My tips and top links for breastfeeding parents to be! Having a baby comes with a lot of questions for parents to be. Which pushchair is best? What should my baby sleep in? What clothes… More
Author: Wendy Jones
Publisher: Pinter and Martin
“There is evidence out there for the vast majority of drugs that should enable mothers to continue breastfeeding while obtaining the medical treatment they need… none of this is difficult. If we value breastmilk for its wonderful properties, practice evidence-based medicine, and respect mothers, we could transform women’s experience of seeking treatment.” Wendy Jones “Why Mothers’ Medication Matters”
A while ago, I had the privilege of reviewing this wonderful book, my review has now been published, so I am excited to be able to share it with you all here.
Wendy Jones is an inspiring figure in the field of lactation. A massively experienced Breastfeeding Supporter for the Breastfeeding Network and a qualified pharmacist; Wendy has tirelessly worked to help parents who breastfeed. Any breastfeeding supporter or counsellor should be aware of the brilliant “Drugs in Breastmilk Information Service”. This wonderful resource tirelessly gives information to lactating people about medications they may need to take during breastfeeding.
Prescribing medication for breastfeeding parents can be difficult for health professionals yet parents often need medication, whether it is short-term use of painkillers, antidepressants, or drugs to treat chronic conditions. Women are often given misinformation about what medications they can and cannot take.
In this book, Wendy Jones sets out to give mothers and health professionals information they need to make decisions about medication and to reassure fears that parents may have about adverse effects on babies of drugs passing through breastmilk.
Wendy Jones opens her book with an introduction to her subject, providing heartstring tugging examples of why better support around medications and breastfeeding really matters. Putting a human face and empathy on what could easily be quite a dry subject matter is something she continues to do throughout the book. The case studies are really moving, covering examples like postpartum women on a maternity ward being told they could only take paracetamol while recovering from c-sections or episiotomies and mothers dealing with weaning decisions after being given a cancer diagnosis, among many others.
Further chapters explore topics like why prescribing for lactating people can be so fraught with confusion, drugs during pregnancy and birth and their impact, treatment of chronic health conditions and depression as well as looking at ‘lifestyle’ drugs including alcohol and recreational drugs. The chapter on over-medicalisation of common issues like infant reflux, CMPA and colic are a must read for any peer supporter, particularly those among us who provide support on online forums where suggestions of reflux and CMPA are common. Some of the facts and studies Wendy discusses are truly eye-opening and the book is well referenced with a focus on remaining evidence-based.
Wendy ends her book with a discussion about where women can go on to get support around prescribing issues, and talking about milk donation. The final chapters are a heartfelt overview of the differences between breastmilk and formula milk and why we shouldn’t be assuming “formula milk is fine” if a lactating parent needs medication and her conclusions about why medication matters for breastfeeding parents.
This book is about so much more than medication; it is a wide-ranging overview of issues breastfeeding parents may face dealing with their healthcare. The ideal length and level of detail for a breastfeeding peer supporter, as well as a good introduction to the topic for training breastfeeding counsellors and health professionals I would whole-heartedly recommend “Why Mothers’ Medication Matters to anyone.
Buy “Why Mothers’ Medication Matters” by Wendy Jones and other excellent titles from the ‘Why it Matters’ range, over at Pinter & Martin
*I draw no income from my writing, my blog features no ads, be reassured links given to purchase this title are completely independent and not affiliate! #adfree
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Enjoying the holidays, and breastfeeding your baby are not mutually exclusive
It’s beginning to look a lot like Christmas! Soon many of us will be spending time with friends and family, and while we may look forward to the holiday, some may find the idea of breastfeeding over the Christmas break brings up a few anxieties.
First of all, in my view, there is one brilliant advantage to breastfeeding over the Christmas period, You have the perfect excuse to slip away and get some quiet time (hopefully with a box of choccies to keep you company) because “baby feeds better without distractions”. Another bonus- you also have the perfect excuse for turning down events you don’t really want to go to. Maybe that’s just me. I am happiest in PJs with a glass of wine.
Other people may prefer to drink their wine wearing their party gear, and worry that this breastfeeding malarkey means they are going to miss out on all the fun.
I know often concerns revolve around family members, particularly breastfeeding in front of them. Some people worry that Auntie Lynda will go on (and on) about how she thinks the baby should be on bottles/formula/Christmas dinner and all the trimmings by now.
So here are a few of my thoughts on how to make life easier as a breastfeeding mum over the Christmas holidays.
Worried about baby being passed around like the tin of Roses, during peak cold and flu season? Wear your baby! You will be surprised how much less well-meaning relatives will demand a cuddle when they see a baby all cosy in a sling.
Wearing Your Baby has the added advantage of keeping them close, which leads me onto my next point…
Expect Baby to Change Their Feeding Habits
Often over holiday periods, things are busier and babies are more stimulated. It is easy to miss feeding cues, or breastfeeds. During long journeys, a baby might sleep more than usual. Lights and music and new people often mean distracted babies that don’t feed as well or cue for a feed less. Quite often babies are being passed around for cuddles. Sometimes Uncle Gary might decide he can soothe the crying baby himself rather than passing them back to Mum. Sometimes mum is distracted entertaining friends and family or making food.
