WBTi’s Twelve Days of Christmas: part 1

WBTi’s Twelve Days of Christmas: part 1

This blog explores links that can be made between the gifts described in “The Twelve Days of Christmas” song and the World Breastfeeding Trends Initiative 2016 report

Day 1 – a partridge in a pear tree

Just as a partridge can find support and protection in the branches of a pear tree, each breastfeeding dyad needs a society that provides a supportive structure; to achieve this needs  coordination at national level through having a national policy, a strategic plan and effective implementation of that plan (WBTi Indicator 1). 

Jeremy Hunt, when Secretary of State for Health, declared that 

“The government is implementing the vision set out in the WBTi UK report. The Maternity Transformation Programme seeks to achieve the vision set out in the report by bringing together a wide range of organisations to work in nine areas… this includes promoting the benefits of breastfeeding by

  • Providing national leadership for breastfeeding celebration week;
  • Publishing breastfeeding initiation data;
  • Publishing breastfeeding profiles; and
  • Improving the quality of data on breastfeeding prevalence at 6-8 weeks after birth.”

A national assessment of UK breastfeeding policies and programmes, “Becoming Breastfeeding Friendly,” has now begun across England, Scotland, and Wales, led by the national governments and public health agencies and the University of Kent. Importantly, this initiative requires government commitment to implementing the resulting recommendations.

Another positive development since the WBTi report in 2016 is that in April 2018 Public Health England created a one-year Midwifery Adviser post for a seconded health professional whose responsibilities include breastfeeding, funded by the National Maternity Transformation Programme.

Day 2 – two turtle doves

This fits very well with Indicator 2 as it assesses the extent to which maternity-related services are Baby-Friendly accredited and the standards support loving relationships. Since the WBTi report, percentages of UK accreditations have increased as follows (2016 figure in brackets):

  • maternity services  62% (58%)
  • health visiting services  67% (62%)
  • universities: 43% (36%) midwifery and 17% (15%) of health visiting courses
  • childrens’ centres  16 (0)
  • neonatal units   6 (0)

Births taking place in fully accredited hospitals:

The WBTi recommendations call for “implementation and maintenance of Baby Friendly standards in all healthcare settings” in England and Wales. New maternity plans in December 2018 from the Department for Health and Social Care include “asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative.” 
We would urge the government to extend the expectation of Unicef Baby Friendly accreditation as a minimum in community settings and Health Visiting Services, in neonatal units, and in midwifery and health visitor training programmes.

Day 3 – three French hens

The French hens are believed to symbolise the virtues of faith, hope and charity. Indicator 3 assesses the extent of implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions. There is faith, that incorporating the Code and resolutions in a country’s laws improves protection for all babies from commercial interests, as the experiences of individual countries like Brazil shows. There is hope that the Code and Resolutions will one day be implemented in UK law. Charity includes helping the vulnerable, such as babies.

Relatively recent changes include the World Health Assembly passing resolution 69.9 in May 2016, welcoming the new World Health Organisation 2016 guidance which clarifies that the Code applies to all milks and commercially produced foods marketed as suitable for infants and young children up to 36 months. A new Implementation Manual for this WHO guidance is also available.

The charity, Save the Children Fund, published its report Don’t Push It: Why the formula milk industry must clean up its act in February 2018.

The Changing Markets Foundation has published two recent exposés of formula company marketing tactics: Milking It and Busting the Myth of Science-Based Formula

The First Steps Nutrition Trust has published numerous reports and statements on topics around the marketing and nutritional composition of infant formula and baby foods 

In addition, the First Steps Nutrition Trust is now taking on the role of secretariat to the Baby Feeding Law Group (BFLG), a coalition of UK organisations working in maternal and infant health who work to bring UK law into compliance with the International Code. The WBTi UK Steering team is a member of the BFLG.

Day 4 – four calling birds

Indicator 4 assesses the protection and support provided by workplaces for employees who are breastfeeding. Four organisations helping to improve the situation include:

Since the publication of the WBTi report, tribunal fees were abolished in 2017

Day 5 – five gold rings

Gold is associated with precious things, and colostrum is known as “liquid gold.”

