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

Breastfeeding During the Covid-19 Pandemic

As part of World Breastfeeding Week, #WBW2020 and #GreenFeeding, we’re emphasising the importance of mothers having easy access to good quality breastfeeding support, if and when they need it. This is partly provided by skilled people and partly by evidence-based written information. 

This short leaflet for new parents gives tips about breastfeeding during the pandemic and also lists reliable sources of information and support. The aim is to help empower families who may be much more isolated than families generally were before the Covid-19 pandemic and have limited access to face to face help from health professionals and local breastfeeding support groups.  

A slightly shortened two-page landscape version of the leaflet can be downloaded from here.

How do I manage as a new mother breastfeeding during the Covid-19 pandemic? 

How can I best protect my baby? 

Breastfeeding is one of the most important ways you can protect your baby. Your body makes antibodies in your milk which help your baby fight infections. Breastfeeding also helps babies develop a good long term immune system, and also help to protect mothers from breast cancer, heart disease, obesity and diabetes. 

No evidence has been found that coronavirus is passed through breastmilk. Mothers make specific antibodies to any infections they are exposed to, and these pass into their milk. This means that a mother with Covid-19 can help protect her baby against all kinds of pathogens by breastfeeding, and may even provide specific antibodies to the novel coronavirus. 

Covid-19 precautions 

However a baby is fed, they could be exposed to Covid-19 if their carer coughs or sneezes over them so the parent/carer might prefer to wear a face covering when in close contact and needs to wash their hands regularly. RCOG (the Royal College of Obstetricians and Gynaecologists) provides more details under Advice for women with suspected or confirmed coronavirus infection who have recently given birth.

Fewer visits to GP or hospital 

Exclusive breastfeeding for 6 months, then continuing to breastfeed alongside other foods, helps babies to be as healthy as possible and lowers their chance of needing to see a GP or have a hospital stay, e.g. for ear or chest infections. 

Food security 

Breastfeeding means parents do not have to worry about formula supplies or even shop for formula. 

How do I know my baby is getting enough? 

Babies are normally weighed at birth, 5 days & 10-14 days (when the health visitor usually takes over from the midwife).  With the pandemic, there may be few opportunities to have your baby weighed or see your midwife or health visitor face-to-face.  

However, your baby’s behaviour and nappy contents can help you know if your baby is getting enough milk.  

The first 6 days are a time of change.  From mid-pregnancy breasts produce a thick, usually yellow, type of milk called colostrum. A few days after birth, colostrum transition to more mature milk. The breasts usually feel very full at this time. The poos change too: 

  • thick black meconium for the first couple of days after birth 
  • green around Day 3 to 4  
  • At least two yellow poos each day, by Day 5 to 6  

A baby who is getting enough shows this pattern, takes themselves off the breast and generally settles after feeds. For photos of nappy contents see this NCT information

From 6 days to around 6 weeks, milk intake is probably fine if: 

  • your baby is usually contented after feeds 
  • has at least 6 heavy wet nappies/ day 
  • has 2 poos each at least the size of a £2 coin per day 

After 6 weeks, some babies poo less often but the overall amount is about the same. 

In the first two weeks, if your baby hasn’t pooed for 24 hours, contact your midwife and a breastfeeding helpline or local supporter for help.  

How do I know breastfeeding is going well? 

It’s going well if your baby is getting enough and you are finding breastfeeding comfortable. 

Start4Life provides very useful information about how breastfeeding helps the health of babies and mothers and how to help your baby latch on well. 

However, if your baby often falls asleep during feeds and wakes up again hungry after a few minutes, feeds are regularly longer than an hour, or it is uncomfortable or painful for you, the most likely reason is that your baby isn’t latched well enough to feed effectively. 

How can I increase my milk supply? 

If your baby is producing less wee and poo than expected, or you are topping up with formula,  

  • can you breastfeed more often – another feed or two in 24 hours? 
  • are you offering both breasts at every feed? you could switch back and forth during a feed 
  • breast compression can increase milk flow 
  • can you contact a helpline or breastfeeding supporter for more suggestions?

