Do you think you might want to train as a breastfeeding counsellor?

Here’s a quick quiz…

1.       Do you find a woman breastfeeding in public puts you off your coffee because…

(a)    It’s a bit awkward

or

(b)   You sit there wondering whether she’d mind if you went up to her and congratulated her for feeding in a café

(and after much deliberation you eventually decide on the ‘warm smile/ thumbs up’ combo)

If you answered ‘a’, this is probably not the article for you.

2.       Can your facebook wall easily display photos of the breasts of five different women from two different continents in one week?

3.       Does your partner mention to pregnant strangers that they might want to talk to you about breastfeeding?

4.       Does your mum save newspaper clippings of articles on breastfeeding? (when you actually heard about the article two weeks ago and have already have three online discussions about it)

5.       Do you wish everyone could breastfeed for as long as they want to and you get frustrated when you hear that doesn’t always happen?

This may be the article for you then.

Becoming a breastfeeding counsellor in the UK is fundamentally about volunteering your time to help mothers to reach their own breastfeeding goals. You will need to be able to empathise, offer emotional support and information. You will need to appreciate that not all breastfeeding mothers look the same or make the same choices. You will not be offering ‘advice’ but empowering mums (and their partners) to make their own decisions.

It is immensely important and rewarding work and breastfeeding counsellors are desperately needed.

It's worth noting that this is not going to be a new career path for most people who train as a breastfeeding counsellor. If you train as an NCT practitioner, you may be able to make a career out of it. There are also some paid breastfeeding support roles available in some parts of the country depending on projects in your area, but these are few and far between.

What is for sure is that the skills you learn, the experiences you have, the people you meet will make this worthwhile – both in a ‘future employment’ sense and a wider life-changing sense.

There are four main organisations you can train with in the UK. There are some things different about the training (cost, location, philosophy of the organisations).

There are some things that are the same about all of them:

You’ll be focusing on the needs of the mother and baby and putting your personal experiences to one side whenever possible.

You will use good listening skills to support mums and their families.

You will be expected to provide evidence-based information – that means information based on science, research and best practice. You won’t be giving personal opinions.

You’ll be working as a team with other people supporting the mum. You may refer to GPs or health visitors or midwives. Breastfeeding counsellors don’t work in isolation and are great at sign-posting to other services.

You’ll get on-going training and supervision to help you in your role.

Here’s how you can go about getting trained:

If you want to train with the NCT, you have a couple of options. You can take the paid option to become a self-employed NCT practitioner. http://www.nct.org.uk/nct-college/work-opportunities#level5   NCT BFCs may take sessions of antenatal classes, run support groups and work on the NCT helpline. The course costs approximately £6,500 and takes two years to complete. It can be done in less time if you study full-time. There are some bursaries available. You study for a foundation degree with the University of Worcester and take the ‘breastfeeding pathway’. You start with the essentials course to become a ‘birth and beyond practitioner’ and then go onto do the breastfeeding specialism.  You will need to have breastfed one child for at least six months. The breastfeeding pathway consists of 3 modules (counselling skills, applying counselling skills, understanding women’s experiences of breastfeeding): each requiring 2 study days and 5 tutorials. Some of the study days will be at the University of Worcester and some arranged in a more local area depending on numbers of students. The course will include writing a 3000 word essay, short answer questions, tutor group discussions and a range of learning experiences.

You can also qualify as a VOLUNTEER NCT breastfeeding counsellor: http://www.nct.org.uk/nct-college/course-options/nct-voluntary-role-breastfeeding-counsellor-training.  You need to have breastfed for a minimum of six months before you apply. The training costs £625 rather than £6500. It still takes a couple of years and is spread over 15 tutorials and study days. Again locations vary but some sessions will be at the University of Worcester. Babes-in-arms can come to study days and you can bring an older breastfeeding child too provided you also bring an extra carer for them. Volunteer counsellors support mothers without receiving payment and may support at drop-in groups and throughout their local community.

If you train with La Leche League, you’ll be called a La Leche League leader rather than a breastfeeding counsellor: https://www.laleche.org.uk/content/thinking-about-lll-leadership.

It’s a good idea to read the La Leche League book, 'The Womanly Art of Breastfeeding' (which is a good read for anyone interested in breastfeeding) and familiarise yourself with the ten concepts that are important to La Leche League. That’s not to say a La Leche League leader wouldn’t support any breastfeeding mother whatever her parenting views but just that the La Leche League is underpinned by a philosophy that will shape your appreciation of the mother/ child relationship and all leaders will share:  https://www.laleche.org.uk/sites/default/files/LAD%20Brochure%20final%20Jan%202011.pdf
You should also find out if there are La Leche League meetings local to you and attend some. 
https://www.laleche.org.uk/find-lll-group

You’ll be expected to have breastfed for at least nine months. Many leaders train with an established leader at an established meeting but if you don’t have one close enough to you, there are other ways of doing it. The training is a combination of face-to-face and written work and can take two years depending on your pace. The pace will be very individual to you and might depend on things like the age of your children. You can find out the current fees by contacting LLLGB.

La Leche League leaders will usually support at a local meeting (they may share running a meeting with other leaders) and can also support on the LLL helpline.

You can also become a breastfeeding supporter with the Breastfeeding Network. That’s their word for a breastfeeding counsellor equivalent – not to be confused with ‘peer supporters’ from other organisations who will have done a shorter course. Training happens locally and is face-to-face: http://www.breastfeedingnetwork.org.uk/get-involved/train-to-be-a-registered-volunteer/

Opportunities depend on funding and what is available in your local area. This is what is currently available: http://www.breastfeedingnetwork.org.uk/get-involved/train-to-be-a-registered-volunteer/areas-where-we-are-able-to-provide-some-training/

You will not have to pay any training fees. You start by training as a breastfeeding HELPER and then you can go on to do the supporter training if it’s available. Helper training consists of 12 two-hour sessions and babes-in-arms are welcome. Supporter training usually takes approximately two years to complete. The expectation is you will volunteer for the BfN after your training by offering face-to-face support at groups or on the BfN helpline or National Breastfeeding Helpline (phone or webchat). The training will often take place in tutors’ homes and consists of written and oral work.

The last charity you can train with is the Association of Breastfeeding Mothers. Like the Breastfeeding Network, you start with the first level course (which the ABM calls ‘Mother Supporter’ course) and then you can go on to train to become a breastfeeding counsellor which takes approximately 18 months to two years. http://abm.me.uk/about-the-abm/training-with-the-association-of-breastfeeding-mothers/

You need to have breastfed for a minimum of six months before you apply. The course costs £100 and you also have to be a member of the ABM. It is then expected that counsellors volunteer on the helpline for a minimum of two years after training. The ABM helps run the National Breastfeeding Helpline with the BfN and have their own helpline. Many ABM counsellors also support in their local community. The ABM training is a distance learning programme. This means that you submit written modules and communicate with tutors via email and phone and through online discussion. There are some practical activities such as observations and practise phone calls and you are required to attend one study day a year. The advantage to a home study course is that you don’t have to leave young children and the training can happen anywhere. However it is not a learning style that works for everyone and requires independent organisation and reading at home. There are eight additional modules after the initial Mother Supporter course has been completed.

So those are your options. If you read those descriptions and felt excitement and anticipation, this may be a path for you. If you read them and thought, ‘that sounds like a tremendous hassle’ – perhaps not.

There are other ways you can support mothers depending on your passion and your experience:

You may be interested in becoming a doula (breastfeeding support is often part of a doula's role too): http://doula.org.uk/content/becoming-doula
Or perhaps training to become a home start volunteer: 
http://www.home-start.org.uk/volunteer/
Or volunteering for a charity like Bliss: http://www.bliss.org.uk/get-involved/ or PANDAS, who help mums with depression: 
http://www.pandasfoundation.org.uk/get-involved/volunteering.html#.VHSVZYusXg8

On Twitter and Facebook, you’ll find counsellors and trainers from all of these organisations who I’m sure will be happy to answer any of your questions.

