Welcome to the 32nd edition of our A Better Start Southend Research Bulletin, bringing you the latest on ‘what works’ in early years’ around our outcomes: Social and Emotional Development, Diet and Nutrition, Communication and Language, Community Resilience and Systems Change. 

This Research Bulletin was edited by Sharon Walker – Interim Researcher, and shows how we’re using these findings to influence our work in Southend. In addition, we invite you to help shape our ‘test and learn’ services, projects and innovations in prevention and early intervention. 

If you would like to contribute to future editions, have a question or would like to sign up to receive these updates, please e–mail: abetterstart@eyalliance.org.uk 

This edition includes contributions from four guest editors: 

• In my experience: Natural Term Breastfeeding by Isabella Gaspari
• Challenging perceptions that longer-term breastfeeding slows down children’s development by Isabella Gaspari
• Bump to Breast by Eleanor King 

We would like to extend our thanks to them for their contributions. 

In my experience: Natural Term Breastfeeding

By Isabella Gaspari

The relationship between a mother and her child is based on trust.  What better way to nurture this than through breastfeeding? As Thompson, Topping and Jones’s (2020) study notes, almost all mums are biologically able to breastfeed, except for those with a (very) few limiting medical disorders.

Breastfeeding is safe, cheap, rewarding, environmentally friendly and boosts health. All the women taking part in the research strongly believe that “breastfeeding ha[s] been, and continue[s] to be, beneficial for their children and themselves in terms of nutrition and bonding” (p.5).

This resonates with my experience, making the findings relevant to my personal life and that of friends who are also longer or natural term breast feeders.  In keeping with the study, I believe that we can support children to become confident as well as good listeners by listening and responding to them. If children ask for hugs, cuddles or boobs it is because this is meant to be. Instinct is essential for survival.  Every mother should be allowed to choose what is best for her and her baby, whether bottle feeding, breastfeeding during infancy or for a more extended period. Here, I reflect on what has been of the most benefit to me and which I encourage others to consider or support.

Society needs to learn to trust children; we know they are sincere; they are pure souls. If they are asking for attention it is because they do need it unconditionally. If they give us signs of distress it is because they have been somehow neglected. If children are interested in learning something, parents and carers, supported by the community, must capture that feeling and try to support them in achieving their goals. And often, this might be easier than we think. The secret is trust.

The research reports that these inspiring women described their approach with their child as “gentle parenting”, which they felt contributed to their successful breastfeeding relationships. They all felt it was important to rapidly respond to infant crying. Personally, I totally agree with this point of view.

As a mother of two, I have been tandem nursing for almost five years now. My experience has taught me that the more I follow my instinct and trust my children, the easier life is and full of joy. I could never have got where I am now without breastfeeding. It saved me from challenging life situations, and I have got through because I have followed my instinct and my children’s needs. And we are growing so well!

Of course, we need support as is the case in anything we do, from achieving a career to being a good parent. We all meet challenges in life, but with the right support we can achieve the impossible.

It is easy to feel isolated when the reality of life with a child does not always meet our expectations. In my experience, being able to meet other mothers was key. It can be a great help. The study suggests that understanding women’s experiences, including the motivators, enablers and barriers they face, may help inform future strategies to support and facilitate mothers to breastfeed for an optimal or natural-term duration.

Bump to Breast breastfeeding support group, a part of A Better Start Southend, welcomes mothers at all stages of nursing. They are professional, friendly, trustworthy mothers, who are happy to hear and share experiences and to give useful tips on request. They support mothers, whatever choices they make about nurturing their child. To end this piece, I have included a Facebook post from a mother who felt supported by the Bump to Breast community, reaffirming the women participants’ emphasis in Thompson et al.’s (2020) study about the need for a community of support in promoting natural term breastfeeding:

‘No point to this post on this rainy Sunday other than to say that yesterday I earned my diamond boobs ?? TWO years of feeding my little lady ? something I feel very proud of considering we battled through six weeks of hell in the beginning and have had lots of challenges along the way! Every single one of them was completely worth it.

For someone who was just going to ‘give breastfeeding a go and see what happens’, it has actually been such an important part of my motherhood journey and identity. Not only has it changed the way I feel about my body, but it’s given me confidence in my parenting style and most importantly, I’ve made some amazing friends through feeding too ? which is something I never expected to happen. 

The best advice I was ever given was ‘don’t give up on a bad day’ and to ‘trust your body, your boobs and your baby’, both of which are so true.

