Mother to mother support in a world of information

Mother to mother support in a world of information

This week, support is the theme of Breastfeeding Celebration Week
#bffriend17

There’s so much to celebrate about breastfeeding, and for me one of the most special things is how much we can learn from each other as mothers.

Of course there is information everywhere, often far too much of it, and there are medical professionals to give technical support, check our babies’ health, and prescribe any treatments that are needed. But in my time as an LLL (La Leche League) Leader, I’ve noticed that passing on pure information is a tiny part of what we do. What brings mothers to our meetings, and turns them into loyal regulars, is the talking – the chance to share their strong feelings about their unique developing breastfeeding relationships.

The simplest of questions: “how do you know when your baby wants to nurse?”; “what surprised you most about breastfeeding?” can easily set off half an hour of discussion. Dazed new mothers with tiny newborns share their shock and wonder; seasoned mothers on their third child talk about how still, every day, there’s something new.

And of course mother to mother conversations like these provide a safe space for complaining. As one mother put it to me: “LLL meetings are the only place where I can sit and moan about breastfeeding without being instantly told to wean”. When a group starts from a safe shared understanding that breastfeeding matters, and a shared knowledge of its many joys, this gives a context that makes it acceptable to explore the lows, too.

The support of peers can also give a rich source of alternative methods and ways to approach breastfeeding-related problems. A mother suffering through a nursing strike can find a “standard list” of solutions online easily, but there’s a whole extra dimension when she can describe it to other mothers who are right there with her. She can show her child other busily nursing babies, and can talk about any mixed feelings she has – perhaps she’s wondering if this might be a chance to wean that she’ll later regret not having taken, or she might be wondering what effect this will have long term on their breastfeeding relationship. Finally, she might return to the next month’s meeting glowing with happiness as she and her baby are back in tune, all is well, and she has added to her stock of experiences to share with the next mother.

Support from medical and lactation professionals has a crucial place; in times of serious need, specialist help from a lactation consultant can be literally life-saving. And sometimes, in the middle of the night, reaching out to strangers on the internet can be enough to get through.

But for everything else, there’s mother to mother support. It’s embedded in its community, and forms a community of its own within that. Mothers come to LLL meetings nervous, uncertain, clutching newborns and wondering what to expect; sometimes they’re still with us years later, bringing all their successive children, perhaps becoming LLL Leaders themselves, or perhaps just carrying on the conversation, and passing on the support to new versions of themselves.

#bffriend17

To recognise the importance of support, mothers are invited to share their photos and stories of support from their own “breastfeeding best friend” on social media, using the hashtag #bffriend17.

Post your own selfie with YOUR #bffriend17 on Twitter, Instagram, or Facebook!

 

Editor’s note:

You can find the findings from the WBTi assessment of mother support in the community in “Indicator 6” in our 2016 report

With further details on mother support in the community in Part 2

 

Helen Lloyd

 

Helen Lloyd is a Leader with La Leche League GB, and fits in as much time  supporting breastfeeding as she can around the needs of her own young children

 

The amazing story of West Herts Breastfeeders

The amazing story of West Herts Breastfeeders

I received too much breastfeeding support – said no mother ever!

Your vibe attracts your tribe

#BFfriend17

I did not realise the power of that statement until I became a breastfeeding mother. Nursing my child became a life philosophy, a kaleidoscope lens, spinning my family, bringing like-minded people together and painting the colours of my parenting. About 3 years ago there was a story all over the media about a mother who was asked to leave a certain store because she chose to breastfeed openly in there. Breastfeeding mothers on social media were furious. Simultaneous protests in branches of that store were set up and I organised one of them. Some great friendships were born out of that movement. This simple act sparked a discussion about the needs of the breastfeeding community. This could not end there.

For Olgas community support

Protest was the beginning.

We wanted to make sure mothers knew their rights. We wanted to educate, empower and bring families together. Slowly a community has been born. It kicked off with a picnic to celebrate National Breastfeeding Week, followed by some meetings in a children’s centre. A year passed and having my third baby gave me a huge boost of confidence to put my peer support training into practice. After another season of outdoor gatherings, I hired a room in a community centre. One of the mothers got inspired and started another group in a nearby town, followed by more of them. All were hosted by mothers who breastfed their own babies and felt they could support others and offer a safe space for befriending.

