Good practice and innovation in breastfeeding

Good Practice Guide 17/11/2004 10:52 Page A

Good practice and innovation in breastfeeding

Good Practice Guide 17/11/2004 10:53 Page B

Acknowledgements

Initiative 1999-2002.

individuals and organisations who have

phase. They include:

Initiative, Angela King - University of Northumbria,

Sussex,

practice in midwifery) University of Leeds,

Janet Fyle - Royal College of Midwives,

consultant, Sussex, Kate Monkhouse - Association of

Krys Henderson - La Leche League,

Liz Jones - University Hospital,

Obi Amadi - Community Practitioners' and

Nottingham,

London,

Document purpose Best practice guide

ROCR Ref: Gateway Ref: 3269

Author DH

Publication Date 26 November 2004

Circulation List

Description

Cross Ref

Superseded Docs NA

Action Required NA

NA

Contact Details Department of Health

London SE1 8UG

For Recipients use

We gratefully acknowledge the work of Fiona Dykes and the breastfeeding practice projects that took part in the Infant Feeding

We particularly thank all the practitioners who are featured in this guide and those

reviewed the guide during its development

Andrew Radford - UNICEF Baby Friendly

Catherine Pardoe - Lactation consultant,

Celia Enyioko - Maternity Alliance Gillian Jessops - Health visitor, Hull, Helen Spiby - Senior Lecturer (Evidence based

Isabel Carrick - Health Promotion Specialist, Hull and East Yorkshire,

Janette Westman - Bradford Teaching Hospital NHS Trust, Julia Savage - Midwife, Nottinghamshire, Julie Williams - Health visitor and lactation

Breastfeeding Mothers,

Linda Kennedy and Michelle Wiseman - Sure Start,

North Staffordshire, Lorraine Best - University of Sheffield, Mandy Grant - Poole Primary Care Trust, Mary Renfrew - University of Leeds, Mary Smale - Breastfeeding consultant, Doncaster, Mary Whitmore - Breastfeeding Network tutor, Lancashire, Mavis Kirkham - University of Sheffield, Melissa Kallat - Royal Victoria Infirmary, Newcastle upon Tyne,

Health Visitors' Association, Phyll Buchanan - Breastfeeding Network, Rosemary Dodds - National Childbirth Trust, Sarah Gill - La Leche League leader,

Sinead Farrell - Whittington Hospital,

Sue Battersby - University of Sheffield, Sue Henry - Queens Park Hospital, Blackburn.

Text and design by The Forster Company, with Caitlin Bodrugan and Heather Welford.

Title Good practice and innovation in breastfeeding

Target Audience Midwives, Health Visitors

Directors of PH, Allied Health Professionals, Voluntary Organisations, Professional Bodies

This booklet aims to provide a practical, evidence-based resource for health professionals to help support good practice and innovation in breastfeeding initiation-with a particular focus on reaching women from disadvantaged groups.

Infant Feeding Initiative – A report Evaluating the Breastfeeding Practice Projects 1999-2002

Timing

Nutrition Policy Officer

Room 704, Wellington House 133-155 Waterloo Road

Good Practice Guide 17/11/2004 10:53 Page C

3-6

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Contents

Positive Policies

Solid Structures,

Strong Staff

Skilling Up -

Professional Training

Early Awareness -

Antenatal Education

The Power of Mother-to-

Mother Support

Reaching Out - Access,

Outreach and Publicity

References and Resources

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7-10

11-14

15-17

18-21

22-26

27-31

Good Practice Guide 17/11/2004 10:53 Page D

of women who continued education to at least age 19.

NHS Improvement Plan

Priority and Planning Framework 2003-06

The National Standards, Local Action 2006-08the Department of Health has published the Local Delivery Plans. These will

planning period 2005 – 2008.

will

financial support disparity with bottlefeeding mothers. The Department of

inequalities.

Melanie Johnson, MP Minister for Public Health

Ministerial Foreword Breastfeeding is a major public health issue. A decision to breastfeed, especially if sustained for the first six months of a baby’s life, can make a major contribution to infant health and development. Moreover, research indicates that cancers and coronary heart disease, and particularly childhood obesity, three of the Government’s priority areas for health improvement, could be positively affected by increasing breastfeeding rates.