Building in times during the day to breastfeed might be a helpful way to combat this, or alternatively see above; Wear baby more so they stay close! If you are undertaking long journeys build in some rest breaks to allow time for boobin’.
Alternatively, baby might be out of sorts, cranky, overstimulated and want boob ALL THE TIME, also normal! In fact, in these situations, nursing can be a godsend. It is often much easier to calm a baby with a breastfeed.
Nursing also gives you an excuse to get out of peeling the sprouts or doing the cooking. I may or may not have personally used this as an excuse to sit on my bum eating Christmas cake (“It’s for the baby!”).
Make time to express if you are apart from your baby
If you are away to a party, or out for the day Christmas shopping you may want to build in some time to express. This is more important the younger your baby is. Not removing milk from your breasts may lead to engorgement and blocked ducts, and eventually lowered milk supply.
If you do find you develop some blocked ducts or engorgement, following self-care is important, this is great information from the Breastfeeding Network.
If your baby is having bottles while apart from you, making sure responsive feeding methods are used can be helpful. Click the link for a video demo.
Alcohol and breastfeeding
Most sources suggest a moderate intake of alcohol while breastfeeding is fine. You can still have a glass of wine or two and breastfeed. However -and this would be true however you feed- as a parent you need to be careful you are still fit to care for a small child. Bedsharing after drinking alcohol is also a no-no. If you fancy a blowout, expressing some milk in advance might be helpful, as well as enlisting a babysitter.
Some useful links:
Pass the stuffing, please!
Christmas is often a time when the food police come out to tell you that you can’t eat your veggies because “baby might get windy” or that you need to avoid the stuffing or after-dinner mints because the sage or peppermint might “lower your milk supply”.
The good news is, there is no evidence-based research showing foods themselves will make your baby gassy (unless they already have a known allergy or intolerance to a certain food), and you would need to be eating absolutely VAST quantities of stuffing/mint for there to be any effect on your milk supply, so tuck in, and don’t worry.
In case you overdo things, many indigestion remedies are safe to take while breastfeeding. All on the link there. You’re welcome.
Don’t feed the baby!
I’m not talking about breastfeeding here of course! However, older babies that have solids may be filled up with Christmas ‘treats’. It can be helpful to put aside some time for boobin’ toddlers too unless you are planning on weaning.
Sometimes, you may need to watch out for relatives trying to feed younger babies solids. Remember, some relatives may be from a generation where babies were given solids much younger than they are now, and may have no idea this isn’t OK. If you suspect this might happen, it might be helpful to be upfront; for example saying something along the lines of “It is important to me that the baby is closer to six months before giving them food, the research now suggests this is best for babies, and this is also what our health visitors have recommended”.
You may even want to think about ‘recruiting’ any prime suspect onside, have them “watch out for anyone who might give baby solids accidentally”. It is amazing how well giving people some trust and responsibility can work in your favour.
If well-meaning relatives are convinced giving baby Christmas dinner is the key to a full nights sleep- show them this!
Dealing with criticism
Make sure people know that you are proud of your breastfeeding relationship and that you see it as a good thing. If your relatives don’t see this as a chore they can relieve you of, you might find their attitude changes.
If you feel your choice to breastfeed is questioned, or that those surrounding you aren’t supportive, the “pass the bean dip” approach can be useful: https://twolittlegrasshoppers.com/tag/the-bean-dip-method/
If you have an older nursling, and you are worried about people questioning why you are “still breastfeeding”, Kellymom has some useful suggestions here too: https://kellymom.com/ages/older-infant/criticism/
Family members are generally well-meaning. They may be basing their ideas on outdated things they have been told. They might be open to learning about how recommendations have changed if you approach the subject gently.
Remember, you are the advocate for your baby/toddler/child. They cannot stand up for what they want. Give yourself permission to be unashamed. You do not have to answer to anyone else about your feeding relationship. Your boobs, your baby, your choice.
Choose clothing that provides easy boob access
Worried about feeding in front of family members? Consider practicing in front of a mirror, seeing how little is exposed might reassure you a little, especially if you use the “one up, one down” technique.
If you don’t feel comfortable getting your boobs out in front of family (maybe you have an inappropriate drunken uncle or two), the muslin trick is an inexpensive tip. Using a large muslin, tie one corner to the strap of your bra, and use the loose cloth to cover up any exposed areas. Or employ your partner on distraction duty to get uncle Roy into the kitchen for another sherry if that’s what makes you feel happier. Or, if like me you like a bit of a breather, use it as an excuse to get a bit of peace and quiet. When it comes to feeding, it is about what makes you feel more comfortable first and foremost.
If you need a party outfit or even some new fashion ideas for breastfeeding friendly clothing, why not join Can I Breastfeed In It? They are a UK facebook group, which have fantastic tips and ideas for feeding fashion (and they even have a selling page so you can grab yourself a bargain too).