If you have the time and the inclination, you can make an incredible difference to the lives of new mums and babies. Your commitment is desperately needed.

Information accurate as of November 2014. Check website links for current updates.

It's World Breastfeeding Week. Another café is offering a free drink to breastfeeding mums.

And another one.

And another one.

I'm meant to think this is great. Surely if anyone would, it would be me?

Co-chair of a national breastfeeding charity. IBCLC. Breastfed my children for longer than considered interesting by a few tabloid newspapers. Spend most of my time thinking about breastfeeding, reading about breastfeeding, knowing how tough it can be for new mums to venture out in public, supporting mums to reach their breastfeeding goals.

But I don't think it's great. Sorry. And no, I won't 'lighten up' and just 'appreciate it for the positive gesture it is' and 'stop being daft'.

Free drinks are lovely. But they aren't so lovely when the sign advertising them causes a tear to come to someone's eye and causes a new mum to bite her bottom lip so that she can hold it together long enough to pay for her coffee.

Like most of us who are dedicated to breastfeeding support, I see a sea of faces of mums who didn't get to breastfeed in the way they wanted to. It didn't quite work out. It was too difficult.

The hospital staff were overstretched. The midwife didn't come on Day 3 after all. That GP didn't know what to do apart from give antibiotics. That group was closed because the children centre was only funded for 'term time only'. That lactation consultant, however brilliant, was too much money. That relative wasn't supportive. That antenatal class didn't talk about this. That tongue-tie was missed. That latch actually WASN'T alright and that pain wasn't 'something I'd get used to'.

Mums are being failed by breastfeeding support in the UK. 90% of those who gave up in the first 2 weeks didn't want to give up.

And you know what, I can carry my own bottle of water and pay for my own drink. Can I buy a coffee for the mum who's trying to fight back the tears over there please as she brings out her bottle of formula?

She's trying really hard to breastfeed at home. She's trying really hard to pump. But she usually takes a bottle out because it's hard to latch on in public when you usually cry out in pain and then you and baby both end up crying.

Of course, that other mum who is breastfeeding has worked bloody hard too. Just because she was lucky to get the right support, doesn't mean she doesn't deserve a drink.

Can they both get one? Because being a new mum is hard.

Can they sit down together and both get a drink? I don't want a sign that puts these women into different groups.

I want breastfeeding to be normal, ordinary, unspecial and something that anyone who wants to do it, gets to.

I wasn't a goddess, a 'wonderful' mum who deserves a sit down and a treat. I was a mum who was lucky enough to reach my breastfeeding goals. In this country, that sometimes does feel like it's down to luck.

Bob is 18 months. He is breastfeeding on demand. This usually means breastfeeding at least 6 times in 24 hours.

Billie is 3 years old. She breastfeeds in the morning, at bedtime and usually once during the night.

Let’s imagine you are Bob or Billie’s mum and you want to end breastfeeding.

First, let’s take a moment to check this is a decision you are happy about. Am I going to try to talk you out of it? Nope.

I breastfed both my children until they self-weaned and I speak to mothers breastfeeding toddlers every day. I know it isn’t for everyone.

If you are in the tiny minority of mothers breastfeeding well into the second year and beyond, that is something to be celebrated and praised and baton-twirled.

You get to choose when you stop.

The job of the breastfeeding support community is to enable each mother to reach her own breastfeeding goals. When it comes to breastfeeding an older child, we are allowed to listen to our own maternal instincts. Not everyone’s maternal instincts tell them the same thing.

However this is an important decision so let’s do a few checks.

If you are 100% confident with your decision, feel free to skip to the row of asterisks.

Are you ending breastfeeding because you want to conceive again and you believe weaning will be necessary?

Every woman’s fertility responds differently to breastfeeding. To conceive, we need oestrogen levels to rise again and ovulation to occur and then we need the womb to receive a fertilised egg and give it enough chance to hang around and implant properly. Most women do not need breastfeeding to end completely for this to happen. However most of us do need at least one gap of 5-6 hours without any breastfeeding in 24 hours.

It might be worth experimenting with night weaning or extending intervals in order to trigger your period before ending breastfeeding entirely if you’d rather not. Get familiar with your cervical fluid (or as my friend Sarah Panzetta, a fertility expert, calls it, ‘your lady liquid’) and get a sense of what it’s likely to look like when you ovulating (stretchy and egg-whitey). Some people are told they need to wean from breastfeeding in order to start another round of IVF. That is a very difficult and personal decision.

We can probably say that is likely that you would be maximising your chances of conceiving by ending breastfeeding. You may still decide you’d rather continue breastfeeding.

Are you ending breastfeeding because you need to take medication and the doctor says you have to?

Check. Many many women are told this inaccurately. In the UK, the Breastfeeding Network is a great source of information – both their medication factsheets and the ‘drugs in breastmilk’ helpline. You can also check with LactMed or the resources (book and website) of Dr. Thomas Hale. There are many lactation consultants available through Twitter who would be happy to check for you.

Are you ending breastfeeding because someone else is putting pressure on you?

Is this someone who you feel has a right to comment on your body and what you choose to do with it? Is it someone who you feel has as much right to make decisions about your child’s health and happiness as you do? If you answer yes to both of those questions, then you may feel you want to listen.

However, you should also feel you have the right to explain very clearly why this matters to you and carry on. You have the right to continue even though other adults in your life are uncomfortable. Just because we live in a society which squirms at the idea of breastfeeding older children, it doesn’t mean a push into unhappy weaning is the ‘right’ opinion. You have science on your side.

This is a decision you will live with for a very long time. You have invested a huge amount in making breastfeeding work up until now. For many women, it has taken literal blood, sweat and tears. You have spent hours and hours and hours breastfeeding. One day, decades from now, you may be a grandmother and breastfeeding will be part in your world again. Wouldn’t it be great to look back with no regrets and know that you stopped breastfeeding at a time that was absolutely right for you?

Your nursling can’t speak up. If you are being pressured to wean when you don’t want to, you may need to be brave and speak up for them.

Are you ending breastfeeding because you aren’t getting enough sleep?

One possibility is to night wean and see how that feels. It may enable you to continue breastfeeding for longer than you imagined you would. You can follow the suggestions below and pause at any point in the process.

***********************************************

So we’re going to try and wean Bob. He’s breastfeeding a lot. He breastfeeds in the morning and at naptime. He falls asleep breastfeeding at the beginning of the night and breastfeeds during the night several times. He uses the breast for comfort when he feels sad or shy. It’s the first thing he wants when he falls over. When you sit together on the sofa, he wiggles over and lifts your shirt with a big smile on his face. He loves it all.

Have you done anything wrong by parenting this way up until now? No, you have not. You have followed your instincts and met his needs and what a lucky little bloke Bob is.

This is clearly going to be tough and Bob may be sad but YOU ARE STILL ALLOWED TO WEAN.  This is your choice and you will be able to make it happen with the minimum amount of upset if you are sensitive and careful.

Some things to bear in mind before we start:

This is not about milk – completely. This is about YOU. Bob is connecting with you and being as close to you as he possibly can. He is feeling safe and loved and cosy and warm. Your milk still contains immunological properties and Vitamin A and protein and all the other useful things. However Bob’s breastfeeding behaviour is about security and love and not much about Vitamin A.

So don’t offer milk in a bottle or sippy cup instead and not in response to a request to breastfeed. Don’t offer milk in a cup at bedtime instead of that connection with you. That’s like you asking a loved one for a hug and he gives you a sausage roll. You may be a big fan of sausage rolls but right then, in that context, that’s a rejection.

We need to talk about ways of trying to avoid the ‘rejections’. It may not be entirely possible but we want to minimise them as much as possible.

Don’t offer another person instead. Does it seem entirely logical that at the moment we are pulling bits of ourselves away from our nursling, we pull our entire self away?

Does it seem logical to leave your toddler for a night or longer just to wean from breastfeeding when breastfeeding was about connecting with you as much as the milk?

We need to show that you are still there and you are still very much there for connecting – just not at the nipply bits.

