Actions to develop ‘Breastfeeding Friendly’ Premises

Background/ Rationale:

Breastfeeding offers significantbenefits for women as well as babies.  Babies who do not receive breastmilk are at higher risk for a range of conditions such as gastrointestinal and respiratory infections, childhood cancers, obesityand lower intelligence; whereas mothers who do not breastfeed have a higher rate of *** and ovarian cancers.   However, despite the overwhelming evidence for the benefits of breastfeeding, the UK’s breastfeeding rates are one of the worst in Europe.

Breastfeeding out of the home environment can operate as a key deterrent to successful breastfeeding.  One of the key difficulties faced by women is the fear of negative comments or feedback from members of the public (Departmentof Health, 2004; Dykes et al 2003; Renfrew et al, 2006; Hoddinott & Pill,1999; Lavender et al, 2005; National Childbirth Trust, 2005).    The findings from a recent local evaluation also identified that the potential of receiving negative remarks, as well as a lack of suitable facilities for breastfeeding women operated as a significant disincentive for women to feed outside the home; and influenced some of the women’s decisions to cease breastfeeding (Thomson et al, 2009).   Feedback from this local work also suggests that breastfeeding mothers want to know where they can go and feed in comfort and confidence; safe in the knowledge that they will not be asked to leave, or made to feel unwelcome.   Furthermore, whilst some women would prefer to use a dedicated breastfeeding room; a numberof them want to be able to breastfeed in public, and not made to feel that they have to hide away. 

In order to try and combat some ofthe difficulties faced by breastfeeding women, and to enhance breastfeeding rates, a breastfeeding outside of the home environment project has been designed (as part of the Community Baby Friendly Initiative project in NHS North Lancashire and NHS Blackpool) to encourage local premises and businesses to become an accredited ‘breastfeeding friendly’ facility. 

The proposed actions/processes involved in this project are outlined as follows:-

1)                  A ‘Breastfeeding Welcome’ Sticker Design Competition was held in May, 2009 (involving entrants from across North Lancashire & Blackpool). A design was chosen from the entries by a multi-agency panel of judges including people unassociated with infant feeding.

2)                 Thefunds to pay for the printing of the Stickers were agreed through Early Years, Lancashire County Council.

3)                 Aletter has been drafted up for local businesses and premises, together with a survey and “Do’s and Do Not’s” of becoming ‘Breastfeeding Friendly’ premises.

4)                 Breastfeeding women / local peer supporters have begun to visit local businesses / premises to talk to owners / managers about becoming a ‘breastfeeding friendly’ facility, and what compliance would mean (i.e. sticker displayed in their premises, agreement to comply with the “Do’s and Do Not’s”). 

5)                 If owners / managers are in agreement – and facilities surveyed by the breastfeeding women / peer supporter and found to be an appropriately ‘breastfeeding friendly’area - the owner / manager will be asked to complete the survey (and return either direct to women/peer supporter; returned in the post; or via email).

6)                 All premises which sign up / perceived to be ‘breastfeeding friendly’ will receive a ‘Breastfeeding Welcome’ sticker to display at the entrance to their premises, as well as a certificate to display inside should they wish.

7)                 All details of the ‘breastfeeding friendly’ premises will be detailed and updated on the local BFI web page – www.NWNWbabyfriendly.org.uk - and will be regularly updated by the Communications Officer appointed to the Baby Friendly project.

8)                 Breastfeeding mothers across Blackpool and North Lancashire will be made aware that there is a list of ‘breastfeeding friendly’ premises available through health professionals and Children’s Centres via posters as well as leaflets provided within the women’s discharge packs.   (It is also envisaged that updated localised lists of these premises can be printed off by health professionals and provided to women as requested).

9)                 Whilst the web page will contain details of the approved premises – breastfeeding women and other service users will be asked to provide comments on their experiences at these premises (via web based options, email, or notification to leaders of the breastfeeding support groups) – as well as offer suggestions for other facilities / premises considered to be ‘breastfeeding friendly’.

