Skilled health professionals are a fundamental building block for successful breastfeeding. Parents expect all healthcare professionals to have the knowledge and skills to help them overcome practical challenges and to offer them emotional support. The reality in the UK is that many have not received the training they need to do this, so parents do not always receive the support they need. While improvements have been seen, UK health professional training still shows gaps in training in infant feeding. Relevant, evidence-based training is needed for all those who work with women, infants and young children.
WBTi findings: mapping UK high level health professional training standards in infant feeding against the WHO Educational Checklist
WBTi’s research has found numerous gaps in the pre-registration training in infant feeding in almost all UK health professional specialisms. Only midwifery training covers most of the topics on the WHO’s Educational Checklist on infant and young child feeding.
Alarmingly, the worst gaps are in the high level training standards for nurses, including paediatric nurses. Since the publication of our first report in 2016, there have been a few improvements in the training standards set for paediatricians and GPs, and our upcoming reassessment will be mapping these against the WHO checklist.
What can YOU do?
If you are a health professional,urge your governing body to strengthen the requirements on infant feeding in your professional standards and examinations by:
It takes a village to raise a child – we all have a role to play to support breastfeeding mothers and babies.
We all are the building blocks responsible for supporting new families: partners and family members, health workers, neighbours and community members, religious leaders, employers, academics, governments and policy makers. We can all make a difference. We need to step up to our responsibilities. Everyone needs to understand the importance of breastfeeding – for maternal and infant physical and mental health and wellbeing, for public health, for our economy, and for our planet.
For WBW this year, WABA has produced an extensive suite of materials looking at all these roles and responsibilities. They have outlined the challenges that breastfeeding families face at every stage from conception, through birth, getting breastfeeding off to a good start, and maintaining breastfeeding all the way through starting solids and going back to work, and the solutions we need in each situation – all backed up by links to the latest evidence.
The #WBW2022 Action Folder pulls all this together: it is a useful resource for anyone using evidence to build policies and best practice. You can download it as a PDF and all the links to research and references will be live.
The UK WBTi team will be highlighting just a few of the concepts this week:
Health workers: the importance of relevant, evidence-based. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding. training for all those who work with women, infants and young children
UNICEF UK Baby Friendly Initiative and the BFHI worldwide sets out ways in which healthcare staff can receive sound, evidence-based, basic training in supporting breastfeeding.
ALSO join a special webinar from the Global Breastfeeding Collective on BFHI, with some added specialist topics on supporting small and underweight breastfeeding infants, and on infant feeding in emergencies. (7-9 AM BST and again at 4-6 PM BST). Register HERE
Community support: Access to skilled, integrated support for all, with a special focus in the GBC webinar on how to support breastfeeding infants who are not gaining well (NICE NG 75,2017). All parents should have easy access to trained healthcare staff- midwives, paediatricians, health visitors and GPs- breastfeeding peer supporters and specialist support (IBCLC, BFCs). Supporting breastfeeding in complex circumstances: Specialist support from IBCLCS, BFCs, or infant feeding leads, integrated with specialist healthcare teams
Protecting infants and young children in emergencies. National policies should guide Local Resilience Forums but these do not exist at present.
The impact of misleading marketing: The International Code. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding.
Governments with national and local policy makers need to protect all families and support them to make informed feeding decisions free of commercial influence.
What can YOU do?
It is time for a reassessment of the UK’s national infant feeding policies and programmes. YOU could help! Volunteers are welcome with knowledge in any of the ten policy areas (Indicators 1-10), or with skills such as research, writing, graphics, social media and more – feel free to contact us for a chat!
WBTi Key Indicators:
Indicator 1: National policy, programme and coordination Indicator 2: Baby Friendly Initiative Indicator 3: International Code of Marketing of Breastmilk Substitutes
Indicator 4: Maternity protection Indicator 5: Health professional training Indicator 6: Community-based support Indicator 7: Information support Indicator 8: Infant feeding and HIV
Indicator 9: Infant and young child feeding during emergencies
Indicator 10: Monitoring and evaluation
Which one will YOU choose?
Contact us: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.
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:
Open to all mothers who have breastfed for any amount of time
Lisa Creagh studied Fine Art and Art History at Goldsmiths College, London. She received a Masters in Photography from Brighton University in 2009. Her work is collaborative in nature: as a producer and curator she has delivered large-scale photographic projects. ‘The Instant Garden’, begun in 2008 was awarded a development grant by The Arts Council of England in 2010 and is still exhibited widely.
