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.

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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.

DSC_1339 copy
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

Mother to mother support in a world of information

Mother to mother support in a world of information

This week, support is the theme of Breastfeeding Celebration Week
#bffriend17

There’s so much to celebrate about breastfeeding, and for me one of the most special things is how much we can learn from each other as mothers.

Of course there is information everywhere, often far too much of it, and there are medical professionals to give technical support, check our babies’ health, and prescribe any treatments that are needed. But in my time as an LLL (La Leche League) Leader, I’ve noticed that passing on pure information is a tiny part of what we do. What brings mothers to our meetings, and turns them into loyal regulars, is the talking – the chance to share their strong feelings about their unique developing breastfeeding relationships.

The simplest of questions: “how do you know when your baby wants to nurse?”; “what surprised you most about breastfeeding?” can easily set off half an hour of discussion. Dazed new mothers with tiny newborns share their shock and wonder; seasoned mothers on their third child talk about how still, every day, there’s something new.

And of course mother to mother conversations like these provide a safe space for complaining. As one mother put it to me: “LLL meetings are the only place where I can sit and moan about breastfeeding without being instantly told to wean”. When a group starts from a safe shared understanding that breastfeeding matters, and a shared knowledge of its many joys, this gives a context that makes it acceptable to explore the lows, too.

The support of peers can also give a rich source of alternative methods and ways to approach breastfeeding-related problems. A mother suffering through a nursing strike can find a “standard list” of solutions online easily, but there’s a whole extra dimension when she can describe it to other mothers who are right there with her. She can show her child other busily nursing babies, and can talk about any mixed feelings she has – perhaps she’s wondering if this might be a chance to wean that she’ll later regret not having taken, or she might be wondering what effect this will have long term on their breastfeeding relationship. Finally, she might return to the next month’s meeting glowing with happiness as she and her baby are back in tune, all is well, and she has added to her stock of experiences to share with the next mother.

Support from medical and lactation professionals has a crucial place; in times of serious need, specialist help from a lactation consultant can be literally life-saving. And sometimes, in the middle of the night, reaching out to strangers on the internet can be enough to get through.

But for everything else, there’s mother to mother support. It’s embedded in its community, and forms a community of its own within that. Mothers come to LLL meetings nervous, uncertain, clutching newborns and wondering what to expect; sometimes they’re still with us years later, bringing all their successive children, perhaps becoming LLL Leaders themselves, or perhaps just carrying on the conversation, and passing on the support to new versions of themselves.

#bffriend17

To recognise the importance of support, mothers are invited to share their photos and stories of support from their own “breastfeeding best friend” on social media, using the hashtag #bffriend17.

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

 

Editor’s note:

You can find the findings from the WBTi assessment of mother support in the community in “Indicator 6” in our 2016 report

With further details on mother support in the community in Part 2

 

Helen Lloyd

 

Helen Lloyd is a Leader with La Leche League GB, and fits in as much time  supporting breastfeeding as she can around the needs of her own young children

 

The amazing story of West Herts Breastfeeders

The amazing story of West Herts Breastfeeders

I received too much breastfeeding support – said no mother ever!

Your vibe attracts your tribe

#BFfriend17

I did not realise the power of that statement until I became a breastfeeding mother. Nursing my child became a life philosophy, a kaleidoscope lens, spinning my family, bringing like-minded people together and painting the colours of my parenting. About 3 years ago there was a story all over the media about a mother who was asked to leave a certain store because she chose to breastfeed openly in there. Breastfeeding mothers on social media were furious. Simultaneous protests in branches of that store were set up and I organised one of them. Some great friendships were born out of that movement. This simple act sparked a discussion about the needs of the breastfeeding community. This could not end there.

For Olgas community support

Protest was the beginning.

We wanted to make sure mothers knew their rights. We wanted to educate, empower and bring families together. Slowly a community has been born. It kicked off with a picnic to celebrate National Breastfeeding Week, followed by some meetings in a children’s centre. A year passed and having my third baby gave me a huge boost of confidence to put my peer support training into practice. After another season of outdoor gatherings, I hired a room in a community centre. One of the mothers got inspired and started another group in a nearby town, followed by more of them. All were hosted by mothers who breastfed their own babies and felt they could support others and offer a safe space for befriending.

A few months later we decided to organise peer support training. The services offered by the local health visiting team and children’s centres were not sufficient at the time. And there definitely was a niche for peer support. Having experienced first hand how unique it is having another mother support you through hardships, I fell in love with the idea. We approached other service providers using the Maternity Services Liaison Committee. At first, not many believed in us but, as time passed, we proved to be worthy of their trust. We asked for help from generous friends, who delivered the training at no charge, and we found a venue for free thanks to a children’s centre manager. But mostly we were incredibly lucky to recruit, through our groups, amazing women who agreed to offer their time to volunteer in the local hospital.