A few months later we decided to organise peer support training. The services offered by the local health visiting team and children’s centres were not sufficient at the time. And there definitely was a niche for peer support. Having experienced first hand how unique it is having another mother support you through hardships, I fell in love with the idea. We approached other service providers using the Maternity Services Liaison Committee. At first, not many believed in us but, as time passed, we proved to be worthy of their trust. We asked for help from generous friends, who delivered the training at no charge, and we found a venue for free thanks to a children’s centre manager. But mostly we were incredibly lucky to recruit, through our groups, amazing women who agreed to offer their time to volunteer in the local hospital.

We decided it was the right time to create something more formal. West Herts Breastfeeders community came to life thanks to the many mothers who nurtured it deeply. This ‘baby’ was very lucky. It was a firstborn who had all the attention and support from local Infant Feeding teams and the Children’s Services department of Hertfordshire County Council. We came a long way. It took us just over a year to train 18 peer supporters, establish six monthly regular meetings in the West Herts area, recruit nearly 550 members to our virtual community to provide them with 24 hour support through Facebook and all that with no official funding. We are all volunteers. You could be too!

Be the Change

As mentioned in the Open Letter of February 2016, organised by the WBTi UK team, a woman’s ability to breastfeed is often determined by the support she receives and the environment in which she lives. While we cannot change everything, we try to help normalise breastfeeding out and about. We also play an important role in normalising feeding older babies and encouraging mothers to carry on, while often dealing with family pressures to wean or the challenges of returning to work. Most children’s centres provide breastfeeding support only in groups for babies under one year, and health visitors do not see mothers as often as they would like. Not having a healthcare professional label also changes the balance of the dialogue and helps mothers to open up.

Together we can do more

What we strive for in the face of recent cuts and challenges is the partnership between all local services. Our success is owed largely to the power of networking. We can see where we are needed most and what else can be done to make sure no woman is left alone at any stage of her nursing journey. You can help to be part of the change, by simply sharing your thoughts with your newly elected MP. Use the WBTi sample email to tell them what breastfeeding mothers need in your local area. Ask them to use their influence on the Local Authority to showcase the importance of breastfeeding to public health and safeguard their budget for health visiting and breastfeeding support.

Your voice matters.

 

 

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Olga Danyluk-Singh photo for community support

Bio

Olga Danyluk –Singh, Chairperson, West Herts Breastfeeders

NHS Breastfeeding Peer Supporter and mother of three breastfed children

Enthusiastic lactivist!

GPs and breastfeeding

GPs and breastfeeding

 

Doctors have to acquire a huge body of knowledge during training and for general practitioners that knowledge is particularly wide-ranging. Their ten or more years of study comprise undergraduate, foundation and specialism levels of training. As qualified GPs they are likely to have thousands of women patients who, at some stage, are breastfeeding mothers, yet the breastfeeding content of the curriculum is minimal.

Placements in the specialism training may offer useful opportunities to learn from midwives and health visitors about the practicalities of supporting breastfeeding but this is a matter of luck, and the knowledge and skills of those mentors can be variable. It would be much more effective to have a requirement for acquiring basic knowledge and skills specified in the curriculum as well.

 

GP Infant Feeding Network and resources for GPs

A number of GPs, mothers who in breastfeeding their own babies became acutely aware of the deficiencies in their training, set up the GP Infant Feeding Network, GPIFN, in February 2016. In April 2017 they launched the GPIFN website, a valuable resource for doctors.

Does your doctor know about this website?

 

Medical training

With regard to medical training (not just GP training), the General Medical Council (GMC) has recently published its Generic Professional Capabilities (GPC) Framework to provide broad outcomes for a consistent approach for postgraduate curricula. The framework was developed in partnership with the Academy of Medical Royal Colleges. Domain 4 (there are 9 domains) looks to be particularly relevant to protecting and supporting breastfeeding as its title is ‘Capabilities in health promotion and illness prevention’.

Royal colleges, such as the Royal College of General Practitioners (RCGP), are responsible for the details of their curricula. They revise them every few years and from the next revision will need to fit with the GPC Framework to be approved by the GMC.

The current standards show several gaps when evaluated by the WHO Education Checklist on infant feeding in the 2016 WBTi assessment of the UK.

Further information about standards for the different health professions can be found in Indicator 5 in Part 2 of the 2016 WBTi report.

 

Are you a doctor or trainee doctor?

If so, you might like to contact your specialty college asking for the infant feeding content of the curriculum to be improved.

 

 

PW Photo for WBTi MAINN presentation

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group, being the lead for Indicator 5, which is primarily about health professional training.

 

 

Cover image  www.stayathomemum.com.au via Szőreg hivatalos honlapja

 

One key question before the election?

