How confident do medical students feel about supporting breastfeeding?

How confident do medical students feel about supporting breastfeeding?

A new study by trainee doctor Kirsty Biggs and senior colleagues has shown that 97% of the 411 medical students who responded to a survey are uncertain of their practical skills to support new mothers with breastfeeding, such as helping with latch issues, although the overall benefits of breastfeeding were moderately well-known. Yet most students (93%) perceived doctors to have an important role in supporting breastfeeding and the same percentage requested further breastfeeding education.

Over 80% of the respondents had a career interest in obstetric and gynaecology, paediatrics and/or general. While the sample was only around 1% of UK medical students, and only one-quarter of the students responding were male, it’s a very clear message that breastfeeding education overall is not adequate. 

Around 80% of the 32 UK medical schools eligible responded to their part of the survey and results indicate that only 70% of medical schools provide compulsory breastfeeding education. 

WBTI’s findings and vision

The WBTi UK report in 2016 indicated that medical curricula have many gaps with regard to breastfeeding, and Biggs’ study confirms that the students themselves find it inadequate. WBTi UK’s vision is that all doctors have sufficient training in infant feeding to protect the decisions of mothers who want to breastfeed.

UK Health Professional training standards mapped against WHO educational checklist. From the WBTI UK report. See also Part 2 for details of individual specialisms

How can the situation be improved? 
High level standards and Unicef BFI learning outcomes

The General Medical Council provides broad guidelines for undergraduate curricula in its Outcomes for Graduates document and each medical school devises its own curriculum to fit the guidelines. For example, the expectation under the Outcomes Health promotion and illness prevention section is: ‘Newly qualified doctors must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice’.  Unicef UK Baby Friendly Initiative’s learning outcomes for several professions, including medical students, published in November 2019 are highly relevant to improving curricula and accompanying resources are being developed. 

RCPCH curriculum – an encouraging sign

Medical training is long, with undergraduate, Foundation and then specialty training. The RCPCH (Royal College of Paediatrics and Child Health) states as part of its activity to promote breastfeeding: ‘The RCPCH training curriculum for General Paediatricians and all paediatric subspecialties requires training to understand the importance of breastfeeding and lactation physiology, be able to recognise common breastfeeding problems, have knowledge of formula and complementary feeding, and be able to advise mothers or refer for support.’

Resources available

Qualified doctors also benefit from improving and updating their skills and knowledge. RCGP’s (Royal College of General Practitioners) Breastfeeding Position Statement has a link in the first sentence to its online resource on breastfeeding. 

by Patricia Wise

I’m very pleased that my e-book Supporting Mothers Who Breastfeed: A guide for trainee and qualified doctors, which is particularly aimed at trainers and trainee doctors, has been included in the Postnatal care guidelines of RCGP Learning.

The GP Infant Feeding Network (GPIFN) and Hospital Infant Feeding Network (HIFN) websites contain extensive information for doctors. 

Other resources include Amy Brown and Wendy Jones’ book A guide for the Medical Professionpublished in December 2019.

Guidance to qualified doctors

Mentioning infant feeding in guidance to doctors to encourage including it in consultations is also important. GP Louise Santhanam (founder of GPIFN) is the lead author of Postnatal Maternal and  Infant care during the COVID-19 Pandemic: a Guide for General Practice that was recently added to the RCGP website. This clarifies that 6-8 week checks need to continue despite the Covid-19 pandemic and that infant feeding should be a routine clinical consideration.

Postnatal Maternal and Infant Care during COVID-19: A Guide for GPs by Louise Santhanam

The challenge

Thus plenty of resources are available but doctors are busy people. While some really understand the importance of protecting breastfeeding, and know how to  – such as signposting mothers to local skilled help – the challenge is how to bring this into every medical student’s training.

If you know anyone at medical school, it would be really useful if you can let them know about Kirsty Biggs’ study.

Sign up to our WBTI UK Mailing list HERE

Banner photo from Freepic

Patricia Wise is an NCT Breastfeeding Counsellor, a member of the WBTi UK Steering Group, and the author of Supporting Mothers Who Breastfeed: A guide for trainee and qualified doctors

Seeing the world through babies’ eyes

Seeing the world through babies’ eyes

This week (7- 12 June) is Infant Mental Health Awareness Week and the theme is ‘20:20 vision: Seeing the world through babies’ eyes’. The Week is led by the Parent-Infant Foundation (PIF) and the First 1001 Days Movement, a collaboration of relevant organisations with the PIF as secretariat, which is being launched during the week.