Indicator 5 assesses both the extent to which care providers are trained in infant and young child feeding and how supportive health service policies are. There are five professions which work most closely with mothers, infants and young children: midwives, obstetricians, paediatricians, health visitors and GPs. If they value breastfeeding and have the training to support mothers effectively they can serve as a golden chain of support.

 However, the WBTi report showed that there are gaps in health professional pre-registration standards in relation to the WHO Education checklist for topics they need to know about. Part 2 of the WBTi report contains further details for each health profession. In 2016, the General Medical Council published its revised Generic Professional Capabilities Framework, which all postgraduate medical curricula must fit. This includes a domain covering capabilities in health promotion and illness prevention. Medical curricula have to be revised to fit the framework and the RCPCH training for paediatricians now includes more about infant feeding at Level 2 (p.31)  Also, the RCPCH made a detailed policy statement on breastfeeding in 2017  and the RCGP developed a position statement on breastfeeding in 2018

The midwifery standards are currently undergoing a thorough review and there will be a consultation in February 2019. 

Members of the WBTi team have been supporting the work of revising and updating professional standards, and a working group led by Unicef Baby Friendly has now formed to take this work forward.

Day 6  – six geese a-laying

In the song the geese symbolise the six days of creation. 

Indicator 6 covers community-based support. So many mothers stop breastfeeding before they want to that it is really important to create an integrated system of support to avoid mothers falling into gaps between services. Six key aspects are:

  • Basic support: Health visitors and other health workers trained to a minimum Baby Friendly standard provide basic but universal help with feeding.
  • Additional: A peer support programme with trained peer supporters provides ongoing social support.
  • Specialist: For more challenging situations, mothers need to be able to access specialist help, for example from certified lactation consultants and breastfeeding counsellors.
  • Ready access to a tongue-tie division service where appropriate.
  • Good data collection is needed to underpin all these services.
  • Families must receive clear information about the services available.

WBTi Indicators 7-12 are covered in part 2

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  • Images from WBTi UK Report and Microsoft ClipArt

Prevention intention

Prevention intention

A Vision for Prevention

Matt Hancock, UK Secretary of State for Health and Social Care since July 2018, launched his prevention vision on 5 November.

His other priorities are to advance health technology and provide better support for the health and social care workforce. He sees prevention as having two aspects. Partly it is about keeping well physically and mentally, to prevent ill health, but  also about the environment around people, their lifestyle choices and how existing health conditions are managed. The aims are for the average person to have 5 more years of healthy independent living by 2035, and to reduce the gap between the richest and poorest. At present there is a large discrepancy in spending with £97 billion (public money) spent on treating disease and £8 billion on prevention across the UK!

The proposed actions in the vision  are:

  • “Prioritising investment in primary and community healthcare
  • Making sure every child has the best start in life (our emphasis)
  • Supporting local councils to take the lead in improving health locally through innovation, communication and community outreach
  • Coordinating transport, housing, education, the workplace and the environment – in the grand enterprise to improve our nation’s health
  • Involving employers, businesses, charities, the voluntary sector and local groups in creating safe, connected and healthy neighbourhoods and workplaces”

The Department of Health and Social Care’s (DHSC) paper is called ‘Prevention is better than cure: Our vision to help you live well for longer‘.

It states there is strong evidence that prevention works and recognises that a healthy population is both vital for a strong economy and for reducing pressure on services like the NHS (almost 10% of the national income is spent on healthcare). Average life expectancy is now 81 years, helped by:

  • advances in healthcare
  • changing attitudes so there is less stigma with some conditions
  • improvements in the environment, at home, work and in neighbourhoods
  • antibiotics and mass vaccination
  • public health programmes.