One key question before the election?
By Emma Pickett
Chair, Association of  Breastfeeding Mothers

I imagine like me you have watched some pre-election television debates in the last few weeks. It’s easy to start daydreaming and picture yourself in that audience putting our leaders on the spot. If you had the opportunity to ask that one key question of the main political leaders and get it broadcast on national television, what would you choose to focus on?

For many of us who have been involved in the WBTi project, it’s a no-brainer: What would they do to improve the situation around breastfeeding and infant feeding in the UK?

Except you’ve only got one sentence to outline a situation that took WBTi more than 70 pages.

You’re talking about health care professional training and the international code of marketing of breastmilk substitutes, national leadership, maternity protection in the workplace, data collection. Plus, you are talking to people who don’t even realise there is a problem in the first place or have little understanding of the complexity. There are few soundbites developed for an issue that affects families across the UK and for a situation that many of us see is in crisis.

Breastfeeding is a public health imperative

Politicians are nervous to touch on an issue which they often see as being about individual choice rather than a ‘collective societal responsibility’, as Dr Nigel Rollins described breastfeeding in The Lancet report last year. But when you look at the reality of what is happening in the UK, there is no need to fear having a conversation about breastfeeding. It’s not controversial to be disappointed to hear that 86% of women who stopped breastfeeding in the first two weeks would have liked to have continued for longer. Or 63% of those who stopped before 10 months. It’s especially not controversial when you learn more about the impact of breastfeeding on maternal mental health and its role in reducing inequality.

Which politicians wouldn’t be interested in something UNICEF describe as ‘a natural safety net against the worst effects of poverty’ or a factor shown to have a significant impact on the national economy? We can read through the manifestos of the political parties and see references to obesity and child health and mental health and find ourselves exasperated that infant feeding hardly gets a mention. However, it IS there. In every discussion about fighting inequality or improving chances or protecting the environment or stimulating the economy or supporting parents or focusing on mental health. They just don’t KNOW it’s there.

It is our duty to get this message across.

We may not be sitting in a Question Time audience but we meet our candidates. We have their emails and Twitter accounts. We can speak to them once they are sitting MPs.

Use the WBTi sample email and add your own messages to all the candidates in your own area. What are the gaps in breastfeeding services in YOUR area? Tell YOUR story.

It’s about emphasising why funding matters and why breastfeeding support in the community isn’t a nice optional extra. We are hearing about the huge variation in community-based support across the UK. Cuts to services in England are particularly a worry. Parents are finding groups closing, peer support services disappearing and when they are struggling with more complex problems, there is often nowhere to go. Specialist positions are either being lost or the integration of services means signposting to more qualified breastfeeding specialists such as IBCLCs is confused.

There is no point sighing about the crisis in infant feeding unless we also act. No point in putting a nice meme on your social media account, without also making sure you take 5 minutes to educate a politician who may simply not understand the basics. No point having anger towards our leaders if they are uninformed. WE are the ones who can do the informing: the new parents, the breastfeeding organisations, the healthcare professionals. It’s all too easy for social media to become a place where we all just talk to people who already agree with us. It has never been easier in history for us to directly contact our candidates and politicians. They won’t understand these issues unless we educate them. It starts with one email or one tweet or one conversation.

Have you done it?

For more information about cuts to community breastfeeding services, see WBTi’s 2016 briefing

See the Open Letter signed by dozens of royal colleges, health professional bodies, researchers and voluntary organisations

Responses from political parties

Baby Milk Action have asked all the major political parties about their breastfeeding and infant feeding related policies. You can read their letter, which refers to the WBTi UK report, and the responses they have received here.

 

Photo credit: Sophie Burrows

Emma PickettEmma Pickett IBCLC is Chair of the Association of Breastfeeding Mothers. She is also an ABM breastfeeding counsellor (www.abm.me.uk) in North London. She has supported breastfeeding mums in Haringey as a volunteer since 2008.

Emma is the author of You’ve Got It In You: A Positive Guide To Breastfeeding  and blogs at Emma Pickett Breastfeeding Support 

What does your doctor know about breastfeeding?

What does your doctor know about breastfeeding?

‘I’m still not convinced breastfeeding 4 year olds should be considered normal!’ – feedback from final year medical student after teaching session

‘Most [UK] pre-registration training for healthcare practitioners who work with mothers, children and young infants has many gaps in the high-level standards and curricula…’ World Breastfeeding Trends Initiative report 2016

 

As a consultant paediatrician, I deliver a one hour seminar to our medical students several times a term. I have the coveted before-home time slot for ‘essentials of paediatric nutrition’, which aims to encompass the investigation and management of faltering growth, the aetiology and treatment of obesity, and all infant feeding issues. Luckily I talk fast.