What is infant mental health? It is the emotional wellbeing of babies. The Movement’s vision is that ‘every baby has loving and nurturing relationships in a society that values emotional wellbeing and development in the first 1001 days, from pregnancy, as the critical foundation for a healthy and fulfilling life.’

What babies want is what they need and these needs are basic. As obstetrician Grantly Dick-Read  wrote in the mid 20th century:  

“The newborn 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.”

They do also need to receive attention from other humans. If their needs are usually met, babies can form secure relationships (attachment) with their caregivers. Usually, there is one primary caregiver, most commonly the mother. Attachment theory was developed by the psychoanalyst John Bowlby in the 1950s. An attachment figure who cares responsively for the infant provides a secure base. It is believed that behaviours by the infant to stay close when separated, like screaming and clinging, have been reinforced by natural selection (see What is attachment theory).

Babies are vulnerable – as Donald Winnicott, paediatrician and psychoanalyst, among his other insightful quotes, stated:

‘There is no such thing as a baby, there is a baby and someone’.

However, infants are not passive as they communicate by giving cues to their needs, such as the rooting reflex when hungry. If their needs are not responded to quickly, they become upset. Dr. Edward Tronick’s ‘still face’ experiments in the 1970s showed the importance of human connection for an infant. If the parent’s face is still and unresponsive to her baby, the baby looks confused and then becomes distressed. The experiments also showed that ruptures in a relationship like this are easily repaired. Parents do not need to respond perfectly.

However, when there is repeatedly no response to a baby’s distress, as in sleep training where the baby is left alone and expected to adapt, it was found that the babies’ behaviour changed so that by the third night they were no longer crying but their cortisol (stress hormone) levels were still high so there was a mismatch between behaviour and physiology; instead of learning to self-soothe it seems as though they were giving up so in despair. 

The significance of the care babies receive is that their experiences, starting before birth, influence the neural connections that are formed in the developing brain – the ‘wiring’. A parent who is emotionally not really available to the baby (so not attuned to their needs) will find it difficult either to respond or to respond appropriately, providing an unintentional ‘still face’ or angry face. The parents could be ill, depressed, addicted, suffering domestic abuse, desperately worried about their financial situation, overloaded with responsibilities………It is therefore crucial for a society to care for parents so that they can be emotionally available to their children.

Feeding is a crucial part of nurturing care and breastfeeding facilitates the process.There is considerable evidence that not being breastfed is linked to poorer physical health in infants (Lancet, 2016). Breastfeeding provides personalised nutrition. Antibodies and other components in breastmilk reduce the chance and severity of infections. Oligosaccharides in breastmilk feed and thus favour beneficial bacteria in the infant’s gut and this helps the development of a healthy immune system. It is difficult to allow for confounding factors in studies on breastfeeding but reviews show it is linked with better cognitive performance, which is likely to be due to the fatty acids in breastmilk. But what about any impact on emotional development? There are studies which suggest that being breastfed is associated with paying more attention to positive emotions in others.  Breastmilk contains the calming hormone oxytocin, which stimulates social interactions, and which is further released through touch and suckling, so the moods of both mother and baby benefit. Several studies indicate that mothers who are breastfeeding tend to touch their babies more, are more responsive and tend to gaze at them more, all of which will help the infant’s emotional wellbeing. The Unicef UK Baby Friendly Initiative leaflet, Building a Happy Baby, provides practical suggestions for parents to support their baby’s brain development and addresses myths and realities. 

Jones found that breastfeeding helps to protect infants from the harmful effects of maternal depression

Mothers who stop breastfeeding before they want to are at greater risk of postnatal depression (Borra et al 2014) so mothers need easy access to breastfeeding support to help them continue, thereby benefitting their babies physically and emotionally. Sadly, there are barriers to breastfeeding throughout society, as outlined in the WBTi UK report.

Parents and carers urgently need more support, especially during the stresses and isolation of lockdown and the COVID19 pandemic. We call on government to make infants and their families a high priority during the pandemic and in our plans to rebuild a stronger society.

Photo used with permission

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

Shocking gaps in emergency preparedness for Europe’s babies

Shocking gaps in emergency preparedness for Europe’s babies

The Covid-19 pandemic has shown how important it is for countries to protect their citizens from illness.

