WBTi’s Twelve Days of Christmas: part 2

WBTi’s Twelve Days of Christmas: part 2

See Part 1 of WBTis’ Twelve Days of Christmas, covering our Indicators 1-6, here

Day 7 – seven swans a-swimming

Swans evoke an image of serenity, even if they’re paddling hard under the water. Support to make breastfeeding more effective can help mothers be calmer and more serene, even though they’re working hard caring for their child or children.

Indicator 7 is about information. There is plenty available, particularly on the internet, but mothers often need help selecting reliable websites. Resources developed since the WBTi report include a new book by Amy Brown (The Positive Breastfeeding Book), a chatbot available on Facebook and and as an Alexa app from PHE, and more breastfeeding information on the Baby Buddy app. 

Indicator 7 also asks whether there is a national communications strategy on infant feeding – while there are strategies in place in Scotland, Northern Ireland and Wales, there is still no communications strategy on infant feeding in England.

In the song, the seven swans represent the seven sacraments, which are Christian rites. There are perhaps seven occasions for a mother when she is in particular need of accurate information about feeding her baby – antenatally, at birth, early days, the challenges when her baby is a few months old, introducing complementary foods, returning to work and stopping breastfeeding.

Day 8 – eight maids a-milking

The maids symbolise beatitudes (blessings) for people considered as unfortunate. Indicator 8 addresses support for HIV+ mothers. There needs to be both appropriate policy and familiarity with the policy by people working with HIV+mothers. In 2016 WHO published revised guidelines recommending that in countries where health services ‘provide and support lifelong anti-retroviral therapy (ART), including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.’  In the UK, BHIVA published revised guidelines in 2018. As in its previous guidelines, these still recommend formula feeding for women living with HIV but also explicitly support women who choose to breastfeed, provided they fulfil certain criteria. The new guidelines are more detailed than the previous ones; they encourage openness and respect the importance of breastfeeding for a mother’s own mental health.

If there were more donor milk available, mothers who don’t meet the clinical criteria for breastfeeding outlined by BHIVA could use it and enable their babies to have breastmilk. Then ‘Maids a-milking’ can be thought of as ‘donor mothers expressing’.

Day 9 – nine ladies dancing

Ladies dancing is how the song represents ‘fruit of the Holy Spirit‘ – beneficial attributes of a person or community, such as love, patience, kindness and self-control. 

Indicator 9 assesses the extent to which policies and programmes are in place to ensure that infants and young children will be fed appropriately during emergencies. Those acting on behalf of the community in emergencies need to plan ahead to provide care that is beneficial and supports optimal infant feeding.

The WBTi report found that infants and young children had largely been overlooked in emergency planning in the UK. The WBTi team and Ruth Stirton from the University of Sussex Law School organised a well-attended forum at the Houses of Parliament in November 2017 to start raising awareness of the issue, with LCGB holding a study event the following week, and a policy briefing is due to be published in 2019.

WBTi UK joint coordinator Helen Gray has also presented on the issue at several conferences in the UK and internationally, and contributed a chapter on infant feeding in emergencies for parents in Amy Brown’s The Positive Breastfeeding Book.

Day 10 – ten lords a-leaping

In the song these refer to the Ten Commandments, which are principles for living. Surely that involves monitoring and evaluating actions to ensure they fit with intentions. And Indicator 10 is about collecting data to monitor and evaluate the systems. Scotland carried out its own Maternal and Infant Nutrition Survey in 2017. England currently still just collects data on initiation of breastfeeding and prevalence at 6-8 weeks postpartum, and there is missing data.

The WBTI UK recommendations include extending data collection to include breastfeeding rates at 6 months and one year, by incorporating questions in the existing health visitor contacts.

Day 11 – eleven pipers piping

The pipers symbolise the eleven faithful apostles. There are many people willing to advocate better support for mothers who want to breastfeed, but far more than eleven!

Indicator 11 asks what percentage of babies are breastfed within the first hour following birth. At the time of the report it was 60%. The key action immediately after birth is unhurried, uninterrupted skin-to-skin contact. During skin-to-skin contact in that first ‘magical’ hour the baby shows nine instinctive, distinct and observable stages, which with the mother-baby dyad makes eleven elements. Interrupting skin-to-skin even briefly for routine care disrupts this essential sequence and can impact the baby’s success at reaching the stage of latching on and suckling the first time.

