So if like me you are steeped in the world of infant feeding you will know that there has been more discussion than usual on support and evidence in the last week or so. The Lancet series on breastfeeding sparked a series of opinion pieces, media stories and this fantastic Open Letter signed by a long list of key organisations. I have thrown my own pen’orth into the ring via a blog post about the strength we need to fight for infant health. Lots of momentum and a desire for change.
As you can imagine, I have been looking at all of this from the perspective of my Hospital Breastfeeding campaign. In discussing my blog post on the Association of Breastfeeding Mothers’ Facebook page, I commented that we don’t need to pressurise mothers into breastfeeding in order to improve the breastfeeding rates in the UK. We simply need to adequately support those who already want to feed their babies that way! Nowhere is this more true than on paediatric wards and in children’s hospitals. If we can’t provide adequate support for mothers who want to breastfeed their sick children, when these children are some of the ones who need breastmilk the most, then what hope is there of families being supported when they are away from a healthcare setting?
Yet this isn’t my focus for today. Today I want to talk about what happens when a breastfeeding mother has to go into hospital for treatment herself.
The support available for breastfeeding mums who are inpatients on adult wards was never meant to be the focus of my campaign. But since supporting Gina last year (read the full story here) I have been contacted by other mothers who have struggled to maintain breastfeeding due to needing to be inpatients themselves. The circumstances they have faced and my desire to address the situation have led me to add a new member to the Hospital Breastfeeding team. Breastfeeding Peer Supporter Asha Crocker has kindly agreed to join the campaign in order to focus on the issue of support on adult wards. I will introduce Asha to you fully at the end of this post.
Looking at the stories that we have heard from women so far, Asha has identified the main areas of concern when a mother tries to maintain breastfeeding throughout her hospital stay. These are as follows:
Medications compatible with Breastfeeding
Luisa Lyons has written an excellent blog post for the #MatExp campaign on what needs to be done with regards to medications and breastfeeding. Even maternity staff and GPs are often unaware of the service offered by the Breastfeeding Network’s Drugs in Breastmilk service, so it is not surprising that clinicians on adult wards are not familiar with Wendy Jones and her fantastic work. This does, however, urgently need to change. There are other good resources as well – Lactmed for example. What needs to be understood is that the standard NHS guidance for medications and breastfeeding is not as up to date or as useful as these resources. This is a key message. If you are treating a lactating woman you need to be using the right resources when considering her medications.
Sadly, the current situation is very variable. And even in situations where the mother is happy to take advice from the BfN and the doctor is not willing to accept that, the result depends on the hospital. If one mother is able to sign a disclaimer to say she is taking guidance from the BfN against her doctor’s wishes (as has happened) why is this option not open to all mothers? We understand that it takes time for hospital’s guidelines to catch up with the evidence, but in the meantime women need to be offered the ability to exercise informed choice.
What is currently happening is that mothers are being asked to choose between continuing to breastfeed and being given adequate pain relief. This is totally unacceptable.
UNICEF Baby Friendly / World Health Organisation Code considerations
Again, it is not surprising that these recommendations are not routinely considered on adult wards, but this does need to be addressed. Mothers and babies are separated for long periods of time, and separated overnight. We know of a case where a mother has been advised to introduce solid foods to her baby, and stop breastfeeding her baby, even though the child is under 6 months old. Just so this mother can undergo surgery. Not only are Baby Friendly recommendations not being considered, but many healthcare professionals seem to think it acceptable to pass on their own opinions of infant feeding to their patients, with no reference to facts or evidence. This then forms their recommendations about their patient’s treatment options, when these options should be being considered in the light of what is best for both mother and baby.
This quotation from page 10 of the World Health Organisation’s Global Strategy for Infant and Young Child Feeding (2003) is crucial in this regard:
“Mothers and babies form an inseparable biological and social unit; the health and nutrition of one group cannot be divorced from the health and nutrition of the other.”
Support for Maintenance of Milk Supply & Avoidance of Infection
Where a Mother has to be separated from her breastfeeding child, it is important for her to be able to express breastmilk in order to maintain her supply, to avoid engorgement and pain and to stave off mastitis. Even in a situation where a clinician cannot be persuaded to care about the health of the child, one would hope that the health of their own patient would be of interest. Sadly, again this is not what we have seen. Access to breastpumps on adult wards is extremely limited. We have also seen mothers being told they cannot use their own pumps on the ward because the noise disturbs the other patients. We have had mothers in extreme pain being told to mobilise themselves and make their way to private rooms in order to express. Bearing in mind that to express to maintain milk supply requires 3 hourly sessions.
To require a lactating woman to simply stop removing milk from her breasts because she is in hospital poses a huge risk to her physical health as well as putting her through unacceptable levels of discomfort.
