National governmental leadership in the UK and devolved nations could make a significant difference by making legal, policy and structural changes. These would filter down through every level of society to show ACTION for the shared responsibility of protecting and supporting every child’s human right to have the best start in life.
There have been Calls for Action before with slow or indifferent responses. The new Health Security Agency has an opportunity to fulfil its responsibility to the health of England’s population by making positive changes NOW.
A WBTi report identifies gaps and makes recommendations. The UK report in 2016 reported that, for Indicator 1, which covers National policy and whether there is an associated programme and coordination, the scores from the assessment were:
England 1
N.I. 10
Scotland 10
Wales 4
Sadly, the situation remains unchanged in England. It is TIME to invest and implement recommendations, which are supported by the broad alliance of infant feeding agencies who have come together to speak, with one voice, on behalf for all new families’ futures in this uncertain world.
Establish a structure for monitoring implementation of the Code and that action is taken against violations.
Create a multi-sectorial, funded lead, for Infant Feeding in England with a strategy and route to share best practice.
Ensure full and equitable access to skilled support for every new mother.
Build in improvements to monitoring and collection of data.
All these improvements would help protect the breastfeeding dyad much better and move much closer to the vision of all UK families experiencing a society that is supportive of breastfeeding with ready accessible skilled support available whenever is needed.
Author: Clare Meynell RM (rtd) IBCLC
Clare trained as a child & general nurse before a long career as a midwife and infant feeding lead. more than 25 years. Clare has also led La Leche League peer support training sessions in her local community. Currently, with Helen Gray, Clare jointly coordinates the UK WBTI working group and co presented the first report for the UK in Parliament in November 2016.
Working with her colleagues she hopes to create “Actions for Change”, through the WBTi report recommendations, so the next generation of mothers are enabled to achieve their personal breastfeeding goals and that society better values the health giving properties of human milk as the physiologically normal food for babies.
A network of trained peer support is an essential part of high quality integrated breastfeeding services.
Unicef UK Baby Friendly Initiative (BFI) outlines three components that good local breastfeeding services must include, in order to be awarded Baby Friendly accredited status.
Basic, or Routine Care
All health workers who work with new families (health visitors and any allied healthcare assistants in the community services) have been trained to BFI standard (approximately 18 hours of initial in service training, with yearly updates of an hour or more).
Additional services
Here BFI outlines how every health visiting and community service must be embedded in and well supported by a network of trained peer supporters, or other social and trained breastfeeding support. NICE recommends that peer support programmes be externally accredited. Good practice includes not only training, but also regular supervision and updates of skills and knowledge. Typical peer support programmes require peer supporters to be experienced breastfeeding mothers, and often expects them to come from similar communities as the population they are supporting. Training generally is part time, over 16-36 hours. Peer supporters work in a supervised setting, acting as an “informed friend,” and referring complex cases on to health professionals or an advanced breastfeeding practitioner such as an IBCLC or breastfeeding counsellor, using a referral pathway.
Breastfeeding counsellors in the UK are also experienced breastfeeding mothers, so they also provide a type of peer support, or “mother-to-mother” support. Their training typically take around two years, and they are autonomous practitioners, who can be responsible for leading their own local breastfeeding support groups, usually through one of the main UK breastfeeding voluntary organisations.
Mothers who are experiencing breastfeeding challenges often need more than one visit – and they need the time that it requires for skilled listening as well as exploration of possible breastfeeding strategies to resolve the issue. Although many health visitors have additional breastfeeding training and skills, the health visitor workforce is vastly overstretched, and it simply isn’t possible to provide the time and the number of visits that many breastfeeding mothers need.
But peer support programmes can provide this – they offer groups where lonely mothers can meet others and gain confidence in their own mothering, alongside skilled listening and well- informed support. Many mothers will find their own “village” in their local breastfeeding support group, and will return again and again. Some will go on to train as peer supporters or breastfeeding counsellors themselves.
Peer support groups are the beating heart of breastfeeding support
Helen Gray, WBTi Joint Coordinator
WBTi audit of peer support and breastfeeding counsellors provided by the voluntary sector, 2016 In Part 2 of our WBTi UK Report
Specialist support
Every area should have a referral pathway to specialist care at the IBCLC (International Board Certified Lactation Consultant) or similar level, for those complex cases where breastfeeding issues cannot be resolved at the level of basic/ routine care or by additional peer support.
The different roles of breastfeeding support in the UK have been outlined in the chart below:
WBTi’s research: Case studies of best practice The WBTi 2016 Report featured several case studies of areas who showed best practice in providing well joined up, integrated breastfeeding services: Brighton and Harrow.
