six months and breastfeeding in conjunction with solid food thereafter. Given the absence of legal protections for breastfeeding women, the vast majority of women who share leave will need to stop breastfeeding prior to return to work. This reduces the number of women prepared to share leave with their partner and also contributes to the UK’s low rate of breastfeeding.
Whether women breastfeed or not, and for how long, is a decision for each woman to make. The role of the law is to remove impediments to breastfeeding, enabling women to make decisions based on their own needs, not the convenience of their employers or other equally irrelevant factors. It is long past time that UK employment law caught up with that of its trading partners and provided formal legal protection for breastfeeding on return to work.
Concerned about gaps in community breastfeeding support in your area?
Did you struggle to find the support you needed to continue to breastfeed? Public Health England have found that 8 out of 10 women would have like to carry on breastfeeding for longer.
Do breastfeeding support services seem like a postcode lottery?
This is YOUR chance to act!!!
Write NOW – during “National Breastfeeding Week” – to your own MP, asking what is being done to address this in your area, and ALSO asking your MP to ask the government what THEY are doing to support and protect breastfeeding.
This sample letter has been developed by Better Breastfeeding for everyone to send to their local MPs.
Better Breastfeeding are also hosting a petition to the Minister for Public Health, and a survey of mothers’ experiences of breastfeeding cuts, so once you’ve written your letter to your MP, please back it up by spending a few minutes signing the petition and responding to the survey HERE.
NOTE: It’s best to put the letter in your own words, but here are some suggestions. Just choose whatever is most relevant to you and to your own area.
Template letter for individuals to write to their MPs during breastfeeding week
I am very concerned about the lack of provision of breastfeeding support in [my constituency] and I want to know what can be done about this.
There have been cuts to breastfeeding support [describe them];
The Unicef Baby Friendly UK standards, supported by Public Health England commissioning guidance and NICE guidance, recommend integrated breastfeeding support in the community, comprised of:
Basic support: provided by health professionals like health visitors, with Baby Friendly training as a minimum
Additional support: social and trained breastfeeding peer support networks
Specialist support from qualified lactation specialists for complex breastfeeding challenges
But in our area we only have [describe gaps in local services]
There is very little practical support for mums who want to breastfeed [describe what’s available]
Whereas in [neighbouring area] there is much more support [describe what’s available if you know]
This has affected me [describe your personal experience]
I’ve seen how this is affecting mums in [my constituency – describe how they’re affected]
I know that it is the responsibility of councils to provide breastfeeding support to mothers in their local areas. But I’d like to know what the government is doing to make sure that councils actually deliver this and hold them to account.
This week is supposed to be National Breastfeeding Celebration Week in England [Last week was National Breastfeeding Week in Scotland and Wales] but I see very little emphasis from government on this important public health issue.
Mothers in [my constituency] are feeling let down, and our low breastfeeding continuation rates show that babies are missing out too.
Contact telephone number]
MPs will not respond unless they have these full details to show that you’re their constituent
IMAGES from @Start4Life and @VivBennett, #CelebrateBreastfeeding campaign
The inquiry is very keen to hear from parents about their experiences and also from those who work with families who are using infant formula. In particular, the inquiry hopes to hear from and about a wide range of people, including those involved with the Healthy Start scheme, teenage parents and refugee and homeless families.
There is a straightforward form that can be used or people can send in a description of their experiences:
I was asked to deliver a 15-minute talk at the Institute of Health Visiting and Royal Society of Public Health conference in April, entitled: The role of the infant feeding specialist. The following is a synopsis.
I started by sharing the story of a client whose journey will sound familiar to many IBCLCs – a first time mum who gave birth in a fully accredited Baby Friendly hospital, but struggled to breastfeed from the beginning. After receiving support with skin to skin, basic positioning, hand expressing and cup feeding, the mother went home exclusively pumping and supplementing with formula. She received a lot of support from midwives, health visitors and peer supporters, but by 10 weeks had still never had a successful breastfeed.
What the mother needed was specialist breastfeeding input, which she eventually found, to resolve her complex issues, and she continues to breastfeed, exclusively, to this day.
While most mothers begin breastfeeding, the sharp decline in the number of mothers still breastfeeding is staggering in the first 2-6 weeks. Many of the problems that women encounter are basic challenges which are solvable with the correct support.
The issue is not whether most health professionals are doing a good job, but whether every mother can access the level of support that she requires. That may be “basic” infant feeding training such as BFI trained midwives and health visitors; or it may be “additional” support from a network of trained peer supporters, or in some complex cases, where the basic and additional levels of care have not solved the mothers’ problems, access to “specialist” infant feeding care may be required (see below). It is an equity issue that there is not access in every area to trained specialist care for complex cases.
Relevant guidance from NICE, PHE and BFI are summarised in this “Guide to the Guidance” from Better Breastfeeding, outlining three recommended levels of support:
1) Basic support: A universal service with health professionals with BFI standard training in infant feeding
2) Additional support: Social and trained peer support
3) Specialist support: access to a referral pathway to specialist support for complex cases.