The above points focus on the ‘bare bones’ of what is happening, but the emotional impact is really the most striking point. Not all babies are content to drink from a bottle or to be separated from their mothers, nor should they be expected to be. Not all mothers are content to be separated from their babies. Healthcare professionals seem to imagine that a baby sent home with Daddy will take a bottle and fall asleep with no problem to anyone, but the reality is that we have had babies screaming all night for their mothers, only to fall asleep exhausted on the breast when allowed in for visiting hours. The distress this causes to all parties is not to be underestimated.
Our hospital facilities can clearly not always accommodate breastfeeding infants. And some mothers will genuinely need to pause their breastfeeding or even cease altogether, even with the best information and support. In these cases, we would hope to see compassion and understanding from the medical teams, as the mother (their patient) will be distressed. As Emma Pickett IBCLC says in her wonderful blog post to GPs, mothers “want to continue breastfeeding and treat their other conditions. They don’t want to stop breastfeeding for even a day. That’s like asking them not to be a mother when breastfeeding really matters to them.”
So what would we like to see change? If you work on an adult ward, if you commission adult services, if you oversee adult services in a hospital, which of these issues could you begin to address?
- Acceptance of the BfN Drugs in Breastmilk Service and/or Lactmed as appropriate information on medications for breastfeeding mothers
- Access to breast pumps for lactating women, the ability to use their own pumps on the ward, and assistance for them to pump when they are in too much pain and discomfort to manage alone
- Provision for breastfeeding mothers to feed their babies on the ward, either by having their babies stay with them or allowing them more access to their children than normal visiting hours would provide
- Appropriate communication as to treatment options that are compatible with breastfeeding, and compassionate care and support for mothers who do have to pause in breastfeeding or cease altogether
From the stories we have seen to date, healthcare professionals on adult wards seem to focus on breastmilk as a source of nutrition, with little understanding as to how breastmilk and breastfeeding differ from alternative feeding options. Formula and bottle feeding are seen as an appropriate and simple alternative for all babies, when we know that this is not the case.
Breastfeeding is often seen by staff to be a “lifestyle choice” rather than the biologically normal way for a child to feed. The WHO recommendations that a child breastfeed exclusively for 6 months and then in conjunction with solid foods for a minimum of 2 years, are disregarded as idealistic by many hospital staff. Yet as The Lancet series and numerous other studies have confirmed, these recommendations are key to the health of women and children.
Hospital departments do not work together or share equipment, so even in hospitals that have maternity units access to breast pumps on adult wards can be near impossible. Even in hospitals that have Baby Friendly accreditation, this is often focused on maternity and neonatal units rather than being a culture across the hospital. We would like to see hospitals put in place policies and guidelines for the treatment of lactating women across all departments, with an understanding that this is far from “just” a maternity issue.
Many adult wards are cramped, so cannot provide a cot next to mother’s bed; private rooms are a rarity. Plus health and safety issues must be addressed if a baby is mobile, as well as the infection risks to other patients of having babies and children on adult wards (and the risks to the children themselves). We understand that perfect solutions cannot always be found. But what we do ask is that staff are willing to be creative. That hospitals are willing to consider accommodations that CAN be made. And that everyone involved in the treatment of lactating women has an understanding of their emotional and physical needs.
For if breastfeeding women are not respected and accommodated by healthcare professionals within our nation’s hospitals, how can we expect the rest of society to take on board the culture shift needed in order to make breastfeeding an easier choice for UK families?
Helen Calvert and Asha Crocker
Please follow our campaign on Facebook
Asha Crocker is a 33 year old first time mum. She says of herself “as a former Sociology teacher I love a good cause! I knew I wanted to breastfeed and assumed that it would be easy. I knew that is was the best thing for my son. However, despite the ‘breast is best’ rhetoric, there’s little support in helping mums to actually breastfeed and many obstacles put in the way to continue breastfeeding. I’ve had quite a traumatic experience breastfeeding my son. If it wasn’t for the help and support from the breastfeeding support groups around me, I don’t think we would have lasted even 2 weeks. He had a severe posterior tongue tie. At every turn, we were told by healthcare professionals that his latch was great. It was the breastfeeding support groups, the ladies that give their time up (for free) to support women like me who were struggling, that got us referred to the right people to have his ties released.
It is these women that got me into breastfeeding support and lit the fire for my passion. They helped me so much, so this is my way of ‘paying it forward’ and giving thanks for all of their time.
So I am a Breastfeeding Peer Suppor volunteer at both of my local Children’s Centres, which also means going to antenatal groups, ‘Bumps and Walkers’ groups etc to promote the breastfeeding support group. I intend to embark on my Association of Breastfeeding Mothers breastfeeding counsellor course this year, which means I will be able to support more women.”