Yet a new WBTi regional report shows gaps in support for families across Europe, with the poorest overall scores in national leadership and, shockingly, emergency preparedness, where the UK scored 0/10. This pandemic is an emergency for infants and young children and only North Macedonia was found to have an adequate strategy.

Babies who are breastfed have better health and resistance to infection, and most mothers want to breastfeed. Yet many European mothers stop or reduce breastfeeding in the early weeks and months, and bottle feeding is prevalent, due to inadequate support from health systems and society.

Launched today, the first European report on infant and young child feeding policies and practices, Are our babies off to a healthy start?, compares 18 countries and identifies the considerable improvements they need to make in supporting mothers who want to breastfeed. A summary report has been published today in the International Breastfeeding Journal .

The full report can be downloaded from the World Breastfeeding Trends Initiative global website.    

The new report, Are our babies off to a healthy start?, compares the  implementation of WHO’s Global Strategy for Infant and Young Child Feeding across 18 European countries. The comparisons show clearly that inadequate support and protection for breastfeeding mothers is a Europe-wide problem. The health of babies, mothers and whole populations  lose out as a result. However, countries do differ considerably. Turkey rates highest overall; the five countries with the lowest scores belong to the European Union. 

     ‘Nutrition is key to achieving the Sustainable Development Goals related to health, education, sustainable development, reduction of inequalities and more.’

Joao Breda, Head, WHO European Office for Prevention and Control of Noncommunicable Diseases

The scope of the assessment is wide-ranging, with ten policy and programme indicators, including national leadership, Baby Friendly hospital and community practices, marketing controls on breastmilk substitutes, health professional training, emergency preparedness and monitoring. There are also five feeding practices indicators, such as exclusive breastfeeding for 6 months, a WHO recommendation. 

The original assessments were all carried out using the World Breastfeeding Trends Initiative (WBTi), a tool first developed in 2004 by the International Baby Food Action Network (IBFAN) but only launched in Europe in 2015. It requires collaboration with relevant organisations within a country on assessment scores, gaps identified and recommendations for improvements. The Report highlights good practice, enabling countries to learn from one another.

     ˝Success …rests first and foremost on achieving political commitment at the highest level and assembling the indispensable human and financial resources.’

WHO Global Strategy 2003

If governments, other policymakers, hospitals and community services, public health departments, institutions that train health professionals, and others, adopt the report recommendations, it will enable more mothers to initiate and continue breastfeeding, strengthening the health of the population for the future.

The WBTi European Working Group, led by Dr. Irena Zakarija-Grkovic of Croatia, produced the Report and comprises coordinators from European countries which have carried out a WBTi assessment. The production of the report was supported by the Croatian Ministry of Health and UNICEF Croatia.

Sign up to our WBTi UK mailing list

UK media contact: wbti@ukbreastfeeding.org

Lockdown with a baby?

Lockdown with a baby?

Maternal Mental Health Day is on the first Wednesday in May, which this year was 6th May.  A group of organisations has launched a new survey to try to capture parents’ experiences in the context of a global pandemic and social distancing. If the survey can be distributed widely to parents with a baby/child under 2 year, or are pregnant, to gather the views of parents of a range of ages, ethnicities and experiences, the data will be particularly useful.

Click HERE for survey link.

The collaborating organisations include members of the First 1001 Days Movement, which is coordinated by the Parent-Infant Foundation, Home-Start UK, Best Beginnings, and the Maternal Mental Health Alliance. The WBTi UK Steering Group have also signed up to support the First 1001 Days Movement.

Do you know anyone who is pregnant or has a child under 2 years who might be interested in completing the survey? Please pass on the survey link. The survey is expected to be open for about 3 weeks, so until late May.

Headline results of the survey are due to be released in Infant Mental Health Awareness Week (7-12 June).

Photo courtesy of Paul Carter, We Do It In Public (wdiip.co.uk)

Patricia Wise is an NCT Breastfeeding Counsellor and a member of the WBTi UK Steering Group.