In 2017 Kajsa Brimdyr and colleagues published a paper about the implementation algorithm they have developed for improving skin-to-skin practice immediately after birth; this was also presented at Unicef Baby Friendly UK’s 2018 conference.

Presentation: https://edu.ilactation.com/seminars/47

Will the algorithm be used in UK maternity units?

Day 12 – twelve drummers drumming

The drummers symbolise the Apostles’ creed, which was an early statement of Christian belief.

Indicator 12 is a measure of the amount of exclusive breastfeeding that happens in a country among babies up to 6 months old. The report had to use 2010 data as these were the most recent; the data gave 17%, meaning the total amount of breastfeeding was the same as if 17% of babies were exclusively breastfed to 6 months and the other 83% totally formula-fed.

There is enough evidence for the better outcomes if infants are exclusively breastfed to 6 months for WHO to recommend it since 2003, yet there seems a lot of doubt in UK society about the value of doing so. Somehow the evidence hasn’t become belief for many people. 

WBTi Indicators 1-6 are covered in part 1

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Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.


Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding and the First 1000 Days: the foundation of life

Breastfeeding: The Foundation of Life

The First 1000 Days of Life (from conception to the age of two years) are a critical window in a baby’s development. The 1000 Days concept was first widely used by the World Health Organisation and UNICEF, and there are currently numerous campaigns building on that theme.*

There is currently an inquiry into the First 1000 Days by the UK Parliamentary Select Committee on Health and Social Care. This blog brings together a few of the key concepts and resources on the importance of breastfeeding during the First 1000 days.

A joint supplement on the importance of breastfeeding in the first 1001 Days was produced by the UK breastfeeding organisations in 2015, which summarises much of the evidence.

A focused briefing on the the role of breastfeeding on infant brain growth and emotional development can be found here.

 

Breastfeeding: cornerstone of the First 1000 Days

Human babies are born extremely immature compared to other mammals; they are completely dependent on their mothers for milk, comfort and warmth.

  • “A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.” ~ Grantly Dick-Read

Scientific research has continued to underscore the vital role that breastfeeding and breastmilk play in the development of the human infant. See our WBTi blog series for this year’s World Breastfeeding Week, from 31st July – 7th August 2018 for a review of the myriad ways that breastfeeding influences human development.

 

Breastfeeding: more than just food

This is the title of a series of blogs by Dr Jenny Thomas which focuses on some of the ways that breastfeeding contributes to immune development and more. Beyond physical health and development, however, breastfeeding also plays a key role in the healthy mental and emotional development of the infant. Breastfeeding provides optimal nutrition for the first months and years of life, alongside suitable complementary food after six months, but it also supports the development of the child’s immune system and protects against a number of non-communicable diseases in later life as well.

The World Health Organization commissioned high level reviews on a range of health and cognitive outcomes which were published in a special issue of Acta Paediatrica in 2015; these formed the foundation of the Lancet Series on Breastfeeding  which was published in 2016.

 

The impact of breastfeeding on maternal and infant mental health and wellbeing.

Breastfeeding can help strengthen mother and baby’s resilience against adversity, and can protect infants even when their mothers suffer from postnatal depression. It supports optimal brain growth and cognitive development. Unfortunately, if mothers don’t receive the support they need with breastfeeding, this can significantly increase their risk of postnatal depression. A summary of evidence can be found here.

The role of breastfeeding in protecting maternal and infant mental health is often poorly understood – mothers who are struggling need skilled support to resolve breastfeeding problems if they wish to continue breastfeeding

 

What does the future hold?

It is essential that policy makers, commissioners, and researchers understand the evidence and importance of breastfeeding, so that women who want to breastfeed get any support they need. The WBTI report outlines major policies and programmes that national infant feeding strategies need to include; other research on the psychological and cultural influences on mothers’ infant feeding decisions will help policy makers to develop sensitive and sound policies and programmes to support all families.

In the end, it will be essential that families themselves are heard, in order to create the support systems that our society needs.