Breastfeeding is also an important equality issue. The Infant Feeding Survey 2000 demonstrated that women from disadvantaged communities were significantly less likely to breastfeed. The survey showed that only 59 per cent of women in manual occupations breastfed initially, compared to 85 per cent of women in the higher social classes; 51 per cent of women who left full-time education at or before age 16 initiated breastfeeding, compared to 88 per cent

The Government has responded to both the health and the inequality issues surrounding breastfeeding. In the , a greater emphasis has been given to the role of public health in the NHS. The National Service Framework for Children, Young People and Maternity Services recommends NHS Trusts adopt the practices and policies found in this good practice guide as a minimum standard for their breastfeeding support.

In support of this priority, the requires an increase in breastfeeding initiation rates by two percentage points per year, with particular focus on women from disadvantaged groups. Following the publication of

, and to support the delivery of the PSA target on infant mortality,

require the NHS to return local data on breastfeeding initiation rates for the

A range of other initiatives also demonstrate our interest in, and commitment to, breastfeeding. Healthy Start: Reform of the Welfare Food Scheme increase the value of vouchers provided to low-income breastfeeding mothers to exchange for fruit, vegetables and milk. This will help to remove the historic

Health’s White Paper on improving people’s health highlights a range of commitments to improving diet and nutrition to promote health and tackling

The successful completion of the three-year Infant Feeding Initiative, funded with just under £3 million of Public Health Development Funds, has significantly contributed to our understanding of the effectiveness of national and local initiatives to increase breastfeeding rates, with a particular focus on women from disadvantaged groups.

The work of the Infant Feeding Initiative, the groundwork laid by committed healthcare professionals over the past 20 years, the many volunteers trained by the breastfeeding support organisations and the active programmes of ongoing research, mean that we are now in a position to make great strides forward in effective, inclusive programmes for breastfeeding.

This guide makes an important contribution to that process. By providing you with practical insights from successful, innovative projects, I hope it will inspire your continued creativity and commitment in policies and practices to help particularly women from disadvantaged communities and their partners, to make the important decision to initiate and continue to breastfeeding. You are the front line in improving the rates of breastfeeding across all of our communities – and in improving the health of current and future generations as a result.

Good Practice Guide 17/11/2004 10:53 Page 1

Introduction

This booklet aims to provide a practical, evidence-based resource for health professionals to help support good practice and innovation in supporting breastfeeding initiation – with a particular focus on reaching women from disadvantaged groups, their partners and influencers.

The basis for this booklet is current research evidence and the evaluation of projects funded by the Infant Feeding Initiative, published by the Department of Health as A Report Evaluating the Breastfeeding Practice Projects 1999-20024. Each of the pilots was developed from existing evidence, and together they represent a comprehensive effort to test how existing research findings are borne out in practice with real women, in real situations.

With the busy practitioner in mind, this booklet takes a second look at some of the most effective breastfeeding initiation projects featured in that report, drawing out key trends, tips and practice pointers. By providing practical insights into the design and delivery of successful approaches to breastfeeding support, the aim is to provide a starting point and stimulus for further research, action and replication.

The projects featured on these pages show some of the enormous commitment and creativity which practitioners bring to the challenge of supporting a positive choice to breastfeed among women from disadvantaged communities. By highlighting just some of that excellent

Breastfeeding is, of course, ultimately a matter of individual choice. You can’t make someone do something they don't want to do! But we have a duty to make sure that every expectant mother knows the facts, so she can make an informed decision.

By encouraging and supporting breastfeeding and tackling the myths that surround it, we are likely to decrease health inequalities that exist between different groups, and in different areas of the country.

Incidence of breastfeeding by social class as based on current or last occupation of husband or partner (United Kingdom, 1995 and 2000)

100

Inci

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80

60

40

20

and vital work, we hope you are inspired to develop your own practice in effective and exciting new directions.

Target audience

There is now a wide body of evidence indicating that attitudes to breastfeeding are affected by a number of factors, including socio-economic status, geography, cultural background and education. For example, the Infant Feeding Survey 2000 showed that 85 per cent of mothers in higher socio-economic groups initiate breastfeeding, compared to only 59 per cent in lower socio-economic groups.1 Healthcare professionals in some areas report breastfeeding initiation rates far below this.