You will still be there at bedtime when he feels scared and vulnerable. You will still be there for comfort. You will be there for him when he’s going through this really tough transition of losing breastfeeding. Does it seem sensible to pull yourself away when he’s potentially going to be losing something that really matters? You are the person he really needs to help him through this.

Of course partners and dads are a key part of this process but in addition to mum – not instead of. I hope daddy/partner is part of the bedtime process and able to comfort your child. I’m just not sure it’s brilliantly sensible for you to be stepping away and leaving them entirely to it.

Together – all 3 of you (mum, partner and nursling) – you will be making new routines and patterns and developing a new parenting language.

That doesn’t take a night and it probably doesn’t take a week. It might take a week for the 18 month old who is only breastfeeding a couple of times in 24 hours and falls asleep without the breast in his mouth – but that isn’t Bob.

First steps:

While it’s true that this isn’t simply about milk, Bob has been having quite a lot of milk which have met a lot of his nutritional demands and provided a portion of his hydration through the day. We need to look at his diet. Is Bob confidently using a cup? Would he be able to indicate if he was thirsty? Can he help himself?

What will be Bob’s sources of calcium, protein, vitamins and minerals and good quality fats? It might be that Bob enjoys drinking cow’s milk but he also might really not. Does he eat dairy? He would ideally get around 300ml of full-fat cow’s milk a day. If he won’t drink milk, he can eat cheese and yoghurt and you can use cream and butter in cooking. He might like a yoghurt-based fruit smoothie or a milkshake. There are other sources of calcium and other minerals like green leafy vegetables, nuts and tofu. Bob doesn’t need to drink a commercial formula. Full-fat cow’s milk is the recommendation.

Take a moment to reflect on what his nutritional sources will be. Do some research.  He’s been taking a significant portion of his calories overnight so you will need to look at extra snacks and opportunities to offer food once that’s gone.

Now it’s time to look at sleep skills. This may be the most difficult aspect of the process so we need to address it from the beginning because it could take the longest.

Bob right now has a prop dependency – a loving and comforting prop dependency. He’s using the breast to aid his drop-off to sleep and he’s using it to transition between sleep cycles at night. As he moves between sleep cycles, he fully rouses and seeks the breast to help him move on to the next sleep cycle. Some babies need dummies replugged or a pat. Bob has a breast as his sleep prop. For lots of mums, this is not really something that bothers them and it can continue until it naturally fades. But if you want to wean from breastfeeding, it’s a problem for you.

Night weaning

You can’t end breastfeeding until you have helped Bob find a new way to sleep. If we just take breastfeeding away suddenly, it’s really not very fair. This has been the way Bob has fallen asleep for a very long time. Sleep time is often when we feel the most vulnerable and when we can really get into habits.

Imagine you’d always fallen asleep by putting your head on a pillow and turning out the light and thinking peaceful thoughts and someone suddenly announces sleep isn’t allowed to happen this way anymore and you have to touch your nose with your thumb while whistling the star-spangled banner. You’d quickly become distressed and angry and think the whole thing was entirely unreasonable. You literally wouldn’t know how to do it.

You would probably prefer to make any transition gradually and with the support of someone you love.

A really good resource for this stage is ‘The No-cry Sleep Solution for Toddlers and Pre-schoolers’ by Elizabeth Pantley. You may already have read about her ‘pull-off’ method in her book aimed at babies. You would start a feed as normal but then resist the temptation to feed right to the end when your toddler is in a deep sleep and absolutely out for the count. You would use your little finger and break the latch just before they completely fall asleep. The first time, it really would only be seconds before. You want them to do the final drop-off from drowsy to deep sleep without the breast actually being in their mouth. You are right there but the breast has been removed. If your nursling fully rouses at this point and searches for the breast, you may gently place your hand on their chin to see if they might still settle. If not, and they wake further, you latch them back on again and try a few moments later. Then, over several nights, you would gradually detach them earlier and earlier in the process. After a while, you may feed them and after the feed they may still pretty much be awake. It has been a gentle and slow process. They learn how to fall asleep without actually sucking. What then often starts to happen is the nursling who can do the final drop-off without the breast being in their mouth is less likely to rouse between sleep cycles during the night. They semi-wake (as we all do between sleep cycles at night) but feel safe about moving onto the next sleep cycle without needing their prop.

At the same time as working on the pull-off technique, you can work on introducing a different structure for bedtime.  Before you even start, you could introduce a lovey – a comfort object that could become associated with sleep and bedtime. It could be cuddled between you during night time breastfeeds. Then as the feeds start to change, the lovey is still there. You could also think about singing a little song that is your ‘bedtime song’. This is a song that you initially sing during the breastfeed and as the breastfeed fades, it’s a new part of your routine. It might happen during the final cuddle or if they appear to rouse and be looking for comfort. It’s calm and soothing and – this is the important bit – you don’t mind singing it every night for a while. If you are feeling very creative, choose a tune you know well and write your own lyrics about your day and your loved ones. Or choose a little poem and phrase that says, ‘this is sleep time now’.

As the breastfeeds end, the song or the poem is still there. It remains consistent. It’s the sign that it’s sleep time now. You are still there and we’re just removing the prop of the breast.

As your nursling finishes a breastfeed more and more awake, you’ve got the chance to insert other things as your new ‘final stage’. You could read a story. It is sometimes said that sharing a book with your toddler is more similar to breastfeeding than offering a cup or bottle of milk. You are devoting yourself to your child. You are sharing a connection. They have your attention and a cuddle.

There are even some books on the process of weaning and night weaning that you might find useful. I don’t mean books for you about technique but picture books for both of you that will usually have illustrations of jolly toddlers and rested mothers greeting the sunrise. ‘Nursies when the sun shines’ is a classic example.

You could also make your own book. Make a photo book using one of the online photo companies about your night weaning journey. Toddlers at this age love seeing photos of themselves and their friends and family. It could just be something as simple as saying ‘goodnight’ to all the things he loves. And I dare you to have ‘good night mummy’s boobs’ on the last page. ‘See you in the morning!’

So the breastfeeding moves back further. After it comes the story and the song (bored of it yet?). Then one day, breastfeeding happens in a different room and then before bath and one day, it gets dropped. Perhaps that night something exciting happens instead – a new toy in the bath, some ice cubes to play with. The breastfeed is something that he will want to get out of the way to get onto the fun stuff.

Some people prefer to leave the bedtime breastfeed as the very last one that gets dropped when full weaning happens. You may have been working on daytime feeding while this whole process was going on. The point is though that we may need to start AND finish with the weaning the bedtime feed because the process of setting up a new routine could take a while.

When a nursling wakes up in the middle of the night, we can hopefully develop new techniques that help them transition without using breastfeeding. Ideally now that we’ve done the pull-off, we are getting fewer night wakings but we may still see some. What else will make your toddler feel calm and safe? You may be able to use some of those techniques from bedtime. The lovey is there. You can sing your special song and use your special phrases. You may stroke and pat. You may put on a gentle piece of music or white noise. You’re going to be finding your own strategies.

There may be tears. It may be tempting to offer the breast because this is too difficult to manage. You have to follow your instincts. You may discover you are not ready to wean and you can cope with just one feed at night. You may decide that some tears of frustration are going to have to happen because you are absolutely ready to end this stage of motherhood. Try and be consistent.

Daddy/partner can be a great help but you also need to develop your boob alternatives now – the way you will show physical love and give your mothering comfort.

Some 18 month olds are verbal enough that they can understand that milkies are sleeping now and they will be awake in the morning – cuddles instead.

What about weaning breastfeeds in the daytime?

Once you have broken the sleep prop, the process will get easier. You will need to ensure of course that naps can happen without breastfeeding. Now the rest of the weaning is about distraction.

We are trying to avoid the need for refusal. This is a key aspect of weaning all older nurslings. You sometimes hear the phrase ‘Don’t offer, Don’t refuse’ used as a weaning technique. It will work for everyone in the end but sometimes we need to jiggle our day around so we don’t actually get to the point of being asked if we want weaning to happen more quickly.

