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Making breastfeeding work when you #StayAtHome

3/28/2020

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So, you are home with your new baby. Someone said something to you antenatally about ‘taking time’ as a new family, reducing unnecessary visitors and making a ‘new baby nest’.

And the world has taken it upon itself to make all that happen by arranging a global pandemic.

Slightly over the top perhaps, but here we are. I hope you have everything you need. And don’t be shy about asking neighbours to help you if not.

There are negatives in this situation for so many of us, but there are also some surprising positives. You will not get work harassing you to pop in for a meeting next week. You will not have your mum’s friend Sue ‘popping by’ to make unhelpful remarks about how often your baby is feeding. You will not be distracted by the desire to go to a restaurant on day 6. You can wear pyjamas all day and feel like you are helping humanity.

We always knew partners had a key part to play in helping to make breastfeeding a success (and a partner may be a husband, wife, parent or good friend living with you in isolation) but now you are even more special as access to face-to-face trained breastfeeding support is likely to be limited for all of us.

Breastfeeding has never been more important. It’s the perfect food for your baby and a wonderful medicine – giving pain relief and delivering anti-bodies and ingredients that kill and limit bacteria and viruses while providing calm and reassurance. It can also reduce anxiety for parents too and we know that when someone reaches their breastfeeding goals, it can reduce their risk of mental health problems.

This article is a summary of some key things you need to know to be the best enabler of good breastfeeding in the days and weeks to come.

1. Despite how it may feel, you are not alone.
 
In most areas, you are being called by your community midwife soon after getting home and if you need to be seen face-to-face, that can still happen. You will get a face-to-face visit within the first few days where your baby will be weighed. Most babies will lose some weight after birth but ideally not more than 10%. If you are ever worried about any aspect of feeding, find help. Don’t wait to see if problems will work themselves out. The breastfeeding support community (lactation consultants, breastfeeding counsellors and peer supporters) are sitting at home too. Calls to the helplines are answered by volunteers who are specifically trained in being able to talk about breastfeeding without being able to see you. It always sounds a bit daft, but we know how to support with positioning and attachment without being in the same room. Try the National Breastfeeding Helpline on 0300 100 0212 (9.30am-9.30pm).  There are several other helplines with different hours. You can also contact lactation consultants from across the UK who will use phone and video consultations to support you.  Many local breastfeeding drop-ins have moved to being online.
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Have a look here for details on how to find different kinds of support: https://abm.me.uk/wp-content/uploads/COVID19.pdf
 
2. Use technology to your advantage.
 
Many lactation consultants and local breastfeeding support teams are using remote support like Zoom consultations, WhatsApp chat, Facetime calls and Skype. We can SEE breastfeeding sometimes more effectively than we were able to before. It’s useful for us to check how a baby is swallowing (more on that later). Usually during a breastfeeding assessment, we politely lean over to take a look at the baby on the breast for a few moments. With video, and a moveable camera like a phone or iPad, we can hover 5cms about the baby’s cheek for 10 minutes and no one thinks we are weird.
 
It’s really useful if you can record some short videos to share with your breastfeeding supporter. Short ones that are less than 30 seconds will be easier to send. Take a video of the feed from different angles including standing a few steps away. We’re looking at how the baby is held, the arms holding them, the chair, the cushions. And close up too – from above and then come around to the side so we can see both of the baby’s cheeks. Stay above for a moment so we can see the baby’s chin moving as they are at the breast. And at the end of the feed, as the baby comes off, what does the shape of the nipple look like?
 
We will keep these videos securely and respect your privacy. We may suggest that during our conversation, we all watch the videos again together. A bit like you are a professional tennis doubles team and we are your tennis coach watching a replay. We’ll talk about what we notice and how perhaps slight changes can improve things.
 
3. If breastfeeding is uncomfortable, there are small changes that could make all the difference.
 
You don’t always have to be trained in breastfeeding support to be able to suggest some changes that could really help. If your partner is in pain, just one comment, just one observation could transform everything and help the baby to get more milk. Breastfeeding isn’t supposed to be painful. A stretching feeling in the first few seconds of early breastfeeding is not the same as a feed that is painful, hurts all the way through and leaves a nipple looking squashed/ pointed/ ridged. If breastfeeding hurts, talk to someone. However, you may also be able to make some suggestions.
 
Are they moving the breast TO the baby? Almost like they are bottle-feeding with a breast? Perhaps they are leaning forward, pulling the breast out of its natural position to reach the baby? If that’s happening, chances are that it’s shifting inside baby’s mouth once baby is on and bringing the nipple back to rub somewhere it shouldn’t. We talk about BABY TO BREAST. Make sure, if cushions are being used, they are the right height. Check they aren’t leaning forward to get to the cushion or lifting up their breast so there’s space for baby to fit in. This article outlines lots of the common adjustments that can make all the difference: https://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/breastfeeding-is-just-like-golf-a-tiny-adjustment-makes-all-the-difference.
 
We want the baby to come to the breast CHIN FIRST. The chin is the first thing that makes contact with the breast. We want the baby really close to you. If clothes are bunched up in the way, or baby’s hands are at their chin, they will get less breast in their mouth. And we want their mouth full of breast. If they come to the breast chin first, with the nipple under their nose, they are more likely to tilt back and get a good mouthful.
 
If I offered you a drink of water now, you’d naturally raise your chin away from your chest to swallow. Try and swallow with your chin pointing down – it’s hard. And it’s also hard to swallow if your neck is twisted. We want a baby’s ear, shoulder and hip to all be pointing in the same direction. Babies don’t like it if they don’t feel anchored and secure and they don’t like it if someone is pushing on the back of their head and holding their head tightly. They want freedom to be able to tilt their head back, so we support their bodies and around their shoulders. Often leaning back helps make breastfeeding more comfortable. Have a look at some of the resources online about biological nurturing or laid-back breastfeeding: http://www.nancymohrbacher.com/breastfeeding-resources-1/2016/12/26/natural-breastfeeding-video
 
Remind yourself about what an effective latch looks like by watching this video: https://globalhealthmedia.org/portfolio-items/attaching-your-baby-at-the-breast/
 
Sometimes a few days go past, or weeks, and things change without us even noticing. If breastfeeding has become more uncomfortable, it might be that a baby has got a little heavier and the position you used when baby was tiny now means their weight is pulling them off the breast.
 
4. Know how to measure how much milk is going in.
 
It’s true that most new babies are going to be weighed a little less over the coming weeks. Again, if you are really worried, there are people who may be able to support you with this, but we’re not going to be popping to the weighing clinic as we once did. Some families are hiring or buying baby scales to use at home. Sometimes this is valuable, but over-weighing is not always useful and can make you feel more anxious. Talk to someone about how often is sensible for your situation. It’s not a great plan to rely on using normal bathroom scales and trying to weigh yourself and then weigh yourself holding baby. This will often have accuracy problems and we are usually only talking about 100 grams here and there.
 
Nappies are the key. When a baby is one day old, we’ll see one poo and one pee in 24 hours. On day 2, two poos and two pees. From then on, we’ll see AT LEAST two poos every 24 hours (the size of a £2 coin or bigger). More poo is better and babies taking in lots of milk will do often more than 4. The poo will change in colour. The first day we will see black sticky tarry poo called meconium. As the days go by, the poo gets paler. By day 2-3, often a bit greenish. We don’t want to see black poo any more after day 4, and talk to someone if you do. By day 4-5, we should be seeing pale, mustardy poo. We carry on seeing several poos a day for the next few weeks. Only around 6 weeks does it slow down for some exclusively breastfed babies and their poo rate may start to slow down and they may skip some days. But young babies do not skip days. We need several poos a day to know milk is going in as it should.
 
