GPs and breastfeeding

GPs and breastfeeding

 

Doctors have to acquire a huge body of knowledge during training and for general practitioners that knowledge is particularly wide-ranging. Their ten or more years of study comprise undergraduate, foundation and specialism levels of training. As qualified GPs they are likely to have thousands of women patients who, at some stage, are breastfeeding mothers, yet the breastfeeding content of the curriculum is minimal.

Placements in the specialism training may offer useful opportunities to learn from midwives and health visitors about the practicalities of supporting breastfeeding but this is a matter of luck, and the knowledge and skills of those mentors can be variable. It would be much more effective to have a requirement for acquiring basic knowledge and skills specified in the curriculum as well.

 

GP Infant Feeding Network and resources for GPs

A number of GPs, mothers who in breastfeeding their own babies became acutely aware of the deficiencies in their training, set up the GP Infant Feeding Network, GPIFN, in February 2016. In April 2017 they launched the GPIFN website, a valuable resource for doctors.

Does your doctor know about this website?

 

Medical training

With regard to medical training (not just GP training), the General Medical Council (GMC) has recently published its Generic Professional Capabilities (GPC) Framework to provide broad outcomes for a consistent approach for postgraduate curricula. The framework was developed in partnership with the Academy of Medical Royal Colleges. Domain 4 (there are 9 domains) looks to be particularly relevant to protecting and supporting breastfeeding as its title is ‘Capabilities in health promotion and illness prevention’.

Royal colleges, such as the Royal College of General Practitioners (RCGP), are responsible for the details of their curricula. They revise them every few years and from the next revision will need to fit with the GPC Framework to be approved by the GMC.

The current standards show several gaps when evaluated by the WHO Education Checklist on infant feeding in the 2016 WBTi assessment of the UK.

Further information about standards for the different health professions can be found in Indicator 5 in Part 2 of the 2016 WBTi report.

 

Are you a doctor or trainee doctor?

If so, you might like to contact your specialty college asking for the infant feeding content of the curriculum to be improved.

 

 

PW Photo for WBTi MAINN presentation

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group, being the lead for Indicator 5, which is primarily about health professional training.

 

 

Cover image  www.stayathomemum.com.au via Szőreg hivatalos honlapja

 

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

Who knows breast: GPs, Midwives, Health Visitors, Paediatricians, Obstetricians, Friends, Family?

By Kate Butler

Peer Supporter, West Hertfordshire Hospitals NHS Trust

As a mum embarking on a new breastfeeding journey with their baby, who could she turn to for support and advice that she can trust? How would she know that what she’s doing is “right”, that her baby’s behaviour is “normal”? Her midwife? GP? Obstetrician? Paediatrician? Health Visitor? Surely the advice and support you get from a qualified and trained healthcare professional can be trusted? The findings from the World Breastfeeding Trends Initiative (WBTi) UK 2016 Report (published November 2016) may surprise you.

Screen Shot 2017 wbti ind 5

Health professional training in the UK

The WBTi UK Report (WBTi UK 2016) was based on the WBTi toolkit developed by the International Baby Food Action Network (IBFAN) to help countries evaluate breastfeeding policies and practices in a systematic way. One area that the report focuses on is health professional training and subsequent impact on breastfeeding initiation and continuation rates across the UK. Worryingly the report highlights many gaps in the pre-registration training of some healthcare professions in the area of infant and young child feeding, particularly in the practical aspects of enabling mothers to initiate and continue breastfeeding. Following qualification, healthcare professionals are then expected to undertake in-service training in infant and young child feeding. The WBTi UK Report reveals that provision and uptake of these courses is limited.

So what does this mean? The very healthcare professionals our new mums ought to be able to trust to give them the right advice may not be the right source of information to enable a mum to breastfeed successfully. It’s through no fault of the healthcare professional, but rather the fault of how their initial training and ongoing training is structured. Therefore their advice and support might often based on personal experiences and/or out of date practices. Not only that but our healthcare professionals also have to work in line with their own NHS trust policies. These differ between trusts and are based not only on NICE guidelines but also considerations such as the skill set of staff and trust finances.