Once we get to the point of being asked, refusal means rejection. Not just a missing out on milk but a rejection from mummy. The request and breastfeed was a way that toddler communicated with you. He asked and it happened and it was magic. It was a dialogue between you that made him feel empowered and special. Really not just about the milk.

What other things can be ask for? Make a special box of books he can request. Make a snuggly book nest with pillows and beanbags. Instead of asking for a breastfeed, he could lead you by the hand and ask for a ‘book cuddle’. Or a dance? Or a big squeezy cuddle with a raspberry on his neck?

You may need to restructure your day for a while - more time outside or at activities. Perhaps meals as a picnic if he normally asks for feed at the dinner table and climbs onto your lap. Perhaps moving the special chair where he normally asks for a feed. In the morning, it’s a big hug and a scoop out of bed and a race downstairs to find the little ice cube tray full of fun snacks to avoid the morning feed. Or Thomas The tank Engine says good morning in a silly voice before mummy says a word. Distraction.

You may need to get up a little earlier for a while so you’ve got the energy to think ahead before he wakes and starts asking.

When you see the glint in his eye that indicates an ‘ask’ is on its way, think imaginatively. It’s really not about offering a cup of cow’s milk instead.

Some toddlers will do really well with limits. Some are starting to become fascinated by counting. If you’ve not managed to avoid ‘the ask’, how about? “We’ll have milkies for as long as it takes mummy to count to ten”. Count as fast or as slow as you like. You are in control. Talk about what you will be doing next. If there’s a big protest at the end of a feed? “OK, one more. Do you want ‘count to ten’ or ‘count to eleven’?” He is control too.

Pre-schooler Billie

A lot of the techniques will be the same for three-year-old Billie. She’ll also need to learn how to drop to sleep without the breast and transition between sleep cycles in another way. It’s likely she’ll have a much greater understanding of what’s going on and you can talk about your plans together.

You may decide to use a token system. Each morning you could give her 2 or 3 (or however many) tokens and she can swap them for breastfeeds at any time but she won’t get new tokens until tomorrow. The tokens may be plastic gold coins (that one seems a bit too ‘Wolf of Wall Street’ for some) or perhaps little stretchy bracelets that she wears in the day and takes off each time she wants to ‘buy’ a breastfeed.

Again – you are both in control. She gets to decide whether to hold on to her tokens. When she requests a feed you might talk through her decision: “Are you sure? Because that means you only have one left for tonight? It’s up to you but maybe check you’re really sure.” You may well find she gains comfort from keeping that last one ‘just in case’ and it never gets used. Gradually there are fewer tokens given.

She would also be old enough to talk about a weaning party or special treat. We don’t want too much emphasis on the ‘you’re a big girl now’ stuff because that sounds pretty scary. Big girls want cuddles and mummy too – but she might be ready for something new that celebrates her moving on.

It’s OK to talk about what’s happening. This is her first intimate relationship and you are teaching important lessons about empathy and understanding. Mummy’s milkies are getting ready to stop breastfeeding soon. We will find new ways to give cuddles and be close. A three year old may also have ideas about a cosy reading corner and a new bedtime routine.

Remember

This might not be easy but you are allowed to stop. You have given such a magical gift to your child but that doesn’t mean you have to continue breastfeeding beyond a point that feels right for you. I once heard a mother of a toddler say she simply couldn’t ‘bear’ breastfeeding anymore. She counted the seconds in her head until each feed finished and felt physically uncomfortable. Is it in that toddler’s interest for his mother to carry on?

If we say mothers of older nurslings are not allowed to wean, we will be frightening people of younger children who will feel stuck on a path. We do not want a world where mothers of nine month olds are ending breastfeeding because ‘it’s easier when they’re younger’.

Breastfeeding can continue when it’s right for toddler AND mother. It can also end when it feels right.

There are forums and Facebook pages with other mums in your situation who you may be able to share your decision and your journey with. You can make up your own rules. You may decide to pause along the way. Perhaps when you have finished night-weaning, it will suddenly seem more manageable for a while. Just see how you feel.

Let’s imagine baby is due in a few weeks. You’ve probably talked quite a lot about your birth. You have a birth plan. You have some ideas of what you are aiming for.

Now let’s take a few moments to imagine the very first breastfeed.

Perhaps you’ve already had a breastfeeding class. Perhaps you already know about things like skin-to-skin and feeding in the first hour. I hope so. Maybe you’ve even written a feeding plan or spend time visualising your first breastfeed. When you’ve finished reading this, close your eyes and do some imagining. Can you really picture what it will feel like? Not really. However, the same is true of birth. Doesn’t stop us talking about preparing about our birth for hours and hours though!  I think we’re entitled to some 'hypno-breastfeeding' or at least talking through the first breastfeeding with our partner.

After you’ve given birth, the ideal is that baby is placed on your tummy (or higher if the umbilical cord lets them get that far). The baby isn’t washed or separated from you unless absolutely necessary. Sometimes we then let the baby perform a ‘breast crawl’. The newborn has an incredible ability to find the breast and latch on all by themselves. They scoot up the mother’s body and are guided by smell and primitive vision and find what they need. These instincts might be affected if they have had any intervention or are dealing with medication in their system.  Spend some time on YouTube watching breast crawl videos and I defy you not the utter the occasional ‘Whoah!’ http://www.youtube.com/results?search_query=breast%20crawl&sm=3

Send some breast crawl videos to your partner at work and I guarantee the chances of a ‘Whoah!’ or ‘That’s coooool!’ text in return are high.

Whether we let baby do their thing, or whether we give them a helping hand, we would aim to have some skin-to-skin as early as possible and plan to try to do the first feed within the first hour after birth. After that babies seem less alert and may want to sleep for a block of time. It’s a good chance for us to sleep too. That first feed can happen in a hospital bed, in a birthing pool, in the recovery room after a C-section, on a sofa after a home birth.

What should that first feed look like? There are lots of ways to position a baby at the breast and there isn’t one correction position. You certainly don’t have to sit up straight to allow the milk to flow and in fact some early breastfeeding is best done lying down or reclining. Breastfeeding classes sometimes reinforce the myth that we have to sit in a chair to make breastfeeding happen. Really not true or helpful. Have a look at www.biologicalnurturing.com for some ideas. This is also a great article: http://www.mothering.com/articles/natural-breastfeeding/

You may find that your baby can do their own thing and you can stop reading here.  Maybe you don't need to overthink this and take control and worry about the baby's positioning. They could get into position and find something that works and you can just lie back and let it happen.

There are some key principles though and if you feel the need to take control, it can be helpful to understand those.. Your baby will need to open their mouth wide –‘the gape’. They need to take a big mouthful of breast and not just to perch on the nipple with pursed lips. The big mouthful of breast gives their tongue a chance to scoop a big chunk of you towards the back of their mouth and get your nipple past their hard palate.

Feel the roof of your own mouth with your tongue. Can you feel the ridges of your hard palate? Your baby has those too but your nipple won't be rubbing against them throughout a feed. If breastfeeding is going right, the end of your nipple will sit in free space towards the roof of baby's mouth and near the junction of the hard and soft palate. If it’s going wrong, your nipple will rub against the hard palate and will get sore. If a nipple comes out looking compressed/ squashed/ with a white line across it/ tapered at the end like an old lipstick – that’s a clue it’s been pressed against the hard palate and something is going wrong.

Your baby needs a big mouthful and hopefully more of a mouthful below the nipple than above. We ideally don’t want the nipple to enter the mouth centrally but asymmetrically – nearer the roof of the mouth. So if we're lying back, we don't want the baby too high on the breast before they start. If they have to 'reach up' and tilt their head a bit to get there, that's useful. Picture that nipple heading where we want it to go – towards the junction of the hard and soft palate. You might think, but if I put the nipple nearer the top half of the mouth how will it go back far enough? Won’t it get jammed on the roof of the baby’s mouth? Nope. The key thing is giving the tongue as much space on the breast as possible. Then it can scoop as much as possible. The nipple will actually be stretched to two-and-a-half to three times its natural length when feeding. It will be extended by that tongue scoop and negative pressure created by the suck.