With pee, we want 3 pees on day 3. Four pees on day 4. On day 5, five wet nappies. From then on, 6 or more heavy wet nappies in 24 hours. You shouldn’t have to think, “Hmmm, was there a pee?”, the nappy should feel heavy enough that you know. If you aren’t sure, talk to someone.
 
https://www.nct.org.uk/baby-toddler/nappies-and-poo/newborn-baby-poo-nappies-what-expect
 
5. Know how to see milk going in.
 
It’s not only nappies that can tell us a baby is getting milk. We can look at the top end too. I don’t mean a baby is being sick (although that sometimes happens, and if nappies are good and the baby doesn’t seem to mind, and it’s not projectile, that can be OK.)
 
I’m talking about knowing what a baby swallowing milk looks like. Breastfeeding happens for lots of different reasons. Sometimes babies are there to feel safe, to help them fall asleep, to feel comforted. All that is important and to be valued. Babies are supposed to ‘use us like a dummy’. They have a lot of brain development to do and they are learning important things about trust and comfort. But we don’t want them to only be on the breast to suckle and comfort themselves. It’s good to be able to recognise when milk is definitely going in.
 
At the start of a feed, a baby will suckle quickly to get the milk flowing. Then they will settle into a suck/swallow pattern where you will be able to hear them swallowing milk. In the first few days, when your milk is still the rich colostrum, you may hear less gulping. But when the milk has begun to transition around day 2-4 and it’s changing to mature milk which is lower in protein, higher in fat and higher in volume, you’ll hear some swallowing at the start of a feed. As the milk gradually gets fattier (which happens gradually as the minutes go by), you may notice they do more sucks for every swallow. But they will still be swallowing. How do you tell when a baby is swallowing?
 
Have a look at another video from Global Health Media:
https://globalhealthmedia.org/portfolio-items/is-your-baby-getting-enough-milk/?portfolioCats=191%2C94%2C13%2C23%2C65
 
And this video from Dr Jack Newman:
 
https://www.breastfeedinginc.ca/really-good-drinking
 
We’re looking for the chin to come down and a pause in the chin to indicate a swallow. By the way, you can’t always tell how much milk a baby is getting by counting how many minutes they are on the breast. A feed that lasts 30 minutes isn’t necessarily ‘better’ than one that lasts 8 minutes. It’s all about what they are DOING in those minutes.
 
This breastfeeding assessment tool from UNICEF Baby Friendly explains that an effective breastfeed may be anything from 5 to 40 minutes. There are lots of good ideas about how to check feeding is going well here:
 
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf
 
 
6. Feed often.
 
New babies feed frequently. You might have been told something about ‘feeding on demand’ and waiting for babies to tell you if they want the breast, but anyone who specialises in breastfeeding will tell you otherwise. SOMETIMES WE HAVE TO TAKE THE LEAD AND MAKE SURE FEEDING HAPPENS.
 
New babies can be sleepy. They sometimes have jaundice. They sometimes sleep through feeds and their blood sugar levels drop. We may have to be bossy at the start. Being bossy also reduces the risk of getting engorged which happens in the first few days and our breasts are moving from colostrum onto the next stage of milk.
 
We don’t want a young baby to go longer than 3 hours from the beginning of a feed to the beginning of the next feed. That includes at night too until we are really confident they are putting on weight and doing well. We will need to wake a sleeping baby sometimes. If a baby is sleepy, you might take off layers or tickle them or blow on them. As long as they are attached to the breast, you can also push milk into them using a technique called breast compressions: https://breastfeeding.support/what-is-breast-compression/
 
And just because we talk about not going longer than 3 hours, that does not mean we are aiming for 3-hour gaps. That really would be a minimum. Healthy babies breastfeeding will often feed a lot more than that. We need to respond to their requests to breastfeed as that helps make sure they get enough milk, they feed calmly and don’t take in more air because they are upset. It also means our milk supply gets the signals it needs. It’s important we don’t try and push babies to ‘go longer’ thinking that will make breastfeeding easier. It can have some serious consequences: https://www.unicef.org.uk/babyfriendly/breastfeeding-the-dangerous-obsession-with-the-infant-feeding-interval/
 
A baby asking to feed will show you in lots of different ways. They will be a little restless, move their head from side to side, open their mouths and sometimes make murmuring noises. They might suck on anything nearby. Crying is what we call a ‘late stage’ hunger cue. But if you are ever not sure a baby wants to be on the breast, you can’t go wrong by offering. You can’t overfeed a breastfeeding baby. If they aren’t wanting to feed, they may suckle instead. As mentioned before, breastfeeding has a lot of value that goes far beyond feeding.
 
7. Expect babies to want to be close
 
We are primates and like other primate parents, our babies want to be close to us. When they are close (and skin-to-skin isn’t just for straight after the birth), they are calmer. Their heart rate and respiratory rate is optimised, and it helps us to notice when they are asking to breastfeed. Babies like being held and you can’t ‘spoil’ a baby. They might like being held in a sling, which can also be helpful if you have other children to look after. They want to be close at night too. About 70-80% of breastfeeding families share their sleeping space with a new baby and it’s important to know how to do that safely. When we don’t prepare and fall asleep accidently when holding a baby, there is far greater risk. The BASIS website has guidance around safe sleep for babies: https://www.basisonline.org.uk/
 
8. If a baby isn’t feeding at the breast…
 
…You’ll want to get some help. You can call a midwife or a health visitor (once you have been discharged by the midwife). You can call a helpline or sometimes you may have been given a number to call at the hospital. In the meantime, there are ways to still get milk into your baby. You can hand express (take milk out of the breast by hand): https://med.stanford.edu/newborns/professional-education/breastfeeding/hand-expressing-milk.html
And you can give milk to the baby in different ways. Cup-feeding using something like an egg cup or small plastic medicine cup is one option (Do watch a video as it’s not pouring milk into a baby’s mouth and needs some care): https://breastfeeding.support/cup-feeding-newborn/
 
You can also spoon feed milk into a baby. Even getting them to suck on a milky finger may mean they take a little milk which may help them to breastfeed.
 
 
No one is expecting you to know everything. You don’t have to solve every problem or know every answer. There are lots of people who are here to help you. But there are some keys principles that will help you to feel more confident and help breastfeeding to go well: know that breastfeeding shouldn’t be painful, know how to tell if a baby is getting milk, know that we respond to baby’s requests for feeds but sometimes we may need to nudge, know where to get help.
 
If a parent breastfeeding does get unwell, continuing to breastfeed is ideal. Your baby will benefit from the anti-viral antibodies that are tailor-made to fight this specific virus and delivered in the milk. There is no evidence that the virus is carried in breastmilk. Some are choosing to express some extra milk and have a store of some milk in the freezer as a protection in case they feel very unwell. For most people, their symptoms will be mild and they can breastfeed as normal while being more careful around hygiene. You can read more here: https://www.breastfeedingnetwork.org.uk/coronavirus/
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Body confidence and breastfeeding: it's up to us to join the dots.

9/18/2019

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You are the most advanced human there has ever been. Thousands and thousands of generations have been preparing for your existence. Millions of years of births and deaths, predators catching prey, creatures mating at the exact right moment, an immense overcoming of unimaginable obstacles and here you are. It’s all led up to you.

Our ancestors would be blown away by our skills and our potential. And they’d probably want to throw something at us (hopefully not a hunting spear) when they realise how many of us spend so much time focusing on what we CAN’T do and our imperfections.

If they had been us, they would have been challenging others as the next leader of the tribe. Instead, we’re often wondering if our thighs are the right shape.

Or when the time comes to be a parent, do our breasts work as they should?

Breastfeeding struggles in our society for a dozen different reasons including lack of investment and gaps in health professional training.

It’s important to recognise that our attitudes to our own bodies are part of the problem.

Online surveys were conducted by the Mental Health Foundation with YouGov in March 2019 of 4,505 UK adults 18+ and 1,118 GB teenagers (aged 13-19). One in five adults (20%) felt shame, about one third (34%) felt down or low, and 19% felt disgusted because of their body image in the last year.

Among teenagers, 37% felt upset, and 31% felt ashamed in relation to their body image.
Just over one in five adults (22%) and 40% of teenagers said images on social media caused them to worry about their body image.