So there you have it, some helpful tips for enjoying Christmas while continuing to breastfeed. Is there anything you think I have missed? What are your tips for breastfeeding over the holidays?
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When advice and help isn’t all that it seems
Boots, it seems, want to help you to breastfeed. They now produce a leaflet which you can pick up in store, and have a section on their website devoted to it. I see photos of this leaflet shared on breastfeeding groups, usually with the caption “Found this in Boots, isn’t it brilliant they have this?”
As someone who volunteers in infant feeding, this sort of thing sets off my cynicism alarm. Retailers are in business to sell you things, altruism usually isn’t high on their list of priorities.
Confession time: I’m going to be picking on Boots a bit here. They are one example in truth, they certainly aren’t the only brand to do this sort of thing. Other companies also like to give out information about breastfeeding. Infant formula or bottle companies, for example, often do this too.
Let’s dissect the website information on Boots.com a little and see what we find.
The first sections: “Why is Breastfeeding Good For Me?”
Boots have chosen not to linger on the well-documented child health reasons to breastfeed, with a ‘blink and you’d miss it’ section, but they do have time to mention our appearance.
“There are lots of really good reasons to breastfeed, including benefits to mum. These include: “It helps you to regain your old figure“.
Here we are, in 2018, with Boots suggesting weight loss is a top three reason to breastfeed. Talking about our body image before they mention the reduced risk of ovarian and breast cancers. I’ll leave you to think about that.
“How Do I Start Breastfeeding?”
Then we come to the next section “How do I start Breastfeeding”, where Boots have some advice from Clare Byam-Cook, a controversial figure* in breastfeeding support due to her lack of any breastfeeding specific qualification.
“Hold the baby close, facing the breast, with its shoulders and body in a straight line and it’s neck supported but the head free to extend (use a feeding pillow if more comfortable), offer your breast to the baby…”
I am wincing reading that description. “Facing the breast” implies a “mouth to nipple” position to me, something most breastfeeding professionals will tell you is a recipe for a painful latch. This is a good demonstration as to why that is (thanks to the Empowered Birth Company for the video). It also says “head free to extend”, a clearer phrase I feel would be: “head free to tilt back”. Thirdly, “Offer your breast to baby” conjures images of a mother holding her breast and smooshing it into baby’s face, this would likely encourage an uncomfortable feed for the mother in an unsustainable position. Finally, we see them suggest “use a feeding pillow if more comfortable”, with a link taking you a range of pillows. I have nothing against pillows as long as they work for the mother, but this should be your first clue this isn’t a selfless exercise on behalf of a retailer.
“Common breastfeeding niggles solved”
The second passage is “Common breastfeeding niggles solved”. If you used the first section to give you information on how to attach your baby, you may need the information here.
My first problem with this section is it is so negative, it almost seems to scream “Breastfeeding will cause you excruciating pain!”
I am not going to sit here and tell you breastfeeding shouldn’t hurt. That would dismiss the lived experience of many mothers. Breastfeeding has a learning curve, and getting to grips with attaching a baby to the breast when hardly any of us see it on a regular basis can be hard. Sometimes, while establishing breastfeeding, mothers experience pain. What I would say is, if this is you, don’t feel like you have to wait for things to “toughen up”, or that the answer is expensive nipple creams. The research just doesn’t support that. A bit of support with attachment or a tweak may make it feel better.
I do question why, in a limited space, a large portion of this leaflet is devoted to pain? Surely some diagrams of attaching a baby instead, might help their mothers prevent some of these issues in the first place?
Well, reading further it becomes clear. They can sell you stuff to help with pain. We see links to nipple cream and a range of nipple shields. I have no doubt nipple shields are useful for some mothers, I know for some mothers, they kept them breastfeeding. However, they can be an absolute faff to use all the time, especially in public. Babies can get overly reliant on them. They also don’t solve underlying issues the mother or baby may have.
Moving on to “engorged breasts”. Here, we see suggestions that using breast-pumps and bottle feeding until the engorgement subsides is a good course of action. This is the section I find most shocking.
Engorgement is most common in the first days after birth. So why encourage parents to pump and bottle feed instead of using simple techniques to soothe and resolve engorgement, such as hand expressing, nipple stimulation and cool packs? Pumping is known to overstimulate supply in the early days (parents are usually advised not to pump unless necessary in the first few weeks). Using a bottle instead means possibly going longer between breastfeeds with engorged breasts! This is not a good thing for breast health or milk supply. Not everyone can effectively remove milk from their breasts with a pump, at least, not as well as their baby. No mention of how early introduction of bottles may be detrimental to breastfeeding in some cases and that the Baby-Friendly Hospital Initiative advises against bottles and teats in early breastfeeding.
Then we come on to the last “common breastfeeding niggle”, mastitis. Hardly a ‘niggle’, is it? Mum is instructed to go straight to the GP, sensible. A bizarre choice though, I feel, to spend so much time encouraging pumping and bottle feeding through engorgement, but offering no well-known self-care methods for clearing a blocked duct.