These figures show how, in some communities, there is a deeply entrenched bottle-feeding culture, with children and adults rarely, if ever, seeing a woman breastfeeding. Partners, mothers and sisters who play a key role in the decision to breastfeed or not, may have been socialised in the same culture. So in these situations, breastfeeding is seen as a marginal activity, and women have negative expectations and a lack of confidence when it comes to choosing whether to breastfeed.

0 I II IIINM IIIM IV V Unclassified & no partner

Social Class1995 2000

Wider context

Mothers do not exist in isolation; fathers, grandmothers, friends – all have an important influencing role. It's crucial that these ‘significant others’ are included in the discussions and dialogues about the benefits of breastfeeding. These ‘individuals of influence’ may be particularly relevant when targeting the harder to reach mothers: adolescents, those less well-educated, those in disadvantaged groups and other communities with the lowest rates of breastfeeding.

The sexualisation of breasts and related embarrassment in public still remains a major social barrier. If we look at today's popular culture there are few references to breastfeeding in advertising, TV soaps and dramas. Where it is included, all too often it focuses on the negative. We need to work with the media to enhance this positive aspect of motherhood so that women who are breastfeeding form part of the backdrop of everyday life. Our long-term aim is for mothers to feel comfortable when breastfeeding their babies in public, without anyone thinking it at all remarkable.

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Evaluating success

With a target for all primary care trusts to improve breastfeeding initiation rates by 2 percentage points per year until 2006, data collection is essential for monitoring and reporting progress. Regular reviews should be timetabled into any project plan. Local results can be compared with the national statistics available as part of the Infant Feeding Survey 20001 . The Local Infant Feeding Audit (LIFA) is a key tool and guidance for this, and is available from the Department of Health.5 There is further information available from the Department of Health's website.6

The Infant Feeding Initiative

• mothers and babies

•

• Antenatal interactive workshops with sensitivity to local needs

•

• •

counsellors/supporters

• minority communities

• • Schemes that involve significant others: partners, mothers,

grandmothers

• •

7/8

guidance for how midwives can extend their work to support

Janet Fyle Royal College of Midwives

Key recommendations

provides a valuable body of evidence from which we can draw key recommendations for primary care trusts, maternity service providers and Sure Start Local Programmes, children’s centres and other early years settings, to include:

Education and training for all healthcare staff involved with

Development of the healthcare assistant role to support

breastfeeding women

Breastfeeding support centres, both the volunteer and the health

professional-led 'drop-in' model

Peer support programmes

Innovative projects with qualified breastfeeding

Schemes that specifically reach and support women from ethnic

Projects that support adolescent mothers

Prison outreach programmes

Media promotion

Two recent reviews from the Health Development Agency have demonstrated that the most effective results are achieved where a variety of interventions work alongside each other. Multi-faceted approaches are therefore highly recommended.

“We welcome this resource guide. It offers strong

breastfeeding” Professional Adviser

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Positive policies

A key step towards improving breastfeeding initiation rates and improving basic standards is the introduction of positive breastfeeding policies. All healthcare facilities should have a policy in place. Crucially the agreed policy must then translate to a change in behaviour. Everyone in contact with pregnant women, new mothers and their families, needs to knows about the policy and put it into practice. Monitoring and evaluation systems need to be in place to ensure the policy is being followed.

An example of a good standard of practice is represented by the 10 steps to successful breastfeeding as set out by the Baby Friendly Initiative. Developed in 1989 by the World Health Organisation and UNICEF, the 10 steps provide a robust approach for ensuring high standards in maternity units. In the UK, UNICEF also provides a seven point plan for community facilities – which can range from covering a single GP surgery, up to a whole primary care trust.

The Ten Steps to Successful Breastfeeding

1

4

5

6 medically indicated.

7

8

9

Have a written breastfeeding policy that is routinely communicated to all healthcare staff.

2 Train all healthcare staff in the skills necessary to implement the breastfeeding policy.

3 Inform all pregnant women about the benefits and management of breastfeeding.

Help mothers initiate breastfeeding soon after birth.

