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

Launch of learning outcomes for health workers

Launch of learning outcomes for health workers

At the start of World Breastfeeding Week, Unicef UK Baby Friendly Initiative launched a new set of resources: recommended learning outcomes for several health professional groups.

New Unicef Baby Friendly learning outcomes for health professional training

It had been announced at the Baby Friendly conference in 2018 that learning outcomes and resources were being produced.

Addressing gaps

WBTi UK Indicator 5: Health professional training

The WBTi report in 2016 (see Indicator 5 in Part 1 of the WBTi UK report for the above table, and Indicator 5 in Part 2 for the detailed findings for each UK health profession) showed that for most health professions in the UK, the coverage of infant feeding in pre-registration training was inadequate. In some case only broad standards are given and the individual universities develop their own curricula.

The infant feeding learning outcomes launched by BFI are for a range of newly qualified health professionals so they ‘articulate the minimum knowledge and understanding of infant feeding that it would be reasonable to expect from a health practitioner at the point of qualification’. There are slightly different ones for the following five groups:

  • doctors
  • dietitians
  • pharmacists
  • children’s nurses
  • maternity support workers/nursery nurses.

For each of these professional groups the learning outcomes are grouped into three broad themes:

  1. The value of human milk and breastfeeding.
  2. Supporting infant feeding.
  3. Infant feeding in context, which includes understanding the importance of the International Code. 

They are intended as ‘a stimulus to universities and others to start to consider what should be covered in relevant curricula and training, and then to take action to make that a reality.’ 

One useful recommendation is that ‘A mapping exercise can help the university to assess how far the topics are already covered and assessed in the curriculum, and to identify and plan for any additions to modules or design alternations needed.’ Plans for the resources ‘include a slide pack to help lecturers deliver the content to students, e-learning for students and assessment examples’. 

Specific learning outcomes like these, provided they are taken on board by the training institutions, will surely help to achieve a higher and consistent level of knowledge and skills within and between health professions.

Cover photo licensed by Adobe Stock

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