Shared learning database

Wigan Council
Published date:
August 2013

Following a competitive tendering process commissioned jointly between NHS Ashton Leigh and Wigan Public Health Department and Wigan Council the Breastfeeding Network now provides a Borough-wide, evidence based, proactive peer support service providing Antenatal infant feeding choice information, and proactive postnatal breastfeeding support on the Maternity, neonatal and paediatric wards of Royal Albert Edward infirmary (RAEI) Wigan and home visiting support to all Breastfeeding families with an additional bespoke service to teenage mothers. The service is staffed by both salaried and volunteer local mothers who have breastfed their own babies and then undergone an accredited training programme supported by monthly supervision. This service is underpinned by NICE Postnatal guideline (CG37) and meets statement 5 of the new Quality Standard (QS37).

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

- To give every child the best start in life and create a culture in which breastfeeding is seen as the conventional way to feed a baby.
- To increase breastfeeding initiation and duration rates within the Wigan Borough.
- To enable those women who choose to breastfeed access to appropriate support services regardless of age, ethnic origin, social status and employment status.
- To offer comprehensive antenatal breastfeeding information and support to all families in a variety of settings and with a range of partners.
- To provide additional innovative antenatal breastfeeding information and postnatal support to vulnerable families including mothers less than 20 years of age.
- To offer comprehensive proactive postnatal breastfeeding support including: information and support on the maternity unit, neonatal unit and within paediatric services at Royal Albert Edward Infirmary (RAEI), Proactive home visiting support to all breastfeeding mothers within the first 6 weeks and continued support dependant on the needs of the family. Additional targeted support for mothers under the age of 20.
- To provide assistance with the organisation and running of breastfeeding support groups and sign post mothers appropriately.
- To recruit, train, manage and develop new and existing volunteers to support the work of the peer support service.
- To provide robust accredited training and monthly supervision to both the volunteers and the peer support workers.
- To ensure the robust collection of qualitative and quantitative breastfeeding data.

Reasons for implementing your project

Breastfeeding rates in the Wigan Borough are much lower than both regional and national averages. The Wigan Borough also has a high teenage pregnancy rate and this group have very low breastfeeding rates.

The service was commissioned in October 2010. At this time only 45% of women initiated breastfeeding, and only 18% were still breastfeeding at 6 weeks. There was also a very rapid drop in rates on discharge from the maternity unit with only 30% still breastfeeding at this point and only 25% still breastfeeding at day 5. Focus groups with staff identified competing priorities that created barriers to providing breastfeeding support to mothers, many of these were addressed. Any training deficits were addressed as the maternity service achieved UNICEF Baby Friendly full accreditation. Focus groups with families reported that they were reluctant to ask for support because 'staff looked so busy'.

How did you implement the project

The service provides breastfeeding antenatal information to all families at a minimum of 2 points during their pregnancy (12-20 weeks and 28-32 weeks) in children's centres and other venues and in partnership with other services. The first of these contacts is an early infant feeding choices workshop. The latter contact is a breastfeeding workshop. This service also provides 1-2-1 information in midwives antenatal clinics and supports midwives in antenatal parent craft sessions.

A peer support worker specifically provides additional antenatal information and post natal breastfeeding support to all mothers under the age of 20.

The service is proactive and provides support to breastfeeding mothers on the maternity unit, neonatal unit and on the paediatric ward between the hours of 9.00-22.00 in 3x2 hour slots per day and is available 365 days per year. The service provides assessment of positioning and attachment using a local assessment tool, guidance on hand expression and information on local services.

Once breastfeeding mothers are discharged, those living within Wigan Borough are contacted by a peer support worker within 24 hours of the midwives first home visit. This visit provides further assessment of positioning and attachment, information on how to self-assess effective feeding and guidance on hand expression.

Following this the service provides further visits within the first 6 weeks and beyond to all breastfeeding families as appropriate to each family's needs and provides proactive telephone support. Close partnership working and integration is key to the success of the peer support service. A clear service and care pathway exists ensuring appropriate referrals and clear peer support boundaries. The teams have created close working relationships on the wards and within community teams within the Maternity service and work in close partnership with Health Visitors, children centres, Family Nurse Partners and other health and local authority partners. Data sharing agreements, honorary contracts, shared documentation aid the close partnership working. A multiagency breastfeeding team meet monthly to monitor effectiveness, identify difficulties and help overcome any barriers.

The entire pathway (midwifery, peer support, health visitors and children centres) all achieved UNICEF Baby Friendly full accreditation at the same time portraying the close partnerships and seamless pathways.

Key findings

The Breastfeeding Initiation rate has increased from 45% (2009/10) to 58% (2012/13). The 6 week rate has increased from 18% (2009/10) to 29% (2012/13).

The early drop off rate has greatly increased with the breastfeeding rate on discharge from the Maternity ward increasing from 30% (2009/2010) to 52% (2012/13) and at 5 days a breastfeeding rate increase from 25% (2009/2010) to 50% from an initiation rate of 58% (2012/13).

The Breastfeeding Network Peer Support Service maintains over 90% of the families who enter their service to still be breastfeeding at 10 days.

Qualitative feedback from families has been extremely positive, especially from mothers who could compare the present service with that received in the past.

Feedback from Maternity, Health Visiting and Children Centre staff is also extremely positive and they recognise the great difference in the support provided to families and also report an increase in their own job satisfaction recognising the quality of care received by families. The joint partnership working has had a mutually beneficial impact on the quality of breastfeeding support provided by all services. The service is a true peer support service, staffed by mothers who have breastfed their own babies and trained through a fully accredited peer support training scheme. The Breastfeeding Network ensures monthly supervision which ensures continual development of skills and constant recognition of service boundaries and appropriate sign posting. The proactive nature of the service enables early support to families and early recognition and hopefully prevention of problems which would otherwise lead to cessation of breastfeeding.

Key learning points

- The close partnership working and working relationship with midwifery and health visiting services enables the early contact with families, ensuring the timely and accurate receipt of referral details.
- The service was commissioned following a competitive tendering process and is closely performance managed to ensure the service gives a quality service giving good value for money.
- The integration of the peer support service within midwifery, health visiting and children centre services is enabled by having the full support and cooperation of senior management within those services and an implementation team who enable the partnership working and the removal of barriers to service delivery.
- Early support is essential, however, many of the mothers resident in the Borough deliver at neighbouring hospitals, these mothers miss out on the continuity of the service. Early referral and home visiting to these families is therefore even more important.
- Clear referral pathways are very important. This ensures that all services may refer to each other seamlessly and appropriately.
- The peer support service has an honorary contract with the acute provider service. This helps to ease the hurdles of data sharing and having access to IT provision and contact details of staff. It also means that peer supporters have access to all mandatory training ensuring safety and governance of the service.
- A current limitation of the service is the difficulty to contact every antenatal mother, the increased training and utilisation of peer support volunteers is planned to help overcome this.
- It is also recognised that as the breastfeeding rate increases the pressure on the service will increase, this will therefore involve a review of the efficiency of delivery, prioritisation of service and ultimately if appropriate review of the financial package.

Contact details

Alison Healey
Lead Commissioner Health Improvement Services (0-5 years), Breastfeeding Strategic Lead
Wigan Council

Secondary care
Is the example industry-sponsored in any way?