However, there are major challenges in the huge discrepancies between areas – ‘A boy born today in the most deprived area of England can expect to live about 19 fewer years in good health and die nine years earlier than a boy born into the least deprived area.’ (p.7)

Duncan Selbie, Chief Executive of Public Health England, welcomed the change of focus to more emphasis on prevention and pointed out the need for collaborative working – NHS, national government, local government, voluntary and community sector, and industry.  It will be important to monitor industry involvement to ensure that it does not create conflicts of interest, undermining health. Infants, young children, pregnant and breastfeeding mothers are particularly vulnerable, which is why the World Health Organisation developed guidance to protect them from conflicts of interest (WHO 2016 Guidance on the Inappropriate Promotion of Foods for Infants and Young Children) and other inappropriate commercial influence (International Code of Marketing of Breastmilk Substitutes, 1981, and subsequent WHA resolutions).

Improvements will depend both on encouraging individuals to choose healthy lifestyles and manage their own health, and expecting local authorities to take the lead in improving the health of their communities. The challenges of smoking, mental ill health, obesity, high blood pressure and alcolol-related harm are mentioned, along with the benefit of having a more personalised approach to health.

The section on ‘Giving our children the best start in life’ (p.20) mentions healthier pregnancies, improved language acquisition, reducing parental conflict, improving dental health, protecting mental health and  schools involvement, but infant feeding is not mentioned at all! 

However, in the Parliamentary debate on the vision (Prevention of Ill Health: Government Vision) on 5 November, Alison Thewliss MP made the case for supporting breastfeeding by investing in the Baby Friendly Initiative to bring all maternity and community services up to the minimum standard. Matthew Hancock’s reply sounds positive: ‘The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.’

 

‘Prevention, Protection and Promotion’ at Public Health England

Earlier in the year (March 2018), Professor Viv Bennett, the Chief Public Health Nurse, and Professor Jane Cummings, the Chief Nursing Officer, came together to launch a campaign on the ‘3Ps –  Prevention, Protection and Promotion’, which is about actions to improve public health and reduce health inequalities. Breastfeeding is mentioned in the Maternity Transformation Campaign and Better Births and there appears to be increased govenment commitment to the key role breastfeeding plays in improving public health.

 

Directors of Public Health have a key role

The DHSC paper expects Directors of Public Health to ‘play an important leadership role’ (p.15). As an example, the Annual Report of Croydon’s Director of Public Health, published in mid-November, We are Croydon: Early Experiences Last a Lifetime, focusses this year on the first 1000 days of a child’s life.

It includes three breastfeeding recommendations:

  • Reset targets for increasing breastfeeding rates at 6 to 8 weeks and 6 months across the Borough and within particular localities
  • Achieve level 3 of the UNICEF Baby Friendly award
  • Turn Croydon into a breastfeeding friendly Borough, so women feel comfortable breastfeeding when they are out and about

 

How can progress on prevention occur unless it starts at the beginning – with infants? Will other Directors come up with similar recommendations?

 

Make London a ‘Baby-Friendly’ city

The Mayor of London, Sadiq Khan, aims to “make London a ‘Baby-Friendly’ city” in the London Food Strategy. This strategy aims to increase the health of all Londoners from infancy onwards, including supporting and normalising breastfeeding across London Transport and across government buildings and workplaces, and encouraging all London boroughs to become Unicef UK Baby Friendly-accredited in maternity and community services.

 

The UK government is due to publish a Green Paper on Prevention in 2019 to set out more detailed plans and, together with the NHS Long Term Plan, which is due to be published soon,  is relevant to a future with better health for all.

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Sign up for our mailing list and to volunteer in our campaigns here!

 

30. Photo for WBTi MAINN presentation
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.

#KingsBrelfie for World Breastfeeding Week 1– 7August

#KingsBrelfie for World Breastfeeding Week 1– 7August

World Breastfeeding Week (WBW)  (#WBW2017) takes place from 1 – 7 August 2017.  It is an initiative led by The World Alliance for Breastfeeding Action (WABA), supported by UNICEF, the World Health Organisation (WHO), and many breastfeeding organisations worldwide. It is now in its 25th year and it is all about working together for the common good.