Breastfeeding rates are dropping off drastically after birth

The issue with all this? Published in November 2012, the 2010 Infant Feeding Survey showed that the initial breastfeeding rate in the U.K. was 81%. Across the UK, at three months, the number of mothers breastfeeding exclusively was 17% and at four months, it was 12% (Infant Feeding Survey 2010). However, exclusive breastfeeding at six months is only around 1%. But with the infant feeding survey being cancelled last year and lack of any national leadership or strategy in infant feeding, what hope do we have to improve these figures? What hope do we have of changing the way our health professionals are trained and how their on-going training is structured?

Some people might ask what’s wrong with these figures presented above. In doing so, they reflect a society, our society, in which formula feeding has become normalised. Where friends and family see formula as “just as good” as breastmilk and don’t have their own personal experiences of breastfeeding in order to support new mothers. The World Health Organisation recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. It is not within the scope of this post to explore the reasons behind this recommendation, more this article is to raise the issue that breastfeeding families have a dwindling pool of resources from which to obtain support during their breastfeeding journeys. Breastfeeding families are unlikely to be able to rely on advice from healthcare professionals, friends or family. That’s a lonely existence.

How can we change society and health care for new mothers and babies?

All is not lost though. The Unicef Baby Friendly Initiative, launched in the U.K. in 1995 (Unicef UK Baby Friendly Initiative 1995), is based on a global accreditation programme of UNICEF and the World Health Organisation. It is designed to support breastfeeding and parent infant relationships by working with public services to improve standards of care. Maternity units and community facilities have the option to become Baby Friendly accredited and in order to do so are required to provide training for its midwives and health visitors. While the majority of maternity units (91%) and health-visiting services (83%) have achieved or are working towards Baby Friendly status, the remainder have not commenced the process. Therefore new breastfeeding mums can hope that the situation is improving and healthcare professionals that have undergone Baby Friendly training will start to provide the trusted information that mums deserve. But this will require quite a culture shift change within the NHS and this will take time.

There is also lots to be done with the image of, and marketing of infant milk so that “normal infant feeding” moves away from formula and focusses on breastfeeding.

Our society needs educating and this will also need the support and investment from the government.

wbti-ind-5-gaps-recs.png

For further information on how mums can find the most appropriate support right now for their breastfeeding journey, visit http://www.lcgb.org/why-ibclc/whos-who-in-breastfeeding-support-and-lactation-in-the-uk/

 

Kate ButlerKate Butler is a Secondary School Biology teacher by day and mother to two boys (aged 1 and 3) day and night. She trained as a breastfeeding peer supporter in 2013 and since then has set up local peer support meetings in her local area and joined the committee of West Herts Breastfeeders to support with fundraising and event management. West Herts Breastfeeders is a community based mum to mum peer support group that supports breastfeeding families with their breastfeeding journeys in the community and within West Hertfordshire Hospitals NHS Trust. This post was first published on Kate’s blog, The Instinctive Parent (www.theinstictiveparent.org), which she started to share knowledge and help further educate parents to help them make properly informed decisions and choices in how they choose to parent.

 

References

Infant Feeding Survey 2010 [ONLINE] Available at: http://www.content.digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf [Accessed 30/13/16]

UNICEF Baby Friendly Initiative 1995 [ONLINE]  https://www.unicef.org.uk/babyfriendly/what-is-baby-friendly/ [Accessed 30/12/16]

WBTi UK Report 2016 [ONLINE] Available at: https://ukbreastfeedingtrends.files.wordpress.com/2016/12/wbti-uk-report-2016-part-1-11-12-16.pdf [Accessed 30/12/16]

World Health Organisation [ONLINE] Available at: http://www.who.int/topics/breastfeeding/en/ [Accessed 30/12/16]

For mothers, for babies and for society

For mothers, for babies and for society

WBTi UK Report 2016 – Key findings and what you can do to help

Breastfeeding matters for mums, babies and society.