Remember – if you feel your baby is feeding very often, they are trying to get enough milk, and also helping to increase your milk supply. 

And if breastfeeding isn’t going well? 

To latch well the baby needs to gape wide, have the nipple in the upper part of their mouth, and chin pressed against the breast. Snuggle your baby close, head free, nose level with your nipple. This detailed information from La Leche League shows different positions you could try, and ways of helping your baby latch better.

If feeding is painful, or you are breastfeeding very frequently but your baby isn’t getting enough milk, get skilled help! You can also express your milk and offer your baby expressed milk until your baby starts feeding better and your nipples have healed. The Breastfeeding Network has information about expressing and storing breastmilk.  Your midwife or health visitor can help you learn to use a cup or bottle safely. 

Where can I get skilled help? 

You can contact the local midwifery team or health visiting service using the phone numbers you’ve been given. Often there is an Infant Feeding Coordinator or team who can provide more specialised support. They may also put you in contact with a volunteer breastfeeding counsellor or peer supporter. There are several charities continuing to offer free skilled breastfeeding support (see below). Your GP is the appropriate contact for medical situations – such as mastitis that isn’t improving after 24-48 hours – alongside breastfeeding support. 

Partners and family support 

Her partner can be a huge support to a mother who is breastfeeding and one possible silver lining of the pandemic is that many are at home and able to give more support.

UK breastfeeding helplines  

National Breastfeeding Helpline 9.30am – 9.30 pm 0300 100 021 
La Leche League GB (LLLGB) (web chat and email also available) 0345 120 2918 
La Leche League Northern Ireland 028 95 818118 
NCT Helpline 8am – 12 midnight 0300 330 0700 
Breastfeeding Helpline for Bengali/Sylheti speakers 0300 456 2421 
Breastfeeding Helpline for Tamil/Telugu/Hindi speakers 0300 330 5469 
Drugs in Breastmilk Information – Breastfeeding Network (BfN) https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/ 
Email: drug-information@breastfeedingnetwork.org.uk 

Virtual Support by Video 

LLLGB has daily free local online support groups   https://www.laleche.org.uk/find-lll-support-group/ 
NCT  – details of free local Zoom support groups available via the helpline: 0300 330 0700 
IBCLCs (International Board-Certified Lactation Consultants) – these may work for the NHS, voluntarily or provide a paid-for service.  To find an IBCLC see the LCGB website.  https://www.lcgb.org/find-an-ibclc/ 

Reliable sources of information 

World Health Organisation

 LLL

BfN

NCT

ABM

The Baby Buddy app from Best Beginnings provides more personalised information. https://www.nhs.uk/apps-library/baby-buddy/ 

Specific concerns 

Further information and self-help suggestions for common concerns listed below are described on several websites, such as the Institute of Health Visiting Parent tips, NCT’s information on breasts after birth and the NHS website.  

My breasts are hard and painful 

In the early days, this could be engorgement. Frequent feeding helps. La Leche League provides detailed information.  

I have a small tender area in one (or both) breasts 

This could be a blocked duct. Gentle massage over the area while feeding often helps.    

I feel fluey and have a hot, hard, red area on my breast 

This is likely to be mastitis. Removing milk, by feeding baby or by expressing, is the most helpful action, along with other self-help measures described here. La Leche League provides detailed information. 

I think my baby has tongue-tie 

A tongue-tie only needs to be divided if it is significantly affecting feeding. If breastfeeding is affected, the first step is to check the baby is as well-latched as possible. For families who may have to wait for treatment during COVID19, this is a very useful and detailed article by Sarah Oakley, IBCLC. 

My baby takes a lot when I bottle feed 

“I’m giving some top-ups for the moment because my baby lost too much weight but he takes a lot quickly and then is uncomfortable with wind.” Having the bottle level rather than tilted and giving the baby pauses helps the baby cope with the flow from a bottle and it can be easier to tell when the baby has had just enough. This is called ‘responsive bottle feeding‘.  

My mother-in-law keeps wanting to give my baby formula 

ABM (the Association of Breastfeeding Mothers) has a leaflet for grandparents to help them understand what is now known about breastfeeding.  