Of course, I’m joking.  Covering the syllabus in that time means focusing on key points, and one way I try to do this is encourage the students to set the agenda. At the start of the seminar, I plot out on a whiteboard what they want to get from the session. The students always ask me to cover the different types of formula. In fact, their syllabus emphasises breastfeeding, but their preoccupation is with learning components of, and indications for, breastmilk substitutes. This is manageable rote learning, standard in undergraduate education, easy to put on a flashcard and commit to memory for exams. It also connects to the overwhelming societal perception that formula is the default feed for babies. It is much harder to open up a discussion about breastfeeding and accept that we, as doctors, know almost nothing about it because we aren’t seeing it or learning about it at medical school. Of the twenty or so students in each session, often only one or two have seen a baby breastfed at all. Usually no one in the room has seen a child over the age of one nursing.

The ignorance around breastfeeding continues into our postgraduate curriculum. The ‘breast is best’ message is emphasised (although that has been superseded elsewhere by the ‘breast is normal’ message) but without the backup of grounding in lactation physiology and how our profession contributes to what I think of as ‘iatrogenic low milk supply’ – medical practices such as separating mother and baby, delaying the first feed, not respecting the importance of skin to skin, feeding on an artificial schedule,  wrongly assuming that maternal and infant medical conditions and medication preclude breastfeeding…  Without understanding the science, doctors will always resort to what they have seen before, are comfortable with, and believe to be normal. At the moment, that is usually formula feeding.

Screen Shot 2017 wbti ind 5 full slide

 

The World Breastfeeding Trends Initiative report flags up the holes in training for healthcare practitioners – illustrated here, the universal minimum pre-registration standards set by the GMC, the NMC and the BDA – and my experience echoes that (see Indicator 5, in Part 1 and Part 2, online). Our doctors need to realise what they don’t know about breastfeeding before they can start to learn. Recognising this is the first step on a very long road, but it is at least a step forward.

Victoria Thomas

 

Dr Vicky Thomas is a consultant paediatrician at the Great North Children’s Hospital in Newcastle upon Tyne. A generalist at heart, she has developed an interest in growth and nutrition and is passionate about the role of breastfeeding in optimising child health.

Happy 6 month anniversary to us!

Happy 6 month anniversary to us!

WBTI reports
The first WBTi assessment of the UK was launched 6 months ago today in Parliament, hosted by Alison Thewliss MP, chair of the Infant Feeding and Inequalities All Party Parliamentary Group.

Huge thanks to Alison and the APPG, and to all the amazing organisations in our Core Group who worked together to identify gaps in UK policy and programmes in infant feeding, and to jointly generate recommendations for Action!

The Core Group of organisations and agencies involved in various aspects of infant and maternal health and infant feeding identified gaps in UK policy and programmes and generated joint recommendations for action.

 wbti-core-group-2015.png

WBTi Core Group:
Association of Breastfeeding Mothers (ABM)
Baby Feeding Law Group (BFLG)
Baby Milk Action
Best Beginnings
Breastfeeding Network (BfN)
Child and Maternal Health Observatory (CHIMAT) Department of Health
First Steps Nutrition
Institute of Health Visiting (iHV)
Lactation Consultants of Great Britain (LCGB)
La Leche League GB (LLLGB)
Maternity Action
Northern Ireland infant feeding lead
NCT
National Infant Feeding Network (NIFN)
Public Health England (PHE)
Scotland Maternal and Infant Nutrition Coordinator Start4Life
Unicef UK Baby Friendly Initiative

 

WBTi Steering Group and main authors:
WBTI steering group

From left to right:
Ayala Ochert, Alison Spiro, Helen Gray, Clare Meynell, Patricia Wise, Liz McGregor

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

By Kate Butler

Peer Supporter, West Hertfordshire Hospitals NHS Trust

As a mum embarking on a new breastfeeding journey with their baby, who could she turn to for support and advice that she can trust? How would she know that what she’s doing is “right”, that her baby’s behaviour is “normal”? Her midwife? GP? Obstetrician? Paediatrician? Health Visitor? Surely the advice and support you get from a qualified and trained healthcare professional can be trusted? The findings from the World Breastfeeding Trends Initiative (WBTi) UK 2016 Report (published November 2016) may surprise you.

