The Breastfeeding Network is commissioned to deliver a systematic and integrated peer support service for breastfeeding mothers in Blackpool to tackle low breastfeeding rates. This service demonstrates how parts of statement 5 (of QS37 Postnatal Care) could be implemented. It is a locally developed service that has contributed to the gaining of Community Baby Friendly accreditation across primary, community and children centre settings in 2011. Peer supporter's (PS) skills and knowledge, as well as those of the health visiting team, are assessed by external Baby Friendly assessors as part of the accreditation process as is the care that women receive. It has also been evaluated by researchers at the University of Central Lancashire. Outcomes are monitored by breastfeeding rates at 6-8 weeks for women who engage with the service, and for Blackpool as a whole, as well as women's experiences of the service.
- Postnatal care (QS37)
Aims and objectives
With steep drop-off rates in Blackpool between numbers of women initiating breastfeeding and those continuing for 6-8 weeks, it was hoped that the provision of proactive, scheduled and skilled PS in hospital and in the home for 8 weeks would enable more women to overcome early difficulties and thereby be able to continue breastfeeding for as long as they wished.
The support that the PSs provided was to be mother centred, so that women were enabled to take their own informed infant feeding decisions without pressure or judgement.
All breastfeeding was to be valued by the PSs, even if just for one day, so that women were supported to appreciate what they had achieved. At the same time, PSs, having breastfed themselves, provided role models for breastfeeding in an area where the culture was entrenched bottle-feeding.
The PSs were tasked with contributing to safer bottle-feeding by ensuring that mothers who introduced infant formula milks or stopped breastfeeding were clear about sterilisation and preparation. They also attended multi-agency workshops 'Talking about infant formula' to ensure that evidence based information free from marketing was shared with parents.
More vulnerable babies on the neonatal unit were to be supported with a dedicated neonatal PS who could provide emotional support as well as help with the practical skills of hand expressing and pumping. Hospital PSs were tasked with working closely with the diabetic midwife so that diabetic mothers received additional support. They were also asked to hold informal conversations about infant feeding with pregnant women admitted to the ward with problematic pregnancies and to where possible support any mothers of breastfed babies admitted to the paediatric ward.
Community PSs not only delivered infant feeding workshops, but also targeted women least likely to breastfeed by attending antenatal clinics in the two major hub Children Centre areas in order to have friendly, non-judgemental conversations with pregnant women about infant feeding. They also delivered proactive and scheduled support to newly discharged breastfeeding mothers.
Reasons for implementing your project
How did you implement the project
Initially volunteer SBs worked on the wards and were organised and supported by a BfN PS coordinator. Volunteers were highly valued, but it soon became clear that mothers and staff valued regular attendance at times that were convenient for mothers and the ward. Consequently a small team of SBs were employed to work regular shifts on the wards 7 days a week, with supplementation by volunteers who worked additional shifts as and when they could, and an overall BfN coordinator who managed the induction, mentoring of PSs and close liaison with the midwifery team.
Community PS was initially piloted with SBs meeting up with pregnant women in early pregnancy and then supporting the same woman once she was discharged from hospital. Although the continuity of care was valued by both mothers and PSs it was difficult to sustain a service which spanned 7-8 months per mother when funding for the service was only available for one year at a time. Instead, the community service concentrated on early postnatal support providing regular support with home visits, phone calls and text messages for 8 weeks and beyond. Because of the scheduled proactive contact with each mother a team of PSs were employed to deliver this care supported by a coordinator who managed the team and integrated with the midwifery, health visiting and children centre staff. PS for pregnant women was the last part of the scheme to be implemented. SBs deliver highly interactive infant feeding workshops within the hospital parent-craft sessions held at weekends and evenings, and more recently at Children Centres. In order to access women who are less likely to attend workshops, the PSs have developed a prize quiz which they use to engage in conversations with pregnant women who are awaiting antenatal appointments.
A dedicated neonatal SB was recently appointed after requests from women and from staff, as women with babies in the neonatal unit can feel disempowered and can struggle to express and to establish breastfeeding. The neonatal SB has been very well received and is helping to increase the use of donor milk where appropriate. A volunteer SB works closely with Wirral Mothers Milk Bank to help recruit local mothers to become breast milk donors. The number of babies on the neonatal unit who are receiving breast milk upon discharge and at aged 6-8 weeks is monitored.
Whilst on the postnatal ward women are offered the community service. A community SB contacts her within 48 hours, and often within 24 hours of her discharge from the hospital, and makes proactive contact for 8 weeks. Detailed monthly reports highlight the number of mothers who are not contactable and the number who have already stopped breastfeeding at time of first contact, reasons for stopping breastfeeding and those achieving breastfeeding at each week up to 8 weeks.
Breastfeeding at 6-8 weeks have continued to increase each year from 18% in 2008/9 to 27.5% in 2012/13 despite initiation rates remaining static recently. Feedback from mothers has been overwhelmingly positive. Blackpool PCT achieved full community Baby Friendly accreditation in 2011, and the hospital achieved Stage 2 in 2013 and is working towards stage 3 in spring 2013.
Key learning points
- In a bottle-feeding culture where breastfeeding can be seen as not achievable, a PS scheme that enables women to take their own decisions and which values any breastfeeding a woman undertakes is likely to help change cultural attitudes.
- Detailed reporting has highlighted areas in need of development, such as women not engaging with the offered support. An innovative weekly gift giving scheme was developed tied into face to face contact with a PS which enabled meaningful relationships and new connections within and between the women, families and PSs to be formed and sustained.
- The inclusion of the PS service in all aspects of the work to implement Baby Friendly standards, including recruitment of businesses to a local 'Welcome Breastfeeding Scheme', has helped integration of the service.
- Volunteers need to be provided with adequate support as their needs can differ from employees. Dedicated PS volunteer coordinators can fulfil this by ensuring that volunteering meets the needs of the localities, that all volunteer activity is logged, that volunteers comply with mandatory training, that prompt payment of expenses are made and that social and networking events are provided.
- Effective training of PSs is essential. Accredited training courses enable women to step back into education or return to work. Further training and development opportunities from a national breastfeeding allow progression to supervisor or tutor as well as provide specialist knowledge for PSs.
- Monthly supervision of PSs is an essential aspect of BfN peer support schemes which maintains quality of the service.