I stopped breastfeeding but now I want to restart 

This can be done but needs commitment as it takes a while to build up the milk supply again. You may find it easier if you have someone providing you with ongoing skilled support with relactation.  

Our message to you 

We hope the above information, and support options if you need them, can help towards you enjoying breastfeeding and continuing for as long as you and your baby want to.    

Authors: The WBTi UK Steering Group – Helen Gray, Clare Meynell, Alison Spiro, Patricia Wise; design by Carol Smyth

Launch of learning outcomes for health workers

Launch of learning outcomes for health workers

At the start of World Breastfeeding Week, Unicef UK Baby Friendly Initiative launched a new set of resources: recommended learning outcomes for several health professional groups.

New Unicef Baby Friendly learning outcomes for health professional training

It had been announced at the Baby Friendly conference in 2018 that learning outcomes and resources were being produced.

Addressing gaps

WBTi UK Indicator 5: Health professional training

The WBTi report in 2016 (see Indicator 5 in Part 1 of the WBTi UK report for the above table, and Indicator 5 in Part 2 for the detailed findings for each UK health profession) showed that for most health professions in the UK, the coverage of infant feeding in pre-registration training was inadequate. In some case only broad standards are given and the individual universities develop their own curricula.

The infant feeding learning outcomes launched by BFI are for a range of newly qualified health professionals so they ‘articulate the minimum knowledge and understanding of infant feeding that it would be reasonable to expect from a health practitioner at the point of qualification’. There are slightly different ones for the following five groups:

  • doctors
  • dietitians
  • pharmacists
  • children’s nurses
  • maternity support workers/nursery nurses.

For each of these professional groups the learning outcomes are grouped into three broad themes:

  1. The value of human milk and breastfeeding.
  2. Supporting infant feeding.
  3. Infant feeding in context, which includes understanding the importance of the International Code. 

They are intended as ‘a stimulus to universities and others to start to consider what should be covered in relevant curricula and training, and then to take action to make that a reality.’ 

One useful recommendation is that ‘A mapping exercise can help the university to assess how far the topics are already covered and assessed in the curriculum, and to identify and plan for any additions to modules or design alternations needed.’ Plans for the resources ‘include a slide pack to help lecturers deliver the content to students, e-learning for students and assessment examples’. 

Specific learning outcomes like these, provided they are taken on board by the training institutions, will surely help to achieve a higher and consistent level of knowledge and skills within and between health professions.

Cover photo licensed by Adobe Stock

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Empowering communities through integrated sustainable solutions #WBW2019

Empowering communities through integrated sustainable solutions #WBW2019

I’m a lactation consultant and writer who has just finished a Masters degree in Health Promotion at Leeds-Beckett University. This blog touches on some of the insights that my studies have given me, not least how data, like WBTi’s reports, can help health promoters create integrated, sustainable solutions that make health a resource to be shared by everyone.

In 1986, the World Health Organization (WHO) Ottawa Charter for Health Promotion defined Health Promotion as “the process of enabling people to increase control over, and to improve, their health.” Whether the focus be on breastfeeding, preventing obesity, supporting mental health or any of the complex (so called ‘wicked’) problems that challenge our societies, it is health promotion’s recognition of the social determinants of health that has most affected my thinking.  All too often our society is quick to blame the individual for unhealthy behaviours; my increased awareness of the social determinants of health, that is, how socio-economic, cultural and environmental conditions determine individuals’ well-being, has changed my perception. It’s given me a heightened awareness of how prevailing political ideologies influence the way we think about society, and how this plays out into how likely (or not) individuals are to be able to make healthy choices throughout the course of their lives. 

“This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements …and bad politics.” WHO[1]

To give an example, indicator 6 of the WBTi looks at community-based support, so key to women continuing to breastfeed.[2]In the UK, the recent NHS Long Term Plan’s recommendation of UNICEF UK Baby Friendly accreditation is cause for celebration and will boost the capacity of midwives and health visitors to support breastfeeding in the community.