In 2016 WABA started the journey to achieving the United Nations’ Sustainable Development Goals  (SDGs) by demonstrating the importance of breastfeeding to each SDG.  However, these goals cannot be achieved without strong partnerships at all levels.  The theme of SDG 17 is “Partnerships for the Goals”, which highlights the vital importance of partnerships between all organisations working towards a sustainable future. This partnership theme echoes  WBTi’s own emphasis on the importance of building partnerships and collaboration. #WBW2017 calls on all those involved to forge new and purposeful partnerships. The objectives for this year’s campaign are Inform, Anchor, Engage and Galvanise.

By Laura Godfrey-Isaacs

Picking up on this year’s campaign themes, a group of midwives at King’s College Hospital in London, including the Director of Midwifery, specialist midwives in Infant Feeding and myself, have come together to devise a campaign to support and celebrate breastfeeding at the Trust, and beyond.

Brelfie1

The “Brelfie”

Our ideas are based around the social media phenomenon of the ‘brelfie’ – a breastfeeding selfie. Celebrities and women of all backgrounds have posted these, often in defiant response to breastfeeding shaming in public. Many have gone viral, and last year WHO declared that the brelfie was a significant tool in normalising and empowering women to breastfeed. This is something that would be highly desirable to see in the UK where we have some of the worst breastfeeding rates in the world, and little acceptance of it in public. This was highlighted recently in a disastrous advertising campaign by the skincare brand Dove (owned by Unilever) which featured posters that appeared to endorse negative public attitudes towards breastfeeding, stating “75% say breastfeeding in public is fine, 25% say put them away, what’s your way?” which received much push back on social media. 

Embarrassment about breastfeeding in public

In addition the TV presenter Jeremy Clarkson outrageously equated breastfeeding in public to urinating, suggesting women should go ‘to a little room to do it’, presumably the toilet, and Claridge’s Hotel famously asked a woman to cover up while breastfeeding in their restaurant. Breastfeeding women have to endure these and many other ‘everyday’ incidences that include negative comments and looks, despite breastfeeding in public being protected in law by the Equalities Act since 2010, and our culture being saturated by women’s breasts being used to sell newspapers, promote music and advertise countless products – an environment, that, as performance poet and birth advocate Hollie McNish puts so well, in her award-winning poem ‘Embarrassed’ is ‘covered in tits’.

What I have also experienced first-hand, as a midwife, is many women telling me they feel nervous about breastfeeding in public, which highlights the lack of cultural support and acceptance that inevitably has a negative impact on women’s ability to sustain the practice, with all the constituent results for both her, the baby and society. More and more evidence points to the importance of breastfeeding on a cultural, public health, psychosocial, ecological and economic level, and the need to support, protect and promote it in all aspects of healthcare and society, as well as asserting breastfeeding as a human right for both babies and women.

The WBTi report identified many barriers along a mother’s breastfeeding journey. Among these there is a disconnect between exhortations to mothers to breastfeed and a prevailing negative attitude towards breastfeeding in public. This can lead to women feeling they are to blame for ‘failing’ to breastfeed, and over 80% give up before they want to. Cultural factors need to be addressed, which is where the power of the brelfie and social media campaigns can – and do – have a really positive effect in shifting attitudes and encouraging activism on the issue.

Nabilabrelfie2

 

#KingsBrelfie campaign for #WBW2017

The #KingsBrelfie campaign links to Indicator 6 of the World Breastfeeding Trends Initiative Report, which calls for community mother support for breastfeeding, as it will open up discussions with women about their own, and society’s attitudes to breastfeeding. It will help us encourage, support and signpost them to online and healthcare provided sources of information and facilitation, such as our King’s Milk Spot centres in the community. Our campaign will use images of King’s midwives breastfeeding, which also points to our commitment as a community of women together – midwives and women – and hopefully steer away from some of the negative feelings around midwives’ use of ‘advocacy rhetoric’ which women can unfortunately sometimes experience as pressure and judgment. As highlighted in WBTi’s Indicator 7 (communication and information) which calls for a national communications strategy around infant feeding, and for promotional activities including World Breastfeeding Week, we are directly exploring new ways to use communication strategies, that are women-led, to address the cultural barriers to breastfeeding in the UK, through an inclusive social media campaign.