“Do I have to breastfeed all through the night?” & Other Anxieties
Not content with suggesting you use a pump once, Boots move on to trying to sell you them again (with handy links to their range of pumps). This time it is to get dad involved in night feeds while mum sleeps. Now, I know this is a strategy some parents will try, and if it worked for your family, great. However, they have omitted the facts that:
- In the early months of breastfeeding, a mother will usually need to pump around the same time in the night, in order to avoid engorged breasts, blocked ducts, and mastitis.
- Quite often a baby will drain the bottle, but still want boob, because breastfeeding is not all about the milk.
- Night feedings can be important in supporting milk supply.
Then there is a section talking about new mothers breastfeeding in public. It’s OK though. Boots have a cover for that they can sell you. Oh and don’t forget about all the leaking. Boots can sell you stuff for that too.
This all seems to me, rather than helpful information, to be a fabulous example of how brands who sell you formula, pumps, bottles, and teats may complicate, or even sabotage breastfeeding, knowingly or unknowingly, in their quest to sell you ‘stuff’.
“What Can I Eat and Drink While Breastfeeding?”
So we come to the final section. The way this is written reads as if a mother needs to be hyper-aware of her diet: “good nutrition is more important than ever”. I find this paragraph pretty undermining. A good diet is important for everyone, it is not a necessity for breastfeeding. If it was I would be worried about my own child, since my early breastfeeding diet was 70% cake, 30% toast. Breast-milk is robust, and will in nearly all cases, still be the healthiest option for your child, (even on a 70/30 cake/toast diet). A mother would need to be malnourished for her breast-milk to be impacted.
“The occasional sweet treat is fine too- goodness knows you deserve a slice of cake”: Wow. Breastfeeding mothers of the world, quite frankly, if you want the whole bloody cake, eat it. Nobody needs permission from a shop to eat cake!
Finally, the article ends with some links showing us more bottles, talking about pumps and baby food (we haven’t even managed to breastfeed yet and Boots are talking to you about baby food? Seriously?) Sadly, no links to any organisation which may help you establish breastfeeding (you can find these at the end of this blog).
Companies like Boots may want you to start breastfeeding. Shops want you to buy stuff for breastfeeding from them. Let’s face it, this is how they make money. I imagine they want to sell you some expensive pumps, nipple creams, covers, bottles, and shields. Unfortunately for some, following this sort of information may mean their breastfeeding journey is over sooner than they hoped.
Luckily, if you do have to stop breastfeeding, Boots have a large selection of infant formula they can sell you, often on code-breaking special displays.
I do wonder what is in it for companies, to suggest things like mothers need to follow a healthy diet to breastfeed? Or to give out information which might make breastfeeding painful for a mother? Or lower milk supply? Why devote so much time to suggesting that breastfeeding usually comes with pain and problems?
I can’t answer these questions for Boots or any other retailer. I don’t explicitly know their intentions. I do think we need to be careful where we choose to get our help from, and that the first question we should ask ourselves when a retailer tries to give advice is- “What’s in it for them?”
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This is an opinion piece, and all opinions expressed here are my own.
*For an example of said controversy Byam-Cook’s last appearance on ITV sparked a petition for them to use qualified breastfeeding experts in future. The petition was signed by nearly 5000 people.
Are the images we see of parenthood realistic?
Back in 2014, I remember it quite clearly, I was sitting in an antenatal class with other expecting parents, who later went on to become good friends. We have often talked about those classes, but one memory which stands above the rest for me is one of the exercises, where we planned “24 hours with our new baby”. I remember filling in hourly slots on the flip chart with stuff like “going to the coffee-shop with the baby” and occasionally saying things like, “Ooh, it has been four hours, so we probably should be feeding the baby now too?” or “Perhaps baby will need their nappy changed now?” It always makes me chuckle when I remember it. I honestly don’t remember if the antenatal teacher tried to question this chilled out picture of the day we painted. I do wonder now how much she was laughing internally at our naivety. The perception some of us had, after babies, was this: the realities of parenting were a well-kept secret, and not to be discussed, at least not until after you have the baby.
Culturally we are all influenced by the image of “happy motherhood”. The commonly sold narrative is that all parents will naturally transition to life with a baby with ease, and will innately understand all aspects of parenting, especially if we buy the right “stuff”. In reality, we are social creatures, and what we learn about parenting, comes from what we absorb, from our wider lives, childhood, and culture. Many of us simply are not around babies and children much, except as children ourselves. We may have had a sibling, but chances are we do not really remember them being babies. We often grow up in small nuclear families, rather than extended families or small communities. We might see a lot of babies on the screen, but many UK parents have rarely held a baby before the day comes when they hold their own.