Doctors and breastfeeding 2: Resource list

Doctors and breastfeeding 2: Resource list

World Breastfeeding Trends Initiative UK (WBTi)

Uses the WBTi Assessment Tool to score a country’s support for breastfeeding according to 10 key indicators based on evidence-based strategies in the 2003 WHO Global Strategy for Infant and Young Child Feeding: 

So far, 97 countries have produced a WBTi report: https://www.worldbreastfeedingtrends.org/

2016 WBTi Report on the UK : see Indicator 5 for health professional training, with the main summary table in Part 1 and details for individual professions in Part 2.

e-book by Patricia Wise of WBTi UK: free downloadable PDF, Supporting mothers who breastfeed: A guide for trainee and qualified doctors

Baby Feeding Law Group (BFLG)

Working to protect all babies by strengthening UK laws on infant feeding in line with UN recommendations

Publications include: Comfort milks, lactose-free infant milks and anti-reflux milks: Why these products should be removed from shop, supermarket and pharmacy shelves

Breastfeeding Network

* Breastfeeding Network Drugs in Breastmilk Information

* Drug fact sheets: https://www.breastfeedingnetwork.org.uk/drugs-factsheets/

 New e-learning module Supporting breastfeeding mothers with thrush £30: www.breastfeedingnetwork.org.uk/product-category/training/

e-learning for Healthcare

e-LfH programmes: https://www.e-lfh.org.uk/programmes/

Programmes include: Breastmilk Provision for Preterm and Sick Neonates,

Infant Feeding: supporting education around the implementation of Baby Friendly standards in infant feeding

First Steps Nutrition

Public health nutrition charity providing independent information and resources to support eating well from preconception to five years old: 

Information on infant milks for health workers

booklets available as free PDFs include: Infant milks in the UK: A practical guide for health professionals: 

*GP Infant Feeding Network (GPIFN)

The website is a clinical resource for GPs.

GP Education

Maternal mental health

 GPIFN Resources

iMAP (International Milk Allergy in Primary Care Guideline 2019)

Hospital Infant Feeding Network (HIFN)

The website provides information on supporting breastfeeding in a hospital setting, and there is also a network with a Facebook page.

HIFN posters on various aspects of caring for breastfeeding women in hospital

* Don’t stay stop look it up campaign on prescribing for breastfeeding women

Human Milk Foundation

Working to help more families feed their babies with human milk

Hearts Milk Bank: Redefining the boundaries of human milk donation

Lactation consultants of Great Britain (LCGB)

Professional association for International Board Certified Lactation Consultants (IBCLCs)

The crucial role of breastfeeding: supporting mothers with anxiety and depression Handout

Breastfeeding: a vital part of the first 1001 Critical Days. Briefing on the impact of breastfeeding on brain development and infant mental health.

Parenting Science Gang

A user-led citizen Science project

Breastfeeding and Health Care Experiences project

Personal Breastfeeding Experience of Health Professionals and Professional Practice

Royal Colleges

Royal College of GPs (RCGP):  Breastfeeding Position Statement and link to online resource on breastfeeding

Royal College of Paediatrics and Child Health (RCPCH):  Breastfeeding position statement

* UKDILAS: UK Drugs in Lactation Advisory Service

Enquiry-answering service, fact sheets and database on drug prescribing during breastfeeding

Unicef UK Baby Friendly Initiative

Working with public services to support families better with infant feeding and developing close loving relationships through training and accreditation

e-learning packages for GPs and paediatricians

Resources list

Recommended learning outcomes for different specialisms of healthcare practitioners

Include learning outcomes for medical students

Other resources

Facebook group: Breastfeeding for Doctors Peer Support

* ed. Amy Brown and Wendy Jones (2020) A guide to supporting breastfeeding for the medical profession Routledge

* Wendy Jones (2018) Breastfeeding and Medication Routledge 2nd edition

Key: * relevant to prescribing

WBTi UK Doctors and breastfeeding project 2020

Vision: That all doctors have sufficient training in infant feeding to protect the decisions of mothers who want to breastfeed.

Doctors and breastfeeding: 1

Doctors and breastfeeding: 1

Doctors have an important role to play in supporting mothers who want to breastfeed.

A continuing theme of the WBTi UK work is improving medical training in infant feeding such that all, not just some, doctors have sufficient knowledge and understanding of breastfeeding to protect the decisions of mothers who want to breastfeed. Enabling more mothers to continue breastfeeding would improve infant and maternal health, reduce NHS costs (Renfrew et al) and reduce the number of GP appointments (Pokhrel et al, 2015).