One survey of 11–16-year-olds in the UK by ‘Be Real’ found that 79% said how they look is important to them, and over half (52%) often worry about how they look. In a survey of young people aged 13–19, 35% said their body image causes them to ‘often’ or ‘always’ worry. 

When we believe our bodies are deficient on the outside, it’s not a stretch for us to feel they are also deficient on the inside? If we feel we are not enough, that is inevitably going to make breastfeeding a challenge.

As breastfeeding supporters are often parents ourselves, we are in a key position to shape how the next generation feel about their bodies and their breasts.

It can be easy to imagine that we are at an advantage because our children overhear the phone conversations and are with us when new parents stop us in the street and talk about nipples. They live in houses surrounded by books about breastfeeding and the normal function of breasts.

But in some ways, we may have to work harder.

​Our home may not represent the messages they will receive from the wider world. Can our pre-teens and teenagers come to us when they feel uncomfortable about breasts, don’t trust them, don’t like them, want to hide them? Our society sends contradictory messages about why breasts matter and it can be confusing.

These feelings do not magically disappear in young women once a positive pregnancy test is in their hands. The grinding pressure that your body is not ‘good enough’ does not disappear as the months go by. Nor do they disappear once breastfeeding begins.

As breastfeeding supporters, we have a duty to join the dots. Can it really be a coincidence that we struggle to maintain breastfeeding and trust breastfeeding when we struggle so much to have faith in our bodies overall?

In Sikhism, the human body is a gift from the divine spirit. When you war against your body – by believing you are deficient and need to change - you are in conflict against God but also in conflict against your own spirit. Even for anyone who isn’t religious, there is a spark of truth there. There’s a lack of peace that comes from feeling you are never enough – just one more pound lost, one more week in the gym, a wish that your facial features were someone else’s.

Of course, it’s not easy to find that peace. We live in a society where many people devote many hours to trying to unsettle us. It is someone’s job (a LOT of people’s jobs) to try and make you feel deficient. Something your ancestor with the spear did not have to worry about – he had different sabre-toothed tigers. Yours work for advertising agencies and large multi-national companies. They sponsor social media posts and pay celebrities to use their products. They hire models. They persuade supermarkets designers to put products in your face. You aren’t an individual to them but part of a sea of bank accounts and cash. They may not even be consciously aware they are one of the bad guys. They have absorbed this culture too and for them, this constant poking is part of normal. When they were younger, it was magazines and billboards that told them they weren’t ‘enough’.

Not all fashion models might be skinny and tall these days, but they are still conventionally pretty. If they are women, their breasts are symmetrical and round (which is often not the case in real life).
It’s interesting how the movement towards a wider representation of body image seems to have bypassed breast diversity. More than 50% of young people experience breast asymmetry as their bodies change and asymmetry remains very common in adulthood. When have we ever seen asymmetrical breasts on a photo, in a film, on television?

What are often called ‘saggy’ breasts are also a variant of normal breast shape. But our culture represents them as either something to do being an old crone or falsely, something to do with breastfeeding. In fact, sagginess is about a lot of things: pregnancy, smoking, weight loss. It’s true that as oestrogen is lost in menopause, connective tissue becomes dehydrated and breast shape can change. But young women can have breasts like that too. Look for the beautiful and brilliant Chidera Eggerue. Her description of trying to buy a bra as a teenager and finding every option available telling her that her body was abnormal is heart-breaking. Not all teenagers would come through that experience as she has.

Some will turn to surgery. Women still make up 92% of cosmetic surgery procedures in the UK. In the British Association of Aesthetic Plastic Surgeons’ 2019 annual audit, of the 26,043 procedures done on women, 11,741 were breast related.

We are finding that even today, surgeons are not telling the full story when it comes to the impact of breast surgery on future breastfeeding choice. A leaflet on breast reduction provided by a major professional surgical association contains one reference to breastfeeding and says, “Rarely, reduced sensation can cause problems with breastfeeding.”

In fact, those of us who support breastfeeding parents post-surgery know that when a nipple has been entirely removed and the intercostal nerves needed for a working milk ejection reflex have been severed, the complications can be significant. There are too many IBCLCs supporting new parents who were told, “breastfeeding shouldn’t be affected” by their surgeons. It can be possible to breastfeed and even exclusively breastfeed after surgery, but it often takes a great effort and the reality is not being shared. Perhaps not through intentional deceit, but by health professionals who lack an understanding of breast anatomy through their own training. If you are told women usually have 20-25 milk ducts (rather than an average of 9), you are likely to make different surgical choices.

We often say when we support new parents and babies that ‘there’s a lot of normal’. That is true of breasts specifically. How often do we talk to the mother who is worried because one breast has a pumping output of X mls and the other only Y? We reassure by saying that we are all a bit asymmetrical and it’s normal to have different pumping output. Wouldn’t it be amazing if she already knew that, because everyone expected breast asymmetry? Instead, she often feels like she has to fix herself.

Women often feel like they are supposed to be fixing themselves. Some of us will have supported mothers who apologise for their body shape. A breast that hangs low with a nipple pointing towards a mother’s lap is not the breast you will often see in the antenatal class handout. We meet them often. These mothers may feel they have to hold and move their breast to fit some sort of ideal: so they can use the breastfeeding pillow they are ‘supposed to’ or so they can do the ‘tummy to mummy’. In reality, their ideal breastfeeding position may involve a baby facing the ceiling and ‘tummy to mummy’ just means a baby having to twist its head uncomfortably.

As breastfeeding supporters, we need to bring the solutions to the mother and her body and her baby’s body. We look for the ‘angle of the dangle’. We don’t try and twist (nor literally twist) the mother to fit what breastfeeding should look like.

We may meet new parents with accessory breast tissue. When 1 in 18 (around 6%) have accessory breast tissue, that won’t take long. It’s rarely talked about. Chandler from Friends has a nubbin and that’s pretty much all most of us know.

Some of us will have accessory breast tissue but perhaps not be aware we have. It may only be in lactation, when that the mole on your tummy starts to do surprising things. You may be used to armpit tenderness during your menstrual cycle, but you are taken by surprise when you experience post-partum engorgement there. It can be frightening when everything you read, at one of the most vulnerable times in your life, tells you that you must resolve this ‘blocked duct’ or you will end up with mastitis. It might be that time and cold compresses are all you really need.

I attended an event in August led by doula Ruth Dennison (@121doula). It was focused on Black Breastfeeding Week and one of the speakers, Nehanda Truscott Reid (@soulamamacoach), led us through a breastfeeding mindfulness session which was powerful even though few of us were breastfeeding. Ruth also shared some breastfeeding affirmations with us. It’s easy to dismiss such techniques as ‘hippy’ or ‘cheesy’ but this is missing the point. It can do no harm to focus on positive messages. All day, and in the years prior to motherhood, we absorb the negative. We are told our bodies are deficient on the outside by powerful forces. Why would we not begin to feel we are deficient on the inside too? When we repeat positive messages and visualise positive messages, that can only be a good thing. We’re just not all used to doing it.

Of course, lactation cookies, taking handfuls of capsules and buying the most expensive pump feel necessary when you believe you are hard-wired to not be enough. When a baby seems unsettled, we’re going to doubt our own body first. Every time we pick up our phones are deficiencies are illuminated. So we need to shine a different light.

As breastfeeding supporters, we not just providing practical information and signposting and solving the nipple problems. We are helping new parents to see themselves in a different way.

We need to put young people in touch with the Chidera Eggerues and the Jameela Jamils. Having conversations about Instagram influencers and Snapchat filters and advertising imagery isn’t just about creating happy teenagers. It’s creating happy 50-year-olds. We need to join all the dots between celebrating body diversity and our ability to be successful human beings and that includes successfully breastfeeding human beings.

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Where's Booby?

9/2/2019

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Here's a conversation starter that can be used with any age group. Can you find all the babies in this picture? Which ones are feeding? Which ones were feeding 10 minutes before? Breastfeeding happens all around us and often we don't even notice when it does.
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Do minutes matter?