Show mothers how to breastfeed and how to maintain lactation even if they are separated from their babies.

Give newborn infants no food or drink other than breastmilk, unless

Practice rooming-in, allowing mothers and infants to remain together 24 hours a day.

Encourage breastfeeding on demand.

Give no artificial teats or dummies to breastfeeding infants.

10 Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

3


Putting good policies into practice Having a breastfeeding policy is one thing, but making it work is quite another. A good policy should include regular reviews, good monitoring and auditing techniques and robust data collection, as well as promotion of the policy to everyone involved and ownership by the people it will affect. To make your policy part of an ongoing plan to improve breastfeeding rates, consider how you can promote it and think about incorporating measures that will extend the policy over time to cover new areas and reach more people. An integrated policy across the maternity unit and the community is important to ensure that parents have a consistent experience. It is essential to include full coverage of special situations, such as a protocol to protect breastfeeding when caring for babies with hypoglycaemia or jaundice, and for babies requiring special or intensive care, as well as for multiple births.

Developing the Bradford Teaching Hospital NHS Trust policy

Bradford Teaching Hospital NHS Trust started to develop its breastfeeding policy over 10 years ago. Janette Westman, Midwife and Lactation Consultant talks through the process which she has led.

“I was a member of our breastfeeding special interest group. We decided that if we wanted to effectively support breastfeeding, we needed to develop a strategic approach to the development of our practices. We felt that we could best achieve this by following the model set out in the Baby Friendly 10 step plan and by securing Baby Friendly status.

“There are lots of useful sources of help available now, much more than there were 10 years ago. You also learn a lot from your own mistakes!

“The first step for us was developing a written policy. Sample “Our policy is now framedpolicies are available from Baby Friendly, both for maternity and community units. It’s critical though, that you don’t take these and displayed on the walls as read, but adapt them so they are relevant to your local throughout the unit. We circumstances.

also have printed versions“When we first looked at the 10 steps, we naively thought we were already applying many of them. But the problem was, to hand out to mothers. we weren’t approaching it in an integrated way. There’s no point But you have to realise that doing one element well, for example offering antenatal classes, if you don’t have the staff available to support post-natal once you have a written women too. policy it doesn’t stop there. “By working collaboratively with colleagues, we identified a practical action plan of how we could set about to raise ourstandards across all the steps. It takes time - you can’t expect to achieve it all in just a few months.

It’s got to be a living document that reflects the day to day reality, so

“You are given a Certificate of Commitment to demonstrate your you need to schedule in intention to achieve Baby Friendly status within two years. For this regular reviews.” you need to meet the conditions for steps 1, 7 and 10. The Certificate is a bit like a contract and it has to be signed by the Janette Westman, Midwife and Chief Executive of the hospital and PCT. It makes a real difference Lactation Consultant, Bradford to have the Chief Executive’s endorsement for your programme, as Teaching Hospital NHS Trust it provides you with strong leverage over your manager to secure the resources you need to turn your plan into reality.”

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“The key element we’re working on is demonstrating that our staff have the requisite skills regarding attachment, positioning and hand expressing. We’ve also had to think creatively about how we can ensure the policy can be accessed by all our women, as about 50 per cent of them are from minority ethnic communities. Translated leaflets aren’t enough, as often the women speak, rather than read, their own language. So we’ve made a translator available.

“We have recently been assessed and are delighted to have been awarded Baby Friendly status. As we are such a large hospital it has been very challenging to ensure we raise our standard to meet all the requirements, but the effort has been so worthwhile.”.

Queens Park Hospital, Blackburn gets Baby Friendly

Blackburn’s Queens Park Hospital achieved its UNICEF Baby Friendly status in 1998. They’ve worked hard to ensure they have the policies in place to give women the breastfeeding support and advice they need. Sue Henry, Acting Infant Feeding Co-ordinator, explains the key to their success:

“We developed a rolling programme of interventions to ensure we are doing all we can to support breastfeeding. You can’t identify any one element as being more important than the others. It all fits together. You need to have someone who has responsibility for breastfeeding who can pull all the activities together and ensure they complement each other to best effect, for example by appointing an Infant Feeding Adviser. Everyone has to be appropriately trained. Otherwise it’s so easy for someone to inadvertently undermine what we are trying to achieve as a unit. We have a two-day breastfeeding management course for new staff and we organise other training sessions throughout the year, including informal lunchtime briefing meetings. You need to provide education and support to mothers and give them opportunities for feedback. Your delivery room practices have to be appropriate and so on. Having a policy in place provides you with a route map of what you have, and what you need to concentrate on.