The #KingsBrelfiecampaign is an invitation to all women to post a brelfie on social media during World Breastfeeding Week using the hashtag to help change attitudes, support mothers and assert the right to breastfeed wherever, and whenever women want or need to.

So let’s create a social media storm and celebrate women and breastfeeding together!

LauraGodfrey-Isaacs2017

 

Laura Godfrey-Isaacs

King’s midwife and birth activist

@godfrey_isaacs

 

 

Every mother needs a #BFfriend

Every mother needs a #BFfriend

Support is the theme for National Breastfeeding Celebration Week in England this year. Mothers are sharing their photos and stories of key support from their own “breastfeeding best friend” on social media with the hashtag #bffriend17

Who was YOUR “breastfeeding best friend”? #BFfriend17?

Ruth’s experience is typical: “[Day 6 after the birth, 4am] Me – sobbing: I don’t think this latch is right. It hurts. No, it really hurts. It’s not supposed to hurt. I’m sure it’s not supposed to hurt. But he’s hungry. I have to feed him. I need help. I’m tired, and I’ve got no idea what I’m doing. Who can I get help from?

First time breastfeeding mums the country over will recognise this. The pain of a poor latch, a hungry baby, knowing you need help and not knowing where to get it. At 4 AM, in a state of nearly delirious sleep deprivation. I hung on until the morning, when my dad brought my ex-midwife grandma to help me. She showed me how to relieve my engorgement and soften my nipples so that my baby had something to latch on to. Though it wasn’t totally plain sailing from there. The several days of poor latching had given me a badly cracked nipple, and then I got mastitis. But it healed, and I went on to breastfeed for 2 years. If I hadn’t had my grandma’s support at that moment, I would have stopped breastfeeding.”

So how exactly do we – in England – support breastfeeding mums? There is support available. They can access support from midwives, health visitors, lactation consultants, breastfeeding counsellors and peer supporters. This might be through the NHS, or via third sector organisations such as the Association of Breastfeeding Mothers, the Breastfeeding Network, La Leche League and NCT. (Indicator 6 in the WBTi report, Part 1 and Part 2) There have, however, been significant cuts to many of these services, particularly peer support and drop-ins (part 2, page 30) and there was already a huge postcode lottery in the services available. This is compounded by the fact that there is no national information and communication strategy in England (Indicator 7). There is no centralised database of breastfeeding drop in support (the NHS Choices “find local support” (http://www.nhs.uk/service-search/Breastfeeding-support-services/LocationSearch/360) service uses information held by Netmums) So while there is support available, it can be difficult to find and difficult to access, and in many areas there is just not enough. And it’s certainly very difficult at 4 AM in the middle of a feeding crisis.

How do we solve this?

The WBTi report recommends (Indicator 6 and 7):

  • Commissioners to ensure there is a range of integrated postnatal services that include both health professional and voluntary-sector breastfeeding support, meet local needs and provide clear access to specialist support.
  • Government to implement existing NICE guidelines on antenatal and postnatal breastfeeding information and support.
  • Government to make Baby Friendly accreditation in all maternity and community settings mandatory.
  • Commissioners to maintain the full range of health-visiting services, and maintain health visiting as a universal service.
  • Funding for public health to be protected.
  • PHE to explore options to enable families to access information about local services.
  • Governments to improve data collection to aid evaluation of services.
  • Government needs to create a national communications strategy to:
  • provide accurate information in publications and online sources, liaising more with relevant organisations;
    • include WBW/National Breastfeeding Celebration Week;
    • launch a public information campaign aimed at wider society (family, community, workplaces).
    • DH to update the NHS Choices website to provide accurate information and details of breastfeeding support organisations.