7/8/2019

3 Comments

 
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A new mum is asking for help. Her 8-week-old baby is refusing the breast and every feed is turning into a battle. She can get him to feed ‘a little’ and nappies seem OK for the moment but she’s worried that her supply will soon decrease and he’s going to have weight gain problems.

Breast refusal can be scary and we start with lots of gentle questions. She’s worried. Plus she’s upset that family members are telling her she’s given breastfeeding a good go and now surely it’s time for bottle-feeding.

It turns out there is one simple problem and it’s not breast refusal. This mother was told that feeds at the breast ‘should’ last a minimum of twenty minutes. She was told that if the baby didn’t feed for twenty minutes, her baby wouldn’t get enough ‘hindmilk’ and there would be big problems. She has spent the last hundred or so feeds thinking that something is horribly wrong and her baby is at risk. Many many minutes of anxiety and fear for no reason.

Breast feeds have been a battle because her baby is efficiently feeding for around 7-8 minutes (this is the feeding ‘a little’) and then baby and mother have been engaging in a wrestling match as she desperately tries to get to the magic twenty minutes and the baby is trying his level best to indicate this isn’t what he wants. He’s not breast refusing. He’s saying, in the only way he knows how, “For Pete’s sake, mum, I’m fine!”

The breastfeeding assessment tool from UNICEF Baby Friendly doesn’t talk about this 20 minutes minimum (https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implementing-standards-resources/breastfeeding-assessment-tools/ ). They say baby, “will generally feed for between 5 and 40 minutes and will come off the breast spontaneously”. This is true for an assessment being carried out by a midwife, a health visitor or anyone else. They might be looking at a newborn or an 8-week-old baby or an 8-month-old baby.

The myth of ‘at least 20 minutes on each side’ exists in many places. Sometimes it’s randomly 30 minutes or 15. I met someone who was once told 18 minutes which was a new one. It’s not necessarily in the baby books you might expect. They will often talk about being guided by the baby. Although it’s interesting how your brain might not absorb the reality of ‘being guided by the baby’ when elsewhere in the same book you’ve been told there’s a 20-30 minute average. Those are the numbers that often seem to stick in the brain of a brand-new parent. We like something we can grab onto.

It’s very hard not to believe that more minutes is ‘better’. SURELY more minutes means better milk and better quality milk. SURELY the short feeds are poorer and worth less. So logically when a baby who once went 15-20 minutes reduces to 7-8 minutes this feels like a deterioration and means bad things.

It’s a common call to the breastfeeding helplines that a baby seems to have suddenly reduced the length of their feeds. Something seems to kick in after a few weeks for many babies. It might be that tongues and cheeks and jaws are more developed and more skilled. It might be that babies are less sleepy and keen to get back to the interesting stuff of absorbing the world. It might be that our supply has increased and our milk ejection reflex is faster. And the same baby might feed for 5 minutes and then later 45 minutes, in the same day, just to keep us really confused.

It feels uncomfortable when it’s been drilled into you from the very beginning that there’s this special stuff called ‘hindmilk’ and it can only be reached after X (20, 30, 18) minutes. If your baby only feeds for 5 or 7 or 10, they will only be getting the ‘foremilk’? Won’t they?

Like most lactation consultants, I often say things like, “We used to talk about foremilk and hindmilk but actually…” Or, “ those terms aren’t very helpful.” Or, “there’s only milk.” Or, “any change in fat content happens gradually.”

When a breast is at full storage capacity, and the alveoli in the lobes are stretched to their maximum and a milk ejection reflex happens, teeny myoepithelial cells will squeeze the alveoli in response to the oxytocin hormone and milk will start to flood through the ducts down towards the nipple. That first flood is going to be high in water content (and lactose and other important things). It still gives energy, it’s still valuable and important, but the fat molecules won’t be maximised in that first flood of letdown. Fat is sticky and it’s stuck to the walls of the alveoli and to other fat molecules. It takes a moment for them to be dislodged and start to enter the milk and do their journey down through the ducts.

The idea that the fat won’t arrive for 5 or 10 or 15 minutes just isn’t evidence-based information. One fat molecule may break away immediately. And its friends will gradually find their way over the next few minutes. The proportion of fat will increase gradually and steadily. There is no ‘foremilk’ or ‘hindmilk’. There is just milk that gradually changes. And first milk that was lower in fat but rich in carbohydrates is not worth less.

There is such a huge amount of variation between breasts. That mum over there has 20 milk ducts. She has a forceful letdown reflex and when she gets a milk ejection reflex there are 4 visible sprays of milk that travel 5-10cm away from her body. That other mum has 6 milk ducts. Her letdown gently happens and there are 2 visible duct openings on her nipple and nothing that could be described as a spray, just some drips. Both are normal. And in both cases, their babies are doing just fine.

Perhaps one baby is buzzing with energy and gulps away loudly. Another baby is sleepier and pauses and swallowing seems more gradual.

One exclusive pumper fills a 100mls bottle in 6 minutes and has to change to a new one. Another exclusive pumper takes 15 minutes to get 40mls and has to use lots of hands on pumping and massage techniques.

How can it be possibly true that in all these situations, it’s taking 10 minutes for some theoretical stage to be reached in milk quality?

In one case, maximum fat levels may be reached in 6 minutes, in another 16 minutes and in another 26 minutes. If we say that ‘everyone must feed for 15 minutes on one side’, bad things will happen. Some babies will be in a constant battle where they are told they should be feeding longer, and they really don’t want to. Feeds will become miserable for both a mum and a baby. Other babies will be removed from the breast before they were ready to be moved and miss out on milk they wanted and needed.

We’ve been saying, ‘watch the baby, not the clock’ for a long time now. It’s rare these days to meet a parent who tries to feed on a three-hourly schedule (and very very rare to meet someone trying for four hours). Parents are getting the responsive feeding message and understand that cluster feeding might be normal and it’s normal for there to be variation as babies come to the breast for a meal or a drink or some connection.

But these same parents who understand responsive feeding are still sometimes focusing on minutes in a way that doesn’t always make sense. They KNOW deep down that breastfeeding is more than just a milk delivery system. They know it might sometimes be a baby who is thirsty on a warm day, hungry, unsettled or asking for comfort. They may even know that their milk production varies during the day and sometimes flow appears to be faster or slower and milk can change. But when their app on their phone counts minutes, a different bit of the brain seems to swing into gear.

I’ve had conversations where someone has told me that a 40-minute feed is ‘better’ than a 15 minute one. I’ve had conversations where a feed was unusually long because there was a latching issue and once that was corrected, the feed became more efficient and effective. But that was disconcerting for parents who always believed long means more milk and short means less.

And what about when the breast wasn’t at full storage capacity to start with? The foremilk/ hindmilk description becomes even more unhelpful when we’re talking about a normal day of breastfeeding where a baby might cluster feed or return to the breast after only 40 minutes or an hour. It might be that there is more fat in the first mouthful of a breastfeed than there was in the last mouthful of the day before.

You can drive yourself up the wall as a new parent trying to work out the science of the minutes of breastfeeding. Should I go back on the side he was feeding from half an hour ago? Will it have reset to ‘unfatty’ milk yet? What about if 45 minutes have passed, NOW should I offer the other side? What about if that last feed was really quick? Should I then go back to that side and ‘finish it’?

So I would try not to focus on this sort of detail. You are not going to be able to fine tune things to this degree. And you will also find that almost everyone you ask about what to do will give you a completely different answer – which is a clue that there isn’t one answer.

Instead, try and give breasts an even go of things (unless you need to spend more time on one breast for a specific reason). They should get an equal chance to be the first breast and get the enthusiasm of a hungry baby. They should get a roughly equal chance during the day. And if you returned to a breast when you ‘shouldn’t have’, the world is still going to turn and you will be OK. When we relax, we help oxytocin to do its thing. When we focus on 11 minutes instead of 9 and pressing buttons on an app, that doesn’t feel very oxytocin-friendly.