“One of the things that I think is great about our trust is that we have a breastfeeding at work policy. The policy allows women working for the Trust to accommodate their breastfeeding patterns within their shift. It applies to all staff across the whole trust. You have to look after your own staff and support them, so they can then help you to support breastfeeding.” “If you want to improve “We’re really proud to be able to say we’re a centre of excellence standards it’s absolutely for breastfeeding. We’re all so enthusiastic about breastfeeding, and essential you havewe work hard to ensure we not only keep our Baby Friendly status, but that we get better and better. It’s a real motivator having the relevant managerial award, and knowing you’re going to get reassessed regularly.” commitment.”

Sue Henry, Acting Infant Feeding Co-ordinator, Queens Park Hospital, Blackburn

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Innovations can bring resultsConsider incorporating new ideas and developments when establishing or reviewing a policy. For example:

• Working with local schools to incorporate breastfeeding wherever you can into the curriculum subjects (such as PSHE, biology etc.);

• Having breastfeeding friendly policies for all health services and local authority premises and promoting these to local employers

• Adopting new practices in maternity units such as immediate skin-to-skin contact between mother and baby, with ongoing adherence on the post-natal ward

• Running a milk bank

• Providing a pump loan scheme

Evidence shows that policies that integrate a wide range of different approaches that affect breastfeeding rates are especially effective.

• • •

to participate

• Display the main points of your policy on a poster in all trust settings

•

•

• • •

• •

Top tips for positive policies

Gain the support and encouragement from the Chief Executive of your trust

Promote a trust-wide integrated policy

Consult and include volunteer groups in your policy development and co-ordinate your policy

with them. Seek to cover expenses such as travel, parking and childcare to enable volunteers

Brief senior managers and clinicians in all healthcare settings in the trust area

to promote widespread adoption of the policy

Advertise your policy to other services used by young families, such as Sure Start

programmes, children’s centres and other early years settings

Publicise the policy through all local healthcare newsletters and bulletins

Translate your breastfeeding policy into a user-friendly leaflet for mothers

Announce your policy to the local newspaper – your trust press office should

be able to arrange a photo-call and a press release

Send information about the policy to nurseries and playgroups

Contact headteachers and heads of departments in schools and offer materials, resources,

activities and speakers/facilitators to help educate schoolchildren about breastfeeding

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Solid Structures, Strong Staff

A growing number of maternity units, healthcare trusts and some community settings are giving the responsibility for driving forward the breastfeeding agenda to a specific person within the trust. Having a designated co-ordinator is a crucial element to improving the rates of breastfeeding initiation.

Some units have a dedicated person. They may be called by one of several different names – infant feeding co-ordinator, lactation midwife, breastfeeding specialist, or feeding adviser.

The job includes co-ordinating activities, facilitating shared learning, training colleagues, ensuring the provision of resources such as breast pumps, and raising general awareness of breastfeeding.

Maternity units that have applied for UNICEF Baby Friendly accreditation, have found it much more achievable when someone has been given responsibility for facilitating the necessary changes.

There is a growing trend for trust-wide breastfeeding support, which demands a full-time specialist. For example, in Gateshead, Tyne and Wear, a project management group made up of representatives from the primary care trust, the acute trust, maternity services and the local council is recruiting a breastfeeding co-ordinator, in a post financed jointly by the Local Public Services Agreement and the primary care trust.

