Shared learning database

University of Bristol
Published date:
September 2013

Implementation of a Breastfeeding Peer Support service as part of the work supporting and enhancing breastfeeding in Bristol which became the first 'Baby Friendly City' in England and Wales.

Information about practical implementation of the peer support service from Nicki Symes, breastfeeding co-ordinator at Bristol City Council:

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

This targeted service was set up to address health inequalities in breastfeeding in 12 wards in Bristol, as part of several initiatives to improve breastfeeding rates from 2007-2010. The reward target project was a Local Area Agreement between Bristol Primary Care Trust and Bristol City Council. The work included becoming the first city to achieve the UNICEF UK Baby Friendly Community award and the first 'Baby Friendly' city in England and Wales.

The aim of the peer support project was to set up a breastfeeding peer support service and conduct an independent evaluation of the effects of the service on mothers, peers and breastfeeding rates. This included paid peer support and training, supervising and monitoring volunteer peer supporters to provide additional help to mothers in their communities.

Reasons for implementing your project

International studies of breastfeeding interventions in primary care are more effective than usual care in increasing short and long term breastfeeding rates. Interventions that combine pre- and postnatal components have larger effects than either alone, and those that include lay support in a multi-component intervention may be more beneficial. Despite the mixed reports of the effectiveness of breastfeeding peer support in the UK, targeted peer support services are being established in many areas of the UK.

Some small volunteer peer support initiatives were running in Bristol as part of the Sure Start initiative in wards with the lowest breastfeeding rates. In 2007, a breastfeeding worker was funded to continue some of the work such as training and supporting peer supporters in 3 wards of the city with low breastfeeding rates (please see supporting information).

As part of the target project, a volunteer peer support project (with a peer support co-ordinator) was commissioned to maintain and extend this work in 8 wards with the lowest rates of the city for 18 months whilst the main paid peer support project proposal was written, funded and the work put out to tender.

In 2010, NHS Bristol Primary Care Trust commissioned Barnardos to run the targeted peer support breastfeeding support service for mothers in 12 lower socio-economic areas of the city, with one antenatal visit and postnatal contact for up to 2 weeks.

How did you implement the project

Funding was obtained from a local public health grant scheme to support the work of the initial stages of the breastfeeding target project. Further funding was awarded by a Department of Health grant scheme to enable the work to be extended from 8 to 12 wards. Barnardos, who had been running a volunteer peer support project in the 8 wards for 18 months before the project began, won the bid in partnership with a local trust. A link health visitor was appointed to help the smooth running of the service and integrate peer supporters. Data sharing was initially an issue but satisfactory local arrangements were agreed through building trust between the organisations and confidence in IT links and information governance processes. A steering group was formed with all partners for the duration of the project. The scheme cost £100,000 per year and evaluation by Bristol University cost £20,000.

Key findings

Evaluation methods. Mothers receiving peer support were invited to complete an on-line survey covering infant feeding; breastfeeding support; and confidence in breastfeeding (using the Breastfeeding Self-Efficacy Scale). Semi-structured interviews and a focus group explored perceptions of mothers, midwives and peer supporters. The effects of the service on breastfeeding rates were documented and compared.

Results. 163 mothers completed the on-line survey; 25 participants were interviewed (14 mothers, 7 peer supporters and 4 maternity health professionals); exclusive and total breastfeeding rates for initiation and at 8 weeks were compared for 12 months before and after the service started. The targeted peer support service was associated with small increases in breastfeeding rates, (particularly exclusive breastfeeding), compared to the rest of the city. The service was very positively evaluated by mothers, health professionals and peer supporters. Mothers felt that peer support increased their confidence to breastfeed; peer supporters found the contacts rewarding, enjoyable and important for mothers; midwives and maternity support workers were positive about the continuity of an antenatal visit and postnatal support from the same local supporter.

Conclusions. In areas where women have little family experience of breastfeeding, local peer supporters, working alongside health professionals, are likely to become more important as they support women before and after childbirth.

Postscript. Recent data have shown that the gap between the top and bottom deprivation quintiles has narrowed from 2009- 2012. This change has happened during the duration of the peer support project.

Key learning points

- The bid originally included 3 postnatal visits but this was much too expensive so we re-commissioned and opted for two fixed points of contact with mothers; an antenatal contact and a postnatal contact at 48 hours after arrival home/after homebirth [NICE 2008].
- It took time to get the service off the ground but was well liked once it was established. Only half of available mothers accessed the service; hard to reach mothers were especially difficult to access.
- More funded hours and attaching the peer support service to the midwifery service would be helpful with integrating the services.
- Since the evaluation, several related activities have been achieved including:
o training Children's Centre staff as peer supporters to increase the reach of informal support for mothers across the city.
o more breastfeeding groups have been set up.
o a pilot scheme to provide teenage mothers with more peer support was run across the city.
o need was identified for mothers in the 12 wards to have access to free good quality breast pumps, which were purchased and in 6 months have supported 50 mothers. They are administered by the local peer supporter with the local Children's Centre.
o peer support training has been accredited by the Open College Network.

Contact details

Dr Jenny Ingram
Senior Research Fellow
University of Bristol

Primary care
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