However, cuts to peer-support services, and the closure of over 1000 Sure Start centres have disproportionately affected poorer members of society. If a mother in the community has persistent nipple pain, no car, no public transport, no money for a lactation consultant and her nearest breastfeeding group is 20 miles away, even with the support of the hard-working volunteers on the National Breastfeeding Helpline, her capacity to protect the health of her family through breastfeeding will be limited. 

Incidentally, the discipline of Health Promotion, while focusing on the up-stream causes of health inequalities, is also focused on empowering communities to participate in the creation of healthier societies. The UK’s WBTi report, under Indicator 6, points out that in England and Wales there is often little coordination between NHS services and peer-supporters, who can offer so much to new mothers. It recommends a range of integrated postnatal services that include voluntary sector breastfeeding support, meet local needs and provide clear access to specialist support.

Integrated breastfeeding support is outlined in the criteria for UNICEF Baby Friendly accreditation for community services:

  • Basic: universal services such as midwives, health visitors, and support workers are trained to BFI standards
  • Additional: a network of trained local peer supporters and support groups
  • Specialist: a referral pathway to specialist help at IBCLC level, for complex cases that cant be resolved by “Basic” and “Additional” support

The guidance and standards on community breastfeeding support from NICE, Baby Friendly and Public Health England are summed up in this “Breastfeeding Support Within Maternity Transformation Plans: Guide to the Guidance” by Better Breastfeeding.

As an individual health promoter, the scale and complexity of the social determinants of health can feel overwhelming. Nonetheless, recognising them sets the challenge to health promoters (in all disciplines, not just those who work in traditional health services or policy) to work empathetically, creatively and collaboratively. After all, ‘Success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective societal responsibility’ (The Lancet).


[1]Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF). World Health Organization. 

[2]Dennis C (2002) The Effect of Peer Support on BreastFeeding Duration among Primiparous Women: A Randomized Controlled Trial. Canadian Medical Association Journal 166(1):21-8.

Alice Allan is a lactation consultant, writer and communication specialist who has worked in Ethiopia and Uzbekistan on maternal and child health. Her novel, Open My Eyes, (Pinter and Martin) set in an Addis Ababa NICU, recently won The People’s book Prize for Fiction. She currently lives near London with her family and an Ethiopian street dog called Frank.

Breastfeeding and medication: training for pharmacists and counter staff

Breastfeeding and medication: training for pharmacists and counter staff

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

In this blog, Wendy Jones MBE discusses gaps in the training of pharmacists (See Indicator 5 in Part 2 of the WBTi report for our detailed findings on pharmacist training) and introduces her new free online educational resources for pharmacists.

On a daily basis I hear that pharmacy staff have advised mothers not to breastfeed whilst taking medication or have refused to sell products such as antihistamines to lactating mothers. This is frustrating for families (and me!) and unnecessary.

We know that there are barriers around breastfeeding and medication:

  1. The patient information leaflet – invariably it says that the product should not be used during lactation. This doesn’t imply risk usually rather that the manufacturer didn’t include breastfeeding when applying for marketing authorisation. For more information see this leaflet on the Breastfeeding Network website.
  2. Understanding of the importance of breastfeeding for the future health of mother and child. Sadly breastfeeding, let alone understanding the pharmacokinetics of transfer of drugs into breastmilk, is not covered currently in most undergraduate training. Most knowledge relies on personal experience (Jones W 2000 Doctoral thesis University of Portsmouth. The role of community pharmacy is supporting mothers requiring medication).
  3. Fear of litigation – to sell a medicine outside of its licence application entails taking responsibility. Pharmacists are concerned, rightly so if they do not access evidence-based information (Hale TW Medications and Mother’s Milk, Jones W Breastfeeding and Medication, LactMed , UKDILAS, Breastfeeding Network factsheets)
  4. Time – frequently counter assistants rather than busy pharmacists are involved in sales of simple medications and do not discuss safety in breastfeeding unless asked by the mother.
  5. Time limitations to consult expert sources.

Conflicts of interest

It has come to my attention recently that continued professional development (CPD) materials on infant feeding are being provided free of charge to make pharmacists and staff “Infant Feeding Champion”. Sadly, these are provided by the formula companies and the support of breastfeeding is considerably less than what I would describe as evidence based and full of advertisements for products ranging from nipple shields to nipple creams and specialist formulas.