“It's still not uncommon for infant

than a few hours, or even less, to

training.” Melissa Kallat,

feeding co-ordinators to have no more

dedicate to the breastfeeding support part of their job. Fortunately, the most forward-thinking units are now realising this is a full-time post, or a job share equivalent, and ideally, it needs a budget for educational resources and

Infant Feeding Co-ordinator, Royal Victoria Infirmary, Newcastle upon Tyne

Staffing for good practice

You may not need to increase staffing levels if staff time and expertise are targeted where they are most needed. The provision of comprehensive antenatal education, and skilled advice in the first few days, will help women to understand correct positioning and attachment. By ensuring women develop good techniques from the outset you can help to prevent problems developing later on, many of which often require a greater time commitment. Where women have had the appropriate expert breastfeeding advice initially, auxiliary staff are then able to provide the ongoing support. It is recommended that women who are most likely to experience difficulties: first time mothers, women who have bottle fed previous babies and mothers of premature babies are a particular focus. Routine, supportive practices – for instance, enabling skin-to-skin contact between mother and baby immediately after birth and keeping mother and baby together on the postnatal ward – can also positively impact on staff time. With evidence showing that early, successful and frequent breastfeeding lowers the risk of jaundice, hypoglycaemia and hypernatraemic dehydration, savings on the cost of treatment can also be used to justify and offset extra staffing costs.

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A breastfeeding support co-ordinator in action

From the mid-1990s, Mandy Grant was instrumental in setting up breastfeeding drop-in groups and a peer support network of over 200 Bosom Buddies in Dorset and Wiltshire. In May 2003, she took up the new post of Breastfeeding Support Co-ordinator with the Poole Primary Care Trust (PCT) Public Health Team. Her first task there was to initiate a monthly collection of breastfeeding statistics to monitor progress towards government targets. Since then, Mandy has developed her role to include:

• working with the Maternity Services Manager to organise training for hospital-based midwives

• training staff at the special care baby unit and attending a weekly drop-in session for “I believe all PCTs should have a mothers there

• training sessions for paediatric nurses, breastfeeding counsellor or lactation paediatricians and doctors consultant in a similar post to mine.

• advising paediatricians and paediatric dieticians on babies who have low It really does open the way to initiate weight gain change, and inspire communication

• facilitating breastfeeding workshops for primary care staff including midwives, and co-operation between the NHS health visitors, nursery nurses, health and voluntary breastfeeding organisations. visitor assistants, as well as local breastfeeding counsellors and trainees. Breastfeeding is now a national

Mandy's plans for the future include government target, and this will only be developing further drop-in groups, achieved by a multi-faceted approach, working with the healthy schools initiative to promote breastfeeding education as co-ordinating all our efforts and part of the school curriculum, lunchtime encouraging good practice."updates for GPs at their surgeries, a quarterly breastfeeding newsletter and Mandy Grant, Breastfeeding Support Co-ordinator, establishing a breastfeeding strategy group. Poole Primary Care Trust

Innovations in staffing Training healthcare assistants to support breastfeeding is an effective way to offer support to the work of midwives. You can also make good use of trained counsellors and supporters from the voluntary sector. They can make regular support visits to mothers in hospital, and also help staff support groups in the community.

Structures that allow for good communication, support and feedback are essential. One such structure can be set up by inviting staff members to join a breastfeeding working group, with representation from the different professional groups working inside and outside the hospital or community setting, including volunteer breastfeeding supporters. A strong steering group can support the co-ordinator in developing innovative policies, establishing relevant monitoring and evaluation criteria, building relevant and influencial links and, crucially, bringing a sense of co-operation and teamwork.

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Introducing a new role

An innovative new role, that of 'consumer-practitioner', was developed in a project managed by Helen Spiby, Senior Lecturer in Midwifery at the Mother and Infant Research Unit, Universityof Leeds.

The aim was to use evidence-based information to promote and support breastfeeding fromconsumer perspectives. The project targeted six areas around Leeds where women were leastlikely to breastfeed, as identified with the help of the Head of the Midwifery service in thelocal trust.

Two experienced NCT breastfeeding counsellors job-shared the post and the work was takenout to a variety of settings:

• women in antenatal education groups with their mothers/partners grandparents and significant others in parent education sessions

• women in antenatal and postnatal wards • fathers in the local prison• pupils studying for the Child Care GCSE at a local school

and teenage mothers-to-be at the local YMCA.