More recently, our WBTi team has presented posters featuring these and additional case studies of best practices in providing integrated breastfeeding services: Medway, Harrow and Swindon.
WBTi Poster on Integrated Breastfeeding Services.
These examples of best practice in integrated breastfeeding services gave concrete results.
They demonstrated:
– a 2% rise in breastfeeding rates in a socially deprived area in 2018 (Medway),
– a 15% rise in initiation and a 12% rise in continuation of breastfeeding over a six year period (Harrow)
– and a 6% reduction in drop off rates from birth to 6-8 weeks over six years (Swindon).
Our WBTi team are always on the lookout for further examples of best practice in integrated breastfeeding services, and we submit them to Public Health England. Please do contact us if you would like to submit your local services!
Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group. She is also an accredited Leader (breastfeeding counsellor) with La Leche League of Great Britain.
For Day 2 of WBW we are very pleased to have a guest blog by Health Visitor and Clinical Research Fellow Dr. Sharin Baldwin.
Breast milk provides the ideal nutrition for infants and its associated benefits to the infant, mother and the wider public health are well documented. Traditionally breastfeeding promotion and advice have been targeted at expectant and new mothers, with an aim to increasing breastfeeding rates in infants. In recent years it has been acknowledged that partners play an important role in supporting women’s decision to breastfeed, while also providing practical and emotional support with the continuation of breastfeeding. Research highlights the important role of fathers in promoting and supporting their partners with breastfeeding (Tohotoa et al., 2011; Datta et al., 2012; Sherriff et al., 2014; Hansen et al., 2018), but in practice fathers continue to report inadequate levels of information and support from health professionals. Training for health professionals therefore should consider men’s needs relating to breastfeeding promotion and support, as well as women’s.
New fathers have often reported finding their partner’s breastfeeding experiences to be much more difficult than they had originally anticipated, with many not knowing how to help or support their partner with breastfeeding when they experienced difficulties (Baldwin et al, 2018; 2019). This is where health professionals can really make a difference. They can help educate and prepare expectant fathers better during the antenatal period by providing them with ‘realistic’ information about the time it may take for their partner to establish breastfeeding. It is also important to highlight some of the breastfeeding challenges they may face in early parenthood and what strategies or support are available to overcome them. This will help men to develop more realistic expectations of the processes involved with establishing breastfeeding and make them feel more empowered to support their partner when faced with any difficulties.
While fathers may not be able to be directly breastfeed their babies, they need to know that they play a crucial role in making breastfeeding a success. They can provide practical support to their partners through helping with household duties, giving them a massage, allowing them to rest, making meals and drinks for them, and giving them emotional support through regular praise, reassurance and encouragement. Good levels of breastfeeding support are likely to make the process easier and more enjoyable, while giving women the confidence to continue breastfeeding for longer. Fathers’ involvement in breastfeeding not only has the potential to increase breastfeeding rates and duration, but also contribute to better outcomes for babies, mothers and the wider public health agenda. So, let’s not forget about including fathers when having those crucial discussions and training about breastfeeding!
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2018) Mental health and wellbeing during the transition to fatherhood: a systematic review of first-time fathers’ experiences. JBI Database of Systematic Reviews and Implementation reports, 16(11):2118–91.
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2019) A qualitative exploratory study of UK first-time fathers’ experiences, mental health and wellbeing needs during their transition to fatherhood. BMJ Open 2019;9:e030792. doi:10.1136/bmjopen-2019-030792 https://bmjopen.bmj.com/content/9/9/e030792.info
Datta, J., Graham, B., Wellings, K. (2012) The role of fathers in breastfeeding: decision-making and support. British Journal of Midwifery, 20(3):159–167.
Hansen, E., Tesch, L., Ayton, J. (2018) ‘They’re born to get breastfed’- how fathers view breastfeeding: a mixed method study. BMC Pregnancy and Childbirth, 18:238 https://doi.org/10.1186/s12884-018-1827-9
Sherriff, N., Hall, V., Panton, C. (2014) Engaging and supporting fathers to promote breast feeding: A concept analysis. Midwifery, 30: 667–677.
Tohotoa, J., Maycock, B., Hauck, Y.L., Howat, P., Burns, S., Binns, C.W. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International Breastfeeding Journal, 4: 15. http://dx.doi.org/10.1186/1746-4358-4-15
Author:
Dr. Sharin Baldwin PhD, MSc, PG Dip, BSc (Hons), HV, RM, RN, QN, FiHV, IHV Research & PIMH Champion
NIHR Clinical Research Fellow, University of Warwick
Clinical Academic Lead (Nursing and Midwifery), London North West University Healthcare Trust
This is the start of World Breastfeeding Week, which runs from the 1st to the 7th August each year. Our focus this year for Day 1 is Health Professionals.