New free training materials

I decided that I wanted to provide training materials for pharmacists and counter staff free of charge using the knowledge that I have gained over the past 31 years as a qualified, registered breastfeeding supporter as well as pharmacist with a specialist interest in the safety of drugs in breastmilk. The first module can be found here. More modules are underway looking at the pharmacokinetics of drug transfer and the treatment of common conditions.

In the meantime, my message is #DontSayStopLookItUp

I’m happy to be contacted:

and I will send detailed information to mothers and professionals.

 Dr Wendy Jones  MBE

Wendy was one of the founder members of a UK charity the Breastfeeding Network. In her employed life she was a community pharmacist and also worked in doctor surgeries supporting cost effective, evidence-based prescribing. She qualified as a pharmacist prescriber using her knowledge to reduce the risk of heart attacks and strokes in clinics to help patients stop smoking, weight optimisation and control of blood pressure and cholesterol. She feels she was best described as the conscience of the village. Her aim was to run clinics for breastfeeding mums needing medication but never managed it. 

Wendy left paid work to concentrate on writing her book Breastfeeding and Medication (Routledge 2013,  2nd edition 2018), developing information and training material on drugs in breastmilk as well as setting up her own website http://www.breastfeeding-and-medication. She has also published Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin).

Wendy is known to many from her work on providing a service on the compatibility of  drugs in breastmilk and has been a breastfeeding supporter for 30 years. She is passionate that breastfeeding should be valued by all and that medication should not be a barrier. She has 3 daughters and 5 grandchildren ranging in age from 6 years to 6 weeks. All her family seem as passionate about breastfeeding as she is and currently all 3 of her daughters are breastfeeding. 

She was awarded a Points of Light award by the Prime Minister in May 2018 and was delighted to be nominated for an MBE in the New Year’s Honours List 2018 for services to mothers and babies. She received her award at Windsor Castle in May 2019 from Her Majesty the Queen. 

Hospital Breastfeeding 3: Posters from HIFN

Hospital Breastfeeding 3: Posters from HIFN

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

Following on from previous blogs about the launch of the Hospital Infant Feeding Network website and the “Don’t Say Stop Look it Up” campaign, today’s blog looks at another set of resources provided by the Hospital Infant Feeding Network.

As a reminder, the Hospital Infant Feeding Network is a place for hospital health professionals to find out more about facilitating and supporting breastfeeding in a hospital setting. It provides a highly referenced, practical website on relevant topics, and a closed Facebook group for discussion and sharing best practice. For National Breastfeeding Celebration weeks in June, HIFN produced a set of A3 posters aimed at hospital staff in different settings to summarise useful, evidence-based information. These can be downloaded here.

The first two posters look at the reasons for health professionals to support breastfeeding, in term babies and in the neonatal unit setting. Families who are finding breastfeeding difficult are unlikely to find this type of messaging useful so it is important that these are placed to be staff-facing only.

The next three posters look at what is normal, common breastfeeding problems and the non-nutritional aspects of breastfeeding:

The final poster is designed for hospital settings where lactating women might be seen or admitted:

More information about all of these topics is available on the HIFN website.

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

Following on from yesterday’s blog about the launch of the Hospital Infant Feeding Network website, today we are looking in more detail at the joint GPIFN, Breastfeeding Network and HIFN campaign “Don’t Say Stop Look It Up”.

DontStopLookItUp

This campaign, started by the GP Infant Feeding Network in 2017, aims to make sure healthcare professionals know how to check whether specific medicines can be taken by breastfeeding women. Most healthcare professionals know that with regard to breastfeeding and medication they should check what the British National Formulary (BNF) says. The BNF is a phenomenal resource, respected around the world, with comprehensive information about medication doses, side effects and cautions. However, in some cases it takes a very cautious line on breastfeeding – for example, for the antidepressant sertraline, recommended by specialist services as a preferred option in breastfeeding, the BNF says “not known to be harmful but consider discontinuing breastfeeding”. For ibuprofen, accepted by specialist services as appropriate during lactation, the BNF says “use with caution during breastfeeding. Amount too small to be harmful but some manufacturers advise avoid”. It isn’t hard to see that well-meaning healthcare professionals are nervous about recommending medicines for breastfeeding women when seeing these descriptions in a trusted source of information, and why they may advise that breastfeeding should be stopped, or that the medication cannot be taken.