Holding Time is a Feminist art piece, which evolved from Lisa’s own difficulties in breastfeeding documented on the project website. Lisa created Holding Time in 2016 to examine the cultural barriers to breastfeeding, listen to the experiences of other mothers and drive change.
Holding Time is a co-created, participatory arts project comprising of videos of conversations and portraits of breastfeeding women, to confront and breakdown the structural and cultural barriers many women face, including stigma about body image. www.lisacreagh.com/about
A network of trained peer support is an essential part of high quality integrated breastfeeding services.
Unicef UK Baby Friendly Initiative (BFI) outlines three components that good local breastfeeding services must include, in order to be awarded Baby Friendly accredited status.
Basic, or Routine Care
All health workers who work with new families (health visitors and any allied healthcare assistants in the community services) have been trained to BFI standard (approximately 18 hours of initial in service training, with yearly updates of an hour or more).
Additional services
Here BFI outlines how every health visiting and community service must be embedded in and well supported by a network of trained peer supporters, or other social and trained breastfeeding support. NICE recommends that peer support programmes be externally accredited. Good practice includes not only training, but also regular supervision and updates of skills and knowledge. Typical peer support programmes require peer supporters to be experienced breastfeeding mothers, and often expects them to come from similar communities as the population they are supporting. Training generally is part time, over 16-36 hours. Peer supporters work in a supervised setting, acting as an “informed friend,” and referring complex cases on to health professionals or an advanced breastfeeding practitioner such as an IBCLC or breastfeeding counsellor, using a referral pathway.
Breastfeeding counsellors in the UK are also experienced breastfeeding mothers, so they also provide a type of peer support, or “mother-to-mother” support. Their training typically take around two years, and they are autonomous practitioners, who can be responsible for leading their own local breastfeeding support groups, usually through one of the main UK breastfeeding voluntary organisations.
Mothers who are experiencing breastfeeding challenges often need more than one visit – and they need the time that it requires for skilled listening as well as exploration of possible breastfeeding strategies to resolve the issue. Although many health visitors have additional breastfeeding training and skills, the health visitor workforce is vastly overstretched, and it simply isn’t possible to provide the time and the number of visits that many breastfeeding mothers need.
But peer support programmes can provide this – they offer groups where lonely mothers can meet others and gain confidence in their own mothering, alongside skilled listening and well- informed support. Many mothers will find their own “village” in their local breastfeeding support group, and will return again and again. Some will go on to train as peer supporters or breastfeeding counsellors themselves.
Peer support groups are the beating heart of breastfeeding support
Helen Gray, WBTi Joint Coordinator
WBTi audit of peer support and breastfeeding counsellors provided by the voluntary sector, 2016 In Part 2 of our WBTi UK Report
Specialist support
Every area should have a referral pathway to specialist care at the IBCLC (International Board Certified Lactation Consultant) or similar level, for those complex cases where breastfeeding issues cannot be resolved at the level of basic/ routine care or by additional peer support.
The different roles of breastfeeding support in the UK have been outlined in the chart below:
WBTi’s research: Case studies of best practice The WBTi 2016 Report featured several case studies of areas who showed best practice in providing well joined up, integrated breastfeeding services: Brighton and Harrow.
More recently, our WBTi team has presented posters featuring these and additional case studies of best practices in providing integrated breastfeeding services: Medway, Harrow and Swindon.
WBTi Poster on Integrated Breastfeeding Services.
These examples of best practice in integrated breastfeeding services gave concrete results.
They demonstrated:
– a 2% rise in breastfeeding rates in a socially deprived area in 2018 (Medway),
– a 15% rise in initiation and a 12% rise in continuation of breastfeeding over a six year period (Harrow)
– and a 6% reduction in drop off rates from birth to 6-8 weeks over six years (Swindon).
Our WBTi team are always on the lookout for further examples of best practice in integrated breastfeeding services, and we submit them to Public Health England. Please do contact us if you would like to submit your local services!
Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group. She is also an accredited Leader (breastfeeding counsellor) with La Leche League of Great Britain.
For Day 2 of WBW we are very pleased to have a guest blog by Health Visitor and Clinical Research Fellow Dr. Sharin Baldwin.