Challenging perceptions that longer-term breastfeeding slows down children’s development

By Isabella Gaspari

Title: Thompson, A.J., Topping, A.E., Jones, L.L. (2020). ‘Surely you’re not still breastfeeding’: a qualitative exploration of women’s experiences of breastfeeding beyond infancy in the UK. BMJ Open, 1-10 DOI: 10.1136/ bmjopen-2019-035199

Research source: https://bmjopen.bmj.com/content/10/5/e035199

Publication date: 2020

Our summary:

This study explored women’s experiences of breastfeeding their children beyond the age of one. The study aimed to understand the enablers, motivators and barriers faced by women in order to inform strategies for facilitating breastfeeding for an optimal duration.

Background

The World Health Organisation (WHO) currently advises that infants, regardless of setting, should be breastfed exclusively until 6 months of age. This is because extensive evidence shows the benefits of breastfeeding across the short and long term. For example, protection from infectious diseases has been shown to persist at least into the second year of life. Longer term breastfeeding is associated with a higher IQ and life-long protection against diseases such as obesity. Mothers also benefit from reduced risks against certain kinds of cancer such as breast cancer. There are also economic benefits, for example, reducing healthcare expenditure, and children’s future earnings due to raised levels of educational achievement.  However, despite this knowledge, there is little clarity and guidance from the WHO of the duration of the benefits of breastfeeding beyond 24 months.

Research participants

Research participants were drawn from across the UK through online breastfeeding support groups. Nineteen women took part in the study. Understanding the experiences of women in the UK to breastfeeding is of interest. This is because evidence from research suggests that most women stop breastfeeding when their child is 6 months old.  For example, in the UK, the last national Infant Feeding Survey (IFS) carried out in 2010 showed that 81% of babies born in the UK were breastfed at birth. However, 6 months following childbirth, numbers fell significantly. Data found that the proportion of mothers exclusively breastfeeding fell to around 1%, and only 25% of infants were still receiving any breast milk.

Conversations with research participants provided insight into the challenges faced by women breastfeeding older children. Broadly, these are divided into three main areas: 1) parenting philosophy; 2) breastfeeding beliefs; 3) transition from babyhood to toddlerhood.

Parenting philosophy

For most, the decision to continue breastfeeding beyond infancy was shaped by a parenting philosophy often described as an attachment parenting paradigm in the literature. This involves breastfeeding on demand during infancy, co-sleeping, extensive carrying of children and responding rapidly to a crying infant. The adoption of this paradigm was not always decided by the women prior to delivery, but occurred as the women learnt to parent, and instinctually followed the cues of their infant. An outcome of adopting this philosophy is the realignment of parenting beliefs and a reinterpretation of health advice. The significance of the philosophy is such that the women ultimately adopt subversive and secretive behaviour to continue breastfeeding. However, this is viewed as necessary to optimally nurture the child. Research suggests that this parenting style has many benefits, including enhanced brain and social development and in the longer term more favourable responses to stress.

Breastfeeding beliefs

Mothers narrated their decisions to continue breastfeeding as “natural” and “evolutionarily appropriate”. This is in keeping with anthropological research that estimates “the human biological weaning age [as] falling between two and seven-and-a-half years of age, if based on physiological parameters alone” (p.9). Linked to this, women preferred the terminology “longer-term breastfeeding” to describe breastfeeding beyond infancy. This compares to the term “extended breastfeeding” often used in the academic literature and for which the women actively expressed dislike.  As one mother stated: “It is important that people know it’s not extended, it’s normal!” (p.6).

While expressing breastfeeding as normal, the women also expressed pride and achievement over successful breastfeeding. The women rationalised this inconsistency by describing breastfeeding as challenging. As a result, success was framed in terms of commitment. Women felt proud of their own achievements and wanted to share their experiences (all the women expressed a desire to support other breastfeeding mothers) even though they felt criticised and considered as “outsiders”.

Transition from babyhood to toddlerhood.

Women described feeling pressured to breastfeed when their babies were young but discouraged as their child grew older. For example, the women perceived that healthcare professionals (HCPs) disapproved of breastfeeding beyond infancy and were even unaware of the benefits of breastfeeding. As a result, the women sought breastfeeding advice among their peers as they were concerned about a lack of knowledge on the subject by HCPs, or that any advice would be coloured by “opinion rather than evidence” (p.7).

The women’s experiences are in line with research showing that the social environment is influential to women’s decisions to continue with breastfeeding. All sections of the community – family, friends, co-workers and strangers – feel at ease in providing critique and unsolicited advice on breastfeeding. Although the women who continued breastfeeding for longer periods often felt judged, the perceived disapproval was not enough to deter them from breastfeeding.