The WBTi report for the UK shows key gaps and recommendations for improvement in how all of society — the UK Government, national assemblies, local commissioners,  friends, family and community — needs to support mothers who want to breastfeed and the healthcare professionals who help them.

In order for this to happen, we need MPs to be aware of the report and recommendations, so that they carry the message to Parliament, and start the change so desperately needed.

MPs are there to listen to your concerns and to represent you in Parliament. Our video explains what the key messages are from the WBTi 2016 Report on the UK, and what we can all do together to make changes happen.

 

We need YOUR help now in this social media campaign with our video.  You can;

  • Take the report and its recommendations to your local MP
  • Tag a friend on our Facebook video launch post, like and share the post
  • Write to your MP or make an appointment to meet them
  • Post a selfie on our video launch post with the hashtags #breastfeedingmatters and #bfaction to raise awareness on social media and help us make this change

If you have breastfed your own children, if you had hoped to breastfeed but didn’t get enough support, or if you are a health care professional or volunteer supporting breastfeeding women, please get involved.

For a step-by-step guide see our campaign:

http://www.babymilkaction.org/wbtiuk-mps0217

For more information on the report, to donate, and to download our FREE report cards to give to your MP:
https://ukbreastfeeding.org/wbtiuk2016/

 

For more information on the work of Baby Milk Action and to sign up to support them
 http://www.babymilkaction.org/
UNICEF Baby Friendly Initiative
https://www.unicef.org.uk/babyfriendly/

Mothers’ voices #BeBoldForChange

Mothers’ voices #BeBoldForChange

#BeBoldForChange International Women’s Day

Mothers have been boldly calling for change, change in the support they need to breastfeed their babies, change in the conversation around breastfeeding. Fathers, partners, health professionals and volunteers have been boldly speaking up in support.

2016 and 2017 has seen lots of activity in the “breastfeeding world”; not that this is a mythical place where breastfeeding is seen as the norm. It’s a real place, just sadly a relatively small world at the moment. We’ve seen a new books on the subject published, we’ve seen campaigns launched, groundbreaking research and reports published, adverts made and most recently a new Bill proposed in Parliament. Any why so much action? Because breastfeeding should be the norm – I’ll go all Biology teacher here and state the obvious – we’re mammals, we have mammary glands in order to be able to feed our young. The breastfeeding world should be everyone’s world.

In recognition of International Women’s Day today, now is the time to #BeBoldForChange (International Women’s Day 2017). Everyone should know about breastfeeding, everyone should feel happy to talk about it, and everyone should feel properly supported about how they choose to feed their baby.

8 out of 10 women stop breastfeeding before they want to (McAndrew et al 2012). There are many reasons for this but Unicef only last week highlighted yet more research showing that breastfeeding support can increase the duration and exclusivity of (Unicef 2017). The World Breastfeeding Trend Initiative UK report (WBTi UK 2016) published in November last year reinforced these findings by identifying a key gap with many mothers lacking access to skilled breastfeeding support. So if mothers aren’t getting support from skilled and trained volunteers or professionals, where is their support coming from?

The current reality is that we live in a society with a formula feeding culture. What does that mean? It means our society sees formula feeding as normal, “just as good” as breastmilk. This is further entrenched in our minds through the media, online, in papers, on television. Families just don’t get the opportunity to make fully informed decisions about how they wish to feed their child because expectations and methods of infant feeding are so ingrained in our culture. “Helpful” friends and family want to support a family’s choice in how they choose to feed their baby but often they have not breastfed so advice can often undermine a family’s breastfeeding journey. Our formula feeding culture is not through the fault of any individual mother or indeed individual healthcare professionals. It’s the result of government not listening to society’s needs; it’s the fault of unscrupulous formula and bottle companies with some pretty amazing marketing strategies. I used to work in marketing – these formula campaigns are ruthless! The Politics of Breastfeeding (Palmer 2009) and Breastfeeding Uncovered (Brown 2016) are fabulous reads if you want to delve further into the impact of politics and commercial interests on breastfeeding.