We decided it was the right time to create something more formal. West Herts Breastfeeders community came to life thanks to the many mothers who nurtured it deeply. This ‘baby’ was very lucky. It was a firstborn who had all the attention and support from local Infant Feeding teams and the Children’s Services department of Hertfordshire County Council. We came a long way. It took us just over a year to train 18 peer supporters, establish six monthly regular meetings in the West Herts area, recruit nearly 550 members to our virtual community to provide them with 24 hour support through Facebook and all that with no official funding. We are all volunteers. You could be too!

Be the Change

As mentioned in the Open Letter of February 2016, organised by the WBTi UK team, a woman’s ability to breastfeed is often determined by the support she receives and the environment in which she lives. While we cannot change everything, we try to help normalise breastfeeding out and about. We also play an important role in normalising feeding older babies and encouraging mothers to carry on, while often dealing with family pressures to wean or the challenges of returning to work. Most children’s centres provide breastfeeding support only in groups for babies under one year, and health visitors do not see mothers as often as they would like. Not having a healthcare professional label also changes the balance of the dialogue and helps mothers to open up.

Together we can do more

What we strive for in the face of recent cuts and challenges is the partnership between all local services. Our success is owed largely to the power of networking. We can see where we are needed most and what else can be done to make sure no woman is left alone at any stage of her nursing journey. You can help to be part of the change, by simply sharing your thoughts with your newly elected MP. Use the WBTi sample email to tell them what breastfeeding mothers need in your local area. Ask them to use their influence on the Local Authority to showcase the importance of breastfeeding to public health and safeguard their budget for health visiting and breastfeeding support.

Your voice matters.

 

 

Please sign up HERE to receive email updates on our WBTi work!

Olga Danyluk-Singh photo for community support

Bio

Olga Danyluk –Singh, Chairperson, West Herts Breastfeeders

NHS Breastfeeding Peer Supporter and mother of three breastfed children

Enthusiastic lactivist!

Cuts to breastfeeding support in England

A number of local and national breastfeeding support organisations have documented cuts to funding and services providing breastfeeding support. This briefing paper was developed by several organisations with the help of volunteers from the WBTi UK team, setting out the current situation in England. It includes a partial list of cuts at the time of writing. Funding situations do change so please send any updates or corrections to wbtiuk@lcgb.org.

The World Breastfeeding Trends initiative is a collaborative effort, bringing together all the key stakeholders in the country to evaluate breastfeeding policies and practices and how well they conform to the Global Strategy on Infant and Young Child Feeding.

Supporting mothers to breastfeed – more on Indicators 5 & 6

baby-holding-hand

74 percent of mothers initiated breastfeeding
44 percent of mothers were still breastfeeding at 6–8 weeks

– Public Health Outcomes Framework (England) 2014/15

90 percent of women who stop breastfeeding in the first six weeks report giving up before they wanted to

– David Bull, Executive Director UNICEF UK

Most mothers in the UK want to breastfeed, yet most mothers stop breastfeeding before they want to. Why?

The fact is that while breastfeeding is natural, mothers need skilled support to be able to breastfeed. Yet many of the health professionals who work with mothers and babies do not have the knowledge or skills to help them.

Indicator 5 of the WBTi examines how well healthcare systems support breastfeeding. It looks in detail at the training of all health professionals who interact with mothers and babies – midwives, health visitors, GPs, paediatricians, lactation consultants and others – both before and after they qualify in their profession. You can see the full education checklist here.

It also asks whether health workers understand their responsibilities under the International Code of Marketing of Breast-milk Substitutes, and whether mothers and babies are able to stay together when one of them is sick.

Support for mothers comes from many sources, not just health professionals. It can come from family, friends, the community at large, and particularly breastfeeding peer-support groups. In the UK, these are run by organisations like the Association of Breastfeeding Mothers, Breastfeeding Network, La Leche League, NCT, as well as by the NHS itself. Mothers who have breastfed their own babies – and who have received training to provide breastfeeding support – are able to provide valuable help to new mothers.

In the UK, just 1 percent of babies are exclusively breastfed for the recommended six months. Common reasons that mothers give for stopping breastfeeding include:

  • finding breastfeeding painful
  • concerns about their milk supply
  • conflicting advice from health professionals
  • lack of support
LLL Mother support group
Trained support is needed at all levels, from peer supporters to lactation consultants. Click here for details of the different roles.

Peer supporters are “informed friends” who can help mothers understand what’s normal and help with many common breastfeeding concerns. They offer a compassionate and empathetic ear to new mothers.

This importance of this community-level support is recognised in Indicator 6 of the WBTi, which looks in detail at access to skilled mother support and community outreach. Good peer-support programmes can increase the length of time that mothers exclusively breastfeed their babies. In other words, they can help mothers who want to breastfeed to carry on for as long they choose.