Conclusions

Providing antenatal education on biological weaning ages and optimum breastfeeding duration could contribute to normalising longer term breastfeeding and motivate more women to breastfeed for longer. HCPs should also be aware of the benefits of breastfeeding and the language used when speaking to women to encourage a positive environment around longer term breastfeeding. Also, the inclusion of a breastfeeding section, as part of the formal documentation provided to mothers at the 2-year review stage, may contribute to promoting normalcy around longer term breastfeeding and provide women with a supportive opportunity to discuss potential issues. WHO guidelines on biological weaning ages and guidelines for minimum breastfeeding duration would also be supportive in this respect.

Limitations

Research participants were predominantly white and highly educated. This might be due to this demographic being most likely to breastfeed past infancy. Therefore, the experiences of parents from other backgrounds and minority ethnic communities is important for future research, to ensure everyone is supported.  Also, only 7 (37%) of the 19 participants were employed full time. Therefore, further research is needed to explore the impact of work on breastfeeding continuation.

How Southend is using the research:

By Eleanor King

ABSS Bump to Breast actions many of the findings presented in the study:

• Provides livestreams on the topics of breastfeeding toddlers, and natural term weaning.
• Recommends, in keeping with WHO guidance and findings from the study, exclusive breastfeeding until six months old and continuing with some breastfeeding until the child is two years of age, or beyond if both mother and baby are happy with this. As reported by the study, this guidance is in place because there are many proven benefits for both the mother and baby, which come with an increased duration of breastfeeding.
• Uses positive and inclusive language, talking about ‘natural-term breastfeeding’ rather than ‘extended breastfeeding’. As found in the research, the latter expression gives the impression that a shorter duration of breastfeeding is either desirable or is the norm. They also use the term ‘introduction of solids’ rather than ‘weaning’, which may be misunderstood to imply weaning off breastmilk, rather than weaning onto food. They consider the impact of the baby food industry on cultural expectations of the length of breastfeeding.
• Makes use of volunteers’ courses and livestreams to discuss ways of dealing with difficult comments such as ‘when’s he going to stop feeding?’ or ‘Not still breastfeeding are you?’, in an appropriate, informed, and, where suitable, gently humorous way.
• Encourages the community to talk more often about the subject in order to inspire parents and families to be open to natural term breastfeeding.
• Creates an environment for mums who have breastfed their babies through toddlerhood and took part in Bump to Breast meetings to complete their volunteers’ training and support others in their journey.

Bump to Breast

By Eleanor King

ABSS (A Better Start Southend) has given shape to a volunteering support group project called Bump to Breast: Breastfeeding Group Support

Bump to Breast provides welcoming social groups for breastfeeding mums and their children, which are toddler friendly, and provide toys and snacks for them. Several of the project’s livestreams have covered the topic of breastfeeding toddlers, and natural term weaning.

The project is very aware of the social and cultural context surrounding women who choose to breastfeed, and the affect of this on those who continue to breastfeed their children through toddlerhood.

Together with the World Health Organisation guidance, Bump to Breast uses findings from research to sustain the recommendation of exclusive breastfeeding until six months old, and then continuing with some breastfeeding until the child is two years of age, or beyond if both mother and baby are happy with this. As reported by Thompson, Topping and Jones’s (2020) study, this guidance is in place because there are many proven benefits for both the mother and baby which come with an increased duration of breastfeeding.

Bump to Breast try to use positive and inclusive language, talking about ‘natural-term breastfeeding’ rather than ‘extended breastfeeding’, which, supporting the research findings, gives the impression that a shorter duration of breastfeeding is either desirable or is the norm. They also use the term ‘introduction of solids’ rather than ‘weaning’, which may be misunderstood to imply weaning off breastmilk, rather than weaning onto food. They consider the impact of the baby food industry on cultural expectations of the length of breastfeeding.

In their volunteers’ course, and in their livestreams as well as in more informal conversations, they discuss ways to deal with difficult comments such as ‘when’s he going to stop feeding?’ or ‘Not still breastfeeding are you?’, in an appropriate, informed, and – where suitable – gently humorous way.

This is exactly what the research is trying to demonstrate. The community needs to talk more often about the subject, in order to inspire parents and families to be open to natural term breastfeeding.

As the research states, many of the mums who have breastfed their babies through toddlerhood and took part in Bump to Breast meetings have gone on to complete their volunteers’ training and have been able to support others in their breastfeeding journey.