Amy Brown is professor of maternal and child public health at Swansea University and director of the research centre LIFT (Lactation, Infant Feeding and Translation). She talks to Alice Ellerby about breastfeeding...
Amy Brown is a force of nature when it comes to advocating for maternal and infant health. Through her research and writing, she is working towards a future in which women and families feel respected, valued and supported in growing, birthing and caring for their babies. Breastfeeding is her particular field of interest. Though she describes breastfeeding her own babies as “fairly straightforward”, it was during this time that she became interested in infant feeding as an area of research. “I often met women who had experienced challenges that led them to stop before they were ready,” she says. “I wanted to make a difference. I wanted to understand all the subtle (and not so subtle) barriers that breastfeeding women face.”
I ask why she thinks breastfeeding is so important for women and babies. “We know that on a population level breastfeeding helps protect maternal and infant health,” she says. “That means that the overall risk of babies experiencing things like gastrointestinal or respiratory infections, or mothers experiencing reproductive cancers or heart disease, is lower for those breastfed or breastfeeding. However, for me, the main reason breastfeeding and breastfeeding research is so important is that when women cannot breastfeed for as long as they want to, it can impact on their mental health. Making sure fewer women are left angry, depressed or grieving due to their infant feeding experiences is why I carry on doing what I do.”
I wonder whether Amy thinks the benefits of breastfeeding are widely understood. “I don’t think society understands it very well at all. This issue began back in the 1950s when formula milk was very strongly marketed as being equal to, or even better than, breast milk for babies – ‘science milk’ that was created by scientists who were far more clever than the female body. Although research shows there is, on a population level, better health and development when babies receive breast milk, the formula industry spends billions of dollars globally each year trying to distract from that data.
“There will always be women who aren’t able to breastfeed for a number of reasons, and formula milk is safe and sufficient to support babies’ growth and development. But it doesn’t contain the immune properties that breast milk does, and formula needs to be prepared safely to avoid any risk of contamination. Also, the act of breastfeeding protects women’s bodies physiologically. It’s really tricky to try and convey these facts without causing harm because so many women do not receive the support and information they deserve when breastfeeding, and we have huge rates of women stopping breastfeeding before they are ready, and carrying a lot of grief because of that.”
The reality of breastfeeding came as a shock to me when my eldest daughter was born. I ask whether Amy thinks women are adequately prepared for what it entails. “No,” she says, “and those early weeks can feel overwhelming. However, once breastfeeding is established, it is usually the more straightforward option. In the very early days, breastfed babies often wake more frequently while milk supply is being established, leading to the myth that it’s more difficult. And many people will tell you that formula will help a baby sleep or be more settled and it’s simply not true. Wanting to be held, frequent feeds and waking at night are biologically normal behaviours and are not caused by how a baby is fed.”
Amy talks about some of the difficulties women experience. “There are some physiological reasons why a small proportion of women might not be able to produce a full milk supply, or some medications that in rare cases mean that breastfeeding is not possible. However, in many other countries, breastfeeding rates are far higher than they are in the UK and that comes down to culture and societal expectations around feeding and caring for babies. We don’t understand that breast milk is easily digested and babies naturally feed often according to hunger and for comfort too. This can be seen as a problem and a sign of not having enough milk. Formula is offered as a solution, which then reduces milk supply, as the body thinks not as much breast milk needs to be produced.”
So, what is going wrong with the support available to women who want to breastfeed? “There is a big issue with a lack of investment in the professional support women need if they encounter difficulties. Few have access to lactation consultants as part of standard care and unfortunately many are given outdated or incorrect advice by GPs who have little breastfeeding training. Midwives and health visitors are stretched thin and don’t always have enough time to sufficiently support women in the early days, meaning small problems turn into bigger ones. Specialist support for issues such as tongue-tie can also be difficult to access.
“We have wider issues around breastfeeding too. Women can still face criticism for breastfeeding in public. Workplaces are often not set up to support women who are breastfeeding on return to work. We live in a culture where although breastfeeding is encouraged throughout pregnancy, when women actually come to breastfeed, they don’t have the supportive environment that would enable this.”
