A winner! Working together to support families

A winner!  Working together to support families

If you attended the 2015 Unicef UK Baby Friendly conference you may have noticed, or taken part, in the informal World Breastfeeding Trends Initiative (WBTi) competition to guess the final assessment score. Sue Ashfield is the winner as her estimate was closest to the actual score of 50.5 out of 100 for Indicators 1-10.

The score is a measure of how the UK is performing against the implementation of key policies and programmes to support mothers who want to breastfeed and the healthcare professionals who help them.

Sue is the lead and Specialist Health Visitor (Infant Nutrition) of First Community Health and Care in East Surrey. Sue is a winner in a much bigger way than the WBTi competition because her community team was reaccredited by Baby Friendly earlier this year and they also supported 10 local children centres in achieving full BFI accreditation in one year. The formal presentation of the award was on March 14th. Sue pays tribute to the hard work of her colleagues for the achievement but it also reflects her commitment and leadership.  Read more here.

Her team is a brilliant example of what the WBTi UK report recommends for Indicator 6 (community-based support). There is close, integrated working between 0-19 public health team, breastfeeding counsellors, peer supporters and children centres at the three Baby Cafes, which have been runnning for 10 years.

Practitioners from the 0-19 team work at the Baby Cafes on a rota basis, alongside the breastfeeding counsellor. When they see mothers at home or at drop-in clinics they encourage them to attend the Baby Cafes for social support or more specialised support or just to chat to one of the peer supporters. The breastfeeding counsellors at the Baby Cafes have now trained over 200 peer supporters and this has increased the breastfeeding knowledge and skills within the local community.

Winner blog
Credit: Eleanor Stock

The photo above shows Sue holding the Baby Friendly Initiative (BFI) accreditation plaque along with some members of the 0-19 team, some senior managers and their BFI Guardian. Since April, all three community services in Surrey have come together as Children and Family Health Surrey to deliver children’s services.

Sue comments that she found particularly useful the information in the WBTi report about interventions and investment offered in the past and also Report Cards and the summary gaps and recommendations. She will use the findings in the report to inform local commissioners and disseminate information to staff and other stakeholders.

An integrated service like this is needed in all areas, yet in so many places services are being cut, particularly peer support programmes and breastfeeding support drop-ins.

Many congratulations Sue.

 

Cover photo credit: Paul Carter

PW Photo for WBTi MAINN presentation

 

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

Building Loving Relationships – Indicator 2: The Baby Friendly Initiative

valentine

Will you be my Valentine? Love matters to all of us.

There will be millions of Valentine celebrations taking place all over the nation on 14 February. Hearts, red roses, chocolates, gifts, expensive treats and marriage proposals will be exchanged to signal love on that day.

But… babies are born every day. People embrace each other every day. Loving relationships begin every day! Lovers kiss every day and babies are universally loved.

Affection and love shape our brains from that first kiss on day one and continually along our life course. They create that extraordinary mother and baby bond, stimulate social interactions and enable long-lasting friendships. Early loving relationships are nurtured and supported by our families, friends, health professionals and wider society. Being held closely, and responded to sensitively, by those who love you more than anyone else, has far-reaching effects on long-term emotional security and health.

The neuroscience evidence behind this is getting stronger every year. Sue Gerhardt explained that in her book Why Love Matters: How Affection Shapes a Baby’s Brain in 2004. Margot Sunderland explained the impact of this knowledge for parenting in 2006, in What Every Parent Needs to Know: The incredible effects of love, nurture and play on your child’s development.

Humans are very adaptable and babies respond to how they are treated, feeling secure and appreciated if they feel loved. Francesca Entwistle explains the importance of helping the baby develop secure attachment in the 2013 Evidence and rationale for the Unicef UK Baby Friendly Initiative standards.

The Unicef UK Baby Friendly Initiative programme has been universal in changing attitudes and encouraging best practice over the last 20 years in the UK through robust accreditation. It delivers the minimum basic standards required to support new parents – no matter how they feed their babies. It aims to create the best environment for the start of every baby’s life but is not yet mandatory for all maternity facilities in England and Wales (see WBTi UK 2016 report – Part 1, Indicator 2).

The question is why isn’t it mandatory as recommended by NICE (the National Institute for Health and Care Excellence) 11 years ago? The guidance states: “All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard.”