The societal norm of not really talking about how parenting can be unless you are talking to another parent, of not admitting to our real feelings, of not discussing widely how normal it is to find it difficult, perpetuates the “big secret” about what it is really like. Search an image site, or google for the term “motherhood” and what you will find is similar to the photo above; a gallery of soft focus images of babies being cuddled, smiling mothers and heartwarming memes talking about how amazing mothers are. And we are amazing, but that doesn’t mean we feel like we are. Yet we are constantly bombarded with this stuff. “Enjoy every minute, it goes so fast!” the memes cry, or they say things like; “Motherhood is messy, and crazy, and challenging, and sleepless, and giving and still unbelievably beautiful“. And just sometimes, seeing this stuff can make you want to scream; “I don’t feel the bloody beauty! I am tired, I am fed up, I want to shower without interruption, I want to pee by myself, I want a full nights sleep and I want my old life back, just for a day”. It can be especially hard to be a new parent in a world where we can be bombarded with “insta-ready” images of parenting. We see smiling parents in adverts for “stuff”. We see lovely snippets of life with kids on our social media feeds, a place where we compare the best parts of other peoples lives, to our everyday.
Amidst the “pre-baby” expectations of what we might gain- a lovely cute ‘bundle of joy’, love, fulfillment and happiness (all of which may be true) we may feel ashamed to admit if we feel a “loss” too. A loss of our old identity, our autonomy, our old body, our professional selves, our time and our sleep! I clearly remember having the realisation myself that my life had completely changed now. It was never going to be what it was ‘before’ and that there was no break from this, no holiday, no time off- and in that moment the responsibility I felt was completely overwhelming.
When you ask new parents what they feel is the most unexpected aspect of caring for their baby, quite often the knee jerk response is: “no-one prepared me for the sleep deprivation”. Our cultural norms do not prepare us for what normal infant sleep is and fears around bed-sharing, can mean more exhaustion for western parents, who are frequently trying to get babies to “go down” in a separate sleep space or even a different room. Their small human often has an entirely different agenda. When we see babies on the television, or in movies frequently we are shown a picture of a newborn, alone, in a lovely crib, while they sleep soundly. In fact to prove this point, here are the top images from a google search for “sleeping baby”.
No wonder it can all come as a bit of shock when the reality for many is not a baby who is happy to sleep alone, but is in your bed, latched on. You are in a fleecy M&S onesie with one boob out because you know you shouldn’t use a duvet, and any sheets that do remain have a few dubious stains on- “Is that breastmilk or baby vomit?” you briefly wonder, before turning your attention to other more pressing matters, like getting your baby back to sleep. Again.
And while we often focus on only how the mother is doing after birth, the same difficulties are often true for the other parent too.
Before we had our baby, my husband often remarked he didn’t see how it would change things a great deal. I remember having a conversation with him about how I wanted to make sure I got my hair done before having the baby, as I might struggle afterward. He was confused by my worries, in his mind, of course I would have time. In reality my baby was 6 months old before I got to the salon. The transition to fatherhood was equally hard on him, and I remember he was also emotional and overwhelmed at times. I’m ashamed to say, I resented him for this at the time, I was dealing with my own struggles to breastfeed, and my transition to motherhood. Where previously we would have shown each other empathy, instead we were often in conflict. Having had a very happy relationship ‘before’, the strain we came under came as a shock to me, we hadn’t anticipated it at all. Our experience felt dramatic at the time, it was our first maritial “rough patch” but we weren’t unique. I only realised this a couple of years later, having a lunch date with an old friend, who confided in me (after a few drinks) she had a really similar experience. Difficulties in relationships after having children are well documented, and also backed up by research. Yet it seems like the huge upheavals to relationships and subsequent difficulties are only alluded to in passing conversations, rarely discussed openly, if at all.
Obviously I love my daughter with a passion, I would never change a single thing about her (ok that is a lie, I do kind of wish she would sleep but that is another story). I don’t want to paint a negative picture because I have gained far more than I ever lost, and being a parent really can be so very wonderful. I think parents are amazing, and that we often are far too hard on ourselves. But I think we need to be telling real stories. Parenthood isn’t trite memes. It isn’t soft focus images of cuddled up babies and tiny feet. Breastfeeding isn’t always smiling down lovingly at a suckling baby, especially at first. Sometimes there is pain involved in becoming a parent, physically and emotionally. Often it is hard work. There is a learning curve. We might not be able to fully prepare for it, but we can be prepared to be surprised. And as we shed our old skin, and our old lives, and become something forever changed, we should reflect on the stories we tell to others who might be next. Our real stories deserve to be told. The truth is rarely “insta-ready”, but sometimes it is good to get a little bit real.
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Why supporting a breastfeeding parent with their diet is really important if their child has CMPA
- Eating other calcium-rich foods.
- Getting plenty of sunlight, particularly between March and October in the UK.
- Taking a vitamin D supplement as recommended by the NHS, especially if you have a darker skin tone.
- Replacing those lost dietary fats-think about things like olive or coconut oils, fish, avocado, or other animal fats (if you eat meat).
- Making sure some foods you eat contain iodine.
- Including more Omega 3 rich foods into the diet may be helpful, to balance any increased intake of Omega 6, this means including in the diet foods like oily fish or eggs (remember the NHS suggests no more than 2 portions of oily fish a week for breastfeeding mothers).