Breast milk provides the ideal nutrition for infants and its associated benefits to the infant, mother and the wider public health are well documented. Traditionally breastfeeding promotion and advice have been targeted at expectant and new mothers, with an aim to increasing breastfeeding rates in infants. In recent years it has been acknowledged that partners play an important role in supporting women’s decision to breastfeed, while also providing practical and emotional support with the continuation of breastfeeding. Research highlights the important role of fathers in promoting and supporting their partners with breastfeeding (Tohotoa et al., 2011; Datta et al., 2012; Sherriff et al., 2014; Hansen et al., 2018), but in practice fathers continue to report inadequate levels of information and support from health professionals. Training for health professionals therefore should consider men’s needs relating to breastfeeding promotion and support, as well as women’s.
New fathers have often reported finding their partner’s breastfeeding experiences to be much more difficult than they had originally anticipated, with many not knowing how to help or support their partner with breastfeeding when they experienced difficulties (Baldwin et al, 2018; 2019). This is where health professionals can really make a difference. They can help educate and prepare expectant fathers better during the antenatal period by providing them with ‘realistic’ information about the time it may take for their partner to establish breastfeeding. It is also important to highlight some of the breastfeeding challenges they may face in early parenthood and what strategies or support are available to overcome them. This will help men to develop more realistic expectations of the processes involved with establishing breastfeeding and make them feel more empowered to support their partner when faced with any difficulties.
While fathers may not be able to be directly breastfeed their babies, they need to know that they play a crucial role in making breastfeeding a success. They can provide practical support to their partners through helping with household duties, giving them a massage, allowing them to rest, making meals and drinks for them, and giving them emotional support through regular praise, reassurance and encouragement. Good levels of breastfeeding support are likely to make the process easier and more enjoyable, while giving women the confidence to continue breastfeeding for longer. Fathers’ involvement in breastfeeding not only has the potential to increase breastfeeding rates and duration, but also contribute to better outcomes for babies, mothers and the wider public health agenda. So, let’s not forget about including fathers when having those crucial discussions and training about breastfeeding!
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2018) Mental health and wellbeing during the transition to fatherhood: a systematic review of first-time fathers’ experiences. JBI Database of Systematic Reviews and Implementation reports, 16(11):2118–91.
Baldwin, S., Malone, M., Sandall, J., Bick, D. (2019) A qualitative exploratory study of UK first-time fathers’ experiences, mental health and wellbeing needs during their transition to fatherhood. BMJ Open 2019;9:e030792. doi:10.1136/bmjopen-2019-030792 https://bmjopen.bmj.com/content/9/9/e030792.info
Datta, J., Graham, B., Wellings, K. (2012) The role of fathers in breastfeeding: decision-making and support. British Journal of Midwifery, 20(3):159–167.
Hansen, E., Tesch, L., Ayton, J. (2018) ‘They’re born to get breastfed’- how fathers view breastfeeding: a mixed method study. BMC Pregnancy and Childbirth, 18:238 https://doi.org/10.1186/s12884-018-1827-9
Sherriff, N., Hall, V., Panton, C. (2014) Engaging and supporting fathers to promote breast feeding: A concept analysis. Midwifery, 30: 667–677.
Tohotoa, J., Maycock, B., Hauck, Y.L., Howat, P., Burns, S., Binns, C.W. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International Breastfeeding Journal, 4: 15. http://dx.doi.org/10.1186/1746-4358-4-15
Author:
Dr. Sharin Baldwin PhD, MSc, PG Dip, BSc (Hons), HV, RM, RN, QN, FiHV, IHV Research & PIMH Champion
NIHR Clinical Research Fellow, University of Warwick
Clinical Academic Lead (Nursing and Midwifery), London North West University Healthcare Trust
This may be the end of World Breastfeeding Week 2020 but campaigning for good breastfeeding support to be readily available to all mothers with young babies and for society to value breastfeeding, in order to maximise the population’s health and help protect the environment, continues.
This year Covid-19 lockdown has been an added complication for families, with minimal face-to-face contacts, and we do not know how long restrictions will need to continue. This is your opportunity to let us know what support you think is needed in the months ahead by using the Leave a Reply button below. Reading S’s story may help you identify what’s needed.
S gave birth to her first baby R in January and movingly describes her experiences and how she found the feeding arrangement that worked best in her circumstances:
“So R turned 6 months old last weekend and he is really thriving! I am still breastfeeding him which I am so proud I continued with, and it definitely got easier as time went on. It has always been a combined method with the bottle but his milk intake of breast has always been at least 60-75%. My milk supply never caught up after the mastitis no matter how much expressing and breastfeeding I did, and I found it was also really hard to try and sustain that vigorous cycle with my ME – I started to have really bad days where I just couldn’t function so it was easier for my husband to feed R with expressed milk and top up with formula if necessary. I do feel that the routine we got into with breastfeeding, expressing and bottles was the best we could do in our particular situation and he’s such a healthy little boy. I’m really glad I persevered with it all.