So we need the big gape. But there’s no point in having a big gape if other things aren’t right too. The baby’s chin needs to be making contact with the breast and even more than that – usually pressed into the breast a little. This means that the baby’s head will probably be slightly tilted. When you are taking a big bite out of an apple or a burger, you’ll usually lead with the chin. Usually the chin makes contact first with the breast. The nose will probably only rest very lightly on the breast or may not even touch at all. Some women with very large soft breasts find that the baby’s nose is slightly buried in too – don’t panic. Baby nostrils are very clever. They are designed to leave little air gaps around the corners even when the nose is making complete contact. You do not need to push your fingers into the breast to move the breast away so they can breathe. That’s a great way to get blocked milk ducts. Many of our ducts are quite close to the surface of the skin and pushing into the breast with a finger is enough to prevent flow. Try first encouraging your baby’s chin to tilt more into the breast. If the baby’s nose is still buried, it might just be about the consistency of your breast. The baby will prioritise breathing and come off if there’s a problem. That’s one reason we don’t hold the baby on the back of their head or put pressure on the back of their head – we need to give them the freedom to be able to come off. Holding the back of the baby’s head firmly to push them onto the breast can repress the sucking instinct and cause a baby to become quite distressed.

The baby’s bottom lip will ideally be a bit flanged out. A bit like a fish lip. This gives the tongue more chance of being where it needs to be – over the gum ridge and scooping breast tissue. If the lip is tucked back, the tongue is probably not far out enough. The top lip doesn’t need to be flanged out. In fact if the top lip is, that can be an indication the gape isn’t wide enough. However here’s a thing – once the baby is on the breast and feeding we can’t check lips and latch anymore. If a baby is positioned properly we probably can’t even SEE the lips and the cheeks are hiding them by making close contact with the breast. If you can see lips or see breast tissue moving in and out of lips, your baby probably doesn’t enough breast in their mouth. Be a bit wary if someone wants to check your latch by pulling at your breast or pulling baby’s cheeks. Best to check latch by watching as the baby goes onto the breast, watching how they naturally feed and looking at the shape of the nipple once it comes out of the baby’s mouth.

So we’ve got the big gape.

The more-of-a-mouthful-below-the-nipple.

The chin contact and chin driving into the breast with a head tilt.

The baby’s body should also be in a line. That’s to say ear, shoulder, hip all facing the same way. Try drinking a glass of water with your neck twisted to one side.

Baby will also be close and tight to your body if we’ve got a hope of getting that chin close enough.

What’s happening with their hands? In the early days, hands can seem a little inconvenient. However they are an important part of a baby’s sensory tools so we try and avoid swaddling when breastfeeding and soon the hands will be your friends. Ideally a baby won’t be wearing any clothing at all or be wrapped in anything when they have that first feed.  You might have a sheet or blanket lightly around both of you. In the early days, if a baby can’t get their face to the breast, they’ll try and get there with their hands. We don’t want the hands to end up on the baby’s chest or tucked at their neck as this will push their upper chest away from you which pushes the chin away which means a shallower latch. Baby’s hands shouldn’t be between your bodies. We also don’t want bulky clothing between you or bras containing breast pads squashed between you. One of the reasons skin-to-skin is so great for breastfeeding is you don’t have to deal with all the unhelpful fabric in the way!

What about holding your breast? Hmmm. Be careful about this. A leading cause of nipple soreness and damage is a mum holding her breast and ‘offering’ it towards the baby or ‘putting it in’. Nooooo. The breast is then going to slip subsequently and probably end up on the hard palate again. And holding breasts is a great way to end up with those blocked ducts again. Not to mention the fact that you’ll be doing this breastfeeding lark for a lot of hours and you’re going to appreciate having a hand free. Be wary of anyone who tries to ‘help you out’ by holding your breast or touching your baby. None of that should be needed. Be firm that people should help you with encouragement and words at this early stage. Touching is a last resort.

There’s a phrase we use a lot: “baby to breast”. That means that the baby moves TO YOU. You don’t move to the baby. Find yourself a comfortable position with good back support and the baby moves to you. If you lean forward, sit bolt upright, push the breast about, lift the breast up - you are risking problems. If you don’t feel you can move the baby towards the breast, check how you are holding them. Do you need to hold them very much at all if they are lying on you? Perhaps you’re holding them just around the head and it feels a bit like your yanking them from the ears? Look at placing more of their body on your arm if you’re using the cross-cradle or cradle hold. If you feel the need to lift the breast, are you using a breastfeeding cushion/ pillow that’s too high? We all have a different amount of space between our lap and our breasts. Breastfeeding cushions perpetuate a myth that we’re all roughly the same shape. For some women, a commercial breastfeeding pillow will be far too high. Their breasts hang such that the baby need only rest on their lap. For some people, it’s far too low. If we lean back slightly, the baby’s weight will be resting on our torso and we should not need a cushion at all. Also look at the angle of our nipples. Some of us have nipples that come out at right angles from our body. So baby will come onto our body at a right angle. A lot of us have nipples that point down slightly, so baby will need to come slightly up from under the breast to make sure both cheeks are making contact with their breast. They will be looking slightly up towards our shoulder, rather than towards the middle of our backs.  If we put that baby to the slightly drooping breast at a right angle, their bottom cheek wouldn’t be making contact and some breast tissue on the lower side wouldn’t be far back enough in the baby’s mouth. Try and breastfeed with your breasts in their natural shape and things will be a lot easier.

So:

Big wide gape with bottom lip out like a fish lip.

The more-of-a-mouthful-below-the-nipple.

The chin contacts on the breast and chin driving into the breast with a head tilt.

Baby’s body close and tight to yours.

The baby’s body should be in a line. : Ear/ shoulder/ hip

Baby to breast, not you leaning forward and ‘offering’. Try lying back if you can.

Breast in its natural shape wherever possible

Both cheeks touching breast. Lips not even visible.

Mum comfortable.

That’s too many things to make a clever mnemonic out of. BMCLBNCC?

What will it feel like?

It feels like a teeny being sucking your nipple to about 3 times its natural length and then massaging your breast with its tongue while creating a vacuum and wiggling its chin up and down .

However that doesn’t quite capture the magic.

It feels exciting and important. It feels like this tiny person is connected to you in ways you couldn’t quite imagine. Oxytocin hormone is flying everywhere and you feel quite blissful. Some people say powerful. Perhaps a bit tired too. Exhilarated and peaceful – you can be both of those things at once. The beginning of a really important journey. Perhaps the most valuable journey of your life.

Again this week, I read a comment by a leading breastfeeding expert tutting over the use of nipple shields. 

Of course, this person has decades of experience.

Of course, there are plenty of times when nipple shields are used incorrectly and over-enthusiastically .

Of course, when they are used without seeking access to other breastfeeding support they can mean supply issues, continued nipple pain and damage and a situation that can be challenging to unpick.

But can I please just take one moment to say that sometimes they can be bloody marvellous.

I’m not ‘supposed’ to say that. I’ve heard lactation consultant colleagues say, “Oooh, I hate nipple shields.” I’m meant to be down on them and focus on all the disadvantages.

But sometimes I just feel they need a little bit of defending.

I don’t know what’s going on with tongue tie at the moment. It seems like every breastfeeding drop-in group I visit has at least a third of babies who are post-frenotomy (tongue tie ‘snipping’) or they have been diagnosed and are waiting to be seen. Obviously the proportion of babies who come to get breastfeeding support will inevitably include more struggling with tongue dysfunction - however the numbers still seem ludicrous.

 I’ve seen mums who are breastfeeding several months after an initial nightmare month living with tongue-tie and a nipple shield has made all the difference.  Tongue tie is often accompanied by a high-arched palate or ‘bubble’ palate as when a baby is in utero the tongue hasn’t been pressing up against the soft bone of the palate due to its restriction and the palate doesn’t end up being smoothed into the typical gentle arch. And although babies can feed just fine on flatter nipples and even inverted nipples, they often do like to feel something touching their palate and triggering their sucking reflex. And if that palate is an extra centimetre away, that can be tough.  A baby may struggle to get purchase. They may appear to be searching for something and become frustrated. Finding a way to get baby to latch on and stay on may not always be easy.

