Infant Feeding in Emergencies – Resources

Infant Feeding in Emergencies – Resources

Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.

This page will serve as a repository for resources for those planning services and those providing feeding support for families in crisis in the UK.

Currently there are many gaps in the support for families who have been evacuated from Afghanistan, so resources in Afghan languages are collected here.

Please send us any suggestions for additional resources

We have a few other resources not included here, including Rapid Assessment Tools and Simple Phrases about feeding, and a Peer Counsellor Training Curriculum in Dari; please email us any enquiries.

CONTACT: wbti@ukbreastfeeding.org

NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.

UNICEF UK Baby Friendly resources

Guidance on infant feeding during COVID19 (from BFI, First Steps Nutrition Trust, and NIFN)

First line guidance for local authorities responsible for supporting families

The provision of formula in food banks (November 2020)

Statement on infant formula in food banks (November 2020) – signposting

See also the response to Question 11 on formula donations and distribution in their FAQ here

International humanitarian guidelines and operational guidance

Sphere Handbook

Operational Guidance on Infant feeding in Emergencies
Operational Guidance for Emergency Relief Staff and Programme Managers
Available in numerous languages

Guides on writing/ talking about infant feeding in emergencies and Media Guide
These are extremely useful in framing the situation

Infant feeding resources – multiple languages

Rapid Assessment tools in various languages – contact wbti@ukbreastfeeding.org

Infant Feeding Counselling resources
Pictorial counselling cards in many languages, adapted to include COVID19 recomendations

Infant Feeding flyer for families in transit (English, Arabic, Farsi, Kurdish)

Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed

Email us for more languages

Pictorial book about breastfeeding (no words) from La Leche League Netherlands

The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.

Breastfeeding resources in multiple languages (Missouri Department of Health and Senior Services, USA)

Infant Feeding in Emergencies Social Media resources:

Support for Refugee Children Facebook Page
Memes/ graphics in multiple languages, with appropriate captions

Safely Fed UK Facebook page – volunteers welcome to create graphics in Canva and to monitor the page! Contact WBTi UK: wbti@ukbreastfeeding.org

Resources in Afghan languages: Dari and Farsi

Background information on breastfeeding in Afghanistan: WBTi 2019 report on Afghanistan

Pictorial counselling cards for Afghanistan, in Dari

Infant Feeding flyer for families in transit: versions in Farsi and English

Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed

Breastfeeding Confidence booklet by the Australian Breastfeeding Association, in Dari

Video from UNICEF in Dari

Breastfeeding Matters – An Important Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Farsi

Breastfeeding information in Farsi and other languages (Missouri Department of Health and Senior Services, USA)

Please do contact us if you are interested in volunteering or have some useful resources to share!!

CONTACT: wbti@ukbreastfeeding.org

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Holding Time exhibit by Lisa Creagh

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Holding Time exhibit by Lisa Creagh

We are thrilled to have a guest blog from artist Lisa Creagh, illustrated with her powerful photographs, to wrap up #WBW2021
Her work focusing on mothers and breastfeeding brings out the importance of everyone in society understanding, supporting and protecting breastfeeding.

Holding Time is an ongoing work designed to create greater cultural awareness of the needs of breastfeeding mothers. The work has a conceptual framework as the central theme is motherhood and time. The centerpiece is a three screen installation of animated portraits of mothers alongside a timepiece which grows as time passes.

The project is multi-channel, multi platform and operates city to city. By working with academics, health professionals and grassroots networks it is a large piece of socially engaged feminist art that is intended to bring about meaningful change in UK breastfeeding policy. 

In Coventry I was commissioned by Warwick University to create a piece combining a grid of mothers with audio about their breastfeeding experiences. It was understood that I may not manage to actually capture Coventry mothers, given the extraordinary circumstances of 2020. So i devised a project that could run without human contact, hoping that the conditions would eventually change. Mothers were recruited via social media and through a network of partners from the Coventry Family Health and Lifestyle Services. I met the infant Feeding Team in August 2018 and received great enthusiasm from them and one of their partners, a project called MAMTA that works with BAME mothers who wish to breastfeed.

When the call for participants went out, we had an overwhelming response! In February I  interviewed sixteen mothers via zoom, suggesting the storytelling workshops (also zoom) to those I felt would benefit. Not everyone took up this offer but those that did reported great benefits from having the chance to discuss openly with other mothers the issues they had faced in establishing breastfeeding. Rachel New, the radio producer and writer who devised and ran the workshops on behalf of Creative Lives did an amazing job of really getting the group to face each other and themselves, to pull out the wealth of experience they had between them and craft this into written pieces.

Breastfeeding is such a complex issue and so poorly understood. Mothers came from a wide range of backgrounds – young, older, experienced, new, British, South Asian, and African, reflecting the incredible diversity and cultural richness found in Coventry which has been welcoming people from across the world for many decades. I was hoping to bring out the contrast between mothers who had inherited an unbroken cultural inheritance of breastfeeding vs those, like me who had needed to start from scratch.