We started baby-led weaning about a fortnight ago and R is loving interacting with all the different foods! He especially loves broccoli (he was so keen on it, that not only was he feeding himself the various stalks I’d put on his tray, but he was trying to lick the tray too to get all the broccoli off!!), avocado, sweet potato, carrot, pear and banana. He wasn’t so keen on mashed potato – he preferred to wear it instead!
Life has been really strange and difficult in lockdown if I’m honest. It’s felt quite lonely, as I’m sure it has for everyone else, but we’ve really struggled at times to keep going without familial or friend support. The extra perinatal support I was having became video calls which I’m really grateful for but isn’t the same as in person. Aside from the difficulties, he’s such a lovely happy boy – I’m so proud!”
Breastfeeding has been shown in many studies to be linked to better health in babies and mothers. As breastfeeding is the physiologically normal way for infants to be fed, it is more accurately stated that not breastfeeding is associated with poorer levels of health. This is not surprising as infant formula only provides the basic nutrition a baby needs (proteins, carbohydrates, fats, minerals and vitamins) but breastmilk is an amazing fluid with over 300 different components, as shown here. It includes growth factors, hormones, enzymes and anti-microbial factors as well as nutrients, and varies in exact composition according to the needs of the baby. It is therefore unique for each mother at each moment in time.
Knowing how amazing human milk is can help a mother have determination to overcome breastfeeding difficulties but it can also feel like pressure. What she needs is access to accurate information and suggestions, offered in a caring way after listening to her particular situation. That means that everyone who has contact with new mothers needs to have sufficient knowledge and person-centred communication skills.
Rachel describes her experiences of giving birth and breastfeeding during lockdown.
Rachel’s story
“During my three years of trying to conceive and infertility treatment I often fantasied about the closeness of holding my baby and feeding them. When I was lucky enough for my IVF to work, I moved on from worrying about if I could have a baby to if I could breastfeed. My mum assured me it was easy for her but her emphasis on its importance felt like further pressure. Many of my friends had stressful experiences and got medical advice that they needed to supplement with formula. Towards the end of my pregnancy I got a phone call from the hospital to explain all the benefits of breastfeeding and recommended I harvest colostrum at 37 weeks. I tried this but couldn’t get even a drop which further made me doubt my ability to breastfeed.
My baby was born in May during the pandemic, so I wasn’t allowed a water birth and my husband was only allowed in during active labour. This meant when I was 3 cm dilated and having intense contractions he had to wait outside the hospital in the car. They refused to check my dilation again for five hours due to infection risk and left me alone. When around 4 hours later I felt the urge to push I convinced the midwife to stay and help. When they could see my baby’s head, I was allowed to telephone my husband and ask him to come. My husband was there for the last 10 minutes but it had been a lonely labour due to COVID-19 without most of the plans I had made that involved a birthing partner.
After the birth the level of support dramatically increased with my husband and midwives all keen to help. My baby was placed on my chest and knew instinctively how to feed and stayed on for hours, it was amazing. I continued to use the gas and air for this first feed as for me the breastfeeding gave me very strong period-like contractions. After this first feed, I no longer had the period-like contractions, but my nipple started to become sore. I decided to stay a night in the hospital for some extra breastfeeding and baby care support, as most face-to-face community support wasn’t available at that time. The midwives repeatedly showed me how to improve my breastfeeding latch throughout the night.
The first breastfeed
Five days after the birth I saw the doctor for routine checks. The doctor calculated my baby had lost 7% of her baby weight (which I believe is normal) but she still asked if I was feeding my baby enough. She asked if my breasts were soft and empty after feeding. At this point my milk hadn’t come in so I didn’t understand the doctor even when I asked her to explain more and had to say no they don’t empty. She also had a look at my nipples and said they were cracked so insisted I must use a nipple shield and wouldn’t discuss any other options. After the appointment I cried in the car park that I couldn’t feed her properly and was failing as a mother. On the way home we rushed to shop for nipple shields (the first shop I had been in since the start of lockdown). I couldn’t get the shields to work and my internet research in some cases strongly warned against their use. I didn’t know what to do so rang my mum and then the hospital. I spoke to a lovely midwife who reassured me and said I didn’t have to use nipple shields and that my nipples could heal with continued feeding.