Babies with tongue tie and high palates can latch on effectively but it’s not easy for everyone to find those ways on their own.

There are ways to get babies to latch on beautifully to flat nipples but it’s not easy for everyone to find those ways on their own.

In some cases, nipple shields can be a useful tool. The baby receives that palate stimulation and settles into a fabulous rhythm of deep swallows and great chin movements, milk is transferred and it’s hard to see what’s so evil about that.

Those who demonise nipple shields might have talked about the need to ‘work harder’ to find a latch that works. That’s fine - but when it’s 2am and mum is exhausted and baby is exhausted a bottle of formula may well be an appealing choice when your nipples are already sore and feeding has never been easy.

If we make nipple shields the ‘bad guy’, you may find that less feeding happens at the breast. Not everyone has a breastfeeding specialist sitting in the corner of their bedroom behind the nightlight. Or even access to good quality breastfeeding support throughout the week in the day time.

This morning I worked with a mum who had nipples that looked naturally quite different. One had a wide barrel shape and a length of about 15mm. The other was a slight dome rising no more than 3mm above her areola. She had been feeding successfully on one breast but when it came to the flatter side, baby was confused and frustrated. He had never really latched on for more than a few moments. Several weeks on, she was feeling desperate. She had been supported to try many positions by several breastfeeding counsellors and lactation consultants. She had visited a cranial osteopath. But the reality was that her son was used to the sensation of the longer nipple and the other side was less straight forward and he was struggling to move between the two. Perhaps she could only feed from one side and express the other? Perhaps she could just lactate on one side?

She tried a shield today and, for the first time ever, he moved immediately to deep chin movements, audible swallowing and mum said, “Yay!”.

She actually said “Yay!” quite a few times.

I would defy someone who had spent time with that mum and heard her history and worked with her to then say, “I hate nipple shields”.

There are certainly times when they don’t work well. I’ve also been to a group and a mum has shown up using shields to help her cope with sore nipples. The low point came a couple of nights ago and she couldn’t continue feeding  just on the breast. Even in that moment, it’s hard to argue it would’ve been better for her to stop breastfeeding and use a bottle in order to ‘rest’ completely. The shields allowed her to keep going and avoid the complication of using a bottle. However the shields were not her solution. Thankfully she sensed that and knew to come to a group and get support but I wonder how many women don’t. Her positioning and attachment could certainly have done with some improvement. She was leaning forward and ‘offering the breast’ and then pushing it in baby’s mouth without really waiting for a gape or bringing the baby to her. Her nipple was coming out after a feed flattened and compressed and was visibly damaged along the ridge where it was flattened. There were lots of things that could be improved. And the shield didn’t help with any of that. But it helped with her psychology and she came to the group. It kept her going.

Shields don’t help with sore nipples. They can exacerbate issues where babies have insufficient gapes and the baby just then transfers their insufficient gape onto the shield. But if the shield means that mum can cope with breastfeeding until she does manage to get the right support, if they stop her giving up, then that surely is a positive.

Shields are connected to a lower milk supply. Possibly because hormones aren’t being stimulated in quite the same way even through the modern thin silicone shields. Possibly because the people who resort to using the shields have issues that are the true cause of milk supply reduction. It can be wise to stimulate your supply using some additional expression if you are using shields and keep a closer on on baby’s weight gain. However I’ve also seen shields get a mum through a difficult couple of days when she had too MUCH milk. After struggling with oversupply and overactive letdown, her baby choking and spluttering with every feed, she found using the shields tided her over until she was able to get proper support and information. The baby was able to come to the breast without being flooded and her alternative would’ve been expressing and bottlefeeding.

If we demonise nipple shields, we reduce options. Options that actually might help when the next breastfeeding group is in two days time and the breastfeeding helpline isn’t open for the next 10 hours. And when the temptation is to pick up a bottle when it’s really not want you want to do.

You can use a shield and practice good body positioning and nose to nipple and head tilting and gaping. The baby works at the breast and is held close and does lots and lots of useful and valuable things and transfers milk as it gradually thickens and this is all still breastfeeding.

If you’ve been a breastfeeding supporter for a gazillion years and you’ve always managed to get babies to latch on superbly and you’ve never needed to use a shield – that’s dandy. But I will hold my hand up and say that sometimes I’ve worked with mothers who did use a shield and it made them happy and they felt great and the baby felt great. They went on to reach their breastfeeding goals, often weaning off the use of the shield with very little difficulty.

I think sometimes nipple shields deserve a teeny little ‘yay!’ They aren’t right in MOST situations and good quality breastfeeding information usually means that they are not needed.  If they are going to be used, they should be used with support from someone who is qualified in breastfeeding. But in a minority of cases, they can be bloody marvellous.

This post was originally written for http://www.nurturingmumsuk.com/ 

The first few weeks are often a blur for new mums. The learning curve is steep and you survive day to day – remembering to shower and put food in the fridge for yourself if you are lucky. For those mums still in the middle of that blur, the thought of the eventual return to work can be one that provokes anxiety.

You can’t imagine how it will feel to leave this new special person in your life.

How do you people cope with drop-offs to childcare and getting back to work after potentially several night-wakings?

What do you do if you don’t want to give up breastfeeding?

As a breastfeeding counsellor and lactation consultant, I’ve been supporting breastfeeding mums on their return to work for the last 6 years and there are a few things that are worth bearing in mind.

Here are my SIX top tips for returning to work as a breastfeeding mum.

1.       Don’t think about it.

OK, now I don’t mean that too literally. My message is just that if you are going to take 6 months, 8 months or a year off work and you spend several months of that stressing about the return to work, you will be seriously missing out.

STOP yourself thinking about it too much. If you stare at your gorgeous three month old and think fleetingly, “How can I ever leave you?” (which is how nature very much wants you to feel), that is fair enough. But if you spend chunks of your maternity leave feeling anxious and worrying about practicalities, you will be wasting the special times you do have together.

This time is precious. Your baby now is not going to be the same person when you return back to work. They will sleep differently, feed differently, and interact differently. You will not be leaving THIS baby but an older one.  So get your childcare sorted (which you may well have thought about in pregnancy anyway) and other than that, there’s not too much more to do! If you intend to express milk at work, it’s a good idea to write to your employer about 2 months before you go back to work to talk about arrangements. And then just carry on as normal. If your 4 month old baby won’t take a bottle and that starts you panicking because you have to go back to work at 8 months, don’t think about it. An 8 month old baby can breastfeed when you are with them in the morning and evening, take a sippy cup, drink from an open cup – you will have options. And a four month old baby that refuses a bottle may not if you try again after leaving it for a few weeks. It’s very easy to set yourself into a panic when the truth is that things usually work out with the right information and the right support.

2.       As mentioned, speak to your employer.

http://www.hse.gov.uk/mothers/faqs.htm#q14

http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-back-to-work.aspx

The recommendation is that you inform them that you will be returning to work as breastfeeding mum so they have a chance to assess your health and safety and what provisions you may need. Your employers are required to keep you safe. They also have a legal requirement to allow you to ‘rest’ as a breastfeeding mother. Sadly, in the UK, there is not a clearly established legal right to express breastmilk at work and it’s important you talk to your employer so they have advanced warning and you can come to an arrangement. Some women need to have break times re-organised or a room found. Although there is no ‘legal right’ the VAST majority of employers understand that it is in their interests to try and meet your needs and provide you with facilities. Your morale matters and a baby receiving breastmilk is less likely to suffer from illness meaning less time off work for you. There are health and safety executive recommendations and many employers understand the benefits of supporting you as much as possible. However, employers will be more likely to be accommodating if you give them warning and explain your needs clearly.

3.       Talk through your schedule with a breastfeeding counsellor or lactation consultant.

Drop-ins are not just for people with problems with positioning and attachment. It’s really common for a mum to come along a few weeks before their return to work to talk about how they hope to organise their feeding and pumping schedule and how to organise things practically. I’ve included some typical scenarios later on.