It’s helpful to understand what swallowing looks like so you can understand when milk is being transferred. Dr Jack Newman has a video called ‘really good drinking’ (https://www.youtube.com/watch?v=4aXY1fy75Is) and it’s useful to watch how the baby’s chin comes down with that deep drop. There’s a pause as the baby’s mouth fills with milk before they do another swallow. It’s not a flutter or a nibble.

Sometimes babies do take a rest. They may sometimes do a little flutter as they fall asleep, or wait for a new letdown reflex, but we would want to see some of that deep chin movement. You would expect to hear swallowing once the milk has transitioned from colostrum and milk has come in. You may not hear it all the way through a feed, but some audible swallowing is a marker for good feeding.

A baby that does that kind of drinking and comes off the breast by themselves happily (they might have fallen into a contented deep sleep) and the nipple is a rounded shape without being squished is in a good place. That might take 5 minutes or 7 minutes or 17 minutes. If it takes 57 minutes every time, I might suggest you get someone trained in breastfeeding just to check everything is OK.

Having said that, if you spend every feed with a fixed stare at your baby’s chin assessing swallows, I’m going to bet you’ll just move to count swallows instead of minutes. And there will be a ‘tap this button on your app every time you see a swallow’ along in just a moment. It’s about finding a balance.

What’s not OK is when a very young or sleepy baby is having a short feed without this kind of active feeding. A baby that falls asleep almost immediately and goes straight to the nibbly flutter needs some help finding his oomph. This kind of five minute feed is not the ideal. Babies might close their eyes and appear to be asleep when they breastfeed. Breastfeeding involves involuntary reflexes rather than a conscious effort. But there’s a difference between a baby closing their eyes and still doing those deep chin movements for several minutes and a baby that does an unenthusiastic flutter when you fiddle with their feet but not much more. There are people who can help you if you aren’t sure. We can talk about latching and breast compressions and helping a baby to get what they need. The answer is unlikely to be ‘more minutes’ as the key bit is what is going on in those minutes.

It's about looking at the big picture. Are you happy about what a baby’s nappies should look like in the first few days and weeks: https://www.nct.org.uk/baby-toddler/nappies-and-poo/newborn-baby-poo-nappies-what-expect

Are you happy about how your baby’s red book can be a tool that tells you how things are going (but it isn’t the only answer)? https://www.nhs.uk/conditions/pregnancy-and-baby/baby-weight-and-height/

Is counting the minutes really helping you? Are you looking at an app when you could be looking at a chin? If you start finding yourself thinking, “Yay, that was an 18-minute feed instead of a 12-minute feed, Woop!”. Pause. Will you feel that way when they are two and they take 16 minutes to eat pasta instead of 11? I know it’s different when they are breastfeeding because we can’t see what they are eating and it’s understandable that we are looking for proof. But counting minutes won’t give you that.

Know what swallowing looks like and over time you’ll relax about that too. You’ll develop a faith that things are going well because the evidence points that way. You won’t stare at their chin forever, and you’ll move onto eating your own snacks and enjoying a boxset.

If someone is saying, “she should be feeding for at least 20 minutes,” ask why? We know that it’s how you spend those minutes that really counts. You can drink beer through a tiny thin straw or be like a college fraternity brother on a challenge downing a pint. Breastfeeding is about what’s happening in those minutes and how you feel about them.

​Don’t let any app tell you different.
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A breast-shaped void: where are the breasts in the new sex /relationships/ health education curriculum?

4/12/2019

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After a long wait and a thorough consultation with more than 11,000 responses, the Department for Education released its updated guidance for Relationships, Sex and Health education a few weeks ago. From 2020, relationships education is compulsory in all primary schools in England and sex and relationships education is compulsory in all secondary schools.

As the chair of the Association of Breastfeeding Mothers and someone who writes about breasts for parents and young people, I predictably jumped on my computer minutes after its announcement and searched the fifty-page document for the word ‘breast’. There are zero responses. 

Disappointing.

While menstruation gets 13, and even gets its own sub-heading.


The PSHE Association scheme of work is recommended as a resource to be used in schools. Let’s check there. A scheme of work that covers 5-to-18 year olds. Anything about breast development, breast function?

There are three mentions of the word breast: two are about breast self-examination. Girls are taught about when their breasts are dangerous and pathological, but not when they are healthy and functional. The final reference in Key Stage 4 (14-16 year olds) talks of “parenting skills…to be able to make informed choices about parenting including issues around breastfeeding.”


‘Issues around breastfeeding’: there’s a phrase that doesn’t warm the cockles of your heart. Those of us who work to support new families to feed their babies can tell you something about the issues around breastfeeding. Girls are growing up not knowing how their own bodies work. They don’t know how breasts start to develop, so spend months thinking they may have cancer (because that’s the only time lumpy tender asymmetrical breasts get a mention) or they are abnormal. They are taught that breasts are to be hidden away and nipples made invisible. But then confusingly, women who show them in particular ways often seem to get more attention, especially on social media.

Girls rarely know that their breast tissue goes into their armpit. They can rarely use the word for the coloured ring of skin around the nipple (the areola) and they even less commonly know how to say it. It’s a clue this is a nationwide problem when 3 different pronunciations are all considered acceptable: arry-oh-la, a-ree-oh-la, uhrowla. They don’t know the very simplest facts about how their body might milk in the future or that breastfeeding isn’t just about making milk anyway but giving comfort, developing relationships and reducing their risk of maternal mental health problems.

The guidance claims to be about promoting healthy relationships, positive mental health and it claims to be about valuing parenthood. But there is a huge hole – and it’s breast-shaped.

If normal breast development and breastfeeding isn’t discussed in schools, we see the consequences years later when parents are expected to gain all their knowledge and confidence between finding out a baby is expected and its arrival. In 2017, The Royal College of Paediatrics and Child Health called on government to put breastfeeding into the school curriculum and that call has been ignored. It’s not about getting everyone to breastfeed. Some mums don’t want to, and some mums are unable to, but we know around 80% try to start and more than ¾ of them are let down by lack of support. We end up with a country with some of the lowest breastfeeding rates in the world as a result.

The new curriculum covers some tough realities: forced marriage, honour-based violence and FGM. Children are to be taught about the treatment of sexually transmitted infections and that alcohol and drugs can lead to risky sexual behaviour. They are taught about adopting and aborting a baby, but not feeding one. In Scotland, we can see places where breastfeeding is on the curriculum and schools can even be awarded ‘breastfeeding-friendly’ status. Why is England not joining up the dots? It’s not happening in this new guidance and it’s not happening in the science curriculum where pupils are taught about ‘the effect of the maternal lifestyle on the foetus’ but nothing about breastfeeding.

You can’t talk properly about ‘the changing adolescent body’ without saying the word ‘breast’. And if you don’t talk about breastfeeding, and instead the breast is simply a sexual organ, you are missing a huge section of the human experience.

If we don’t talk about healthy normal breasts openly, then when it DOES come time to worry about breast self-examination, the discussion is uncomfortable and embarrassing. Young women avoid doctor visits and worry alone. If we don’t talk about what breasts can do, that gap gets filled with a conversation controlled by photo-shopping, air-brushing and breasts as commercial tools to sell products. When girls and women don’t feel like they are good enough, they are encouraged to spend money to fill the void. And women who don't feel they are good enough and their bodies are deficient become mothers who don't feel their bodies are good enough.

We might imagine that retail and modelling has become more body positive but look closer. Breasts aren’t yet part of that conversation. The larger models being used have round, even, symmetrical breasts with invisible nipples. Attractive models of any size don’t sag, breasts are immoveable and symmetry is essential. We have a long way to go and it’s dangerous when we think ‘real women’ are being celebrated when parts of them are still required to fit an ideal of artificial perfection.
​
We need to get this right now. We need conversations in schools and we need to talk about real breasts doing real things. If we don’t get this right, those of us supporting new mums, and talking to young women about their body image, will pick up the pieces in years to come.