“It takes a village to raise a child; it takes a community to support mothers to breastfeed
Sue Ashmore, Unicef UK Baby Friendly Initiative
Sue Ashmore of the Unicef UK Baby Friendly Initiative (BFI) wrote in 2017 ‘Just as the saying goes: ‘It takes a village to raise a child’, it takes a community to support mothers to breastfeed.’ (blog for the Huffington Post). That community includes health professionals but also breastfeeding specialists, such as IBCLCs and breastfeeding counsellors, and trained peer supporters.
Health professionals who have contact with mothers and their babies are a crucial part of that village of support. Since the WBTi report was pubished in 2016, an improvement has been the requirement of the NHS England Long-Term Plan (p.49) that all maternity units work towards achieving Baby Friendly accreditation. In comparison, all Scotland and N.I. maternity units were already accredited by 2016. Meeting this requirement will help provide a good basic standard of infant feeding support in English maternity units but as yet there is no requirement for neonatal units or community services (primarily that means the health visiting service) to achieve Baby Friendly status.
Summary table mapping UK health professional standards against WHO Educational Checklist on Infant and Young Child Feeding. See our report part 1 (for the table) and Part 2 (for details of individual health professions) https://ukbreastfeeding.org/wbtiuk2016/
The 2016 WBTi report highlighted the need for better training for most health professionals who work with new mothers. Since then, we’re very pleased to report that many more resources have been made available, including:
The GP Infant Feeding Network (GPIFN) and Hospital Infant Feeding Network (HIFN) were created and both have highly informative websites.
There have been some improvements to the paediatric and GP education curricula.
BFI has produced learning outcomes for students of several professions – medical, dietetic, pharmacy and maternity support workers/nursery nurses.
The University of Glasgow, working with BFI, has developed an e-learning module for first year medical students to support meeting the learning outcomes.
The Royal College of Paediatrics and Child Health has regularly updated its position statement on breastfeeding, the latest being June 2021, and includes: ‘RCPCH strongly supports breastfeeding, the promotion of breastfeeding, the provision of advice and support for women, and national policies, practices and legislation that are conducive to breastfeeding. All child health professionals should be trained to deliver simple breastfeeding advice.’
The Royal College of General Practitioners launched its position statement on breastfeeding in 2017 and then a free e-learning course on breastfeeding in 2018.
Thus some progress has been made towards the vision of all mothers who want to breastfeed being able to access seamless support from health professionals, additional breastfeeding specialists and trained peer supporters, all of whom value breastfeeding and are knowledgeable enough either to provide evidence-based information and support themselves or signpost to appropriate support.
The theme of International Women’s Day (IWD) this year is Choose to Challenge. The IWD website explains: ‘from challenge comes change. So let’s all choose to challenge.’ However, challenging can take courage. It’s preferable if it can be done in a way that shows understanding – as a critical friend – rather than confrontational, as the latter can trigger a defensive reaction that blocks change.
The WBTi report in 2016 showed that considerable change is needed to support breastfeeding better in the UK. This is part of achieving a larger picture in which babies are valued and there is no discrimination against women. In part it is a human rights issue. ‘Women have the right to accurate, unbiased information in order to make an informed choice about breastfeeding … and they have the right to … appropriate conditions in public spaces for breastfeeding which are crucial to ensure successful breastfeeding.’
IWD is also an opportunity to celebrate women’s achievements. How amazing it is that the female body naturally produces milk that is just right for her baby – in nutrition and immunity – and the milk changes to match her baby’s changing needs. But childbearing is no reason to discriminate against women in a different role – in the workplace. And, turning to economics, GDP does not include unpaid work or the production of human milk, leading to the anomaly that increased formula sales increase GDP and greater production of valuable human milk reduces it!
What are some ways of challenging?
Challenging government
This could involve commenting on draft laws when they are out for consultation and/ or supporting amendments, as is happening with the Domestic Abuse bill currently going through Parliament, which currently overlooks the impact on babies. Writing to your constituency MP to raise awareness of an issue is another way. The UK Regulations on Infant Formula and Follow-on formula are still considerably weaker than the WHO International Code and are not enforced, but it is also useful to consider when effort to challenge is most likely to be productive. Revised guidance that was due to come into force in February 2021 has been delayed by a year, but the pandemic has led to some government department timescales slipping.
The original guidance from Public Health England about vaccinations for breastfeeding mothers was discouraging but members of national breastfeeding support organisations and the GP Infant Feeding Network (GPIFN) challenged this, and the guidance was improved. The guidance now states that, although there are no data, ‘vaccines are not thought to be a risk to the breastfeeding infant, and the benefits of breastfeeding are well known.’
