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: firstname.lastname@example.org
Aims and objectives
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
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
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
- 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.