I waited hopefully for the restrictions to lift and finally on April 12th 2021 it was legal again to set up a photo studio. With the help of some local talent and the support of a wonderful arts organisation, Artspace, I was finally able to set up a temporary photo studio in Coventry in early May. Now all the mothers I had met only virtually started to appear every day at the door in 3D! it was a wonderful experience to meet them all finally, albeit under strict Covid safety conditions. 

By now the Storytelling group had a WhatsApp group and were organizing park meetups. We quickly set up a WhatsApp group for everyone and once the week was over I went into a supercharged post production period. My commission and proposal to Arts Council England had not included new animation but I felt it would be a travesty to the mothers who had shown such support and commitment to the project, to show mothers form another city in the final show. On my last night in the Premier Inn (I spent a lot of time in the Premier Inn) I decide I could make a new piece in time for the show.

It as an ambitious plan but I feel tremendously proud of the work that came out of Coventry: 12 new animated portraits, one large group portrait, sixteen VLOGS still being released onto Youtube channel and a legacy of seven still images hanging permanently in the labour ward where each mother gave birth, at UHCW in Coventry to inspire new mothers in the city to listen to their stories and if they can, follow them on the journey of breastfeeding.

Here’s a selection:

Hannah and Jacob, 2021

Hannah had a very premature baby who, at 25 weeks, was lucky to survive. She expressed for many months until finally she was given the go ahead to feed Jacob on the breast. Her story is an epic journey of resilience, stamina and self belief with some real insight into what mothers under this tremendous pressure need to keep going: https://youtu.be/P22EgsAIvJQ

Rayyan and Yusuf, 2021

Rayyan is a typical Coventry mother, although she would point out she was actually born in Hull…she lives in a tight knit family who supported her through some incredibly dark days after the birth of her first child. She came through it and is now tremendously positive about her experience and the support she received from family and the local maternity team: https://youtu.be/wrfbEAFB2HI

Mel and Harley, 2021

Mel is breastfeeding her third child and talks about finally feeling confident enough go to baby groups. She is very funny and I think we can all relate to her description of herself when she was a new mother and was too embarrassed to feed in public, even when she had the support of her mother by her side: https://youtu.be/vNnmPHN8Jj0

Hema and Devani, 2021

Hema was one of the first mothers I met in Coventry, back in 2018 at a Big Latch event. She is a tremendous role model as someone who came through huge physical challenges to breastfeed and eventually trained as a peer to peer mentor and is now supporting many mothers in the Coventry Gujarati community. It was fascinating hearing about how Hema sought help when she needed it and is now there to help others: https://youtu.be/5Ku97-Vig3k

Emilie and Jean, 2021

Emilie is not alone in finding herself surprised to be ’still’ feeding her child aged three. I found it really sweet how she says that it wasn’t the plan (but there never really was a plan….). I meet so many mothers who have fed full term doing this work and I’m always fascinated to hear their insights as it really is a journey of self discovery, as much as learning about your child and their needs: https://youtu.be/i4rsRJBy3wg

Follow online on #BreastfeedingBuddy

Holding Time Cheshire and Merseyside: https://holdingtime.org/cam/

https://www.lisacreagh.com/holding-time-1

www.youtube.com/c/HoldingTime

@TheHoldingTimeProject

@holdingtimeproject

Improving Me https://www.improvingme.org.uk/about-us/

Improving Me

The NHS Cheshire and Merseyside’s Women and Children’s Partnership proudly announce the Holding Time Project launch and call for participants

Women are invited to express an interest in any of the following:

1. Mother-talk with Lisa: Interview with the artist about your breastfeeding experience for a 5 minute VLOG to be distributed on social media channels and Youtube. 16th September through to 28 October 2021 For examples see www.youtube.com/c/holdingtime

2. Group Mother-speak:  Zoom storytelling workshops led by the experienced BBC Producer, Rachel New over six weeks starting on 16th September through to 28 October 2021. These collaborative writing workshops will be delivered in partnership with BBC Radio Merseyside’s community broadcast team. For previous examples listen here: https://www.bbc.co.uk/sounds/play/p09g27bg

3. A Breastfeeding portrait: Feed your baby whilst being photographed by the artist in a Covid safe temporary photographic studio during a 1.5 hour session. These portraits will be the basis of animations and stills for a permanent display. January 2022

Mothers who wish to participate should fill out the form at:

http://www.holdingtime.org/CAM

Open to all mothers who have breastfed for any amount of time

Lisa Creagh studied Fine Art and Art History at Goldsmiths College, London. She received a Masters in Photography from Brighton University in 2009. Her work is collaborative in nature: as a producer and curator she has delivered large-scale photographic projects. ‘The Instant Garden’, begun in 2008 was awarded a development grant by The Arts Council of England in 2010 and is still exhibited widely. 
 
Holding Time is a Feminist art piece, which evolved from Lisa’s own difficulties in breastfeeding documented on the project website. Lisa created Holding Time in 2016 to examine the cultural barriers to breastfeeding, listen to the experiences of other mothers and drive change. 
 
Holding Time is a co-created, participatory arts project comprising of videos of conversations and portraits of breastfeeding women, to confront and breakdown the structural and cultural barriers many women face, including stigma about body image. 
www.lisacreagh.com/about

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Communities

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Communities

‘Creating breastfeeding Communities’.