10)             ANY premises / facilities which receive negative feedback will be approached for comment, and if it is evident that they have not met the “Do’s and Do Not’s” (evaluated through the service user feedback received) they will have theirname removed from the approved list, and will be asked to remove their sticker and take down their poster.   (Note: all businesses have been notified of this caveat within the letter)

Most people who work in maternity services or infant feeding, or who have themsleves recently had a baby, will have seen a variety of the breastfeeding printed materials available - for example locally we routinely use the square purple "Off to a Good Start" book, the NHS "Off to the Best Start" leaflet, the UNICEF / FSIDS "Sharing a Bed with Your Baby" leaflet and the UNICEF "Breastfeeding" pamphlet, as well as the Sterilisation leaflet.

All of these resources are available online - and often at no charge in hard copy if you call and request them - in a variety of languages ither than English - for example, Polish (as listed below) Lithuanian, Spanish, Russian, Portugese, French and so on as well as South Asian languages and others.

Listed below are some resources for the Polish speaker - but if you hunt online you can usually find versions in other languages too, so it's worth looking for the if you have a patient who doesn't read well in English. 

http://www.healthscotland.com/uploads/documents/3363-BreastfeedingWebPolish.pdf.pdf

http://www.babyfriendly.org.uk/pdfs/polish/bot_polish.pdf

http://www.babyfriendly.org.uk/pdfs/polish/ster_polish.pdf

http://www.babyfriendly.org.uk/pdfs/polish/byb_polish.pdf 

Sharing a bed with your baby  A leaflet with information on the benefits and risks of bed sharing, designed to help parents make informed decisions about safely sharing a bed with their babies.  Available in French, Portuguese, and Spanish.  Unicef UK Baby Friendly Initiative  June 2005

 

The Asian Helpline is a multilingual service run by the NSPCC for the UK's Asian communities. It provides counselling, information and advice to anyone concerned about a child at risk of ill treatment or abuse. Its qualified Asian Child Protection Officers will provide expert help and advice in five South Asian languages: Gujarati, Hindi, Punjabi, Bengali/Sylheti and Urdu. There is also a service in English that offers the same sensitivity towards cultural and religious issues. The NSPCC also offers help in the following languages: Arabic, Chinese, French, Greek, Italian, Somali, Spanish and Turkish.

http://www.nspcc.org.uk/helpandadvice/nspcchelpline/nspccasian/aboutasianhelpline/about_asian_helpline_wda59118.html

Breastfeeding  The information in this leaflet will help you to breastfeed your baby. Breastfeeding provides the best possible food for your baby. By breastfeeding, you are giving your baby protection from a variety of infections and other illnesses. Available in Arabic, Bengali, Chinese, Farsi, French, Gujarati, Kurdish, Punjabi, Somali, Turkish and Urdu.  Department of Health  September 2004

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084370 

***-feeding information  La Leche League International has breastfeeding information in Chinese, Italian, Russian and Spanish.

Feeding Your New Baby: Important information for mothers to be  A leaflet for pregnant women with useful information to help you decide how to feed your baby and how to care for him or her in the early days. In Arabic, Bengali, Chinese, French, Gujarati, Hindi, Mirpuri, Portuguese, Punjabi, Somali, Spanish, Tamil, Turkish, Urdu, Vietnamese and Welsh.   No longer avialable in English, but may be downloaded online (for translation purposes)  http://www.babyfriendly.org.uk/page.asp?page=115&category=2

 

 

Breastfeeding Your Baby  A leaflet for new mothers with useful information on how to breastfeed successfully, including positioning and attachment, tips for success and a section on expressing your breastmilk by hand. In Arabic, Bengali, Gujarati, Hindi, Mirpuri, Punjabi, Spanish, Tamil, Turkish and Urdu.     http://www.babyfriendly.org.uk/page.asp?page=115&category=1