Navigating the world of online groups and forums
Lots of people feel passionate about the world of online breastfeeding support. It’s easy to recognise the value. I’m a member of several groups myself, I’ve been an admin in an online breastfeeding support group. Mother to mother support is so important. Many of us have found groups immensely helpful. There’s no doubt for me these online communities save breastfeeding relationships in a world where breastfeeding support groups, and even other breastfeeding parents can sometimes be thin on the ground.
The admin teams of good online support groups are amazing too, they give up so much of their time, for free, to support women. It is an incredibly generous thing to do.
An online support group should ideally be a complement to, not instead of, in real life, face to face support. The best groups know this, and you will often see those asking things like “do you have a local breastfeeding support group?” or “have you thought about seeing an IBCLC?”
Online we often don’t have the full picture of what is going on for somebody. Many of us may have also been unknowingly given ‘advice’ which isn’t always evidence-based when it comes to breastfeeding. And when we start to pass that ‘advice’ onwards, that can be a problem.
Examples of commonly heard phrases in online support groups which may be detrimental to another’s feeding journey:
- “A gain is a gain, don’t worry about the charts- they are based on formula fed babies anyway” (Incorrect, charts in the UK have been based on breastfed babies for years now, and a gain, unfortunately, is not just what’s important, lower than average gains over a consistent period of time = faltering growth and failure to thrive).
- “Breastfeeding really hurts at the start but just power through!” (Imagine you are a mum with severe nipple damage hearing this).
- “Just feed, feed, feed” (What happens if that baby isn’t producing enough wet and dirty nappies? Or has faltering growth? Most of the time cluster feeding is normal, but we need to be sure we have the whole picture).
- “I used formula top ups/bottles/dummies/weaned early and it was fine! No effect on my supply at all!”
So how, as mothers, do we protect our breastfeeding relationship while still making use of the support and information from an online group?
Identifying a good online breastfeeding support group and making the most of it- 10 tips!
1. If you are seeking breastfeeding support consider the audience. Is this a breastfeeding specific support group? If not, the responses you will get will be wide-ranging and reflect the nature of the group, and not everyone will feel positively about breastfeeding. Are they selling a service, or affiliated with a brand name? If so, consider the information you get might not be impartial. This is particularly true for parenting groups affiliated with infant formula or baby food companies.
2. Ask for evidence if you feel unsure. Never take something at face value, especially if it doesn’t feel ‘right’. There are evidence-based sources out there you can check in with too, a reliable source will be run by a national body like a breastfeeding charity or in some cases a lactation consultant. Alternatively, the national helplines are on hand to talk things through with.
3. Who are the group admins? Are they active? Are there enough of them for the size and activity level of the group? Do you see them addressing misinformation regularly? Importantly- are they nice? Do they treat the members with respect? All of these points are important for keeping groups a positive place to be.
4. If it is a breastfeeding support group, are the admin trained peer supporters or above? If the admin running the group aren’t trained in breastfeeding it might be wise to be a bit wary, as they may not have the knowledge base to know the good from the bad.
5. Is it a closed group, and do you have to go through a screening process to get into the group? If you are going to discuss intimate details of your life, make sure they don’t let any old random into the group. Some popular parenting websites use an open forum format, where anyone can comment or join in, and the results are searchable and completely open to the public. It is worth considering if that is a safe environment to get breastfeeding information.
6. Do they have group rules? Do they seem well thought out? Are the rules enforced?
7. This might be a controversial point, but it is something I feel is important. If we undermine health care professionals in an open forum we breed distrust among breastfeeding parents when it comes to their healthcare. This, in turn, means we see people disengaging with their healthcare services, and this isn’t always a good thing. Nurses, doctors, dentists, and health visitors can also be participants in the group, seeking breastfeeding support themselves. It’s nice to be nice. So thinking about this point, is the group generally respectful towards health care professionals?
Health care professionals are people who take a lot of responsibility for child health if we aren’t in the consultation we do not know the full picture, and we do not know how what was actually said was interpreted or understood. A good group will ensure the members pass on evidenced-based information without insulting the mother’s health care team, and if they are concerned by the actions of a HCP they will pass on details of the appropriate channels to pursue a complaint.
8. If you have a lactation consultant or are already under the care of a real life breastfeeding specialist, remember they are absolutely best placed to support you effectively. It can be sensible to think twice before you throw out a plan from a professional based on advice you get online. Remember you can always go back to discuss it with the trained person supporting you.
9. What rules are in place about recommending other groups? Some support groups will have recommended groups which they know are safe. If there is a free for all around groups, those groups suggested may not be totally evidenced based. It might be worth asking the admin for their opinion on the groups they prefer.
10. Finally, use normal internet caution within a group. Don’t post identifying information, be cautious with your photos, even with a well-run group, trolls can infiltrate.
Make sure that when you are out there in the big wide internet world of breastfeeding support, you keep yourself safe, and remember you are the advocate for your baby-so if in doubt- check it out with a reputable source or seek out a trained breastfeeding professional.
Breastfeeding helplines and websites
Your health visitor or midwife should know details of local groups in your area, or you can search here for information on your local group.