"The Breast Book: A puberty guide with a difference – it's the when, why and how of breasts" is available now.
http://www.pinterandmartin.com/the-breast-book

​​https://www.amazon.co.uk/dp/1780664753/ref=cm_sw_r_tw_dp_U_x_p9mSCbCWGFCPX
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Grannies matter

10/19/2018

3 Comments

 
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​Yesterday, I met a wonderful granny. I was doing a home visit and she was staying with her daughter after the arrival of a first grandchild. She had that ability to be present without being THERE all the time. She sat quietly during the consultation and sometimes appeared to be doing something else, but her ears were always on. When her daughter asked a question, she was there. She made comments at the right time and had the needed balance of encouragement and acknowledging this was hard.

At one point, the mother was looking forward to reducing bottles and moving to more breastfeeding. At the moment, she’s doing the grim routine of breastfeeding and pumping and bottle-feeding and it’s tough. She was wondering whether to retain one bottle for her husband to give her a rest and her mum reminded her that once she’s just breastfeeding, a breastfeed can feel ‘like a rest’. It’s a ‘sit down’ and a chance to take a load off. That’s often true in a society which expects mums to complete a dozen other tasks on top of looking after a newborn. And the daughter smiled. Right then, she needed that reminder things were going to get easier.

This granny had breastfed. She remembered one child being easy and one child being harder, but breastfeeding was her normal. She was relaxed around breastfeeding. She trusted it. She knew it worked. That trust for breastfeeding had seeped into the pores of her daughter. Despite her struggles, she had a confidence that her problems could be overcome, and her husband shared that confidence. I didn’t get to meet his mum.

I meet a lot of grannies. I meet the ones who make an excuse to get me into the kitchen and it turns out they weren’t a cup-of-tea pusher (as many are) but they desperately wanted a moment to talk about their own breastfeeding experience. It was decades ago – usually 30 years plus – but there’s an emotional mother in front of me and she’s not the one I was expecting to be trying to help. She might be worried about her daughter or grandchild but often she’s reflecting on her own mothering experience and she wants to share. She might want to tell me that she didn’t breastfeed at all and she needs me to know that. Sometimes she’s filled with regret: “I wish I knew someone like you when my babies were small” is a common phrase. Sometimes she’s angry about the lack of support she received. I’ve even had anger about the lack of support she received from her OWN mother.

When we support a mother, we are shaping a future grandmother too. One day she might be cornering someone in a kitchen. What will she say? Will she be filled with sadness, angry that her local breastfeeding group got cut, angry about her lack of midwife visits? And we’re making the great-grandparents too. The gaps in support now will be felt for generations. And when support is there for new mums, we are helping an infant who may not be born until the next century.

It takes a great maturity to own your own regret, appreciate what happened to you and how YOU were failed and move on to be the kind of grandparent needed for a new generation. It’s an enormous ask. And how much easier it is when a woman was able to reach her own breastfeeding goals and breastfeeding for her is a fond memory, not a space where she is feels awful.

The grannies I meet in kitchens sometimes thought all was well. They didn’t realise they DID regret anything. Feeding their infant was a very long time ago and it’s only when they are suddenly faced with seeing breastfeeding again, a surge of emotions has taken them by surprise.

Sometimes we know that surge can lead grandparents in unhelpful directions. It’s a natural instinct to want to protect yourself. It’s natural to want validation that what you did was ‘the right way’. How you chose to mother is at the heart of who you are as a woman. And after a long time, you might have forgotten that perhaps you didn’t always get to choose how you fed your baby. Was it your choice when your healthcare professional told you to only breastfeed every four hours, or not to breastfeed at night, or to keep your baby in the hospital nursery for hours at a time? You were sabotaged, but you may not have realised it at the time.  You may not be conscious that trying to lead a new parent down the same path is another act of sabotage.

Now, a baby is in front of you again. This new mother is making very different choices. She’s doing this thing called ‘responsive feeding’. She’s hardly using a cot. She doesn’t seem to mind when her baby feeds again after only an hour. She’s not even that keen to put the baby down. That can all feel very alien. It can also feel like an implicit criticism of the first few weeks and months you spent as a mother. You remember being worried about babies being ‘hungry’ and wanting to fix that, but this mum hardly seems to mind why her baby might want to come to the breast. It takes a special person to take a pause and acknowledge that some of your struggles might be because of your need to validate your own mothering choices.

If you didn’t breastfeed at all, you want to believe that your children are healthy. Seeing someone who is unhappy about giving formula is a tough thing to see when it was ALL you did. Even reading leaflets and books can be challenging.

If you did breastfeed, it may have been in a very different way. Someone told you not to ‘spoil’ your baby and you believed them, and it’s feels uncomfortable to imagine you might have been misled. Perhaps your own mother or mother-in-law didn’t provide you with the support you might have wished for and now you are trying to break a cycle. It’s hard.

Thank you for being there in a world where new parents can often feel alone and isolated. I’ve seen what a difference you can make. I salute the granny who was waking through the night to sit with her daughter-in-law while she breastfed (and was in charge of nappies and winding). I salute the granny who wore a baby in a sling while a mum slept. I salute the granny who lived far away and whose gift was the time of a postnatal doula in some difficult weeks. And for some mums without partners, the granny can be the partner in raising a child.

There are grannies out there right now who are holding people together in the best way. There are the ones who lives far away who send the ‘I’m  proud of you’ texts. And the ones who send the articles about breastfeeding. We don’t care that we’ve seen the article 5 times across 3 different forms of social media – we just care that you sent it.

No one expects you to know everything. It’s OK to ask questions about breastfeeding and it’s great if you do some reading. You can even do it before the baby arrives. It’s important to know that new families sometimes want some time without grandparents at the very start and that’s no reflection on you. Encourage honest conversations about how much help they need and how they want to make use of you.

Your job is to empower the new parents to be the new parents they want to be. It’s going to be different from how you made your choices. And that’s OK. Science and research show us new things. You did what you did based on the knowledge and society around you. They will do their thing too and it might all change again in a few more decades. We all do the best we can with what we know. If you say the wrong thing or blurt something out, that’s OK because no one is super human. Just give yourself space to reflect and learn and if you need help, it’s OK to ask.

If you are feeling things you weren’t expecting, you call a breastfeeding helpline too. You really can. The National Breastfeeding Helpline is 0300 100 0212. We can answer your questions about the mechanics of breastfeeding and things that are confusing you, but we can listen to feelings too. We know that mothering can bring up strong emotions. Even if the feeding was a long time ago.
 
 
Reading:
The Importance of Dads and Grandmas to the Breastfeeding Mother by Wendy Jones
https://abm.me.uk/breastfeeding-information/grandparents/
The Positive Breastfeeding Book by Amy Brown
The Womanly Art of Breastfeeding 

And a final word to say, I'm sorry if you are a breastfeeding mum without a granny in the picture. I know that can bring all kinds of emotions. Breastfeeding counsellors might be able to offer some support to you too.
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Announcing....The Breast Book. Coming from Pinter & Martin in March 2019.

10/7/2018

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​When breasts first start to grow, no one talks about it. There aren't any greetings cards that say, 'Woo Hoo! Your breasts are developing!' but you get a birthday card when you are ten and that's just about planet Earth going around the Sun ten times.

​
Why don't we say, 'Woo Hoo!'? Because we live in a society where we often get uncomfortable and look at the floor when it comes to talking about breasts.

They seem to be important in lots of ways but then there are these confusing rules that say when we're allowed to notice them and talk about them, and when we're not.

This book tells you all about breasts and helps you to feel confident about their arrival. They are much more than just a pair of bumps that can fit into a bra. Breasts can do amazing things that scientists are only beginning to understand. This book says, 'Woo Hoo!' and 'Wow!' and 'Isn't that amazing?' It says, 'Congratulations!' and also says, 'I know this feels a bit weird too.' Your body has looked the same for a long time and now things are changing. That can take some getting used to.