The #Don’tSayStopLookItUp campaign seeks to highlight the position of the National Institute for Health and Care Excellence (NICE), which states “Ensure health professionals who prescribe drugs to a breastfeeding mother… seek guidance from the UK Drugs in Lactation Advisory Service… the ‘British National Formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions… Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse”. The campaign poster set can be downloaded, and covers common classes of drugs such as antibiotics, antidepressants, painkillers and anaesthetics. The rest of the blog will cover in more detail how health professionals can effectively use the UK Drugs in Lactation Advisory Service (UKDILAS).

UKDILAS is an NHS service specifically set up to help health professionals make informed decisions about the use of medicines during breastfeeding. It is provided by a team of highly specialised pharmacists. The website is not the easiest one to navigate so we’ll go through the three particularly useful services they provide, step by step.

Using UKDILAS

Firstly, UKDILAS provides thorough lactation-specific information on individual medications. When a health professional wants to check a single medication, where they would normally look it up in the BNF, they can go to www.sps.nhs.uk (or Google UKDILAS) and use the search box at the top of the page:

Searching for codeine, for example, will bring up first the individual drug name and any lactation (and other specialist service) factsheets as well:

Clicking on the individual drug name codeine brings the reader to a long list of articles and other specialist information so the last step is to click on the “Lactation Safety Information” link under the medication name to go straight to the relevant section.

In this case, the final result is “Use when breastfeeding – No” with useful comments about how much data this is based on and what effects are seen. This will also link you through to any other relevant lactation safety information held about this medicine:

The other two UKDILAS services are the factsheets and the ability to ask specific questions. Question & Answer factsheets are available via a link from the UKDILAS part of the SPS website (www.sps.nhs.uk/ukdilas) and cover general topics like “which oral antihistamines are safe to use while breastfeeding?”. There are also general “safety in lactation” articles covering specific classes of medication – these will come up when you search for an individual medication, as shown above with codeine, which is an opioid analgesic.

To ask UKDILAS a specific question, health professionals can telephone (9am-5pm Mon to Fri) or email – full details are on the website. The team will answer any breastfeeding and medicine-related question, but particularly specialise in highly complex areas such as multiple medications and premature infants.

Other sources of information on drugs in breastmilk

As lactation professionals know, there are many other ways to access information about medications in lactation – for example the wonderful Drug Factsheets put together by Wendy Jones at the Breastfeeding Network, American national resource LactMed and textbooks such as Medications and Mothers’ Milk (Hale). This blog has focused on UKDILAS because it is an NHS source, which is reassuring to busy UK health professionals who may not have time to check the credentials of other sources.

So, in summary, health professionals naturally use the BNF to check information about lactation, but by using the Don’t Say Stop Look It Up campaign, we can help them find out about specialist sources of information to help families make informed decisions.

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

Strengthening breastfeeding support through a new hospital network (HIFN): 1

Strengthening breastfeeding support through a new hospital network (HIFN): 1

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

There is exciting progress to strengthen breastfeeding education and policy in a hospital setting in the UK, with the launch of a comprehensive website resource for hospital health professionals this week www.hifn.org. Co-chair Ilana Levene tells us more about the Hospital Infant Feeding Network (HIFN).