Another opportunity is provided by public consultations on NICE guidance when new guidance is produced or existing guidance is reviewed, as for the Postnatal Guidance in the autumn of 2020.
Commenting on articles or writing them
Recently, several letters were sent to the editor of ‘New Scientist’ following publication of an article which misunderstood why infant formula is not made available at Food Banks, despite Unicef UK already having produced an information sheet.
An article by Naomi Joffe, Flic Webster and Dr Natalie Shenker in 2019, Support for breastfeeding is an environmental imperative, was published in the British Medical Journal, helping to raise awareness among the medical profession.
Challenging myths and poor information on social media sites
Misinformation can spread quickly so it is important, sensitively, to try to prevent its spread.
Challenging supermarkets/ pharmacies and advertising
This could be about special offers in stores that break the UK Regulations; finding the courage to raise this with the manager raises awareness and hopefully lead to change. Advertising that is misleading can be reported to the Advertising Standards Authority. There is relevant information on the Baby Feeding Law Group (BFLG) website.
Representing and supporting parents
This might, for example, be working to improve practice by representing service users on a Maternity Voices Partnership or local Breastfeeding Strategy group. It could also involve empowering a mother who has received poor care to make a complaint.
Trained supporters educating and helping parents help to spread evidence-based information and challenge myths. Mothers can face a variety of barriers to achieving their breastfeeding goals – being separated unnecessarily from their baby, poor and conflicting advice, undermining comments, over-cautiousness when medicines are prescribed……..Enabling them to overcome such barriers can be like starting ripples in a pool that then influence others positively.
Looking to the future
The pandemic has shown that people with underlying health issues such as obesity or diabetes, which are linked to a poorer immune system, are at greater risk of severe Covid-19. Breastfeeding helps babies establish a balance gut microbiome which in turn aids the development of a strong immune system.
With global warming and the overuse of the Earth’s resources, it is essential to reduce carbon emissions and live much more sustainably. Breastfeeding is the most locally produced food there can be. In contrast, the manufacture and use of formula milks leaves significant carbon and water footprints.
Thus supporting mothers to breastfeed for as long as they wish helps in very significant ways – improving population health and protecting the Earth. In addition, mothers who achieve their breastfeeding goals are less likely to suffer mental ill-health or have feelings of guilt, loss and failure. Infants have a right to the highest attainable standard of health and they also gain because they receive breastmilk and experience the nurturing effects of breastfeeding for longer.
This may be the end of World Breastfeeding Week 2020 but campaigning for good breastfeeding support to be readily available to all mothers with young babies and for society to value breastfeeding, in order to maximise the population’s health and help protect the environment, continues.
This year Covid-19 lockdown has been an added complication for families, with minimal face-to-face contacts, and we do not know how long restrictions will need to continue. This is your opportunity to let us know what support you think is needed in the months ahead by using the Leave a Reply button below. Reading S’s story may help you identify what’s needed.
S gave birth to her first baby R in January and movingly describes her experiences and how she found the feeding arrangement that worked best in her circumstances:
“So R turned 6 months old last weekend and he is really thriving! I am still breastfeeding him which I am so proud I continued with, and it definitely got easier as time went on. It has always been a combined method with the bottle but his milk intake of breast has always been at least 60-75%. My milk supply never caught up after the mastitis no matter how much expressing and breastfeeding I did, and I found it was also really hard to try and sustain that vigorous cycle with my ME – I started to have really bad days where I just couldn’t function so it was easier for my husband to feed R with expressed milk and top up with formula if necessary. I do feel that the routine we got into with breastfeeding, expressing and bottles was the best we could do in our particular situation and he’s such a healthy little boy. I’m really glad I persevered with it all.
We started baby-led weaning about a fortnight ago and R is loving interacting with all the different foods! He especially loves broccoli (he was so keen on it, that not only was he feeding himself the various stalks I’d put on his tray, but he was trying to lick the tray too to get all the broccoli off!!), avocado, sweet potato, carrot, pear and banana. He wasn’t so keen on mashed potato – he preferred to wear it instead!
Life has been really strange and difficult in lockdown if I’m honest. It’s felt quite lonely, as I’m sure it has for everyone else, but we’ve really struggled at times to keep going without familial or friend support. The extra perinatal support I was having became video calls which I’m really grateful for but isn’t the same as in person. Aside from the difficulties, he’s such a lovely happy boy – I’m so proud!”