The recommendations from the WBTi report and BFI both agree that for some mothers, access to specialist breastfeeding support should be available and readily accessible.
While most mothers only require routine care, with the adjunct of drop in groups, peer support and telephone helplines, some mothers will require a more thorough and specialised level of care in order to overcome their breastfeeding challenge and continue to breastfeed for as long as they wanted to.
The problem is how that service is provided. The BFI provide guidelines on the person specification of the Infant feeding lead . Many of these individuals are very experienced, skilled, hard-working and dedicated. But the fact remains that there is no set of core competencies, and no requirement for the infant feeding lead to have an infant feeding qualification. This makes the skill set of the infant feeding lead a vulnerability in itself .
In many cases, the infant feeding lead is required to achieve an enormous amount, encompassing audit, training, logistical management, liaising with key partners and commissioners, as well as provide a clinical service. This role is usually undertaken on a part time basis, often supplemented with countless hours of unpaid overtime in order to fulfill the requirements of the post.
Specialist infant feeding support: a team effort
Ideally, in order to provide the best service for families, and achieve sustainability, infant feeding support should be the responsibility of a team. Appropriately trained professionals should work together to deliver a service, so that it is not the sole responsibility of one overworked individual. These teams should include medical input from paediatricians, alongside dietetic and speech and language specialist support. Health visitors, midwives, community nursery nurses, and specialist breastfeeding support from an extensively trained member of staff, such as an IBCLC or accredited breastfeeding counsellor, should also make up the team.
For women and babies with complex feeding problems, the infant feeding specialist service should be readily accessible, timely, and high quality, with a clear referral pathway as recommended by the BFI. But importantly, this service needs to seamlessly transfer families back into routine care and follow up support. This would free up the specialist service and reduce the likelihood that the other health professionals providing routine and additional care become de-skilled.
Research indicates that delayed, inaccurate and inappropriate advice can reduce maternal confidence and self-efficacy, and leads to frustration, confusion and ultimately reduces the duration and exclusivity of breastfeeding.
Specialist skills and knowledge
The value of the infant feeding specialist is that their advanced skills and training provides them with expert listening and problem-solving skills. Infant feeding specialists such as IBCLCs possess the necessary clinical skills and training to accurately assess a problem and make an individualised plan: keeping the baby fed, protecting the maternal milk supply, and ultimately tackling the underlying cause of the problem (ILCA, 2011).
Having initially trained as a paediatric nurse, and later as a health visitor, I quickly realised that to be an effective practitioner, competent and confident to take on the management of more complex breastfeeding challenges, I needed some additional training. IBCLCs are required to not only have more than 1000 clinical practice hours, but also study an extensive curriculum, to equip them to understand and support mothers and babies with a whole range of breastfeeding problems. Moreover, we are required to keep our skills and knowledge sharp by completing 15 hours of CPD in advanced lactation and ethics every year, and by resitting our exam every ten years. I have now been an IBCLC for over 7 years, and though I still feel like a ‘junior’ compared to many of my IBCLC colleagues for whom I have a great deal of respect, my training and experience has helped me to feel capable of handling both entrenched and complex breastfeeding problems, and also to be a resource for the wider healthcare team.
Faulkner and Finch’s 2016 research found that many IBCLCs already hold infant feeding lead posts, or work in the voluntary sector. Other infant feeding leads have accessed further skills and training that equips them to run a specialist service.
However, there are challenges. Firstly, many infant feeding leads are swamped with administrative and managerial tasks which detract from their clinical and educational role. Secondly, many infant leads are working in isolation, and simply do not have any cover when they are sick, take holiday or are overloaded. Thirdly, some infant feeding leads do not have enough access to advanced training to equip them to run specialist services, or do not have the time to be able to disseminate best practice to their team. Finally, many third sector services have been cut, which leads to services becoming overwhelmed, or women simply not having anywhere to turn when challenges crop up.
A successful specialist infant feeding referral service should be free, accessible, well-resourced, seamlessly linked with routine and additional care, and multi-disciplinary. Professionals should know where to access further training and be able to signpost families to quality sources of information. IBCLCs are well-placed to run these NHS services, and in many case they already are, but a greater emphasis on training of the entire infant feeding team would strengthen the approach and ultimately make the service more sustainable.
Lyndsey is an experienced Paediatric Nurse, Health Visitor, International Board Certified Lactation Consultant, Holistic Sleep Coach and Birth Trauma Recovery Practitioner, with almost 20 years experience working with infants, children and families in hospitals, clinics, and the community.
Lyndsey runs a busy practice offering one-to-one specialist breastfeeding, bottle feeding, sleep, eating, behaviour and parenting support to families in the UK and Internationally. Lyndsey is the author of Holistic Sleep Coaching and has published a number of articles in academic journals, as well as parenting magazines regarding breastfeeding, caring for premature babies and sleep issues in children. She regularly teaches health and childcare professionals, lectures as an independent speaker, and hopes to begin her PhD later this year.