 

 

Sterilising baby feeding equipment  Information to help parents who have chosen to bottle feed their babies to do so as safely as possible. In Albanian, Bengali, Chinese, French, Hindi, Punjabi and Urdu.   http://www.babyfriendly.org.uk/page.asp?page=115&category=4

 

 

Preparing a bottle feed using baby milk powder  Information to help parents who have chosen to bottle feed their babies to do so as safely as possible. In Albanian, Bengali, Chinese, French, Hindi, Punjabi and Urdu.  Unicef UK Baby Friendly Initiative http://www.babyfriendly.org.uk/page.asp?page=115&category=4

Weaning 

Fun first foods: An easy guide to introducing solid foods  This booklet gives information on the different stages of weaning with tips, advice and recipes. Available in Bengali, French, Mandarin, Polish, Russian, Turkish and Urdu.  Health Scotland  2005 

http://www.healthscotland.com/documents/303.aspx 

• The Northwest achieved the highest percentage of infants with known breastfeeding status as a percentage of infants due a 6-8 week check for Q1 VSB11 reporting, this represents the best performance across all regions.

• Primary Care Trusts that failed the validation criteria have all been contacted and reasons for failing have been discussed along with plans to improve.

• Copies of the latest version of the validation criteria for 2008/09 have been shared with all relevant PCT staff.

• 12 out of 22 (54%) Northwest areas have selected NI53 in their Local Area Agreement. 8 areas have identified it as one of their national priorities and a further 4 have it as a local indicator.

• Additional support has been offered to Local Area Agreement areas where NI 53 has been selected and the PCT failed the validation criteria at Q1.

• A briefing paper has been provided to HCOP and C&YP LAA leads about NI53 including the latest information about the refresh process and the dates when Q2 data will be published.

• A questionnaire has been sent to all PCTs to find out if there is an Infant Feeding Co-ordinator in post (both at the PCT and provider organisations), the wte for the post and the pay grade. Job descriptions have also been requested. The results of this mapping activity will be available for Nov 10^th.

• Work is underway to promote the UNICEF Baby Friendly university standard award and to influence NW providers to ensure that, as a minimum, Standard 2 “All students are equipped with the knowledge and skills to support breastfeeding mothers” is fully met.

• The progress of all Northwest PCTs and hospitals towards achieving Baby Friendly status was mapped in Dec 07 and this has now been updated.

• 3 sub-regional infant feeding coordinator networks have been established to ensure that all Infant Feeding Co-ordinators have access to peer support.

• Work is underway with the regional Teenage Pregnancy Coordinator to produce some guidance relating to breastfeeding and teenage mums.

• Although the NICE commissioning tool for breastfeeding peer support services has been welcomed it is becoming evident that a comprehensive commissioning toolkit for breastfeeding services is required. If there are no plans to produce one nationally this may be commissioned for the NW region to go alongside the NW Breastfeeding Framework.

• A working group has been established to explore the feasibility of providing a regional solution to the issue of dealing with disseminating new and important information from formula milk representatives. Blackpool and North Lancashire PCTs have a best practice model in place (our 'Infant Feeding Information Team', which meets monthly) and it is hoped this can be replicated at a regional level.

http://www.mirror.co.uk/life-style/kids-and-family/2009/01/07/could-you-donate-***-milk-to-another-woman-s-baby-115875-21021455/

Could you donate breastmilk to another woman’s baby?

By Louise Baty

"The thought of giving someone else’s child your breastmilk might sound strange but a national service is being set up to do just that. Your Life spent a day at a milk bank to see why they’re so vital..

New mum Clare Gold arrives at Queen Charlotte’s and Chelsea Hospital, West London, clutching baby Sam in one arm and swinging a heavy cool bag in the other.

She’s come with a delivery of her breastmilk for the hospital’s milk bank manager Gillian Weaver.