4.       Practise pumping.

Is the breast pump you are using a home something you are familiar with? Do you have a backup if you need to pump at work? Is it worth sourcing a double pump if time is an issue or even hiring a hospital grade electric breast pump for a few months which can just stay at work? You’d be looking at paying around £45 a month (http://www.ardobreastpumps.co.uk/breastpumps_for_hire)

There are tricks such as preparing the breast using massage and warm compresses. And we know that women who finish a pumping session using hand expression techniques can increase their output considerably.

http://lllrochester.weebly.com/uploads/7/9/5/4/795404/marmet_technique_tearoff.pdf

It’s also not a bad idea to build up a bit of a freezer stash before you go back. If you start pumping for one extra session each day and storing that in a freezer bag (store them flat and build up layers of thin flat bags which defrost more easily and take up less space), you will have some wiggle room if you need it. It’s not entirely predictable how pumping will go at work and some women find that their pumping output decreases towards the end of the week and then a weekend of normal breastfeeding boosts it back up again. If you have that freezer stash, it will take away some of their anxiety.

5.       Get your kit.

So you need a pump and some bottles and some breastmilk storage bags. What else? Surprisingly not much. You don’t need to store freshly expressed breastmilk in the fridge at work if you don’t want to. You can have a freezer block and an insulated bag and put any expressed milk in there. It is fine in that for 24 hours. So if you store it like that at work, put it in the fridge when you get home, then that milk can be given to your baby’s carer for the next day.

http://www.breastfeedingnetwork.org.uk/pdfs/BFNExpressing&Storing.pdf

It’s also really important to note, you don’t need to wash and sterilise the pump between pumping sessions. Breastmilk is fine at room temperature for up to 6 hours. So you certainly don’t need to wash a pump between your 11am pumping session and your 2pm one. Lots of working mums use a technique called ‘wet-bagging’, putting a pump in a plastic bag between sessions and then putting it back in the fridge. Then simply take it out next time and wipe any wet parts with paper kitchen towel if you don’t fancy cold drips against you! This also saves precious time.

6.       Breastfeed when you can.

Your supply is more likely to be maintained if you breastfeed when you get the chance. Is your childcare near work or home? Could you visit your baby at lunchtime?  Could you work from home for one day a week for the first few weeks? You could breastfeed early in the morning, then once more at drop-off, once more at pick-up and again at home later in the evening. Those 4 feeds would be enough breastmilk overall for a baby of 8 months or more. You may not need to be carrying bottles back and forth. And breastfeeding at the weekends and during holidays will help to boost your supply.

Here are the stories of three mothers I have supported (names and some details have been changed):

Carla is going back to work full-time at 6 months. Her son is an enthusiastic exclusive breastfeeder and she’d like to avoid using formula if she can. When her son is 4 months old, she writes to her boss (she is a PA in a law firm) and explains she would like to express her milk at work. Her boss explains the company procedure of having a small office set aside for pumping and there is also a fridge available. Carla explains she intends to express around 3 times in the working day and one of those times will be during her lunch break. Her boss is fine with that. She has a double electric pump which she starts using from 4 months and she gives her son a bottle every other day to get him used to it. She finds he prefers to sit a bit more upright and usually takes 3-4oz from the bottle.

She starts solids around 10 days before she goes back to work and he takes small amounts initially and Carla knows his breastfeeding schedule will remain unaffected for a while. The week before she starts work, they visit the nursery together and he has a few hours there. He then has two trial days where Carla practises her expressing schedule and the nursery workers give him a bottle and some solids.

On her working day, she breastfeeds him as normal at 6am. She drops him off at nursery at 7.45am and offers again and he takes a small feed. At work she expresses at 11am, 1.30pm and 3.30pm. She collects her son from nursery at 6pm. He is keen to breastfeed when she arrives and they breastfeed at nursery. She breastfeeds him again at home at around 10pm as a dreamfeed.  He wakes once at around 2am and she breastfeeds him again.

While he is at nursery, the carers give him bottles and offer solids and he usually takes around 12oz in total while they are separated. As he has 3 good breastfeeds in addition to that in 24 hours, Carla isn’t worried. Carla expresses more milk at work than her son takes in a bottle at the moment. Over the next few weeks, she moves to expressing only twice. Carla ends up offering exclusive breastmilk until 12 months and then she gradually introduces cow’s milk.

Phoebe is returning to work at 10 months. She is a graphic designer and works from home with some client visits necessary around London. Her daughter breastfeeds around 4 times in 24 hours and enjoys solids which she started at 6 months. Phoebe doesn’t enjoy pumping and finds it difficult so would rather avoid it if possible. She finds a child-minder who lives near her home. Phoebe breastfeeds at 8.30am and drops her daughter at the child-minder. If she is working from home she visits at lunchtime for another breastfeed. She then collects her daughter at around 4pm and takes her home to breastfeed at 6pm and around 11pm. While her daughter is at the child-minder, she eats solid food and drinks water. The child-minder doesn’t give her milk. When Phoebe has a client visit, she sometimes hand expresses for a few minutes into a plastic bag when she can grab a private moment. This is just to stay comfortable when she feels particularly engorged. This will help to reduce her risk of blocked ducts and mastitis and help to maintain her supply. She doesn’t keep the milk. Phoebe continues breastfeeding her daughter until she is 18 months old. At the end she is only breastfeeding in the morning and evening and Phoebe doesn’t feel the need to use any hand expression when they are separated.

Catherine is returning to work at 8 months. Her son breastfeeds around 6 times in 24 hours. He started solids at 6 months. He doesn’t particularly like bottles and usually only takes around 2oz max. Catherine finds that he will take more milk from an open cup called a doidy cup. He will also more likely to take it if she mixes the breastmilk with ripe banana and makes a smoothie! Catherine gets through a lot of bananas! She works 4 days a week (and at 12 months will go back to being full time). Catherine is a teacher. Her headteacher has struggled to find her a private room for pumping but has given her the key to the medical room and if that is in use, she uses a stock cupboard and she has told staff that when her scarf is on the door, please knock! Usually the medical room is empty. Her colleagues have agreed to relieve her of playground duty while she is breastfeeding. She breastfeeds her son at 5.45am and again at 7.45am at the child-minder. She arrives at school at 8.15am. She expresses at 10.45am during morning break. She expresses for 10 minutes. She expresses again at lunchtime for 15 minutes and at around 4pm for another 10 minutes. She has to use a double pump as her pumping time is restricted. She remains at school for meetings and lesson preparation and collects her son at around 6pm. She breastfeeds him at 7pm and 10pm. He wakes to feed between 1-2am and Catherine is happy for that to continue for the time being as he feeds and goes back to sleep quickly.

With the child-minder, her son takes around 3oz of breastmilk in his smoothie, 2oz mixed into a porridge and another 1-2oz from his doidy cup. She also makes sure his solids contain good sources of fats and calcium. Sometimes she struggles to pump in her breaks as she really needs to continue working. She finds herself dipping into her freezer stash and as time goes on, the child-minder sometimes uses formula to make up the porridge. On the weekends and on her day off, he breastfeeds more frequently.  

There are many women who effortlessly combine breastfeeding and working. If it sounds hard, remember that in the USA there is no statutory maternity leave and women often return to work after just a few weeks. However they have 16% of babies exclusively receiving breastmilk at 6 months and the UK manages 1% (http://www.cdc.gov/breastfeeding/pdf/2012BreastfeedingReportCard.pdf).

Working and breastmilk are not incompatible. With modern electric breast pumps and using breastfeeding support available locally and through the National Breastfeeding Helpline, it’s never been easier. However if we could get the statutory right to pump at work it would certainly help. Contact your MP if you feel the right to express at work (as exists in 92 countries throughout the world) is something UK mums should be entitled to. 

So I wrote to Lynne Featherstone, my MP, previously the government’s equalities minister.

