Author: Charlotte Davies, Joanna White / Editor: Elizabeth Herrieven / Codes: / Published: 05/11/2024
In the UK, exclusive breastfeeding of infants is recommended until the introduction of solids at six months. That doesnt 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.
Wed also like to mention that breastfeeding is a very emotive subject, and not everyone finds it easy. If someone isnt breastfeeding, that doesnt mean they didnt want to, or didnt try. If someone is supplementing breastfeeding with formula feeding, thats not a bad thing and there are a myriad of reasons for this.
1. If relevant, ask mums if they are breastfeeding. Dont 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 theres 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 mothers 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. Dont 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 – dont do it if youre 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.
- Extra breaks for pumping are allowed.
- Encourage your colleague to pump as needed. Dont wait for their boobs to become uncomfortable or leaky.
- Identify a place for pumping and milk storage in your department. The toilets arent 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. Dont assume.
- If youre leaving the hospital with them, make sure theyve remembered to take their pumped milk home!
- Like patients, your colleagues may be breastfeeding infants of any age. Its still not your place to judge.
- Share resources – Breastfeeding for Doctors is excellent – closed to new members/posts now and just open for archive. New group is called Medics Lactation Community – MiLC: Breastfeeding Peer Support.
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.