Supporting Mothers Who Breastfeed, by Patricia Wise.
E-book downloadable from the WBTI website

On 16 January WBTi UK held an evening event at the Burfoot Court room at Guy’s Hospital on this topic to celebrate the third anniversary of the launch of our report. The event was well-attended with a mixture of doctors, breastfeeding supporters and other professionals. There were several presentations and a display of relevant resources. Bringing the resources together made it obvious that actually there are plenty available. For example, there are the Baby Friendly learning outcomes for different professions, my free book Supporting Mothers Who Breastfeed: A Guide for Trainee and Qualified Doctors, on the WBTi website, particularly aimed at medical trainees, and the e-learning for Healthcare modules for educating and training the health and social care workforce. There is a great deal of information on the GP Infant Feeding Network (GPIFN) and Hospital Infant Feeding Network (HIFN) websites and the new book edited by Amy Brown and Wendy Jones, A guide to supporting breastfeeding for the medical professionwith chapters by different specialists, is practical and comprehensive; all royalties from sales of their book will go to the Human Milk Foundation. Sources of information on prescribing include the UKDILAS website (UK Drugs in Lactation Advisory Service) and the Breastfeeding Network website information and Breastmilk Information Service. 

To access the full list of resources see our next blog.

In the first presentation at the event, Clare Meynell and Helen Gray briefly explained a WBTi assessment and some of the report findings, but also mentioned progress made in the past 3 years. This includes the requirement in the NHS Long-Term Plan for all maternity services to achieve Baby Friendly status, and local Maternity systems in England asked to produce a breastfeeding strategy as part of the implementation of Better Births and the National Maternity Transformation Programme (which are now aligned)

Georgie BHS and Dani Phillipson from the Parenting Science Gang

Georgie BHS and Dani Phillipson from the Parenting Science Gang, which runs citizens’ science projects using mothers to collect evidence, spoke next. They described the breastfeeding and healthcare experiences project (inspired in part by the WBTi findings on health professional training) with its subsidiary small project of 8 interviews looking at healthcare professionals’ own experiences of breastfeeding on their professional practice. From the themes identified, PSG has produced MILK cards to guide health professionals:

  • Mothers’ voices matter
  • Investigate common issues, but also
  • Look for underlying causes§
  • Know where to find information

GP Dr. Terri Lovis (seen in banner photo above) described how the GP Infant Feeding Network (GPIFN), initiated by Dr. Louise Santhanam, was set up as a pharma free network to improve the quality of support in infant feeding with the work provided voluntarily. The website is a comprehensive educational resource for primary care and there is partnership with the Hospital Infant Feeding Network (HIFN). Additional achievements include working collaboratively with IMAP (International Milk Allergy in Primary Care Guidelines) to produce the 2019 version and bidding successfully with PHE and Surrey Heartlands to train Infant Feeding champions across Surrey (as Norwich already does).

Dr Natalie Shenker from the Human Milk Foundation

The fascinating keynote presentation was by Dr. Natalie Shenker on Doctors and Breastmilk, and included the initiation of the Human Milk Foundation in 2017 and the work of the Hearts Milk Bank, which she co-founded with Gillian Weaver. The Milk Bank is involved in research as well as providing pasteurised donor milk.

The challenge is how to enable all medical students, trainees and qualified doctors to acquire an adequate minimum standard in infant feeding knowledge and skills. Yes, there is a huge amount that they need to know in total but being breastfed as an infant can make such a difference to the health of baby and mother (not to mention the environmental sustainability of breastfeeding!) that it is crucial to include. Some examples of what is already being done to help achieve this:

  • Imperial College Medical School is running a programme in which medical students are allocated to follow a mother from the end of pregnancy until the child is 3 years old.
  • Norwich CCG has a GP Champion in Infant Feeding scheme, which Surrey Heartlands is also rolling out, in which the champion receives training and disseminates the learning throughout the practice.

Imagine if all medical schools ran such a programme and all GP practices had a breastfeeding champion!

Banner photo: Dr. Terri Lovis

Patricia Wise is the author of ‘Supporting Mothers Who Breastfeed: A Guide for Trainee and Qualified Doctors’. She is an NCT Breastfeeding Counsellor and tutor, and a member of the WBTi UK Steering Group

We want the new government to invest in the health of women and children by supporting and protecting breastfeeding.

The WBTi UK team are proud to be part of producing this joint statement calling for our next government to make breastfeeding a priority in setting the agenda to prioritise the early years of life.