- National Breastfeeding Helpline – 0300 100 0212
- Association of Breastfeeding Mothers – 0300 330 5453
- La Leche League – 0345 120 2918
- National Childbirth Trust (NCT) – 0300 330 0700
- The Breastfeeding Network and the Association of Breastfeeding Mothers provide breastfeeding support and information.
- La Leche League offers mother-to-mother support with breastfeeding.
- LCGB can help you find a local IBCLC
- The National Childbirth Trust (NCT) is a charity that provides information and support on all aspects of pregnancy, birth and early parenthood via their branches and helpline (above)
- Best Beginnings have a wealth of information about breastfeeding premature babies.
- Breastfeeding Twins & Triplets have a brilliant website and a supportive Facebook group for breastfeeding parents of multiples
- UK Association for Milk Banking can help you with enquiries about donated milk or becoming a milk donor.
Identifying CMPA and how to cope if your baby is diagnosed with it
Cows Milk Protein Allergy is a hot topic. Hop onto any online breastfeeding support group, on any given day, and you will find someone asking about whether their baby could have a dairy allergy, or being told their baby might have a dairy allergy. When it comes to colic, reflux, general grumpiness, or a bit of green poo, it seems to be one of the go-to suggestions.
So this is my personal story, and some information about CMPA, covering diagnosis, how to live with it, what it is, and what it isn’t.
What is CMPA?
CMPA stands for “cow’s milk protein allergy” and it is the most common infant allergy in the world. If you look at what the guidance, and some of the research, says it is less common than seems.
Some research suggests:
- Formula feeding increases the risk of CMPA.
- 2-7% of formula infants and 0.5% of exclusively breastfed babies are thought to suffer from the condition.
Many people feel these numbers are conservative and research is ongoing. However, I include these figures here to make an important point- often what is going on is a lot more basic, and resolving the issue won’t involve you making huge changes to your diet. If you are concerned that your breastfed baby may have CMPA, it’s probably a good idea to have a chat with an IBCLC or breastfeeding specialist to rule out other, more common breastfeeding issues, for example, tongue tie, or a shallow attachment.
There are two kinds of allergy response to consider:
- ‘IGE allergy’ is what people commonly identify as an allergy- in its most severe form it includes anaphylactic shock. Symptoms of IgE allergies include hives, wheezing, swelling, and projectile vomiting.
- ‘Non-IgE allergy’ used to be called ‘intolerance’ or ‘CMPI’. Non-IgE allergies are delayed response allergies, meaning they can occur up to 72 hours after exposure. Symptoms of Non-IGE allergies include reflux (GORD), eczema and ear infections.
It’s possible for a child to have a combination of IGE and Non-IGE symptoms.
The Breastfeeding Network has a great fact sheet on CMPA here which talks about the symptoms.
BfN CMPA symptoms list
Is CMPA the same as Lactose Intolerance?
I want to shout this from the rooftops. CMPA is NOT lactose intolerance! (more here).
Lactose intolerance is fairly common in adults. It is caused by the body not producing enough lactase to digest sugars in milk. Lactase production declines as we get older, and in some adults, it declines to a level where it is a problem.
Babies and infants normally produce plenty of lactase, which would make sense since their diet is entirely milk. Lactose intolerance from birth is a different condition. It is a very rare enzyme disorder, not an allergy. Lactose-free products are not suitable for anyone dealing with a cows milk protein allergy.
My daughter has both CMPA and a soy protein allergy, which was diagnosed late on. Unfortunately, no-one involved in our care took an allergy-focused clinical history which might have speeded up the diagnosis. A’s Dad suffers from a few allergies. We have extensive food allergies on my mother’s side of the family. My daughter suffered from silent reflux, mild- but difficult to treat- eczema, and recurring ear infections. She was congested a lot of the time, so she snored loudly, slept with her mouth open, and had a persistently shallow latch (due to a blocked nose). It was an IBCLC who suggested CMPA to us after I visited her. She was 12 months old. I was slightly desperate at the time due to the fact she also woke up around once an hour (or more) so I was up for trying anything that might help. My husband and I were also concerned we were still medicating her for reflux, and as her eczema only seemed to be getting worse, we decided it was worth investigating it further. I went to talk to my GP.
To confirm whether or not A had CMPA I followed the NICE guidelines which meant removing all milk products from my diet for at least 4 weeks. An elimination diet like this is considered the best way to confirm allergies in infants. The reason for this is that tests to confirm allergies in babies are unreliable, and they will not identify Non-IgE allergies.
I also made sure I didn’t substitute my cow’s milk products with soy products, so I avoided soya milk, yogurt, and cheese. I had learned a large percentage (somewhere between 20 and 60%) of babies with CMPA will also have a soy allergy and I was keen to not confuse things with the elimination trial. This was my personal choice, it certainly isn’t a blanket recommendation, but it is something to bear in mind and discuss further with your health care team.
I carried on breastfeeding while I followed the elimination diet, it’s rare for a mum to have to stop breastfeeding if CMPA is suspected.
