Author: Charlotte Davies, Joanna White / Editor: Elizabeth Herrieven / Codes: PhP1, SLO1, SuC5 / Published: 05/11/2024
In the UK, exclusive breastfeeding of infants is recommended until the introduction of solids at six months. That doesn’t mean breastfeeding stops automatically as soon as baby takes their first bite of broccoli – it continues for as long as the baby and mother want, and the World Health Organisation and the Quran recommend continuing for two years. There are benefits to continuing breastfeeding for longer.1-3
Although we have used the words “breastfeeding” and “mother” in this blog, we recognise that not everyone who lactates identifies as a woman/mother. These principles apply to anyone who breast/chest feeds.
We’d also like to mention that breastfeeding is a very emotive subject, and not everyone finds it easy. If someone isn’t breastfeeding, that doesn’t mean they didn’t want to, or didn’t try. If someone is supplementing breastfeeding with formula feeding, that’s not a bad thing and there are a myriad of reasons for this.
1. If relevant, ask mums if they are breastfeeding. Don’t assume that because the child is older they are no longer being breastfed. One mum may be feeding more than one child at once, and at any age. Unless expressly asked and knowledgeable, it is not your place to judge this.
2. Never suggest “pump and dump” to allow you to give a medication. Pumping is useful for maintaining supply, and allowing another caregiver to give breastmilk in a bottle. However, not all breastfed babies will take a bottle. IV Contrast and breastfeeding is safe – but there’s a theoretical risk of allergy.
3. Check for side effects of medication you give. LactMed is considered more reliable than the BNF.4 The Breastfeeding Network has lots of factsheets about commonly used medications and their safety in breastfeeding. During “office hours” the trust infant feeding team or pharmacist may be able to provide prescribing support as well.
4. If she is well enough, breastfeeding should continue if the mother has an infectious disease as the mother’s antibodies will pass through the milk to the infant. This is true even if the mother has HIV,5 but I would ensure the mother is on treatment and has the support of the local HIV team.
5. Provide privacy to breastfeed as much as possible. A pillow, a chair, and a large glass of water will be very much appreciated by most breastfeeding mums. Most hospitals have a breastfeeding room – find out where it is. If breastfeeding mothers are admitted to hospital, advocate for them to keep their infant with them, or have access to a hospital grade pump and fridge. The policy on this will vary from hospital to hospital – advocate!
6. Treat mastitis appropriately using the ABM or NICE guidelines and remember the importance of feeding support and a “good latch”. The most up to date guidelines recommend anti-inflammatories and “normal” feeding – extra pumping and pumping and dumping is NOT recommended. Consider sending a breastmilk culture in severe mastitis.6-9
7. Remind Mum to consider taking vitamin D.10
8. If relevant, check for the possibility of pregnancy, as breastfeeding alone is not a reliable contraceptive.
9. Don’t provide untrained advice. Breastfeeding is complicated, with a lot of dogma. In a new breastfeeding parent, conflicting advice can be devastating to their breastfeeding journey. Recommend they contact the hospital infant feeding team if they need advice, or a lactation consultant. They can also call the free NCT breastfeeding helpline to speak with a trained breastfeeding counsellor and there may be face to face sessions available depending on location. Checking latch, and even for tongue ties, is a specialist topic – don’t do it if you’re not appropriately trained.
10. Give them a glass of water – making milk is thirsty work, and parents might not ask for water. Just give it to them.
11. Breastfeeding patients can still develop breast cancer, so please refer to the 2WW pathway if indicated.
12. In the unfortunate event of an infant death, consider whether mum is breastfeeding. Cabergoline is a medication that can be used to suppress milk production.
Top Tips for Supporting Breastfeeding Colleagues
Colleagues may return to work before they have finished their breastfeeding journey, especially if their infant is under one. Their milk supply has probably settled, but they will probably appreciate some extra support from you.
- A risk assessment should be completed by their manager and this may lead to modification of duties, regardless of the age of the child. Remember WHO advise feeding until 2 years.
- Extra breaks for pumping are allowed.
- Encourage your colleague to pump as needed. Don’t wait for their boobs to become uncomfortable or leaky.
- Identify a place for pumping and milk storage in your department. The toilets aren’t ideal.
- Make sure they keep their fluids up
- Check in to confirm what they want. Many people are happy pumping in company, and continuing to do non-patient facing (or patient-facing) work. Some feel a bit more uncomfortable with this and would prefer to pump in solitary. Don’t assume.
- If you’re leaving the hospital with them, make sure they’ve remembered to take their pumped milk home!
- Like patients, your colleagues may be breastfeeding infants of any age. It’s still not your place to judge. Colleagues may return to work before they have finished their breastfeeding journey. If their child is over one, their milk supply has probably settled, but they will probably appreciate some extra support from you.
- Share resources – Breastfeeding for Doctors is excellent – closed to new members/posts now and just open for archive. New group is called Medic’s Lactation Community – MiLC: Breastfeeding Peer Support.
- Trainees should have a SupoRRT request made as part of their parental leave planning.
Modification of Duties
Modification of duties is allowed, but may not be pay protected. Documents are unclear, but the NHS terms and conditions state:
The BMA breastfeeding guidelines suggest modifications of duty, but do not state these should be pay protected.
A Risk Assessment
Employers are required to undertake a risk assessment and to provide breastfeeding women with suitable private rest facilities. The Health and Safety Executive guidance recommends that employers provide suitable access to a private room to express and store milk in an appropriate refrigerator and a clean, healthy and safe environment for women who are breastfeeding.
Your trust will have a risk assessment of varying quality. Essentially you want to check staff are not going to get mastitis because they are not feeding regularly. If you don’t feel comfortable talking through this, find someone in your department who is- essentially its how often are they feeding at the moment, how are they going to pump. For people who are feeding 8-10 times overnight, taking them off night duties is probably advisable. Stopping night feeding is especially risky because of the prolactin produced overnight. This is why the BMA advise you have the right to request to come off night shift.
We don’t have the crash bleep, so people won’t be disturbed when pumping, but they need to know they can leave wherever they are to go and pump.
Long shifts (>10hours) are probably a problem – but luckily we don’t do them!
OH can advise, but are unlikely to say any more than what has already been done.
The Thames Valley risk assessment is a good example.
Talk to them about how to:- Identify a place for pumping and milk storage.
References
- La Leche League GB – Breastfeeding Beyond a Year
- Breastfeeding for Doctors – Position Statement on the Shared Caregiving of the Breastfed Child
- Royal College of Paediatrics and Child Health (RCPCH) – Breastfeeding in the UK – position statement
- National Library of Medicine (NlM) – Drugs and Lactation Database (LactMed)
- World Health Organisation (WHO) – HIV/AIDS: Infant feeding and nutrition. 2021
- National Institute for Health and Care Excellence (NICE). Mastitis and breast abscess: Scenario: Management of mastitis and breast abscess in lactating women. NICE CKS, 2024.
- Academy of Breastfeeding Medicine (ABM) – Protocols.
- RCEMLearning Clinical Case – Red Breasted, 2022.
- RCEMLearning SBA – Acute Breast Problem, 2022. (member only)
- Start for Life, Better Health – Breastfeeding vitamins. NHS UK.