Download the PDF HERE

The new government needs to prioritise the first 1001 days of a child’s life, from conception to age two, to enable children to survive and thrive. How an infant is fed and nurtured strongly influences a child’s future life chances and emotional health. Importantly, if a woman breastfeeds there are substantial health benefits for her – having impacts onher future long after breastfeeding has stopped.

Independent, practical, evidence-based information and support is essential for every family.  Supporting women with breastfeeding can go a long way to protecting children and mothers from a wide range of preventable ill health, including obesity and mental health problems.

This window of opportunity cannot be missed for the future health outcomes of mothers and the next generation. In addition to well documented health outcomes, supporting breastfeeding will also contribute to a stronger economy – potential annual savings to the NHS are estimated at about £40 million per year from just a moderate increase in breastfeeding rates.

Support for breastfeeding is also an environmental imperative and recognition of the contribution breastfeeding can make to avoiding environmental degradation should be a matter of increasing global and political attention.

In the UK, the majority of women start to breastfeed but breastfeeding rates drop rapidly – our continuation rates are some of the lowest in the world and are even lower amongst women living in deprived areas, where increasing rates could make a real difference to health inequalities. Support for all women, parents and families with breastfeeding falls short of what is wanted and needed. 

Women tell us they encounter difficulties with the public perceptions of breastfeeding out of the home. Families tell us they are still regularly exposed to conflicting messaging and marketing for formula milks that drowns out advice from healthcare professionals.

Women tell us they receive little to no help with infant feeding and that their health visitors, midwives and doctors often have little training or knowledge about breastfeeding and limited time to support them.

Recent cuts in health visitor numbers and breastfeeding peer support services mean many women may be left without the support they need however they choose to feed their infants. 

Despite robust evidence showing that investment in breastfeeding support and protection makes sense, politically breastfeeding has been viewed by governments as a lifestyle choice and so left to parents to work out for themselves. For too many women, trying to breastfeed without support, or stopping before they want to, is deeply upsetting and the situation is made worse by fragmented care, and poor and often conflicting advice from those they are seeking to support them. To ensure an increase in breastfeeding rates, to help reverse obesity rates and to reduce widening health inequalities will require significant investment in breastfeeding. 

It is essential that our new government prioritises breastfeeding and invests in its support and protection.

We call on all political parties to commit to the following actions, if elected:

  • To appoint a permanent, multi-sectoral infant and young child feeding strategy group and develop, fund and implement a national strategy to improve infant and young child feeding practices
  • To include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • To implement the Unicef UK Baby Friendly Initiative across community and paediatric services, building on the recommendation for maternity services in the NHS Long Term Plan.
  • To protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
  • To commission, and sustainably fund, universal breastfeeding support programmes delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists, such as IBCLC lactation consultants and breastfeeding counsellors, alongside trained peer supporters with accredited qualifications.
  • To maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline and sustaining the Drugs in Breastmilk Service.
  • To deliver universal health visiting services and the Healthy Child Programme by linking in with local specialist and support services.
  • To establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.
  • To make it a statutory right of working mothers and those in education to work flexibly as required and to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
  • To commit to resourcing for charitable organisations who play a key role within the health agenda working at a national and local level to support families and communities with infant feeding.
  • To support the commitment to undertake an Infant Feeding Survey which builds on the data previously collected in the Infant Feeding Survey 2010 (now discontinued). 
  • To implement the recommendations of the Becoming Breastfeeding Friendly (BBF) study.

CASE FOR ACTION

  1. Breastfeeding benefits all babies, and studies have shown that just a small increase in breastfeeding rates could cut NHS expenditure considerably.  It is vital to invest in breastfeeding support in the early months and this will reap rewards in the future that are likely to exceed the initial cash flows associated with putting proper support in place.
  2. UNICEF report states that “no other health behaviour has such a broad-spectrum and long-lasting impact on public health. The good foundations and strong emotional bonds provided in the early postnatal period and through breastfeeding can affect a child’s subsequent life chances”. 
  3. Evidence has also demonstrated that a child from a low-income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula-fed. Breastfeeding provides one solution to the long-standing problem of health inequality.
  4. Research into the extent of the burden of disease associated with low breastfeeding rates is hampered by data collection methods. This can be addressed by investment in good quality research.

