WHO and UNICEF launched the Baby Friendly Initiative (BFHI) over thirty years ago; three years later, UNICEF UK Baby Friendly Initiative (BFI) was born. The original BFHI framework of Ten Steps was created to improve maternity and hospital practices that undermined breastfeeding, such as separating mothers and their newborns or routine formula supplements, as well as implementing the International Code of Breastmilk Substitutes in maternity settings, in order to eliminate conflicts of interest with the baby feeding industry (companies that manufacture or distribute infant formula/milks, baby foods, feeding bottles and teats) such as promotion of formula milk in healthcare settings, or direct contact by companies with parents.
Routine care: all staff in the universal services (midwives, health visitors, support workers etc) are trained to BFI standard with sound, evidence-based, basic training in supporting breastfeeding and responsive infant feeding.
Additional services: every area should have additional support available, such as trained, skilled peer supporters who can act as an “informed friend” for new mothers, and a network of local peer support groups where new parents can find social support alongside help with everyday breastfeeding issues.
Specialist services: every area should also have a referral pathway for specialist care for more complex breastfeeding problems; breastfeeding specialists should have extensive experience or training such as the IBCLC qualification or a recognised breastfeeding counsellor/supporter credential, and either be a registered health professional themselves, or co-lead the specialist service with a registered health professional.
A good example of how the BFI community standards work is Harrow. Read more HERE about how WBTi UK Steering Team member and specialist health visitor Alison Spiro led Harrow’s local community health services through BFI accreditation, to develop a well integrated services and become
“the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies”
More recently, UNICEF UK BFI have produced Learning Outcomes for a wider range of health professions: medical students, paediatricians, pharmacists, paediatric/ children’s nurses, maternity support workers and nursery nurses. These will help to address the gaps in high level health professional training standards found in WBTI’s 2016 report. Every health professional who works with women, infants and children should understand the basics of lactation and breastfeeding management, prescribing during lactation, and how to refer parents on to local breastfeeding support.
The entire webinar runs from 7-9 AM BST and again from 4-6 PM BST, and will be recorded.
The Week runs from June 27th to July 2nd and the theme is ‘Everyone has a part to play in helping mums to breastfeed’. The early weeks with a new baby are hard for most mothers and some find that time very challenging but support can make a huge difference. Some people around the mother, particularly partners, can offer practical help in looking after the home and the mother so that she can recuperate after the birth and focus on nurturing the baby, which primarily means feeding.
Sometimes skilled support is needed to enable breastfeeding to work better, which often means improving the latch. This can be from health professionals, such as midwives and health visitors, and specialists – breastfeeding counsellors and IBCLCs (International Board-Certified Lactation Consultants); the specialist services include national helplines*. Trained breastfeeding peer supporters are available in many areas and can offer invaluable mother-to-mother support. They often work in volunteer or paid roles in local support groups, where mothers can give each other confidence and build self-reliance through sharing their stories.
Everyone having contact with the mother can be emotionally supportive, indicating that they value what she is doing and respect her decisions, helping to build her confidence that she can make breastfeeding work. These includes friends, relatives, neighbours, GPs, pharmacists, shop staff…
However, alongside these personal contacts, society’s infrastructure and attitudes can also influence a mother’s experiences with infant feeding. A World Breastfeeding Trends Initiative assessment demonstrates the extent to which a country’s support for breastfeeding implements the Global Strategy on Infant and Young Child Feeding, by scoring ten policy and programme indicators:
1. National policy and funding
2. Baby Friendly in maternity settings
3. WHO International Code of Marketing of Breastmilk Substitutes (the Code)
4. Maternity protection in workplaces
5. Health professional training
6. Support services for pregnant and breastfeeding mothers
7. Accurate and unbiased information
8. Infant feeding and HIV
9. Infant and young child feeding during emergencies
10.Data – monitoring and evaluation
The UK assessment in 2016 showed the variability between indicators, particularly as an assessment identifies gaps and makes recommendations.
Carrying out a WBTi assessment in a country around every 5 years monitors the progress, or lack of it, in a country. It is time for a reassessment in the UK.
If you would like to be involved in collecting data, please do contact us, and let us know which of the indicators above YOU are interested in?
A shocking new report on formula marketing which was commissioned by the World Health Organisation and Unicef has been launched. Called ‘How the marketing of formula milk influences our discussions on infant feeding’, it is a large scale and thorough report in which women’s voices are a key part. The report can be downloaded from this page.
Eight countries were included (Mexico, Bangladesh, UK, Vietnam, S. Africa, Nigeria, China and Morocco) and it involved 8500 mothers talking about their experiences of being targeted and also interviews with health professionals and marketing executives. The survey was conducted by M&C Saatchi World Services, which states on its website: “Our aim is to harness the power of cutting-edge marketing, communications and creativity, so that they become key tenets of behaviour change activity throughout the International Development sector.”
The conclusions of the report are that the marketing is highly targeted, pervasive and exploitative, uses misleading scientific claims and incorporates appeals to aspiration. It therefore backs up robustly what has been known about infant formula marketing for many years. Industry invests more in marketing each year than the funds WHO has available!
‘Marketing the $55 billion formula milk industry’, the webinar of the launch of the report on 23 February is available here.
What needs to happen:
1. Invest in mothers and families (e.g. good maternity legislation)
2. Protect the integrity of science and medicine (including strong conflict of interest policies)
3. Urgently legislate, regulate and enforce regulations in order to protect all families.
The launch was hosted by Kathriona Devereux, science communicator and Cuidhu breastfeeding counsellor, on behalf of WHO, Unicef, Save the Children and two other organisations. Dr. Nigel Rollins gave a brief history of infant formula marketing and presented the key findings. Anu Narayan of Unicef framed the issue – it’s about marketing, the right to accurate and impartial information, and public health v commercial interests, not about breastfeeding v bottle feeding or limiting access or rights. The study questions were:
What are women’s experiences of and attitudes towards formula marketing?
What are health professionals’ experiences of and attitudes towards formula marketing?
The presentation was followed by comments from a panel that comprised Helen Clark (former Prime Minister of New Zealand), Rebone Ntsie, dietitian from South Africa, Duong Vu from Alive and Thrive in Vietnam, Professor Caroline Homer, specialist in maternal and infant nutrition, and Katie Gilbert, Managing Director at M&C Saatchi World Services. Recommendations for action from the panel included: framing the issues as supporting the right to health, engaging political leaders, recognising the scale and urgency of the problem, improving national regulations and checking imports comply with regulations. It was also suggested that public health needs both to provide the services that mothers need and to demonstrate empathy in its communications, as breastfeeding counsellors are trained to do, indicating understanding of what it’s like to be a mother; formula marketing conveys that impression of understanding.
Worryingly, updating the International Code to address marketing through social media better was also suggested; however, the Code has been updated by 19 subsequent resolutions since 1981 to close loopholes and it does cover all marketing. Governments need to have strong enforceable regulations to implement the Code and resolutions, including addressing digital marketing, and thus protect infants and young children.
What wasn’t mentioned was the significant negative environmental impact of formula feeding. Protecting and supporting families who want to breastfeed to do so will reduce that negative impact.
In addition there is a petition to stop unethical formula research on babies, and particularly a new study in Africa in which low birthweight exclusively breastfed babies will randomly be allocated formula.
If you’d like to check the content of the current UK Laws, the Baby Feeding Law Group (BFLG) has information and links on its website.
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
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:
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:
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.
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
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
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?
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.
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.
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.
“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.
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.
The year 2020 has seen us facing unprecedented multiple crises and emergencies:
· 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.
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