Due to COVID-19 I had a triage phone call with the health visitor the following week, to assess if I needed a visit. She decided that I needed a visit to weigh my baby and gave me leaflets about local breastfeeding support as my nipples were still painful during feeding. There was no face-to-face support available, but I had a video call with the breastfeeding advice line and joined a virtual group. These calls have been great for giving me personalised support to improve my breastfeeding latch so that feeding is no longer painful, listen to my concerns and build my confidence. It is also very convenient as I don’t need to leave my home for it.
My baby is now almost 10 weeks old and breastfeeding is going well. I can feed her watching TV, half asleep in the dark or on the bench in the park without much effort and with no discomfort. I am also pleased not to need to warm up formula as that might be harder when cafes and other facilities are closed due to COVID-19. I love being close to my baby during breastfeeding and being able to provide what she needs.”
Thank you very much, Rachel, for sharing your story.
As part of World Breastfeeding Week, #WBW2020 and #GreenFeeding, we’re emphasising the importance of mothers having easy access to good quality breastfeeding support, if and when they need it. This is partly provided by skilled people and partly by evidence-based written information.
This short leaflet for new parents gives tips about breastfeeding during the pandemic and also lists reliable sources of information and support. The aim is to help empower families who may be much more isolated than families generally were before the Covid-19 pandemic and have limited access to face to face help from health professionals and local breastfeeding support groups.
A slightly shortened two-page landscape version of the leaflet can be downloaded from here.
How do I manage as a new mother breastfeeding during the Covid-19 pandemic?
How can I best protect my baby?
Breastfeeding is one of the most important ways you can protect your baby. Your body makes antibodies in your milk which help your baby fight infections. Breastfeeding also helps babies develop a good long term immune system, and also help to protect mothers from breast cancer, heart disease, obesity and diabetes.
No evidence has been found that coronavirus is passed through breastmilk. Mothers make specific antibodies to any infections they are exposed to, and these pass into their milk. This means that a mother with Covid-19 can help protect her baby against all kinds of pathogens by breastfeeding, and may even provide specific antibodies to the novel coronavirus.
Covid-19 precautions
However a baby is fed, they could be exposed to Covid-19 if their carer coughs or sneezes over them so the parent/carer might prefer to wear a face covering when in close contact and needs to wash their hands regularly. RCOG (the Royal College of Obstetricians and Gynaecologists) provides more details under Advice for women with suspected or confirmed coronavirus infection who have recently given birth.
Fewer visits to GP or hospital
Exclusive breastfeeding for 6 months, then continuing to breastfeed alongside other foods, helps babies to be as healthy as possible and lowers their chance of needing to see a GP or have a hospital stay, e.g. for ear or chest infections.
Food security
Breastfeeding means parents do not have to worry about formula supplies or even shop for formula.
How do I know my baby is getting enough?
Babies are normally weighed at birth, 5 days & 10-14 days (when the health visitor usually takes over from the midwife). With the pandemic, there may be few opportunities to have your baby weighed or see your midwife or health visitor face-to-face.
However, your baby’s behaviour and nappy contents can help you know if your baby is getting enough milk.
The first 6 days are a time of change. From mid-pregnancy breasts produce a thick, usually yellow, type of milk called colostrum. A few days after birth, colostrum transition to more mature milk. The breasts usually feel very full at this time. The poos change too:
thick black meconium for the first couple of days after birth
green around Day 3 to 4
At least two yellow poos each day, by Day 5 to 6
A baby who is getting enough shows this pattern, takes themselves off the breast and generally settles after feeds. For photos of nappy contents see this NCT information.
From 6 days to around 6 weeks, milk intake is probably fine if:
your baby is usually contented after feeds
has at least 6 heavy wet nappies/ day
has 2 poos each at least the size of a £2 coin per day
After 6 weeks, some babies poo less often but the overall amount is about the same.
In the first two weeks, if your baby hasn’t pooed for 24 hours, contact your midwife and a breastfeeding helpline or local supporter for help.
How do I know breastfeeding is going well?
It’s going well if your baby is getting enough and you are finding breastfeeding comfortable.
Start4Life provides very useful information about how breastfeeding helps the health of babies and mothers and how to help your baby latch on well.
However, if your baby often falls asleep during feeds and wakes up again hungry after a few minutes, feeds are regularly longer than an hour, or it is uncomfortable or painful for you, the most likely reason is that your baby isn’t latched well enough to feed effectively.