Breastfeeding has been shown in many studies to be linked to better health in babies and mothers. As breastfeeding is the physiologically normal way for infants to be fed, it is more accurately stated that not breastfeeding is associated with poorer levels of health. This is not surprising as infant formula only provides the basic nutrition a baby needs (proteins, carbohydrates, fats, minerals and vitamins) but breastmilk is an amazing fluid with over 300 different components, as shown here. It includes growth factors, hormones, enzymes and anti-microbial factors as well as nutrients, and varies in exact composition according to the needs of the baby. It is therefore unique for each mother at each moment in time.
Knowing how amazing human milk is can help a mother have determination to overcome breastfeeding difficulties but it can also feel like pressure. What she needs is access to accurate information and suggestions, offered in a caring way after listening to her particular situation. That means that everyone who has contact with new mothers needs to have sufficient knowledge and person-centred communication skills.
Rachel describes her experiences of giving birth and breastfeeding during lockdown.
Rachel’s story
“During my three years of trying to conceive and infertility treatment I often fantasied about the closeness of holding my baby and feeding them. When I was lucky enough for my IVF to work, I moved on from worrying about if I could have a baby to if I could breastfeed. My mum assured me it was easy for her but her emphasis on its importance felt like further pressure. Many of my friends had stressful experiences and got medical advice that they needed to supplement with formula. Towards the end of my pregnancy I got a phone call from the hospital to explain all the benefits of breastfeeding and recommended I harvest colostrum at 37 weeks. I tried this but couldn’t get even a drop which further made me doubt my ability to breastfeed.
My baby was born in May during the pandemic, so I wasn’t allowed a water birth and my husband was only allowed in during active labour. This meant when I was 3 cm dilated and having intense contractions he had to wait outside the hospital in the car. They refused to check my dilation again for five hours due to infection risk and left me alone. When around 4 hours later I felt the urge to push I convinced the midwife to stay and help. When they could see my baby’s head, I was allowed to telephone my husband and ask him to come. My husband was there for the last 10 minutes but it had been a lonely labour due to COVID-19 without most of the plans I had made that involved a birthing partner.
After the birth the level of support dramatically increased with my husband and midwives all keen to help. My baby was placed on my chest and knew instinctively how to feed and stayed on for hours, it was amazing. I continued to use the gas and air for this first feed as for me the breastfeeding gave me very strong period-like contractions. After this first feed, I no longer had the period-like contractions, but my nipple started to become sore. I decided to stay a night in the hospital for some extra breastfeeding and baby care support, as most face-to-face community support wasn’t available at that time. The midwives repeatedly showed me how to improve my breastfeeding latch throughout the night.
The first breastfeed
Five days after the birth I saw the doctor for routine checks. The doctor calculated my baby had lost 7% of her baby weight (which I believe is normal) but she still asked if I was feeding my baby enough. She asked if my breasts were soft and empty after feeding. At this point my milk hadn’t come in so I didn’t understand the doctor even when I asked her to explain more and had to say no they don’t empty. She also had a look at my nipples and said they were cracked so insisted I must use a nipple shield and wouldn’t discuss any other options. After the appointment I cried in the car park that I couldn’t feed her properly and was failing as a mother. On the way home we rushed to shop for nipple shields (the first shop I had been in since the start of lockdown). I couldn’t get the shields to work and my internet research in some cases strongly warned against their use. I didn’t know what to do so rang my mum and then the hospital. I spoke to a lovely midwife who reassured me and said I didn’t have to use nipple shields and that my nipples could heal with continued feeding.
Due to COVID-19 I had a triage phone call with the health visitor the following week, to assess if I needed a visit. She decided that I needed a visit to weigh my baby and gave me leaflets about local breastfeeding support as my nipples were still painful during feeding. There was no face-to-face support available, but I had a video call with the breastfeeding advice line and joined a virtual group. These calls have been great for giving me personalised support to improve my breastfeeding latch so that feeding is no longer painful, listen to my concerns and build my confidence. It is also very convenient as I don’t need to leave my home for it.
My baby is now almost 10 weeks old and breastfeeding is going well. I can feed her watching TV, half asleep in the dark or on the bench in the park without much effort and with no discomfort. I am also pleased not to need to warm up formula as that might be harder when cafes and other facilities are closed due to COVID-19. I love being close to my baby during breastfeeding and being able to provide what she needs.”
Thank you very much, Rachel, for sharing your story.
As part of World Breastfeeding Week, #WBW2020 and #GreenFeeding, we’re emphasising the importance of mothers having easy access to good quality breastfeeding support, if and when they need it. This is partly provided by skilled people and partly by evidence-based written information.
This short leaflet for new parents gives tips about breastfeeding during the pandemic and also lists reliable sources of information and support. The aim is to help empower families who may be much more isolated than families generally were before the Covid-19 pandemic and have limited access to face to face help from health professionals and local breastfeeding support groups.
A slightly shortened two-page landscape version of the leaflet can be downloaded from here.