 I said I had been concerned that the recent conversations about flexible parental leave had made no mention of breastfeeding. Perhaps a mother returning to work two weeks after birth might need a teeny weeny bit of help if she was going to make breastfeeding work – and follow the government’s own recommendation to breastfeed exclusively for 6 months? The NHS website states: “Exclusive breastfeeding (with no other food or drink) is recommended for around the first six months of a baby's life. After this, breastfeed alongside other foods for as long as you and your baby wish. This might be into their second year or beyond”.

Lynne Featherstone appreciated that breastfeeding was an important area and wrote to Nick Clegg to ask more about the government’s commitment to this issue.

Here is the government’s reply.

“Dear Lynne

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness; breastfed babies are generally healthier; increased staff morale and loyalty, and a subsequent higher rate of return to work; lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice.

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding, women who return to work whilst nursing will continue to:

·         Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

·         Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk.

·         Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers

I would like to thank you for bringing this matter to my attention.

Jo Swinson MP

Shall we unpick this letter?

Dear Lynne,

Thank you for your letter of 15 November to Nick Clegg concerning breastfeeding and flexible parental leave. I am replying as this matter falls within my portfolio.

The Government encourages breastfeeding and recommends employers enable women to breastfeed as a matter of best practice. There are no plans to introduce a specific entitlement for women to take time off work to breastfeed or express milk. This is due in part to our concern about setting a time limit on the periods of time mothers will need off work, as the frequency and length of time a woman needs to breastfeed or express milk is very individual. It will depend on how easy the mother finds breastfeeding/ expressing, how many feeds there are during the time she is not with her baby and how much milk her baby normally needs to take.


[How many breastfeeding women do you think have been surveyed to arrive at this opinion? 
Do you think the government is aware that a breastfeeding baby takes about the same amount of milk at 6 weeks as they do at 6 months and there is remarkably little variation? 
Do you think the government knows that the vast majority of women pump about 90% of available milk in the first 10 minutes of pumping? 
And with a double electric breastpump, this may mean that a mother of a 3 month old baby need only spent 30 minutes pumping during a working day of 8 hours? 
Talk to mothers of 3 month old babies, 5 month old babies, 8 month old babies – you’ll find that the ‘very individual’ requirements are actually pretty boringly not that individual, pretty easy to work out and that the MAXIMUM a mother may require is really not so burdensome and using that as a guideline does not result in the crumbling of an economy]

Many employers already recognise the benefits that allowing their staff to take the time they need to breastfeed or express milk, brings to their business as well as to their employees, in terms of reduced absence due to child sickness;  breastfed babies are generally healthier;  increased staff morale and loyalty, and a subsequent higher rate of return to work;  lower recruitment and training costs and an extra incentive to offer potential employees. The Government welcomes this, but believes that time off work relating to breastfeeding is a matter best left for employers and their employees to agree between themselves. 


[Which makes it sound delightfully like we all sit around a table, share a flagon of ale and come up with agreements that make everyone feel warm and fluffy. Would you like to meet the mother of an 8 month old baby who was told by her employer he was not willing to provide ANY time for expressing?]


Alongside the planned reforms we will continue to work with employers to highlight the business benefits of supporting breastfeeding; and promote best practice. 


[If an employer employs a disabled person he has to make ‘reasonable adjustments’ to accommodate that person in the workplace. This might include a change to working hours or providing a special piece of equipment. But it’s apparently burdensome and unthinkable to imagine an employer might make reasonable adjustments for weeks or months to allow a baby to continue to have access to breastmilk. A room, a fridge, ten minutes here and there. Really too hard? We don’t even need the fridge.]

Under the planned flexible parental leave system, new mothers will continue to have the right to the same amount of leave and pay to which they are currently entitled.

This means that new mothers can take time off work to prepare for and recover from childbirth, to establish breastfeeding, and to remain at home to breastfeed their baby throughout the Department of Health’s recommended period of 6 months.


[Hang on now, dear Government. So do you WANT mothers to stay home for 6 months? Do you want babies to receive exclusive breastmilk for 6 months and to continue to breastfeed alongside solids after that, or not? Or do you want mother to return to work as quickly as can be conceived – perhaps only 2 weeks after giving birth – and return to a workplace with ‘no specific right’ to breastfeed or express (your words)?
 Are we saying that breastfeeding for 6 months is a luxury some women might choose to indulge and if you want or need to return to work, hard luck? 
And don’t think I haven’t noticed that a government minister appears to have misunderstood the government’s recommendations on breastfeeding and has confused the ‘exclusive breastfeeding for 6 months’ with a recommendation to ‘breastfeed for 6 months’. I noticed.]

The decision to remain at home does not affect the parents’ right to flexible parental leave as the option will exist for the father to take leave concurrently or subsequent with the mother’s maternity or flexible leave period.

Whilst there is no specific right to time off for breastfeeding [Nope, no specific right for the mother NOR the baby. Have we read the United Nations Rights of the Child Article 4: “You have a right to special care and protection and to good food, housing and medical service”?], women who return to work whilst nursing will continue to:

•             Be protected under the Workplace (Healthcare, Safety and Welfare) Regulations which require employers to provide breastfeeding women with a place to rest; and where there is any risk to the health and safety of the mother or baby, the Management of health and safety at Work Regulations 1999 and the Employment Rights Act 1996, provide that employers must take reasonable steps to avoid the risk. This can include changes to the mothers working hours or conditions.

[So let’s get this straight, the breastfeeding mother has a legal right to ‘rest’? 
Would you mind awfully if she take along her breast pump while she ‘rests’ and pops something in a mini-fridge after she’s ‘rested’.
 But oh, hang on, people can get tired in very different ways? Getting tired is a very individual thing. That’s surely very hard to legislate when it’s all so individual but yet that one seems to have made it into law. 
Can we just declare now that the mention of ‘rest’ for the breastfeeding woman is one many of us could write essays about. It was a concept from a different world – a world before the electric breast pumps of today and the modern working practices of modern women. CAN WE SWAP IT FOR SOMETHING ELSE PLEASE?]

•             Have the right to request flexible working to support them in adjusting their working pattern to accommodate time for breastfeeding and/ or expressing milk. [Have the right… also have the right to go to our employer and ask for a special day when everyone dresses up as Spiderman. Doesn’t mean the request will be granted.]

•             Have the right to unpaid parental leave to support them in extending the period of time they are able to dedicate to breastfeeding their baby.

In the meantime, the Health and Safety Executive (HSE) advises employers that it is good practice to provide a private, healthy and safe environment for nursing mothers to express and store their milk and publishes comprehensive guidance on how employers can meet their legal requirements: www.hse.gov.uk/mothers [comprehensive guidance on how to provide a place and time for ‘rest’ – these women may even need to lie down. And “You may provide a private, healthy and safe environment for employees to express and store milk, although there is no legal requirement for you to do so”. So guidance on how employers can meet their legal requirements won’t take long then, hey?]

I would like to thank you for bringing this matter to my attention. [Thanks Jo, Hope you don’t mind if we come back to you on a few things. Here’s one thing: employers have to keep mother and their babies safe. The guidance says ‘There may be risks, other than those associated with pregnancy, to consider if an employee is still breastfeeding on their return to work. These will depend on her working conditions but could include:

working with organic mercury

working with radioactive material

exposure to lead

This list is not exhaustive (see EC guidance  for further information). You will need to consider any other risks that could cause harm to the mother or child’s health and safety, for as long as she wishes to continue to breastfeed’.

You do realise, don’t you, that a mother denied the right to breastfeed is at greater risk of blocked ducts, mastitis and possibly breast abscesses? That’s even the ones who aren’t working with organic mercury. That’s all breastfeeding mums. And that a baby whose mother ends breastfeeding early will be at greater risk of health problems? So how about we make it a legal requirement that an employer makes ‘reasonable adjustments’ to accommodate breastfeeding women?

We don’t want a legal right to ‘rest’ and lie down. We want a legal right to give our babies breastmilk if we return to work. I promise nothing will crumble. It’s not scary and it’s not hard. Let’s just focus on that word ‘reasonable’.]

Jo Swinson MP