The governments of Scotland and Northern Ireland have a funded national strategy with a coordinator supporting all maternal and infant health professionals, and 100% of maternity units in Scotland and Northern Ireland are accredited, with community facilities aiming to achieve the same.

This cascade of national to local support aims to ensure all parents receive the best possible information, free from the undermining effects of commercial persuasion, with practical support to be enabled to make healthy decisions for themselves, which helps fulfil the government’s health message.

Families would benefit if England and Wales followed the best practice example of their neighbours.

What does Baby Friendly care mean for parents? Relevant information from pregnancy onwards, skin-to-skin contact immediately after birth as standard practice, and practical help with learning how to feed your baby. For more details, see You can expect the following standards of care from a Baby Friendly hospital. If all expectant parents knew about the standards, they could help press for them to be implemented universally.

The WBTi UK report points out gaps and provides recommendations to overcome the many barriers that women face in their daily lives, journeying from pregnancy through birth, the postnatal months, back to work and beyond, living in their own communities. See Part 1, Indicator 2 of the report for more information, with further details in Part 2.

Implementing the WBTi recommendations would contribute to the provision of the optimal conditions all parents need to begin raising their child in a loving and supportive society.

 

References

  1. Gerhardt S (2004) Why Love Matters: How Affection Shapes a Baby’s Brain E.Sussex: Brunner-Routledge
  2. Sunderland M (2016) What Every Parent Needs to Know London: Dorling Kindersley
  3. Entwistle F (2013) Evidence and rationale for the Unicef UK Baby Friendly Initiative standards
  4. WBTi UK (2016) World Breastfeeding Trends Initiative UK Report 2016
  5. NICE (2006) Postnatal care up to 8 weeks after birth
  6. Unicef UK BFI Support for Parents 

More on Indicator 2 – Baby Friendly Care and Baby-Friendly Hospital Initiative

 

A baby is born and placed on his mother’s chest. His newborn reflexes kick in and he starts to crawl to her breast, calm and alert. This skin-to-skin contact triggers a surge in oxytocin – the so-called “mothering hormone” – and she responds by instinctively helping him to the breast. He latches on, and her milk flows.

breast crawl

When breastfeeding begins in this uninterrupted way, soon after birth, research shows that babies are more likely to breastfeed well, and mothers tend to continue to breastfeeding for longer.

Now compare this to the typical birth scenario, repeated in so many maternity hospitals:

A baby is born, and her cord is cut. The midwife announces “It’s a girl!” and then wipes the baby clean and wraps her up. Then she passes her to her mother. Then the baby is passed to her father. After a few minutes, the midwife unwraps the screaming baby and puts her on the scales and gives her a vitamin K injection. The baby is dressed and returned to her mother.

It was the recognition of this importance of this first hour that led to the development of the Ten Steps to Successful Breastfeeding – a set of guidelines that became the cornerstone of the Baby Friendly Hospital Initiative, which began in 1992.

The ten steps encompass the practices that are needed to support a “breastfeeding culture” in hospitals. They are:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within half an hour of birth.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
  7. Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

In order to call itself “Baby Friendly” a hospital or institution must also adhere to the WHO International Code of Marketing of Breast-milk Substitutes (more on this in the next blog on Indicator 3).

There is clear evidence for better outcomes for babies born in Baby Friendly hospitals – for example, a study in Scotland found that these babies are 28 percent more likely to be exclusively breastfed at 7 days old.

The meaning of Baby Friendly has also evolved over time, and in recent years it has moved beyond the ten steps. In the UK, as well as protecting breastfeeding, the Baby Friendly approach now helps mothers to begin a nurturing relationship with their baby – and this protection applies to all babies, whether or not they are breastfed.

The Baby Friendly Initiative has also moved beyond maternity hospitals. In the UK, it is now possible for university courses, health visitors, children’s centres, and neonatal units to become Baby Friendly accredited.

The World Breastfeeding Trends initiative (WBTi) assessment scores each country out of 5 based on how many Baby Friendly hospitals it has. It needs have more than 89 percent of its hospitals and maternity units accredited to gain the top rating.

The assessment also looks at the quality of the Baby Friendly programme – how comprehensive the training is, whether it monitors hospitals adequately, whether mothers’ experiences are taken into account – for another possible score of 5.

How do you think your local services would score?