How do I manage as a new mother breastfeeding during the Covid-19 pandemic?
How can I best protect my baby?
Breastfeeding is one of the most important ways you can protect your baby. Your body makes antibodies in your milk which help your baby fight infections. Breastfeeding also helps babies develop a good long term immune system, and also help to protect mothers from breast cancer, heart disease, obesity and diabetes.
No evidence has been found that coronavirus is passed through breastmilk. Mothers make specific antibodies to any infections they are exposed to, and these pass into their milk. This means that a mother with Covid-19 can help protect her baby against all kinds of pathogens by breastfeeding, and may even provide specific antibodies to the novel coronavirus.
Covid-19 precautions
However a baby is fed, they could be exposed to Covid-19 if their carer coughs or sneezes over them so the parent/carer might prefer to wear a face covering when in close contact and needs to wash their hands regularly. RCOG (the Royal College of Obstetricians and Gynaecologists) provides more details under Advice for women with suspected or confirmed coronavirus infection who have recently given birth.
Fewer visits to GP or hospital
Exclusive breastfeeding for 6 months, then continuing to breastfeed alongside other foods, helps babies to be as healthy as possible and lowers their chance of needing to see a GP or have a hospital stay, e.g. for ear or chest infections.
Food security
Breastfeeding means parents do not have to worry about formula supplies or even shop for formula.
How do I know my baby is getting enough?
Babies are normally weighed at birth, 5 days & 10-14 days (when the health visitor usually takes over from the midwife). With the pandemic, there may be few opportunities to have your baby weighed or see your midwife or health visitor face-to-face.
However, your baby’s behaviour and nappy contents can help you know if your baby is getting enough milk.
The first 6 days are a time of change. From mid-pregnancy breasts produce a thick, usually yellow, type of milk called colostrum. A few days after birth, colostrum transition to more mature milk. The breasts usually feel very full at this time. The poos change too:
thick black meconium for the first couple of days after birth
green around Day 3 to 4
At least two yellow poos each day, by Day 5 to 6
A baby who is getting enough shows this pattern, takes themselves off the breast and generally settles after feeds. For photos of nappy contents see this NCT information.
From 6 days to around 6 weeks, milk intake is probably fine if:
your baby is usually contented after feeds
has at least 6 heavy wet nappies/ day
has 2 poos each at least the size of a £2 coin per day
After 6 weeks, some babies poo less often but the overall amount is about the same.
In the first two weeks, if your baby hasn’t pooed for 24 hours, contact your midwife and a breastfeeding helpline or local supporter for help.
How do I know breastfeeding is going well?
It’s going well if your baby is getting enough and you are finding breastfeeding comfortable.
Start4Life provides very useful information about how breastfeeding helps the health of babies and mothers and how to help your baby latch on well.
However, if your baby often falls asleep during feeds and wakes up again hungry after a few minutes, feeds are regularly longer than an hour, or it is uncomfortable or painful for you, the most likely reason is that your baby isn’t latched well enough to feed effectively.
How can I increase my milk supply?
If your baby is producing less wee and poo than expected, or you are topping up with formula,
can you breastfeed more often – another feed or two in 24 hours?
are you offering both breasts at every feed? you could switch back and forth during a feed
breast compression can increase milk flow
can you contact a helpline or breastfeeding supporter for more suggestions?
Remember – if you feel your baby is feeding very often, they are trying to get enough milk, and also helping to increase your milk supply.
And if breastfeeding isn’t going well?
To latch well the baby needs to gape wide, have the nipple in the upper part of their mouth, and chin pressed against the breast. Snuggle your baby close, head free, nose level with your nipple. This detailed information from La Leche League shows different positions you could try, and ways of helping your baby latch better.
If feeding is painful, or you are breastfeeding very frequently but your baby isn’t getting enough milk, get skilled help! You can also express your milk and offer your baby expressed milk until your baby starts feeding better and your nipples have healed. The Breastfeeding Network has information about expressing and storing breastmilk. Your midwife or health visitor can help you learn to use a cup or bottle safely.
Where can I get skilled help?
You can contact the local midwifery team or health visiting service using the phone numbers you’ve been given. Often there is an Infant Feeding Coordinator or team who can provide more specialised support. They may also put you in contact with a volunteer breastfeeding counsellor or peer supporter. There are several charities continuing to offer free skilled breastfeeding support (see below). Your GP is the appropriate contact for medical situations – such as mastitis that isn’t improving after 24-48 hours – alongside breastfeeding support.
Partners and family support
Her partner can be a huge support to a mother who is breastfeeding and one possible silver lining of the pandemic is that many are at home and able to give more support.