How can I increase my milk supply?
If your baby is producing less wee and poo than expected, or you are topping up with formula,
can you breastfeed more often – another feed or two in 24 hours?
are you offering both breasts at every feed? you could switch back and forth during a feed
breast compression can increase milk flow
can you contact a helpline or breastfeeding supporter for more suggestions?
Remember – if you feel your baby is feeding very often, they are trying to get enough milk, and also helping to increase your milk supply.
And if breastfeeding isn’t going well?
To latch well the baby needs to gape wide, have the nipple in the upper part of their mouth, and chin pressed against the breast. Snuggle your baby close, head free, nose level with your nipple. This detailed information from La Leche League shows different positions you could try, and ways of helping your baby latch better.
If feeding is painful, or you are breastfeeding very frequently but your baby isn’t getting enough milk, get skilled help! You can also express your milk and offer your baby expressed milk until your baby starts feeding better and your nipples have healed. The Breastfeeding Network has information about expressing and storing breastmilk. Your midwife or health visitor can help you learn to use a cup or bottle safely.
Where can I get skilled help?
You can contact the local midwifery team or health visiting service using the phone numbers you’ve been given. Often there is an Infant Feeding Coordinator or team who can provide more specialised support. They may also put you in contact with a volunteer breastfeeding counsellor or peer supporter. There are several charities continuing to offer free skilled breastfeeding support (see below). Your GP is the appropriate contact for medical situations – such as mastitis that isn’t improving after 24-48 hours – alongside breastfeeding support.
Partners and family support
Her partner can be a huge support to a mother who is breastfeeding and one possible silver lining of the pandemic is that many are at home and able to give more support.
UK breastfeeding helplines
National Breastfeeding Helpline 9.30am – 9.30 pm
0300 100 021
La Leche League GB (LLLGB) (web chat and email also available)
0345 120 2918
La Leche League Northern Ireland
028 95 818118
NCT Helpline 8am – 12 midnight
0300 330 0700
Breastfeeding Helpline for Bengali/Sylheti speakers
0300 456 2421
Breastfeeding Helpline for Tamil/Telugu/Hindi speakers
NCT – details of free local Zoom support groups available via the helpline: 0300 330 0700
IBCLCs (International Board-Certified Lactation Consultants) – these may work for the NHS, voluntarily or provide a paid-for service. To find an IBCLC see the LCGB website.https://www.lcgb.org/find-an-ibclc/
Further information and self-help suggestions for common concerns listed below are described on several websites, such as the Institute of Health Visiting Parent tips, NCT’s information on breasts after birth and the NHS website.
My breasts are hard and painful
In the early days, this could be engorgement. Frequent feeding helps. La Leche League provides detailed information.
I have a small tender area in one (or both) breasts
This could be a blocked duct. Gentle massage over the area while feeding often helps.
I feel fluey and have a hot, hard, red area on my breast
This is likely to be mastitis. Removing milk, by feeding baby or by expressing, is the most helpful action, along with other self-help measures described here. La Leche League provides detailed information.
I think my baby has tongue-tie
A tongue-tie only needs to be divided if it is significantly affecting feeding. If breastfeeding is affected, the first step is to check the baby is as well-latched as possible. For families who may have to wait for treatment during COVID19, this is a very useful and detailed article by Sarah Oakley, IBCLC.
My baby takes a lot when I bottle feed
“I’m giving some top-ups for the moment because my baby lost too much weight but he takes a lot quickly and then is uncomfortable with wind.” Having the bottle level rather than tilted and giving the baby pauses helps the baby cope with the flow from a bottle and it can be easier to tell when the baby has had just enough. This is called ‘responsive bottle feeding‘.
My mother-in-law keeps wanting to give my baby formula
ABM (the Association of Breastfeeding Mothers) has a leaflet for grandparents to help them understand what is now known about breastfeeding.
I stopped breastfeeding but now I want to restart
This can be done but needs commitment as it takes a while to build up the milk supply again. You may find it easier if you have someone providing you with ongoing skilled support with relactation.
Our message to you
We hope the above information, and support options if you need them, can help towards you enjoying breastfeeding and continuing for as long as you and your baby want to.
Authors: The WBTi UK Steering Group – Helen Gray, Clare Meynell, Alison Spiro, Patricia Wise; design by Carol Smyth
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:
The value of human milk and breastfeeding.
Supporting infant feeding.
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.
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
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).
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 trends (UK) 