 

A joined up service which meets the individual needs of each mother is essential to properly support mothers to breastfeed. Different mothers need different levels of support and their needs vary during their breastfeeding journeys. On some occasions an understanding friend is enough, sometimes a peer supporter and on others a highly skilled lactation specialist is needed. When we fail to meet these needs, we fail families. It is time for this to stop. It is time to properly support women in their choice to breastfeed their babies.
Who was YOUR #bffriend17?

Post your own selfie with YOUR #bffriend17 on Twitter, Instagram, or facebook!

 

 

A #BFfriend can change your life!

 

Ruth Stirton

 

Dr Ruth Stirton is a Lecturer in Healthcare Law at the University of Sussex. She works on healthcare regulation, She is an admin of the My breastfeeding Story facebook group  and is currently breastfeeding her second child.

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

Normalising breastfeeding in the community: peer support and professional training

Normalising breastfeeding in the community: peer support and professional training

 

The inspiring story of breastfeeding support in a London borough

What changed?

I have been reflecting recently on my experiences as a specialist health visitor and infant feeding lead in an outer London borough. The story began twelve years ago, in 2005, when there was a lack of confidence among mothers and staff about the reliability of breastfeeding, which was hidden and rarely seen in public. Over the next eight years, the initiation rate increased from 67% in 2005 to 86% in 2013, and the continuation rate at 6-8 weeks from 50% to 75% (52% breastfeeding exclusively). Breastfeeding became the way most mothers fed their babies. Gradually breastfeeding mothers became visible in cafes, shopping centres, supermarkets, streets, GP surgeries and children’s centres.   The Unicef Baby Friendly Initiative assessors stated in a report that, in this borough, breastfeeding had become ‘the normal way to feed babies’.

How did it happen?

How did this change come about in a relatively short period of time? It began in 2005, as a joint project between the NHS and NCT, which secured local health authority funding to set up a breastfeeding support group in an area of social deprivation with low breastfeeding rates.   This group became very well attended and was facilitated effectively by two NCT breastfeeding counsellors and a health visitor. A similar group was set up in another part of the borough and was run by me, together with other health visitor colleagues. Many of the mothers were very grateful for the support they received in the groups and some of these women expressed the wish to train as volunteer peer supporters, so that they could help other mothers enjoy breastfeeding their babies, as they had. Two training courses were organised and, that year, 20 peer supporters were trained, registered by the voluntary services of the local Primary Care Trust (PCT), and started working in breastfeeding support groups, in the children’s centres and health service clinics. The news of the training spread rapidly and soon there was a waiting list of mothers wishing to train!

Reaching out

The numbers of groups expanded to be easily accessible to mothers across the borough, running every weekday, in children’s centres, cafes, and health premises. The new peer supporters brought fantastic skills with them, one setting up a website, another a mothers’ Facebook page and another designing our leaflets and posters!   One had breastfed twins and set up antenatal sessions for parents expecting multiple births plus a weekly support group for mothers with twins and more. She also visited these mothers at home and lent them cushions, which helped them tandem feed. Soon the exclusive breastfeeding of twins and even triplets became common. A group of Somali mothers was trained and an outreach peer supporter started seeing Somali pregnant women in the hospital.   A teenage ‘buddy’ scheme was also started by some of the younger peer supporters, working with the specialist midwife and running antenatal sessions and postnatal support for young mothers. Two peer support co-ordinators were employed to job-share this important role and to deal with concerns of the peer supporters as well as helping with training and supervision. Over the next ten years, more than 200 voluntary peer supporters were trained in the borough and the training continues until the present day.

DSC_0804
Unicef UK/Mead

Public Health prioritises breastfeeding

In 2006, under the government scheme of “Every Child Matters’, the Director of Public Health made breastfeeding the top priority for all children in the borough with accompanying ‘stretch targets’ and funding.

London services are monitored through the ‘Good Food for London’ report on their Baby Friendly status, with details on how each borough is achieving and sustaining the Baby Friendly standards

Baby Friendly accreditation

In 2012 Unicef UK Baby Friendly Initiative carried out a major review that resulted in new, more holistic, child rights-based standards relating to the care of babies, their mothers and families, with a strong emphasis on building responsive loving relationships. A new award has also been introduced to encourage a focus on sustainability after the accreditation.