UK breastfeeding helplines
National Breastfeeding Helpline 9.30am – 9.30 pm
0300 100 021
La Leche League GB (LLLGB) (web chat and email also available)
0345 120 2918
La Leche League Northern Ireland
028 95 818118
NCT Helpline 8am – 12 midnight
0300 330 0700
Breastfeeding Helpline for Bengali/Sylheti speakers
0300 456 2421
Breastfeeding Helpline for Tamil/Telugu/Hindi speakers
NCT – details of free local Zoom support groups available via the helpline: 0300 330 0700
IBCLCs (International Board-Certified Lactation Consultants) – these may work for the NHS, voluntarily or provide a paid-for service. To find an IBCLC see the LCGB website.https://www.lcgb.org/find-an-ibclc/
Further information and self-help suggestions for common concerns listed below are described on several websites, such as the Institute of Health Visiting Parent tips, NCT’s information on breasts after birth and the NHS website.
My breasts are hard and painful
In the early days, this could be engorgement. Frequent feeding helps. La Leche League provides detailed information.
I have a small tender area in one (or both) breasts
This could be a blocked duct. Gentle massage over the area while feeding often helps.
I feel fluey and have a hot, hard, red area on my breast
This is likely to be mastitis. Removing milk, by feeding baby or by expressing, is the most helpful action, along with other self-help measures described here. La Leche League provides detailed information.
I think my baby has tongue-tie
A tongue-tie only needs to be divided if it is significantly affecting feeding. If breastfeeding is affected, the first step is to check the baby is as well-latched as possible. For families who may have to wait for treatment during COVID19, this is a very useful and detailed article by Sarah Oakley, IBCLC.
My baby takes a lot when I bottle feed
“I’m giving some top-ups for the moment because my baby lost too much weight but he takes a lot quickly and then is uncomfortable with wind.” Having the bottle level rather than tilted and giving the baby pauses helps the baby cope with the flow from a bottle and it can be easier to tell when the baby has had just enough. This is called ‘responsive bottle feeding‘.
My mother-in-law keeps wanting to give my baby formula
ABM (the Association of Breastfeeding Mothers) has a leaflet for grandparents to help them understand what is now known about breastfeeding.
I stopped breastfeeding but now I want to restart
This can be done but needs commitment as it takes a while to build up the milk supply again. You may find it easier if you have someone providing you with ongoing skilled support with relactation.
Our message to you
We hope the above information, and support options if you need them, can help towards you enjoying breastfeeding and continuing for as long as you and your baby want to.
Authors: The WBTi UK Steering Group – Helen Gray, Clare Meynell, Alison Spiro, Patricia Wise; design by Carol Smyth
The year 2020 has seen us facing unprecedented multiple crises and emergencies:
· COVID19
· The Climate Emergency
· A crisis propelling equity, racial and social justice to the forefront through #BlackLivesMatter
The global theme of World Breastfeeding Week 2020, “Support breastfeeding for a healthier planet,” is a focus on the Climate Emergency, and the impact of infant feeding on our environment and the planet.
#SupportBreastfeedingforaHealthierPlanet
We can all think of so many ways that breastfeeding is good for the planet – no food miles at all, no pollution or litter from manufacturing or distribution, a very small carbon footprint to feed a breastfeeding mother rather than a herd of cows! Most mothers in the UK want to breastfeed, and mothers are already doing the best they can. It is really our governments and policy makers who need to wake up to this, and they who should provide the policies and programmes that families need to breastfeed. And it is our governments who have the responsibility to plan a “green recovery” from COVID19, so that we can return to a healthier world for everyone.
“Overall, breastfeeding for six months saves an estimated 95-153kg of CO2 equivalent per baby”. This comes from an 2019 BMJ editorial by Joffe, Webster and Shenker called Support for Breastfeeding is an environmental imperative. Yet only 1% of babies in the UK are exclusively breastfed for six months (PHE).
Most formula is based on cows’ milk, and dairy farming has a significant burden of greenhouse gases, both carbon and methane. (GreenFeeding). Processed, powdered formula milk has a large water footprint as well – up to 4700 litres for every kg of milk powder! (IBFAN)
Bottle feeding also requires multiple plastic bottles and teats, as well as fuel to boil water, sterilise equipment, and store formula safely. Bottle feeding in hospitals creates waste, as described by Becker and Ryan-Fogarty in the BMJ.
One example of a government policy that could support families and reduce the need for these would be breastfeeding breaks at work, and childcare close by. This would enable mothers to feed their children themselves, without the additional burden of expressing and storing their milk. Going back to work was cited as one of the main reasons that women stopped breastfeeding early.
