Specifying a peer-support programme for women who breastfeed

Service components

The key components of a peer-support programme for women who breastfeed are:

• engaging communities and recruiting peer supporters
• training and supervision
• developing a high-quality peer-support programme for women who breastfeed

Engaging communities and recruiting peer supporters

When considering a model for a breastfeeding peer-support programme commissioners may wish to consult with and learn from and/or build on existing breastfeeding activities. NICE public health guidance PH9 on community engagement provides information about working with local community networks and infrastructures when planning services. Peer supporters will need to be recruited from and reflect the diversity of the community in which they live. They may provide peer-support services voluntarily or receive basic remuneration and/or expenses for their work. When commissioning service models that recruit volunteer peer supporters, commissioners should refer to Volunteers across the NHS: improving the patient experience and creating a patient-led service to ensure best practice in volunteer management.

Training and supervision

Commissioners may need to make resources available to ensure that health professionals are competent to provide information and advice to breastfeeding mothers and ongoing support to peer supporters in line with the recommendations in NICE public health guidance PH11 on maternal and child nutrition and NICE clinical guideline CG37 on postnatal care, using the BFI training as a minimum standard.

NICE public health guidance PH11 recommends that peer supporters should receive training in breastfeeding management from someone with the relevant skills and experience before they start working with breastfeeding mothers. Peer supporters should attend a recognised, externally accredited training course in breastfeeding peer support. Commissioners and managers should also ensure that all those who work in maternity and children's services, including receptionists, volunteers and ancillary staff, are made fully aware of the importance of breastfeeding and help to promote a supportive environment. Commissioners and managers may wish to consider providing resources to train peer supporters and link workers to help mothers, parents and carers follow professional advice on feeding infants aged 6 months and over.

Developing a high-quality peer-support programme for women who breastfeed

Commissioners need to commission service models for pregnant women and new mothers. These should focus particularly on women who are least likely to start and continue to breastfeed, for example young women, women with low educational achievement and women from disadvantaged groups.

NICE public health guidance PH11 on maternal and child nutrition recommends that commissioners and managers of maternity and children's services should:

Provide local, easily accessible breastfeeding peer-support programmes and ensure peer supporters are part of a multidisciplinary team.

Ensure peer supporters:

• attend a recognised, externally accredited training course in breastfeeding peer support
• contact new mothers directly within 48 hours of their transfer home (or within 48 hours of a home birth).
• offer mothers ongoing support according to their individual needs. This could be delivered face-to-face, via telephone or through local groups.
• can consult a health professional and are provided with ongoing support.
• gain appropriate child protection clearance.

Commissioners may wish to consider jointly commissioning services to ensure an integrated approach to service planning and continuity of care across sectors and disciplines. These services may include breastfeeding support organisations, Sure Start, local maternity services and infant feeding specialists. Commissioners may wish to refer to the Joint planning and commissioning framework for children, young people and maternity services.

Peer-support programmes can be commissioned in a number of different ways. Mixed models of provision may be appropriate across a local health economy. Examples include:

• health professionals establishing, facilitating and evaluating local peer-support programmes with paid and/or volunteer peer supporters
• regional/local voluntary and/or not-for-profit organisations providing services directly and/or offering training and support for other programmes.

Commissioners may wish to consider contacting or working with a number of national voluntary organisations/networks when designing a service model.

The Topic-specific Advisory Group suggested that commissioned services ensure multiple access points through which women can be referred or contacted directly by peer supporters. Access points may include health centres, postnatal wards and community and hospital antenatal clinics, (because women who are provided with appropriate breastfeeding information during the antenatal period are more likely to initiate and continue breastfeeding), and drop-in centres or baby cafes.

Other suggestions offered by the Topic-specific Advisory Group include:

• Amending local policies to allow volunteer peer supporters to provide support to women in the hospital and community setting.
• Appointing a breastfeeding coordinator to provide strategic direction, liaison and coordination between acute trusts, PCTS, local authorities and other stakeholders.
• Appointing a peer supporter/volunteer coordinator to provide day-to-day support, supervision, training and coordination of peer supporters.
• Providing an accreditation system to enable peer supporters to gain a formal qualification.

Local stakeholders, including service users, should be involved in determining what is needed from a breastfeeding peer-support programme, in order to meet local needs. The programme should be family-centred and integrated with other elements of care for women wishing to breastfeed.

The service specification should be based on the following considerations:

• the required competencies of, and training for, staff responsible for providing the service
• the expected number of maternities (taking into account how quickly any changes in service provision are likely to be made)
• ease of access and service location; commissioners should engage with service users and other relevant individuals and organisations locally
• care and referral pathways
• information and audit requirements, including IT support and infrastructure
• planned service improvement, including redesign, quality and equitable access
• service monitoring criteria.

Useful sources of information may include:

• National Breastfeeding Helpline funded by the Department of Health. Calls are diverted to the nearest Association of Breastfeeding Mothers or Breastfeeding Network) volunteer who can offer local support.
• La Leche League provides training for both peer supporters and support scheme coordinators, along with ongoing support for both.
• Infant feeding initiative: a report evaluating the breastfeeding practice projects 1999-2002.
• Promotion of breastfeeding initiation and duration: evidence into practice briefing offers suggestions on how to overcome barriers to the recruitment and retention of peer supporters, and enable the sustainability of the program.
• Good practice and innovation in breastfeeding is a booklet that aims to provide a practical, evidence-based resource for health professionals to help support good practice and innovation in breastfeeding initiation, with a particular focus on reaching women from disadvantaged groups.
• Modernising maternity care - a commissioning toolkit for primary care trusts in England.
• The NICE shared learning database offers examples of how organisations have implemented NICE guidance locally.