References

1. Laurence M. Grummer‐Strawn Nigel Rollins, (2015), Impact of Breastfeeding on Maternal and Child Health. https://onlinelibrary.wiley.com/toc/16512227/2015/104/S467

2. Borra C, Iacovou M, Sevilla A (2015) Maternal Child Health Journal  (4): 897-907. New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions

3. Brown, A, Rance J, Bennett, P (2015) Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties.  Journal of Advanced Nursing 72 (2): 273-282

4. https://www.brunel.ac.uk/research/News-and-events/news/Breastfeeding-for-longer-could-save-the-NHS-40-million-a-year

5. Li R, Fein SB, Chen J, Grummer-Strawn LM, (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year.  Pediatrics 122: S60-S76

6. Support for breastfeeding is an environmental imperative. (2019) BMJ 2019;367:l5646 https://www.bmj.com/content/367/bmj.l5646

7. McAndrew F et al (2012) Infant Feeding Survey 2010

8. NHS (2019) NHS Long term Plan https://www.longtermplan.nhs.uk/

9. National Institute for Health and Care Excellence (2013) Postnatal Guideline NICE, London https://www.nice.org.uk/guidance/cg37

10. National Institute for Health and Care Excellence (2012) Improved access to peer support   NICE, London

11. Rollins N, Bhandari N, Hajeebhoy N, et al (2016) Why invest, and what it will take to improve breastfeeding practices?  The Lancet 387 491-504

12. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. 1998 Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. Jan 3;316(7124):21-5.

13. Brown, A, Finch, G, Trickey, H, Hopkins, R (2019) ‘A Lifeline when no one else wants to give you an answer’ – An Evaluation of the BFN’s drugs in breastmilk service. https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf       

New e-book on breastfeeding for doctors and trainees

New e-book on breastfeeding for doctors and trainees

Background

Doctors have an important role to play in supporting mothers who are breastfeeding, through providing encouragement, accurate information and signposting to sources of specialist and peer support. Their impact can be significant because doctors and their advice are held in such high regard, and this is particularly important in the UK, where a mother’s intention to breastfeed can so easily be undermined.

There are doctors who have made themselves really knowledgeable but sadly the UK universal standards for pre-registration medical training in breastfeeding have significant gaps, as shown by Indicator 5 of the WBTi 2016 report (see Part 1 for the summary table below, and Part 2 for the details of standards for different health professions)

Curriculum developments

However, there have been some positive changes since the publication of the WBTi UK report.

Paediatrician training

Level 2 of the RCPCH general curriculum for paediatricians (section Capabilities in Health Promotion and Illness Prevention) has been revised and lists more breastfeeding topics (https://www.rcpch.ac.uk/sites/default/files/2018-03/rcpch_progress_curriculum_level_2_generic_syllabus_for_use_from_1_aug_2018.pdf).

GP training

GP training has also been revised by the RCGP with more mentions of breastfeeding/ infant feeding in the topic guides on Children and Young People and Maternity and Reproductive Health (https://www.rcgp.org.uk/-/media/Files/GP-training-and-exams/Curriculum-2019/Curriculum-Topic-Guides-300819.ashx?la=en).

The WBTi UK team contributed to both curriculum consultations.

GP Infant Feeding Network and Hospital Infant Feeding Network

Dr. Louise Santhanam founded the GP Infant Feeding Network (GPIFN) in 2016 and in 2019 Drs Vicky Thomas and Ilana Levene launched the Hospital Infant Feeding Network (HIFN), which are valuable resources for medical professionals. See our series of three guest blogs from HIFN: Launch of HIFN, #DontStopLookItUp campaign on prescribing for breastfeeding women, and free posters on breastfeeding issues in the hospital setting.

New learning outcomes published by Unicef UK Baby Friendly Initiative

Doctors have a long training so there needs to be input at different stages of training and also encouragement for already qualified doctors to update. A group looking at this was initiated by the WBTi team and went on to be led by Unicef UK Baby Friendly Initiative, and chaired by paediatrician Charlotte Wright. Unicef UK Baby Friendly launched the resulting infant feeding learning outcomes in World Breastfeeding Week, with accompanying resources expected to follow soon (see our August 2019 blog). These are intended as a guide for training for various health professions from undergraduate courses through to the point of qualification.

New online book for trainee doctors

My book, Supporting mothers who breastfeed: a guide for trainee and qualified doctors, is primarily for trainee doctors but relevant to qualified doctors too. At the trainee stage they have specialised and are working clinically. The book provides a combination of factual knowledge about breastfeeding and an insight into mothers’ experiences. It includes some examples of good practice in responding to common situations and ends with a short quiz. It is available on the WBTi website (https://ukbreastfeeding.org/supporting-mothers-who-breastfeed-a-guide-for-trainee-and-qualified-doctors/) as a free PDF. Being electronic, it is easy to click on links to be taken to references and sources of further information, and can be updated more readily than a paper book. 