There will always be a need for formula and bottles for those babies who cannot be breastfed. But most mothers in the UK do want to breastfeed, and it is the responsibility of our government, of our health system, and our local authorities, to provide the policies and programmes to enable women to continue breastfeeding as long as they want to.
With breastfeeding support under strain, service providers propose plan to tackle inequalities
This World Breastfeeding Week (1-7 August 2020), #WBW2020 and #GreenFeeding, we are calling on the UK government to address the fragility of breastfeeding support services.
Our organisations have seen first-hand how the Covid-19 crisis has exposed the fragility of infant feeding support available for women, parents and families.
Over the past few months, the need to support babies and families has escalated and support services have been stretched beyond anything in our experience.
Existing variations in provision for infant feeding support have increased as services have been cut, health visiting teams redeployed and provision moved online, leading to unknown outcomes on infant nutritional health, worsening maternal mental health and widening health inequalities.
Tremendous efforts from the NHS and Third Sector organisations, including many volunteers on the National Breastfeeding Helpline and other charity-run helplines, along with swift adaptation to offer online support, have provided many families with support but this is not sustainable without a longer term strategy.
Meanwhile, the need to protect infant and young child feeding in pandemic emergencies has not previously been considered and has been entirely missing from the Scientific Advisory Group for Emergencies’ reports.
Investing in the health of new families, including supporting and protecting breastfeeding and supporting safe and responsive formula or mixed feeding, enables children not just to survive, but to thrive.
Rebuilding infant feeding support for communities after Covid-19 and giving important attention to the needs of mothers and children from Black, Asian and minority ethnic backgrounds will help tackle inequalities.
Infant feeding is a critical component of first 1001 Days and Early Years Health
We welcome the appointment of Andrea Leadsom MP as the Government’s Early Years Health Adviser and the announcement of a review at a time when infant feeding support services for women, parents and families have been stretched to an unprecedented degree.
Protecting breastfeeding and ensuring safe and responsive formula and mixed feeding during those first 1001 days would make a significant contribution to reducing inequalities in health. As a result, it also upholds the work of the NHS and helps build a healthier population.
While COVID-19 has undoubtedly placed a strain on support systems, it has also highlighted a huge omission in UK policy on planning for the care and feeding of infants and young children in case of emergencies, leaving our youngest members of society vulnerable.
While the benefits of breastfeeding are well-evidenced, merely stating these benefits does not ensure breastfeeding is protected or supported. At a time of global health crisis, and increasing recognition of the impact of human behaviour on the health of our planet, support for breastfeeding is also an environmental imperative.
10-point Infant Feeding Action Plan to address Inequalities
We call on the UK government to adopt the following 10-point Infant Feeding Action Plan below which has a particular focus on working to reduce inequalities:
For the new Government Early Years Advisor to appoint a permanent, multi-sectoral maternal, infant and young child nutrition strategy group to implement a national strategy to support good nutrition across the first 1001 days.
To commission and sustainably fund universal, accessible, confidential breastfeeding support delivered by specialist/lead midwives, health visitors and suitably qualified breastfeeding specialists, recognising the role of charitable organisations and community groups and their strong links with communities.
To ensure there are children’s centresor family hubs, disproportionately located in areas of disadvantage, offering joined-up universal services that include breastfeeding peer support, guidance on the introduction of solids and eating well in the early years.
To ensure that health visiting services are properly funded and the number of health visitors increased to ensure consistent timely nutritional support for all families to support good maternal and infant mental and physical health.
To integrate planning to support infant and young child feeding in emergencies into legislation, the Civil Contingencies Act, and Local Resilience Forums across the country.
To recognise the importance of breastmilk for preterm and vulnerable babies and the need for equitable access to donor breastmilk for these babies through the establishment of a fully funded regional donor milk banking service.
To implement the Unicef UK Baby Friendly Initiative across community, hospital and neonatal services, building on the recommendation for all maternity services to be accredited in the NHS Long Term Plan.
To make it a statutory right of working mothers to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
To support the commitment to re-instate the quintennial Infant Feeding Survey which builds on data previously collected every five years since 1975, most recently in 2010.
To protect babies from harmful commercial interests by bringing, as a minimum, the full World Health Organisation International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
The Breastfeeding Network Association of Breastfeeding Mothers NCT La Leche League GB HENRY Institute of Health Visiting Best Beginnings Human Milk Foundation Local Infant Feeding Information Board Lactation Consultants of Great Britain World Breastfeeding Trends Initiative UK Hospital Infant Feeding Network GP Infant Feeding Network UK Association of Milk Banking Diversity in Infant Feeding Better Breastfeeding Nursing Matters Save Time Support Breastfeeding Swansea University Breastfeeding Twins and Triplets
Breastfeeding trends (UK) 