Amy has conducted research that shows close ties between infant feeding experiences and mental health. “When women who want to breastfeed are unable to do so, they can feel many emotions – including anger and grief. These emotions can last a long time and can affect their experience of caring for their baby. It’s not just about the experience of not being able to breastfeed for as long as you want to, but also what happens when you are unable to do so. There needs to be much better support to recognise how women feel about having to stop. Often, these emotions aren’t to do with having to give formula. You can be relieved that your baby is being fed but still carry pain at not being able to breastfeed.”
If we have had a difficult breastfeeding experience or we weren’t able to feed our babies in the way we had hoped, what can we do to heal? “I think a big step is allowing yourself to experience those emotions and letting yourself grieve. There are lots of people you can talk to about how you feel, including through the National Breastfeeding Helpline and other breastfeeding charities. These organisations are not just there to support breastfeeding but can support you to process your experiences and your emotions.”
A fascinating area of Amy’s research is around donor breast milk, which can be especially important when babies are born prematurely. “If babies cannot receive their own mother’s milk, either at all or at first while she is establishing a supply, donor milk from other mothers can be life-saving. It helps protect babies against life-threatening disease and supports their development.”
But it’s not just about the baby’s health, as Amy explains. “Our collaborative research with the Human Milk Foundation shows that being able to access donor milk for your baby protects parental mental health. We have conducted two studies that show that parents feel relief that their baby is receiving human milk, and that their feeding choices are being respected. The kindness and support they feel helps improve their wellbeing at a difficult time. Levels of anxiety and depression significantly decrease after receiving donor milk and parents attribute this to having the option to access it. We have heard many stories from mothers who receive donor milk in these circumstances who go on to become donors themselves when their baby is older, to ‘pay forward’ the kindness of those who donated to them.”
Amy describes how milk is donated and received. “Mothers who are breastfeeding their own babies and have more milk than they need express it and store it in their freezer,” she says. “It is then taken to a milk bank where it is pasteurised, meaning that it is heat-treated to destroy harmful bacteria or viruses. This process heats milk very quickly to 62.5°C before rapidly cooling it to limit the destruction of the healthpromoting components in the donated milk. Around 70% of the antibodies in the milk will usually survive and be functional to help the baby fight infections; the special sugars called oligosaccharides are preserved and functional after pasteurisation, which helps support the development of the gut, microbiome and immune system.
“This treated milk is then sent to neonatal units around the UK. Babies are typically only given donor milk if they are born under 32 weeks, although this does vary. There are calls to expand this so that more babies can benefit, though this would require investment into the donor milk system to ensure that more women have the opportunity to donate their milk and there is capacity to increase pasteurisation and availability. There are many families who could potentially benefit from donor milk. The Human Milk Foundation has supported families to receive donor milk outside the neonatal unit. This includes babies of mothers who cannot breastfeed due to cancer or other health issues, babies with serious health issues, and babies who have experienced maternal bereavement.”
Amy’s children are now teenagers and I wonder what changes Amy has seen in terms of breastfeeding support since they were babies. “Sometimes it feels like nothing has changed, but when I look back over the years, there has been positive change. Breastfeeding rates are slowly climbing, and I think there is far less public criticism of breastfeeding. I think we also recognise breastfeeding grief better and are more supportive and less quick to argue when a woman says that she wanted to breastfeed for longer. Saying that, we still have a long way to go – the same myths are circulating, we don’t have enough money and funded roles to support mothers and babies, and industry is becoming more calculated in the ways it promotes its products.
“We need much more investment so that challenges can be tackled at the early stages. We need greater training for a range of health, medical and social care professionals so that everyone who comes into contact with a breastfeeding mother is equipped to support her and can direct her to those who specialise in infant feeding support.”
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Find out more about donor breast milk:
Instagram @prof_amybrown
Alice Ellerby is sub-editor at JUNO.
Photo by Mateusz Dach
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Published in issue 82. Accurate at the time this issue went to print.