“HIFN was set up in 2018 and consists of a network of health professionals interested in supporting and facilitating breastfeeding in a hospital setting in the United Kingdom. I’m a paediatric trainee with a special interest in neonatal nutrition and my co-chair Vicky Thomas is a consultant paediatrician with a special interest in complex nutritional difficulties in infancy and childhood. Our steering committee includes a parent, a nurse practitioner, a dietitian and doctors from other specialities such as anaesthetics, endocrinology and emergency medicine. All health professionals and those who have a strong interest in hospital breastfeeding are welcome to become active within HIFN – if you would like to join, please search for the closed Facebook Group “Hospital Infant Feeding Network” and follow us on Twitter @HIFN12. To understand more about HIFN, just dive right into our new website www.hifn.org, launching this week to mark World Breastfeeding Week. It covers our principles and goals, general background issues of infant feeding in the UK and specific topics relevant to health professionals looking after both mothers and children in a hospital setting. If you’re not a hospital health professional, signpost those you know to the website as a source of expert, referenced, practical breastfeeding-friendly knowledge.

Why did we decide to form a new network for hospital health professionals? In 2016, the GP Infant Feeding Network (GPIFN) was set up in order to improve infant feeding support by General Practitioners, and this arena showed that there was a significant appetite and unmet need not only from GPs, but also hospital professionals. A recent survey of paediatric doctors in a large UK hospital found that 30% did not agree that breastfeeding is the most beneficial form of nutrition in the first 6 months of life, and over 50% felt inadequately trained to manage breastfeeding when they encounter it. WBTi has documented the many gaps in undergraduate and postgraduate training (see Indicator 5 in both Part 1 and Pat 2 of the WBTi report) , and sources like the parent-led Hospital Breastfeeding campaign have clearly shown the poor practice families experience on the ground every day as a result. With this pressing need in mind, a group of hospital professionals active in GPIFN decided to form a sister network. From the moment of inception, we have reached out to families, the lay organisations active in the breastfeeding field, and lactation professionals, in order to work in partnership.

Apart from working on our website content, HIFN has achieved major campaigning wins through advocacy with the Royal College of Paediatrics and Child Health, who recently announced they will no longer accept any funding from breastmilk substitute manufacturers. This has started to ripple out to other associated organisations such as the British Association of Perinatal Medicine. We re-launched a longstanding campaign related to medication in lactation, alongside GPIFN and the Breastfeeding Network, and with support from the UK Drugs in Lactation Advisory Service, called #dontsaystoplookitup. We provided poster resources for National Breastfeeding Celebration weeks – both of these sets of resources are available for download on the website www.hifn.org/dontsaystop and www.hifn.org/posters.

We look forward to continuing to serve UK families moving forward and welcome you to have a look at the new website and get more health professionals involved.”

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

#WBW2019: Empower parents, enable breastfeeding

#WBW2019: Empower parents, enable breastfeeding

The theme for World Breastfeeding Week this year is “Empower parents, enable breastfeeding,” which fits the philosophy of our WBTi work very well.  The WBTi recommendations have been produced by a Core Group of 18 of the UK’s key government agencies, health professional organisations and charities working in infant and maternal health. The 46 recommendations, across ten areas of policy and programmes, parallel many of the recommendations of previous national breastfeeding initiatives such as the UNICEF Baby Friendly Call to Action, the Becoming Breastfeeding Friendly project (completed in Wales and Scotland so far), and the Breastfeeding Manifesto.


The WBTi assessment and recommendations for action are all about providing the structures, policies and programmes that families need in order to support mothers and infants to be able to breastfeed successfully. It is not a woman’s responsibility on her own, it is the responsibility of ALL of us, across society, to provide the support that mothers and babies need.

This has been echoed by the UN Human Rights experts, who have stated that breastfeeding is a human right of the breastfeeding dyad, and that states/ society is responsible for providing the structural support they need. Likewise this is the key message of the Lancet 2016 Series on Breastfeeding.

Gaps and barriers

Our UK report found many gaps and barriers in ten areas of policy and programmes across the UK:

  1. Lack of national leadership and national strategy on infant feeding, except in Scotland.
  2. Areas where maternity settings still do not meet the minimum UNICEF Baby Friendly standards, in particular in England.
  3. Weak regulations governing marketing by baby milk companies, no regulations governing bottle and teat marketing, and little enforcement of existing provisions.
  4. Lack of provisions to support new mothers to continue breastfeeding when they return to work.
  5. Gaps in health care professional training in infant and young child feeding (See both Part 1 and Part 2 of the WBTi report for full details)
  6. Cuts to peer support and other community breastfeeding support.
  7. No national communications strategy on breastfeeding.
  8. Lack of understanding of current guidance on breastfeeding for HIV+ mothers.
  9. No national guidance on planning for the care of infants and young children in emergencies or disasters.
  10. Poor data collection and monitoring of breastfeeding rates.