“This bag is really heavy because it’s full of frozen milk,” explains Clare, 34, of Rickmansworth, Herts. “The bottles have been in my freezer at home. I’ve cleared a whole shelf.”

The milk bank at Queen Charlotte’s celebrates its 70th anniversary this year and is one of just 17 NHS centres across the UK. This year also sees the centenary of the first-ever milk bank.

One baby in eight is born prematurely and the number who survive is rising – 22,000 need intensive care each year.

The service is under immense pressure. However, as each bank is run by separate NHS trusts, there were worries that babies might miss out, depending on where they were born.

Now the Department of Health has ordered its clinical watchdog NICE to draw up national guidelines to help improve safety and meet growing demand.

There’s a good reason why milk banks are so important.

Breastmilk is more easily digested by babies than formula and contains antibodies which boost their immune system.

It is also thought to be more beneficial in the long run. Studies show that babies who are breastfed are less likely to suffer sickness, asthma and eczema. And as premature babies have underdeveloped guts, *** milk can be essential for their survival.

But many new mums of premature babies cannot produce *** milk as their bodies aren’t sufficiently prepared.

In other cases, they’ve been so ill before or after the birth, they’re unable to breastfeed. That’s when the milk bank steps in.

“We have two groups of donors,” explains manager Gillian. “Some are new mums whose baby has established breastfeeding. They decide to help premature and sick babies in hospital by expressing milk to donate. Sometimes these are mums who have had a premature baby themselves. They will either bring the donations in to the hospital or we go and pick them up.

“The other group consists of mums whose baby has been in hospital and who have stored a large amount of breastmilk. When their baby goes home they donate whatever they won’t need.

“We give them lots of labelled sterile bottles into which they can express their milk and ask them to freeze it straightaway at home.”

Clare decided to become a donor after her baby son Sam was born two months premature and had problems feeding.

“Sam only weighed 3lbs 6oz,” she explains. “He was in an incubator and was so weak my husband Pete and I could only hold him for 10 minutes each day.

“The only thing we could do for him was make sure that he was fed so I expressed milk using a breastpump and it was then fed to him through a tube leading to his stomach for the first three weeks. That’s how we bonded with him.”

Thankfully, Sam is now five months old, a healthy 11lbs and Clare breastfeeds him herself.

As she produces more than he can drink, a nurse suggested that she donate her milk and she was more than willing. “It’s a great scheme,” she says.

Once the bottles of frozen milk arrive at the milk bank storage freezers, they are each meticulously screened by Gillian and her assistant Christina Worle. //'); //]]>

Babies can have breastmilk from any woman but if traces of harmful bacteria are detected, the donations will be binned.

During the 80s, many milk banks were shut down due to fears over HIV. However, donors are now all screened and all milk is heat-treated as it’s been proved that pasteurisation destroys the HIV.

Once the milk donations have been screened and pasteurised, they are refrozen and stored in huge freezers, ready for use.

The donations can be kept for up to six months and mums can only donate when their baby is under six months old – after that, their milk may be unsuitable for newborn babies.

Much of Gillian’s day is taken up on the phone liaising with other hospitals. With only 17 banks in the whole country each covers a large area. “This milk bank supplies up to 400 babies a year,” she says. “Only last week, we had two sets of twins both needing milk.”

She also spends time speaking on the phone – in confidence – to new and regular donors. “If they can’t bring their donations in, I’ll arrange for the milk to be collected from their home.”

Often premature or poorly babies are transferred to hospitals such as Queen Charlotte’s to receive the right care. Once they are strong enough, they will be sent back to the original hospital by ambulance – along with a supply of donor milk if they still need it.

It’s a tricky and time-consuming process usually requiring two nurses to go with the incubator while Gillian supervises the transfer of the donor milk.

First-time mum Natalie Walker brings her four-month-old son Seth to see Gillian. It is a poignant reunion.

Seth’s life hung in the balance when he was born nine weeks premature after Natalie, 29, of Brook Green, West London, developed deadly pre-eclampsia during pregnancy.