The Harrow Example.

How can communities change to give parents consistent support with breastfeeding?

Our Harrow model of integrated working across hospital and community services showed that when professionals, lay supporters and specialists worked effectively together under a shared strategy and infant feeding policy, that more parents felt supported to breastfeed their babies.   Over two years higher breastfeeding initiation, continuation and exclusivity rates were beginning to be reported.   Parents found that they experienced less conflicting advice and breastfeeding gradually began to be seen as the normal way to feed babies in Harrow.

This was achieved through joint training sessions involving community and hospital staff.  Midwives, midwifery managers, paediatricians, neonatal nurses, paediatric nurses, A&E nurses, health visitors, peer supporters and breastfeeding counsellors all attended the same sessions.  Through these, they were able to understand each other’s roles and responsibilities and plan care together.  

Peer supporters helped to run daily community drop-in groups with health visitors, and some worked in the antenatal clinic and postnatal wards of the hospital.   Specialist, targeted peer support was offered to teenage parents, those with multiples and Somali mothers.  A copy of Best Beginning’s ‘Bump to Breastfeeding’ DVD was given to all antenatal parents, who were also invited to a popular Saturday morning breastfeeding workshop.

Over a period of ten years, mothers felt comfortable breastfeeding their babies all over the borough and became visible in shopping centres, cafes, supermarkets, parks, and school grounds.  

The National Maternity Review reported in 2016:

‘In Harrow, a multi-ethnic London borough with high infant mortality rates, and areas of deprivation and poverty, the Director of Public Health identified breastfeeding as a top priority for 2006. A multi-professional approach was adopted with Harrow Community Health Services working with the local hospital to improve breastfeeding rates. UNICEF Baby Friendly training was commissioned for midwives, health visitors and support staff in 2007. A peer support training programme began and mothers were recruited from a local support group. A network of breastfeeding support groups was established running from children’s centres, eventually achieving one every day within walking distance for all mothers. In 2008, Bump to Breastfeeding DVDs were given to every pregnant woman by midwives, health visitors and peer supporters. Harrow became accredited as Baby Friendly in 2012 and the local hospital gained the award in 2013. The staff training, peer support programme and free DVDs increased breastfeeding rates, so by 2010 initiation rates had risen to 82% and 6-8 weeks to 73%. By 2013, Harrow had 87% of mothers initiating and 75% breastfeeding at 6-8 weeks (50% exclusively), with one of the lowest drop-off rates in the UK. UNICEF assessed Harrow for its re-accreditation in 2014 and stated that it was the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies’.[1]

Other examples of Integrated community breastfeeding support:

https://www.wearebesideyou.co.uk/Swindon

Harrow was featured in the UK WBTi report in 2016, as an example of good practice

Email us at wbti@ukbreastfeeding.org

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Dr Alison Spiro -Specialist health visitor (rtd) is a member of the WBTi UK Steering Group.


[1] ‘national-maternity-review-report.pdf’ (2016). Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Government

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Government

It has long been recognised that breastfeeding is the ‘single most effective intervention’ to improve health and support human rights, while making excellent economic sense and reducing social inequality.

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.

Take ACTION on:

Legislation

  • Introduce legislation for breastfeeding/ expressing in every workplace.

Policy

Structure

  • 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.

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Peer Support

#WBW2021  Protect Breastfeeding: A Shared Responsibility – Peer Support

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:

Who’s Who in Breastfeeding Support and Lactation in the UK, from Lactation Consultants of Great Britain

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.

Case studies of two breastfeeding services providing integrated support, 2016.
In Part 2 of our WBTi UK Report

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!

Email us at wbti@ukbreastfeeding.org

Sign up to our mailing list HERE

Banner photo credit: Pixabay

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.

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Fathers

#WBW2021  Protect Breastfeeding: A Shared Responsibility – Fathers

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!

World Health Organization

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References:

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

#WBW2021 Protect Breastfeeding: a Shared Responsibility – Health Professionals

#WBW2021  Protect Breastfeeding: a Shared Responsibility – Health Professionals

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.
  • An e-book for trainee doctors that I wrote, available on our website.
Free e-book on breastfeeding for doctors, by Patricia Wise
https://ukbreastfeeding.org/supporting-mothers-who-breastfeed-a-guide-for-trainee-and-qualified-doctors/

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.

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Patricia Wise is an NCT Breastfeeding Counsellor and a member of the WBTi UK Steering Group

International Women’s Day – March 8th

International Women’s Day – March 8th

Introduction

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.

Patricia Wise is an NCT Breastfeeding Counsellor, a member of the WBTi UK Steering Group, and the author of Supporting Mothers Who Breastfeed: A guide for trainee and qualified doctors

What support is needed?

What support is needed?

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!”

Thank you, S, for sharing your story.

Patricia Wise

Image from Adobe Stock

Breastfeeding in lockdown

Breastfeeding in lockdown

#WBW2020; #GreenFeeding; #BreastfeedingInLockdown

Breastmilk is amazing

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.

Patricia Wise