Shared learning database

Breastfeeding Network, commissioned by Public Health in Blackpool and Lancashire
Published date:
August 2013

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.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The overall aim of the peer support programme was to enable more Blackpool women to breastfeed for 6-8 weeks.

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

Before the implementation of the PS programme there were two breastfeeding groups led by PS organisations in Blackpool. Feedback from mothers at the groups was that they would have loved to have had the PSs on the hospital ward, to listen and sit with them, and to have received less conflicting information from health care staff. A case was therefore made to the Breastfeeding Subgroup of the Maternity Services Liaison Committee that Baby Friendly accreditation should be implemented in both the hospital and the community, and that PSs should be available on the hospital wards. At the start of the work implementing Baby Friendly in the community and the piloting of the PS on the hospital ward researchers at the University of Central Lancashire interviewed women to hear about their experiences of infant feeding. Themes that arose included that women valued a woman centred (emotional as well as practical) approach, and highly valued peer support and wanted increased access to it.

How did you implement the project

Short term funding was initially obtained from Blackpool council to run a three month pilot of Breastfeeding Network (BfN) PSs on the hospital wards. In order to overcome the hurdle of volunteers needing to go through a lengthy volunteer induction process, the pilot was undertaken by BfN volunteer PSs who were also local health professionals. The feedback from mothers, midwifery staff and the PSs, known locally as Star Buddie's (SBs), was overwhelmingly positive and the service was further developed with funding from Public Health.

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.

Key findings

Monthly reports were prepared of all hospital contacts, with detailed tracking of those who were missed, in order to achieve 90% of women who initiated being offered support on the postnatal ward. This entailed checking birth details, and two shifts a day of peer support as well as weekend coverage. Sustained efforts have been made to hear women?s experiences of the service, in order to better meet their needs. Reasons for women stopping breastfeeding in hospital are recorded, and the number supplementing with infant milks together with reasons. A hospital poster was developed to help women think about strategies other than supplementing when coping with restless babies. Banner pens were developed with key information for mothers who may be struggling at times when no-one is available such as in the night. The PSs wear lime green T shirts with 'Breastfeeding? Ask me' on the back, so that they are clearly identifiable by mothers and health staff.

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

- Women's views of the service, both externally collated by university researchers, and proactively collected by SBs, have led the development of the work.
- 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.

Contact details

Mary Whitmore
Infant Feeding Coordinator and Breastfeeding Network Peer Support Lead in Blackpool and North Lancas
Breastfeeding Network, commissioned by Public Health in Blackpool and Lancashire

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