 

 

*Unfortunately a number of infant milk and baby food companies have jumped on the “1000 Days” bandwagon too, despite the fact that breastfeeding is the centrepiece of the original 1000 Days concept, and replacing breastmilk with formula or baby food actually removes that fundamental building block from a baby’s development.

 

 

 

Helen Gray IBCLC photoHelen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She is a founding member of National Maternity Voices. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

Data matters: How do we know what’s happening with breastfeeding?

Data matters: How do we know what’s happening with breastfeeding?

Indicator 10 of any World Breastfeeding Trends Initiative report is about that country’s monitoring and evaluation systems. It may not seem an exciting topic but it’s essential to collect robust data on infant feeding to know what the breastfeeding rates are and how mothers are experiencing services. Without having monitoring data how can services be evaluated and then improvements planned?

For small projects, feedback from mothers may be the most effective evaluation but for larger projects and sizeable areas, the percentages of babies being breastfed (called prevalence) at particular ages help to monitor what is happening. Figures don’t capture the ripple effect of support, though, such as a mother who’s been helped on her breastfeeding journey then supporting friends or being more likely to breastfeed a subsequent baby or deciding to train as a peer supporter.

The WBTi UK report in 2016  found that data collection and analysis had reduced considerably since the ending of the 5-yearly infant feeding survey. There is variation between the four nations with England collecting the least data.

Changing systems in England

In England, record level data on infant feeding is currently submitted by service providers to NHS Digital as part of the Maternity Services Dataset (initiation/first milk feed) and the Children and Young People’s Health Services Dataset (6-8 weeks). Whilst these new datasets are reaching full maturity, NHS England and Public Health England are publishing official statistics on an interim basis for breastfeeding initiation and breastfeeding at 6-8 weeks respectively. Both sets of data are assembled from aggregate data submitted on a voluntary basis by service commissioners. These two breastfeeding indicators are included in the Health Improvement part of the Public Health Outcomes Framework (https://fingertips.phe.org.uk/profile/public-health-outcomes-framework).

Data on infant feeding at birth are submitted by maternity units. Babies were previously counted as breastfeeding if they went to the breast at least once in the first 48 hours. However, this is now changing to a record of the baby’s first milk feed. This is captured as part of the Maternity Services Dataset and NHS Digital publishes monthly reports on the statistics of all the indicators in the data set: as well as annual data.

Local authorities have responsibility for ensuring that their commissioned providers of the universal health visiting service submit infant feeding data for babies aged 6-8 weeks as part of the Children and Young People’s Health Services Dataset (which is about to be renamed the Community Services Dataset). As this data collection is not yet mature, aggregate infant feeding data is submitted to PHE on a quarterly basis. Official statistics are produced annually and quarterly

The Early Years part of PHOF, including these indicators, is maintained by the National Child and Maternal Health Intelligence Network.

In theory, the information at 6-8 weeks provides a picture of what is happening for the whole population but, disappointingly, there are quite a number of gaps. In most cases the local authority submits data to PHE but it cannot always be published as official statistics as a result of validation failures. This is most often due to too many records of ‘unknown’ breastfeeding status.

In one area, the health visiting service has found a solution to this by including a mandatory field on infant feeding in the electronic record of the questions about maternal mood at 6-8 weeks.

There needs to be information on at least 95% of the eligible population of babies (called coverage) to be valid and thus included. This results in some gaps in the published statistics even though the underlying data is available.

 

Try it yourself!

There is now a facility to compare different sets of the annual data, such as comparing gastrointestinal or respiratory infection rates with breastfeeding rates. §If there is sufficient correlation between two datasets, a red line appears. It doesn’t prove there’s a causal link though. You can try this for yourself here:
You select the Region, Area and Indicator you are interested in and then another Indicator for the Y-axis. You need to tick ‘add regression line’ to see if there is a correlation.

Using data to advocate for services

However, even if a service is well-evaluated, that does not guarantee its continued existence, as occurred with the Blackpool peer support Star Buddies programme, although this can be a useful tool in challenging actual or proposed cuts. Zoe Walsh, in her speech to Blackpool council (at 4mins 30s in the recording) in September 2017 used data as part of her clear explanation of why the service needs to be reinstated.

Data collection counts!

 

Cover photo credit: Paul Carter

30. Photo for WBTi MAINN presentation

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.