Screen Shot 2017 wbti ind 5

Health professional training in the UK

The WBTi UK Report (WBTi UK 2016) was based on the WBTi toolkit developed by the International Baby Food Action Network (IBFAN) to help countries evaluate breastfeeding policies and practices in a systematic way. One area that the report focuses on is health professional training and subsequent impact on breastfeeding initiation and continuation rates across the UK. Worryingly the report highlights many gaps in the pre-registration training of some healthcare professions in the area of infant and young child feeding, particularly in the practical aspects of enabling mothers to initiate and continue breastfeeding. Following qualification, healthcare professionals are then expected to undertake in-service training in infant and young child feeding. The WBTi UK Report reveals that provision and uptake of these courses is limited.

So what does this mean? The very healthcare professionals our new mums ought to be able to trust to give them the right advice may not be the right source of information to enable a mum to breastfeed successfully. It’s through no fault of the healthcare professional, but rather the fault of how their initial training and ongoing training is structured. Therefore their advice and support might often based on personal experiences and/or out of date practices. Not only that but our healthcare professionals also have to work in line with their own NHS trust policies. These differ between trusts and are based not only on NICE guidelines but also considerations such as the skill set of staff and trust finances.

Breastfeeding rates are dropping off drastically after birth

The issue with all this? Published in November 2012, the 2010 Infant Feeding Survey showed that the initial breastfeeding rate in the U.K. was 81%. Across the UK, at three months, the number of mothers breastfeeding exclusively was 17% and at four months, it was 12% (Infant Feeding Survey 2010). However, exclusive breastfeeding at six months is only around 1%. But with the infant feeding survey being cancelled last year and lack of any national leadership or strategy in infant feeding, what hope do we have to improve these figures? What hope do we have of changing the way our health professionals are trained and how their on-going training is structured?

Some people might ask what’s wrong with these figures presented above. In doing so, they reflect a society, our society, in which formula feeding has become normalised. Where friends and family see formula as “just as good” as breastmilk and don’t have their own personal experiences of breastfeeding in order to support new mothers. The World Health Organisation recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. It is not within the scope of this post to explore the reasons behind this recommendation, more this article is to raise the issue that breastfeeding families have a dwindling pool of resources from which to obtain support during their breastfeeding journeys. Breastfeeding families are unlikely to be able to rely on advice from healthcare professionals, friends or family. That’s a lonely existence.

How can we change society and health care for new mothers and babies?

All is not lost though. The Unicef Baby Friendly Initiative, launched in the U.K. in 1995 (Unicef UK Baby Friendly Initiative 1995), is based on a global accreditation programme of UNICEF and the World Health Organisation. It is designed to support breastfeeding and parent infant relationships by working with public services to improve standards of care. Maternity units and community facilities have the option to become Baby Friendly accredited and in order to do so are required to provide training for its midwives and health visitors. While the majority of maternity units (91%) and health-visiting services (83%) have achieved or are working towards Baby Friendly status, the remainder have not commenced the process. Therefore new breastfeeding mums can hope that the situation is improving and healthcare professionals that have undergone Baby Friendly training will start to provide the trusted information that mums deserve. But this will require quite a culture shift change within the NHS and this will take time.

There is also lots to be done with the image of, and marketing of infant milk so that “normal infant feeding” moves away from formula and focusses on breastfeeding.

Our society needs educating and this will also need the support and investment from the government.

wbti-ind-5-gaps-recs.png

For further information on how mums can find the most appropriate support right now for their breastfeeding journey, visit http://www.lcgb.org/why-ibclc/whos-who-in-breastfeeding-support-and-lactation-in-the-uk/

 

Kate ButlerKate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 1 and 3) day and night. She trained as a breastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust. This post was first published on Kate’s blog, The Instinctive Parent (www.theinstictiveparent.org), which she started to share knowledge and help further educate parents to help them make properly informed decisions and choices in how they choose to parent.

 

References

Infant Feeding Survey 2010 [ONLINE] Available at: http://www.content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf [Accessed 30/13/16]

UNICEF Baby Friendly Initiative 1995 [ONLINE]  https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/ [Accessed 30/12/16]

WBTi UK Report 2016 [ONLINE] Available at: https://ukbreastfeedingtrends.files.wordpress.com/2016/12/wbti-uk-report-2016-part-1-11-12-16.pdf [Accessed 30/12/16]

World Health Organisation [ONLINE] Available at: http://www.who.int/topics/breastfeeding/en/ [Accessed 30/12/16]