So what change do we need? On International Women’s Day?

Fundamentally we all – families, supporters, employers, health professionals, politicians – we need to listen to the woman’s voice, the mother’s voice. The mother asking for support and the mothers who can offer the support. We need to celebrate the voices and the hard won wisdom of mothers who have had successful breastfeeding journeys, who have managed to overcome the many challenges they faced. Families who plan to breastfeed need to know what is normal. Many breastfeeding mums ARE happy to talk about their experiences and support and help other mums. But many shy away for fear of stimulating the breast vs. formula debate, the “mummy wars” that are so often fuelled by both the strong feelings of mothers who have been let down, and the deep pockets of the baby feeding industry. Very often the mums who formula feed have done so because they’ve been let down by gaps in the support around them. As mentioned before 8 out of ten women give up breastfeeding before they are ready to and many are not happy about it; this can even lead to an increased risk of postnatal depression (Borra et al; Brown et al). It’s not their fault but the guilt can lead to defensive conversations about how they feed their baby. It therefore shuts down the conversation around breastfeeding and we’re back to square one. These issues are what inspired UNICEF’s ongoing #changetheconversation campaign launched last year (Unicef Baby Friendly Initiative 2016).

Social media is full of private groups where breastfeeding mums have a “safe” place to share and support each other in their breastfeeding journeys without fear of upsetting mums who are not breastfeeding. But why should this be done in private? Why shouldn’t breastfeeding mums shout from the roof tops? It’s great to see that the government’s Start4Life campaign have recently requested to hear from breastfeeding mothers about their stories (Start4Life 2017). It’s a small step but one that may prove powerful. What we really need is to educate our children and our society on breastfeeding. I’m not just saying this because I’m a teacher, but if our children don’t know about it, what hope have we got to normalise it? Breastfeeding families also hold a special role, not shying away from sharing their experiences, but being bold for change and sharing what’s normal in the hope that we can normalise breastfeeding and make our “small” breastfeeding world everyone’s world.

Let’s celebrate the strength of mothers everywhere.

#BeBoldForChange

 

References

Borra C, M Iacovou and Q Sevilla 2014 New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions Matern Child Health J DOI 10.1007/s10995-014-1591-z

Brown A, J Rance and P Bennett 2016 Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing Volume 72 (2):273–282 DOI: 10.1111/jan.12832 [Accessed 6/3/2017]

 Brown, A. (2016) Breastfeeding Uncovered, Pinter & Martin Ltd 2016

International Women’s Day 2017 https://www.internationalwomensday.com/

McAndrew F, Thompson J, Fellows L, Large A, Speed, M and Renfrew M (2012) Infant Feeding Survey 2010. The Information Centre for Health and Social Care. Available at http://www.esds.ac.uk/doc/7281/mrdoc/pdf/7281_ifsuk-2010_report.pdf

Palmer G 2009 The Politics of Breastfeeding: When Breasts are Bad for Business, Pinter & Martin Ltd.; 3rd Revised edition (29 April 2009)

Start4Life 2017 https://www.facebook.com/Start4LifeInformationServiceForParents/?fref=nf

Unicef UK Baby Friendly Initiative 2017 Supporting Breastfeeding https://www.unicef.org.uk/babyfriendly/supporting-breastfeeding-make-it-happen/

Unicef UK Baby Friendly Initiative 2016 https://353ld710iigr2n4po7k4kgvv-wpengine.netdna-ssl.com/babyfriendly/wp-content/uploads/sites/2/2016/04/Call-to-Action-Unicef-UK-Baby-Friendly-Initiative.pdf

WBTi UK Report 2016 [ONLINE] Available at: https://ukbreastfeedingtrends.files.wordpress.com/2016/12/wbti-uk-report-2016-part-1-11-12-16.pdf [Accessed 30/12/16]