Highlights of progress

There are several bright spots, however, and in the two years since the WBTi report and recommendations were published, there have been improvements in several areas

  1. National policy work: Scotland already had strong national policy leadership. Scotland, Wales and England have taken part in the Becoming Breastfeeding Friendly project on scaling up breastfeeding interventions, with a government commitment to act on recommendations.
  2. With the latest NHS England Long Term Plan, all of the UK has now pledged to reach full UNICEF Baby Friendly accreditation in all maternity settings.
  3. Increased awareness of International Code issues in the UK include a relaunch of the UK Baby Feeding Law Group, a coalition of UK organisations working in infant and maternal health, to advocate for implementation of the International Code in UK law.
  4. The Alliance for Maternity Rights has included the protection of flexible breastfeeding/ expressing breaks and suitable facilities in their Action Plan.
  5. Several health professional councils have begun to review their training standards on infant feeding, and a working group led be UNICEF Baby Friendly has launched a new set of learning outcomes for the training of medical students, paediatric nurses, dietitians, pharmacists and maternity support workers/ nursery nurses.
  6. Continued cuts to local authority and public health budgets has continued to severely impact community breastfeeding support such as trained peer support. The WBTi team organised a conference on the public health impact of breastfeeding with the Institute for Health Visiting, exploring in particular the UNICEF Baby Friendly community requirements for “basic” health professional BFI training, “additional” local trained support such as peer support groups, and a “specialist” referral pathway at IBCLC level. The BFI, NICE and Public Health England guidance are clearly explained in the “Guide to the Guidance” by Better Breastfeeding. However there is potential for strengthening the commissioning of integrated breastfeeding services, through the increased profile of breastfeeding in England in the NHS Long Term Plan, breastfeeding representation now being included in the NHS England National Maternity Transformation Programme Stakeholder Group, and in Scotland and Wales with renewed national leadership and funding.
  7. Although no national communication strategies on breastfeeding have been developed, the national governments and public health agencies have developed breastfeeding campaigns and have supported national breastfeeding weeks again across all four nations.
  8. New guidance on infant feeding for HIV+ mothers from the British HIV Association has included detailed guidance on how to support mothers who wish to breastfeed (see also our guest blog from Pamela Morrison IBCLC explaining the new guidance here)
  9. Infant feeding in emergencies is still not covered by national guidance or universally in local disaster resilience planning, however a national forum hosted by Alison Thewliss MP, and led by the UK WBTI team and Dr Ruth Stirton from the University of Sussex Law School has kick-started the discussion to improve awareness and standards.
  10. Monitoring of breastfeeding rates remains uneven across the UK; Scotland has continued to conduct robust infant feeding surveys, while, in England, the PHE data on breastfeeding rates still have gaps in reporting. The UK government has now proposed to reinstate the national infant feeding survey in a new consultation on prevention. See also our blog by Patricia Wise on gaps and changes in our data (including how YOU can access the fingertips data), and guest blog by Phyll Buchanan MSc on how we can use the infant feeding data to reveal insights into health inequalities.

So we are in interesting times – we still face budgetary and cultural challenges, and families still face many barriers.

However change is clearly happening!

Coming up on the WBTi blog for #WBW2019

For World Breastfeeding Week, we are hosting a number of guest blogs detailing some exciting innovations: 
The launch of the Hospital Infant Feeding Network, with a website and a collection of posters and resources for health professionals working with mothers, infants and young children in hospital.

A new set of educational resources on breastfeeding and medications for pharmacists, from the wonderful Wendy Jones.

And a blog looking at some of the public health issues around breastfeeding support in the community, from Alice Allan IBCLC MPH.

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Helen Gray IBCLC is Joint Coordinator of the WBTi UK team, with a special interest in supporting families in emergencies.