In parallel with the rapidly increasing numbers of peer supporters, the journey in the borough to become Unicef Baby Friendly (BFI) accredited started and professional training in the community and local hospital began with the two health trusts starting their journeys jointly. A model of multidisciplinary training of midwives, maternity assistants, neonatal nurses, nursery nurses and health visitors began initially with BFI-facilitated training. This enabled hospital and community staff not only to improve their breastfeeding knowledge and skills, but also each other’s roles, co-operate on work challenges and break down any barriers which may have existed previously. Communication skills and talking about their own life experiences, in order to gain an understanding of their impact, especially with infant feeding, became an important part of the in-service training. Interactive group exercises on different breastfeeding situations became an integral part of the training, emphasising the importance of empathy and seeing the problems through the eyes of the mothers.   A neonatal breastfeeding co-ordinator was appointed and started training all the neonatal staff in the hospital, including the doctors, and by 2014, Unicef had awarded both the community and hospital trusts their Baby Friendly accreditation.

Peer support

Peer supporters were also employed by an adjacent borough to work in the hospital, supporting mothers on the postnatal ward, one even working all night once a week; others taught hand expressing and colostrum harvesting in the antenatal clinic, especially for mothers with diabetes.

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Unicef UK/Mead

Achieving cultural change

Within ten years, breastfeeding became a normal and accepted way to feed babies in the borough. Mothers, fathers, and grandmothers-to-be came in large numbers to the twice monthly breastfeeding workshops, gaining confidence and information, with the expectation of the support that would be available to them to help them achieve their goals. A mother said ‘the session expelled myths and I now know how milk is made and transferred to my baby. I am looking forward to skin-to-skin contact after the birth and will follow my baby’s instincts’. Parents meet peer supporters in the support groups, at toddler groups, in the school grounds, in cafes, at sports events, in churches, temples, synagogues and mosques.   Peer supporters live and work in the community and spread their knowledge through everyone they meet. Even when they move away from peer support, they take their embodied knowledge into the work place and support their colleagues there.   Cultural change can happen through peer support, resulting in breastfeeding becoming embedded in a community. This change is sustainable over time and in future generations, as it spreads through different social groups. Voluntary peer support and informed, professional support is capable of changing attitudes and behaviour within a community to make breastfeeding ‘normal’ in a very cost-effective way. Commissioners need to be aware of how health outcomes can be improved through breastfeeding, for mothers and children, in the immediate and long-term, and it is essential to protect and increase future funding for midwives, health visitors and peer supporters, in order that vital programmes like this can continue.

The World Breastfeeding Trends Initiative UK report in 2016 affirmed the borough’s actions as it recommends in Indicator 6 (Community-based support) that ‘commissioners ensure that there is a range of postnatal services that include both health professional and voluntary-sector breastfeeding support to meet local needs and provide clear access to specialist support’ and that they ‘maintain the full range of health visiting services, and maintain health visiting as a universal service’. Indeed, the borough’s transformation in breastfeeding support is used as a case study in Part 2 of the report.

One mother with an eight-month old baby told me:

‘I so much wanted to breastfeed, but found it incredibly hard at the beginning. I was convinced that it wouldn’t work and it was such a lonely feeling, like I was failing where other mothers were succeeding. Getting support made all the difference- having someone to listen to me and give me confidence to carry on. Suddenly, I didn’t feel alone any more and it changed everything. I know that I would not be breastfeeding now if I hadn’t got help in those crucial first weeks.’

What one London borough has achieved shows what is possible. Unicef UK Baby Friendly Initiative’s Call to Action spells out four key actions to create a supportive, enabling environment for women who want to breastfeed, ranging from national strategy and legal protection from harmful commercial practices to the local implementation of evidence-based practices, as described

 

Photo credits: Unicef UK/Mead

A Spiro photo

 

Dr Alison Spiro

Specialist Health Visitor

Member of the WBTi Steering Group