“It was so scary,” she says. “Seth was just 2lbs 2oz at birth. He looked like a baby bird.”

While Seth was kept alive in an incubator in the Neonatal Unit at Queen Charlotte’s, Natalie was fighting her own battle.

“My blood pressure was very high and I was seriously ill,” she says. “Seth needed to be fed through a tube but there was no way I could express milk for him. When the nurses explained that he could be given donor milk I was so relieved he could be helped.”

After two weeks, Natalie was well enough to express her own milk but it was another three weeks before Seth was strong enough to breastfeed. After that, Natalie and her husband Matt could at last take him home.

Now thriving, Gillian says he’s a great example of the essential work done by the milk bank.

“One of the most rewarding things about this job is when a baby has received donated milk and the mum is able to take over,” she says.

Although Gillian has been running the bank for 20 years, she says that each day is different.

“It can be emotional,” she says. “Even some mums who lose their babies carry on donating milk.”

And she’s keen to stress that donors do not receive any financial reward for their gift.

“I feel very privileged to work with these amazing women,” she says. “At a busy time in their lives, with new babies, they are making time to help others.”

Visit www.ukamb.org if you are a mum of a baby under six months old and you would like to become a milk donor. Financial donations can also be made via the website."

As we have rpreviously reported on this blog, guidance was issued by the National Institute for health and Clinical Excellence (NICE) in 2006 that all maternity units and community settings within the NHS should work towards achieving the award, but England still lags behind other UK countries and much of Europe.

Of course in Blackpool and North Lancashire we are on the case and progess is being made in the move towards Baby Friendly Accreditation for both Primary Care Trusts, (community) and also in Children's Centres throughout the patch. The hospitals serving the area (Blackpool Victoria, Royal Lancaster and Royal Preston) have yet to announce their commitment to becime Baby Friendly, but that is the long term intention.

In fact they are not alone: only 26 maternity units out of 238 have the full Baby Friendly Award, which is around 11 per cent of the hopsitals with maternity units in England.

Nationally, around three quarters of mothers start breastfeeding but a third have stopped by the time the baby reaches six weeks of age, despite guidelines saying babies should be fed naturally for the first six months exclusively if possible.

In our locality, the current figures are just over 60% initiating breastfeeding in North Lancashire, and just over 50% in Blackpool. Sadly, the figures for Blackpool have dropped to somewhere between 15 and 20% of babies receiving any breastmilk at just 6-8 weeks of age - so two thirds of those who started breastfeeding will have stopped, compared with the national average of one third), so obviously there will be only a small group of babies still exclusovely breastfed at 6 months of age.

The Baby Friendly Initiative takes a 'no blame' approach with mother's giving information to make their own choice without pressure to breastfeed; as we have staed previously, any locality going for the Baby Friendy award must also comply with international guidance that bans the promotion of bottle feed formula and ensure that they do not sell formula on site. There are also standards to support women to continue breastfeeding once they are discharged from hospital.

Anne Woods, Deputy Director of the Unicef UK Baby Friendly Initiative, speaking from the annual conference in Glasgow this week, said: "There is evidence that being Baby Friendly makes the big difference: we see that those who are working towards accreditation don't get the increase in breastfeeding statistics - because it is the impact of the external evaluation that makes the difference. Of course if the ten steps are in place this will make some difference – it is like a jigsaw and these are the pieces you need to put in place. The reason that many units have not got the award is because it is hard work. But it is a globally recognised, prestigious award, and it is demonstrating an excellent standard of care."

In hospitals that have the Baby Friendly accreditation, 28% more babies are breastfed, she said.

The NICE guidance points out that increasing breastfeeding rates benefits hospitals and communities financially because after three to four years there is a corresponding drop in childhood illness.

Two weeks ago the Dept of Health invited 50 primary care trusts at the bottom of the league for breastfeeding initiation to apply for a share of £4m to implement Baby Friendly standards.