I am very grateful to Charlotte Wright, who is Professor of Community Child Health at the University of Glasgow and a consultant paediatrician, for writing the foreword.

If you know any trainees or qualified doctors, perhaps you would pass the weblink to them.

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Patricia Wise is an NCT Breastfeeding Counsellor and tutor, and a member of the WBTi UK Steering Group

Empowering communities through integrated sustainable solutions #WBW2019

Empowering communities through integrated sustainable solutions #WBW2019

I’m a lactation consultant and writer who has just finished a Masters degree in Health Promotion at Leeds-Beckett University. This blog touches on some of the insights that my studies have given me, not least how data, like WBTi’s reports, can help health promoters create integrated, sustainable solutions that make health a resource to be shared by everyone.

In 1986, the World Health Organization (WHO) Ottawa Charter for Health Promotion defined Health Promotion as “the process of enabling people to increase control over, and to improve, their health.” Whether the focus be on breastfeeding, preventing obesity, supporting mental health or any of the complex (so called ‘wicked’) problems that challenge our societies, it is health promotion’s recognition of the social determinants of health that has most affected my thinking.  All too often our society is quick to blame the individual for unhealthy behaviours; my increased awareness of the social determinants of health, that is, how socio-economic, cultural and environmental conditions determine individuals’ well-being, has changed my perception. It’s given me a heightened awareness of how prevailing political ideologies influence the way we think about society, and how this plays out into how likely (or not) individuals are to be able to make healthy choices throughout the course of their lives. 

“This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements …and bad politics.” WHO[1]

To give an example, indicator 6 of the WBTi looks at community-based support, so key to women continuing to breastfeed.[2]In the UK, the recent NHS Long Term Plan’s recommendation of UNICEF UK Baby Friendly accreditation is cause for celebration and will boost the capacity of midwives and health visitors to support breastfeeding in the community.

However, cuts to peer-support services, and the closure of over 1000 Sure Start centres have disproportionately affected poorer members of society. If a mother in the community has persistent nipple pain, no car, no public transport, no money for a lactation consultant and her nearest breastfeeding group is 20 miles away, even with the support of the hard-working volunteers on the National Breastfeeding Helpline, her capacity to protect the health of her family through breastfeeding will be limited. 

Incidentally, the discipline of Health Promotion, while focusing on the up-stream causes of health inequalities, is also focused on empowering communities to participate in the creation of healthier societies. The UK’s WBTi report, under Indicator 6, points out that in England and Wales there is often little coordination between NHS services and peer-supporters, who can offer so much to new mothers. It recommends a range of integrated postnatal services that include voluntary sector breastfeeding support, meet local needs and provide clear access to specialist support.

Integrated breastfeeding support is outlined in the criteria for UNICEF Baby Friendly accreditation for community services:

  • Basic: universal services such as midwives, health visitors, and support workers are trained to BFI standards
  • Additional: a network of trained local peer supporters and support groups
  • Specialist: a referral pathway to specialist help at IBCLC level, for complex cases that cant be resolved by “Basic” and “Additional” support

The guidance and standards on community breastfeeding support from NICE, Baby Friendly and Public Health England are summed up in this “Breastfeeding Support Within Maternity Transformation Plans: Guide to the Guidance” by Better Breastfeeding.

As an individual health promoter, the scale and complexity of the social determinants of health can feel overwhelming. Nonetheless, recognising them sets the challenge to health promoters (in all disciplines, not just those who work in traditional health services or policy) to work empathetically, creatively and collaboratively. After all, ‘Success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective societal responsibility’ (The Lancet).


[1]Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF). World Health Organization. 

[2]Dennis C (2002) The Effect of Peer Support on BreastFeeding Duration among Primiparous Women: A Randomized Controlled Trial. Canadian Medical Association Journal 166(1):21-8.

Alice Allan is a lactation consultant, writer and communication specialist who has worked in Ethiopia and Uzbekistan on maternal and child health. Her novel, Open My Eyes, (Pinter and Martin) set in an Addis Ababa NICU, recently won The People’s book Prize for Fiction. She currently lives near London with her family and an Ethiopian street dog called Frank.