Let's get to know more about our two lifelong buddies with the WHEN, HOW and WHY of breasts.

You can pre-order The Breast Book here: 

www.amazon.co.uk/Breast-Book-puberty-difference-breasts/dp/1780664753/ref=sr_1_3?s=books&ie=UTF8&qid=1538903852&sr=1-3&keywords=emma+pickett

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Sometimes responsive feeding looks like this...

9/5/2018

1 Comment

 
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The mother above is practising responsive feeding but… brace yourself…her baby showed absolutely NO feeding cues before the breastfeed started. Wasn’t remotely interested. No cues. No ‘demand’.

And…put on a second brace…the mother looked at her watch before starting a feed. The feed started because of the clock.

How can that be?
Isn’t responsive feeding all about being ‘baby-led’?
Shouldn’t the mother be feeding in response to the baby’s cues and messages?
Isn’t responsive feeding simply another way of saying ‘feeding on demand’ but we don’t use the word ‘demand’ anymore because it sounds a bit bossy and rude?

Nope.

Responsive feeding is not just a polite way of saying ‘feeding on demand’.

Let’s imagine this mum was looking at her watch because she has to go and pick her toddler up in an hour. She wanted to get a feed in before she had to leave.
Still responsive feeding.

Let’s imagine she has to leave for work. She has a Zumba class. She wants to go and have a bath and leave the baby with her partner.
Still responsive feeding.

She’s feeling engorged. She is feeling anxious. She just had a horrible phonecall and really wants a cuddle.
Still responsive feeding.

Because mums can have ‘demands’ too. They are allowed to have needs and urges and instincts and wishes. Responsive feeding is a two-way street. It’s a relationship between two people with back and forth and compromise. Sometimes one takes the lead. Sometimes the other.

It’s not a mother under the control of a teeny babygro-wearing master (or mistress).

Mothers can make decisions too. They can take the lead. They can be demanding. Sometimes their feelings might take priority for a while. Responsive feeding isn't all about a mother sacrificing her own needs. Or always putting herself second (or third or fourth).

Responsive feeding is two people meeting each other’s needs. The mother won’t get milk out of the arrangement but then the baby often isn’t looking for milk alone either. Responsive feeding meets the emotional needs of both mother and baby.

Here are some extracts from the UNICEF Baby Friendly infosheet which can be found in full here:
https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf

“Responsive breastfeeding involves a mother responding to her baby’s cues, as well as her own desire to feed her baby. Crucially, feeding responsively recognises that feeds are not just for nutrition, but also for love, comfort and reassurance between baby and mother.”

“She can also offer her breast to meet her own needs, for example before she goes out, before bedtime or because she wants to sit down, rest and have a cuddle with her baby.”


So, yes, sometimes a new mother might feed ‘by the clock’ and that can be OK. She might want to breastfeed for her own reasons - and that's how it's supposed to work.
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"COME ON ENGLAND!"

6/25/2018

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​This is the week when I’m supposed to be #celebratingbreastfeeding and I can’t do it.

I’m sorry.

The last fourteen years of my life have been about breastfeeding: doing it, reading about it, qualifying as a breastfeeding counsellor and then a lactation consultant, taking helpline calls, running groups, doing home visits, writing about it, getting a breastfeeding tattoo and helping to train others.

If I can’t find it in me to #celebratebreastfeeding, we’re in big trouble.

It feels dishonest to focus on celebration when I’ve lost count of all the campaigns from local families desperately trying to save their breastfeeding support service; when I get another text from someone in a hospital bed; when I hear of a mother desperately trying to find a specialist who understood the complexities of her situation and being told they were on maternity leave and no one is available.

Where I’m sitting now, there is no infant feeding coordinator in post in my London borough. Our last specialist left several years ago and was replaced by a lovely health visitor who wasn’t a breastfeeding specialist and she has now left. The last job advert read like the job of three people combined.  We were going to have breastfeeding champions – health visitors and health professionals trained to give some extra support in breastfeeding. That initiative has gone away.

A couple of miles south, mums can meet a breastfeeding peer supporter in hospital and she might then come to your home. In my borough, you don’t get home visits.

You had a c-section? You have mobility problems? Shame you don’t live just one street over, isn’t it?

You want to meet someone who understands the implications of the fact you had breast implant surgery on the NHS aged 18 and can talk to you about how to maximise the amount of breastmilk your baby will receive? You want to meet someone who can assess your baby for a tongue tie (which was mentioned briefly at the hospital but the person who mentioned it wasn’t qualified to do a referral)? That sometimes seems to be more about luck than anything else.

You might only have a breastfeeding support group in term-time. You might only have a breastfeeding support group because a group of volunteers are busting a gut to run marathons (LITERALLY run marathons) to raise money to pay for a room. You might only have access to an IBCLC because one happens to volunteer in your area OR a local midwife self-funded to get specialist training in breastfeeding.

You might have NO support groups because someone actually believes a health visiting service can simply take over a breastfeeding support service. Health visitors weren’t exactly having long coffee breaks and twiddling their thumbs waiting for things to do before, you know.

I meet a midwife who has been 'told off' for spending too long trying to support a mum to breastfeed without pain. I meet another who tells me that when she looks at the list of women she has to see that day in the community, she finds herself hoping that not very many are breastfeeding – they are likely to be the ones who need a longer appointment slot and she’s not been given the time. I meet another who says she had half a day of Powerpoint slides as part of her training on breastfeeding.

I meet a doctor who says she is embarrassed when she realises how little she knew about breastfeeding before she had her own children. Actually, I’ve yet to meet a doctor who DOES NOT say that.

In 2018, Scotland published the results of their national feeding survey. Rates at six months are up. How does that compare to England, you ask? WE DON’T KNOW and we won’t know because it’s not considered important enough to find out. The last set of figures are from 2010.

100% of Scottish babies are born in UNICEF Baby Friendly accredited settings. How many in England? 58%

Can we see the English national strategy on infant feeding and talk to the English national lead on infant feeding about this? Sorry, no. Because England doesn’t have those things.

At the time of the World Cup, I need to shout LOUDLY, “COME ON ENGLAND!” and I don’t give a hoot about the football.

Don’t ask me to #celebratebreastfeeding when I just feel like crying.

What can we do?

Tell our MPs to attend the All party parliamentary group on infant feeding and inequalities. This is about supporting all babies and with Brexit approaching, formula fed babies are at risk if laws that protect the quality of formula are threatened. If your MP doesn’t think feeding babies is important, it’s time to have a word.

Write to your MP and ask them to press the government to do more about breastfeeding support, ask THEM to ask for information. Tell them about cuts in your area.  If you had time to read this article, you had time to write to your MP. I think sometimes people hold off writing to their MP because they imagine it has to be a well-crafted eloquent essay. They can cope with two paragraphs where you explain that infant feeding matters to you, tell them what is happening locally and ask them to press the government to do more. Busy people, or people who don't write much, are allowed to have strong opinions too.

Fight when cuts are announced. Sign this petition: https://www.change.org/p/steven-brine-mp-uk-minister-for-public-health-and-primary-care-end-cuts-to-breastfeeding-support-stop-letting-down-millions-of-mothers
And respond to this survey about the impact of cuts: https://tinyurl.com/yars43rg

Join up the dots to the areas people are talking about. The Health and Social Care committee have highlighted the links between obesity and infant feeding: https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/882/88202.htm
Don’t forget babies in conversations about obesity.

And don’t forget feeding support in conversations about maternal mental health. It is unethical to promote breastfeeding without giving mums the resources they need to be able to reach their feeding goals. When mums want to breastfeed and they are unable to reach their goals, they are at significantly greater risk of developing mental health problems.

Be a customer of the NHS. We are grateful for the NHS and like having affection for an old aunt, it can feel a bit cruel to make complaints. We are not complaining about individual staff, we are complaining about the system that is failing them too. We need to COMPLAIN when our hospital isn’t Baby Friendly accredited. Why not? Who do we need to write to and say that isn’t acceptable? COMPLAIN when you can’t speak to a breastfeeding specialist. COMPLAIN that your neighbour gets a home visit and you don’t. COMPLAIN that your midwife didn’t have time to watch your breastfeed.

