Quality statement 2: Information and advice about babies' feeding | Postnatal care | Quality standards

Quality statement

Parents are given personalised information and advice about feeding their baby before transfer to community care or before the midwife leaves after a home birth. [2013, updated 2022]

Rationale

Revisiting information and advice about the babies' feeding before transfer to community care or before the midwife leaves after a home birth will support parents to make informed decisions. Discussions should acknowledge the parents' emotional, social, financial and environmental concerns and respect feeding choices, while highlighting the nutritional and health benefits of breastfeeding. Giving parents the opportunity to discuss feeding will help them know what to expect, what support is available, when to seek help, and will address any questions or concerns they have. This will reduce the chance of feeding problems occurring at home and the need for readmission.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of women who had a live birth who received personalised information and advice about feeding their baby before transfer to community care or before the midwife left after a home birth.

Numerator – the number in the denominator who received personalised information and advice about feeding their baby before transfer to community care or before the midwife left after a home birth.

Denominator – the number of women who had a live birth.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

a) Rates of new-born hospital attendances and admissions for feeding-related conditions.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from attendance and admissions data. NHS Digital's Hospital Episode Statistics includes data on admissions for feeding-related conditions such as weight loss, dehydration and jaundice.

b) Proportion of parents who were satisfied with information and advice about feeding their baby given before transfer to community care or before the midwife left after a home birth.

Numerator – the number in the denominator who were satisfied with information and advice about feeding their baby given before transfer to community care or before the midwife left after a home birth.

Denominator – the number of parents of babies.

Data source: Data could be collected from a local survey of parents of babies following transfer to community care. The Care Quality Commission maternity survey collects information about women's experiences of maternity care including satisfaction with support with infant feeding.

What the quality statement means for different audiences

Service providers (such as NHS hospital trusts or community providers) ensure that healthcare professionals have the skills and knowledge to give personalised information and advice about the babies' feeding to parents before transfer to community care or before the midwife leaves after a home birth. Providers ensure that accessible information about the babies' feeding, including how to get support locally, is available.

Healthcare professionals (such as midwives) give personalised information and advice about the babies' feeding to parents before transfer to community care or before the midwife leaves after a home birth. Healthcare professionals check that parents understand the information they have been given, and how it relates to them. Healthcare professionals acknowledge parents' emotional, social, financial and environmental concerns about feeding options and are respectful of their feeding choices.

Commissioners (integrated care systems) commission services that provide personalised information and advice about the babies' feeding before transfer to community care or before the midwife leaves after a home birth.

Parents of babies are given personalised information and advice about feeding their baby before they are discharged from the hospital or birth team.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.1.5, 1.1.10, 1.5.1 to 1.5.3, 1.5.12, 1.5.16 to 1.5.17 and 1.5.19

Definitions of terms used in this quality statement

Information and advice about feeding their baby

Information and advice about breastfeeding should include revisiting any or all of the following, to meet individual needs:

nutritional benefits for the baby
health benefits for both the baby and woman
how it can have benefits even if only done for a short time
how it can soothe and comfort the baby
how the partner can support breastfeeding, including the value of their involvement and support, and how they can comfort and bond with the baby
how milk is produced, how much is produced in the early stages, and the supply-and-demand nature of breastfeeding
responsive breastfeeding
how often babies typically need to feed and for how long, taking into account individual variation
feeding positions and how to help the baby attach to the breast
signs of effective feeding that show the baby is getting enough milk (it is not possible to overfeed a breastfed baby)
expressing breast milk (by hand or with a breast pump) as part of breastfeeding and how it can be useful; safe storage and preparation of expressed breast milk; and the dangers of 'prop' feeding (when a baby's feeding bottle is propped against a pillow or other support, rather than the baby and the bottle being held when feeding)
normal breast changes after the birth
pain when breastfeeding and when to seek help
breastfeeding complications (for example, mastitis or breast abscess) and when to seek help
strategies to manage fatigue when breastfeeding
supplementary feeding with formula milk that is sometimes, but not commonly, clinically indicated
how breastfeeding can affect body image and identity
that the information given may change as the baby grows
the possibility of relactation after a gap in breastfeeding
safe medicine use when breastfeeding.

Information and advice about formula feeding for parents who are considering it, or who need to fully or partially formula feed, should include revisiting any or all of the following to meet individual needs:

the differences between breast milk and formula milk
that first infant formula is the only formula milk that babies need in their first year of life, unless there are specific medical needs
how to sterilise feeding equipment and prepare formula feeds safely, including a practical demonstration if needed
for someone trying to establish breastfeeding and considering supplementing with formula feeding, the possible effects on breastfeeding success, and how to maintain adequate milk supply while supplementing
advice about responsive bottle feeding and help to recognise feeding cues
positions for holding a baby for bottle feeding and the dangers of 'prop' feeding
advice about how to pace bottle feeding and how to recognise signs that a baby has had enough milk (because it is possible to overfeed a formula-fed baby), and advice about ways other than feeding that can comfort and soothe the baby
how to bond with the baby when bottle feeding, through skin-to-skin contact, eye contact and the potential benefit of minimising the number of people regularly feeding the baby.

[NICE's guideline on postnatal care, recommendations 1.5.2, 1.5.3, 1.5.12, 1.5.17 and 1.5.19 and expert opinion]

Equality and diversity considerations

Parents should be given information that they can easily access and understand themselves, or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed. The interpreter or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language. For parents with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.