We saw an improvement in A’s symptoms within a few weeks. After six weeks I “challenged” to be sure we had an issue with CMPA- this involved simply having a glass of milk and watching for 72 hours to see if her symptoms returned, which they did.
In cases of children with severe allergies, this process must be managed under medical guidance My daughter didn’t have a severe allergy so we could do this at home without supervision- do check with a health care professional if you are unsure.
Once you have confirmed CMPA it is important to have some input from a dietitian (especially if the baby is on solids). It is also really important to consider how you will replace essential nutrients which may be lost from your diet if you eliminate milk longer term. More on this here.
“What do you mean there’s milk in the pickled onions?”- Living with CMPA
I quickly had to get to grips with checking labels! I’ve found milk in wine, crisps, chorizo, bread and yes- pickled onions! I quickly learned you cannot assume something will be okay.
This wine reduced me to tears one Friday. Proof– wine can contain milk! So check the labels on everything!
In the UK we have strict labeling requirements and common allergens need to be highlighted on the label in bold, which makes things easier for sleep-deprived parents!
Sticking to chain restaurants when eating out made our lives easier. Big chains tend to take allergies seriously, and often have a special folder or menu for people with allergies. All places which serve food have to be able to tell you (at least verbally) what allergens their food contains. Zizzi, Pizza Express and Pizza Hut all now offer vegan cheese and have dairy free pizza bases. Who would have thought you can still go out for pizza and be dairy free?
Make your server aware you have a milk allergy so they can take care not to cross contaminate food as they prepare it. It is always worth asking “what’s in that?” rather than just “what is dairy free?” You don’t know what the person serving you understands as dairy. Many people assume eggs are dairy so they may be excluding things from the menu unnecessarily or worse, may assume something isn’t dairy when it is.
I also always make sure I take ‘safe’ snacks with me or a packed lunch for Amy just in case if we are going out now she eats solid foods and a small pot of alternative milk for me.
The thing about cheese and chocolate
Good news- there is amazing dairy free chocolate! Most dark chocolate is dairy-free and many are soy free too. There are also specialised “free from” chocolates like “Moo Free” and “Booja Booja” (who do the most amazing ice cream too)!
I’ve personally found vegan cheese can have a bit of an aftertaste, as well as a strong smell! If you are going directly from eating proper cheese to ‘chease’ it can be a shock! I found after giving up on cheese for a while I was happier with the vegan stuff. The major supermarkets all seem to have a wide variety of dairy and soy free cheeses which makes life a lot easier. Currently, the ASDA cheeses are my favourites, they have a mozzarella alternative (which is also available at their pizza counters!) and a cheddar which are pretty good.
The bad news? I, unfortunately, didn’t lose weight on a dairy-free diet after I discovered loads of biscuits were dairy free…
May Contains- to eat or not to eat?
One thing which can be confusing when you first go allergen free is the labeling on products like “may contain milk” or “not suitable for milk allergy”.
Now, this looks like it isn’t suitable if you are eliminating milk, doesn’t it? However, what may be useful to know is that a ‘may contain’ label isn’t a legal requirement. Any food you buy which is pre-prepared, in a café, or restaurant is a ‘may contain’ even if it doesn’t say this. If you still prepare dairy foods in your own kitchen means everything you make is a ‘may contain’! Avoiding ‘may contains’ can make eliminating dairy or other allergens difficult. The risk of reaction from these products is small, so many parents of children who do not have life-threatening reactions decide not to avoid ‘may contains’.
Adjusting to your new normal
It can feel overwhelming when you first go dairy free. That’s okay. It’s not selfish to feel fed up about not being able to have cheese or to feel upset because OAT MILK IN YOUR TEA IS NOT THE SAME. I get that. It does get an awful lot easier as time passes.
It helps to seek out ongoing support, either in real life or online. There are some fantastic breastfeeding support groups on Facebook (https://www.facebook.com/groups/breastfeedingwithCMPA/ is my favourite and you will often find me chatting there). You can get recipe ideas, tip-offs on CMPA friendly treats and generally have a rant if you need to.
It probably took about 6 weeks to come to terms with my new diet, and it was all worth it in the end. The end result was a much happier tot! I’m so grateful I was able to breastfeed her. My milk means I have never worried about my daughter’s nutrition or tricky prescription formulas and for me, that all makes it worth giving up cheese.
This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure before making significant changes to your diet or your child’s diet to discuss this with a medical professional or a health visitor first.
Find me on Facebook! https://www.facebook.com/OxytocinAndOtherStories
More information on CMPA
Finding impartial information on CMPA can be difficult. Unfortunately, this is one area where industry (namely infant formula companies) are very heavily involved. The conflict of interest is clear so I won’t go into too much detail here other than to say the below resources will provide reliable, independent information, free from industry bias.
*I originally wrote this article for Breastfeeding Support and Information UK‘s blog “Through the Eyes of a Breastfeeding Support Group” and you can still read the original here*
“We don’t need to promote breastfeeding in western societies we need to enable it”- Maureen Minchin