 And if someone offers to bring you round a lasagne post-natally, thank them for the lasagne but ask them to stay and type out the letter to your local hospital while you dictate.

We need to STOP BEING SO ENGLISH AND MAKE A FUSS.
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Friends in your pocket: a few words about online breastfeeding support.

4/29/2018

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Picture
 
I have a friend who I’ve known for nearly 14 years. We got to know each other when our first children were tiny. We share photos and stories. We share a similar sense of humour. When we were bleary-eyed with baby days, we were often in touch several times in 24 hours. I know that if I were to ask her for advice and support, she wouldn’t hesitate, and she’d be honest and helpful.

But of course, because why would I be mentioning her in this article otherwise, we’ve never been in the same room. We’ve never met. She’s a friend in my pocket, in my phone and sometimes on my laptop (although that needs really big pockets).

If you’d told me twenty years ago I’d spend more time talking to people each day I hardly ever meet (and many people I will never meet) than ‘real life’ friends, I’d be very very worried.

But for many new parents in the 21st century, it is completely and utterly normal. These are the friends who live all over the world. You find them in nooks and crannies on the internet and you both recognise a kindred spirit and you hang on to each other when things seem shaky. The original forum/ group might sometimes have long gone but the connection hasn’t.

There are hundreds more online semi-mates who you bump into in your Facebook group or forum and you share information and stories. There are the faces you recognise, the admin you trust and the mothers you offer to support and encourage at 3am.

Online informal support is not going to be a substitute for real life groups and face-to-face sessions. Does anyone really need to spell that out? And I’m talking about real humans, not even ‘bots’ who read out bits of websites at you. No mother really thinks that when she has damaged nipples and she knows the latch isn’t right, Cassie from Swindon writing twenty words is the answer ahead of the lactation consultant she can call tomorrow or the trained breastfeeding counsellor at the group three miles away.

But you know what, Cassie is there at 11pm when you are praying your baby doesn’t wake up because you are in so much pain you just can’t face another feed. And she’s followed moments later by six other people who were in your shoes just a few weeks ago.

Cassie can link you to a video which has some great suggestions and she knows that this matters to you. This is a group that listens to what your goals are and when you say it’s important to you that you make breastfeeding work, they get that. They are there for the lows and the highs. Your group is a place where you can celebrate, and your team are happy for you. You can share what really matters to you with joy.

Here are 8 things that make online breastfeeding support extra great:


1. People who listen first and ask more questions.
When a mum says she’s uncomfortable, you ask more. Does she mean her nipples? Her breasts? Her back or her shoulders? What has she tried so far? What does she think might be happening? Of course, not every mum supporting online is a trained breastfeeding supporter, but some principles apply to everyone who is offering help. Great people ask for more information.
 

2. Knowing that your experience is not everyone’s.
It can really be tempting to talk about ‘what worked for you’ straight away but first, we start with what does that person want and need.
 
 

3. Knowing that this is a conversation with a lot of vulnerable people eavesdropping.
The person who started a post might not even be the person who benefits the most from it. They may be too shy to start a conversation or someone who searches on the group weeks and months later. They may be people who don’t know the lingo so a lot of ‘DD’ and ‘DS’ and even the occasional ‘IYSWIM’ and ‘AFAIK’ can be off-putting and isolating.
 

4. Knowing what you don’t know.
I have been known to literally cheer when I see someone saying, “I’m not sure” and signposting somewhere else. Three cheers for the person who says, “there could be an underlying issue we can’t identify here so why don’t you talk to X”. And a wet raspberry to the person who just says, “pump more,” or “It sounds like you definitely have thrush.” You don’t know someone’s mental health or their physical health. You don’t know someone’s support network. You may not be aware of something that someone trained is aware of.
 

Who do you refer to? With any medication question, it can be the drugs in breastmilk service run by the Breastfeeding Network. https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/. The answers might be on the drug factsheets or you can email or send a Facebook message.
 
It might be someone needs a breastfeeding support group. They can be found through the ABM page, the Breastfeeding Network page or simply by googling someone’s town and ‘breastfeeding’.

The National Helplines can be invaluable. Their volunteers will be trained to ask the right questions.

National Breastfeeding Helpline – 0300 100 0212
Association of Breastfeeding Mothers – 0300 330 5453
La Leche League – 0345 120 2918
National Childbirth Trust (NCT) – 0300 330 0700
 
They might need a lactation consultant (lcgb.org) or a private tongue tie practitioner (www.tongue-tie.org.uk).
 
They might need to go back to their GP or their midwife or their health visitor.
 

5. Reading what other people have already said.
Hooray, for the person who says, “I can see someone earlier said, Y and I just want to add Z” and wet raspberry to the person who just repeats what’s been said an hour earlier. If you’ve got time to read the original person’s question, you’ve got time to read at least some of the comments already there. You might be missing a big twist. Perhaps someone earlier asked some questions and learnt something crucial and your contribution might not be reinforcing what is helpful. Sometimes it’s better to step away and write when you do have time to reflect more carefully. It’s better to say, “I’m sorry I don’t have time to read all the comments, but I just wanted to say that I’m sorry you are having a hard time,” than to post a suggestion without reading a chunk of conversation and missing something important. Yes, it might take time to load comments on your phone. Still better to wait and brownie points for the people who take the extra few moments to find out what’s going on, so they can offer proper informed support.
 

6. People who are kind.
They know that the first job is help someone to feel supported. They might not agree with an earlier comment, but they manage the situation with an emotional intelligence that means the original poster doesn’t feel like she’s in the middle of a squabble at a time when she feels vulnerable. They know that new parents get stressed and people can misread tone on the internet and they give people the benefit of the doubt and ask before making assumptions. They are kind enough to give of themselves and try and help.
 

7. Fab admin.
Three cheers and then another three cheers for the admin of Facebook groups and online forums. They are the people who know when it’s time for a conversation to end. They know when to gently raise an eyebrow when the mother worrying about milk supply is told to eat lactation cookies and drink lots of water. They know when to link to the right article and signpost to real life when someone else is simply saying, ‘not to worry’ about a baby not putting on weight as we might hope. There’s a team that look after each other. No admin gets to the point of feeling burnt out and there’s a very careful rota system.  The reason why the breastfeeding charities don’t tend to run their own online support groups is because the burn-out is a huge problem and when a volunteer who’s been trained for sometimes two years plus burns out, that’s a huge loss. Being an admin is a big responsibility. Once you are known to represent a particular organisation, it becomes an actual legal responsibility. Even without that, you are taking on responsibility for the health of the most vulnerable. You need a team who look after each other. Great admin makes a safe space. The best admin knows they might have more to learn because ANYONE worthwhile in this world knows they have more to learn. Without them, thousands and thousands of new parents wouldn’t get the help they need. Thank you, online admin stars.
 

8. The ‘specialised’ groups.
The one for breastfeeding twins and triplets, the one about relactation, the one with people breastfeeding older nurslings, the one that contains your team who get exactly what you are going through and when you found them you felt like you were home. Yay for the people that thought to start them and yay for the people who hang around even after their own experience ends to support those who might be struggling.
 

Online breastfeeding support can be magic. It can inform us and encourage us and direct us to the right information. It can connect people and be the ‘village’ we’re told so often we need to raise a child. In a local breastfeeding support group, what would be chances have been that you would have found someone with this shared experience?

Friends in our pocket can help us get is through the day. Just raise an eyebrow at anyone who claims we can do without the support that doesn’t fit in your pocket too. Families need it all.
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    Author:
    Emma Pickett IBCLC

    Find me on twitter: @makesmilk

    Find me on pinterest: 
    https://www.pinterest.com/makesmilk/youve-got-it-in-you-a-positive-guide-to-breastfeed/

    A Lactation Consultant supporting families in North London.

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