The consumer-practitioners also delivered training to colleagues within the NHS and toundergraduates studying at local higher education institutions.

The feedback from the community on the value of the educational input was overwhelminglypositive with strong support for continuation. The principles learned from the original project are now being taken forward in two separate initiatives, one with the local primary care trust,and another in conjunction with a local Sure Start Local Programmes, children’s centres andother early years settings.

“It’s absolutely key to involve experienced and appropriately trained people, but they need not necessarily be healthcare professionals. Attitudes to breastfeeding are affected by so many factors: information available, cultural norms and family views and you need someone who is comfortable addressing all of these factors." Helen Spiby, Senior Lecturer (Evidence based practice in midwifery), University of Leeds

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Breastfeeding Support Centres

As part of the Infant Feeding Initiative, two Breastfeeding Network (BfN) Support Centres were set up at health centres and were staffed by paid, qualified supporters working in partnership with local health professionals. The opening times were organised to coincide with antenatal clinics, to increase the likelihood of women attending during their pregnancy.

The supporters encourage mother to mother networking and they help facilitate discussions on issues raised by new mothers. A number of these women have gone on to take up the BfN training and become qualified supporters, thereby ensuring the sustainability of the centres.

One of the centres is located within a Bangladeshi community in East London where breastfeeding rates were considerably lower than average. Contributing to the success of the centre is the fact that one of the supporters also works in the local maternity unit as a Bengali Health Advocate.

Outreach work also takes place in the surrounding communities. This includes visits to the local secondary schools to talk to teenage girls.

Top tips for staffing and structures

• Estimate potential savings to be made from increasing rates of breastfeeding (from reduced costs of treatment and hospitalisation of babies due to infections such as gastroenteritis and respiratory conditions).

• Utilise trained breastfeeding counsellors and supporters from the volunteer groups. • Train healthcare assistants to provide breastfeeding support. • Ensure all staff in the delivery suite encourage skin-to-skin contact between mother and

child from immediately after birth. • Allow staff time to attend working group meetings. • Schedule working group meetings several months in advance to accommodate all parties

and allow for time in work rosters. • Extend an open invitation to non-represented or under-represented groups (often doctors). • Present breastfeeding results at meetings in addition to circulating written audit reports. • Minute meetings and send to all interested disciplines and volunteer groups.

"PCTs can effectively support breastfeeding initiatives by ensuring their NHS premises have appropriate facilities and space for breastfeeding mothers." Obi Amadi Lead Professional Officer, health visiting Community Practitioners' and Health Visitors' Association

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Skilling Up – Professional Training

Giving health professionals the right skills to support breastfeeding is essential to making progress on increasing initiation rates. All healthprofessionals who come into contact with mothers and babies shouldhave breastfeeding management training.

A minimum standard of training should be delivered to all pre-registration trainees. Basic pre-registrationtraining is currently patchy and of an inconsistentstandard. A number of training models exist. For example, some training institutions are takingnotice of the UNICEF UK Baby Friendly Initiative, which has set standards for pre-registration trainingwith respect to breastfeeding. Recruiting staff trained at these institutions will ensure that new staff have the skills they need to support mothers to breastfeedsuccessfully. It is hoped more training institutions willsign up to the BFI accreditation scheme and adopthigher training standards.

Over the past few years, a number of training courses have emerged forqualified and practising staff. Some post-registration in-service training ismulti-disciplinary, which encourages co-operation and communication acrossthe professions. Some trusts run in-house workshops. This may be especiallyappropriate when introducing a new breastfeeding policy.

University of Leeds

“There is still a paucity of high-quality breastfeeding education at pre-registration and post-registration levels.” Professor Mary Renfrew, Mother and Infant Research Unit,

There is also a strong case for discipline-specific training. Healthcare assistantshave been trained in a number of maternity units as a discrete group. The needsof the family doctor will be different from the hospital midwife. But they shouldall be aware of what others outside their own professional group are saying to mothers, and where the mother can go to find the right help.

Crucially, information which focuses on trainingprofessionals to provide antenatal education to mothersand on hospital practice, especially at birth andimmediately after birth, is likely to have the most

immediate impact on initiation of breastfeeding.

"I didn't breastfeed my first baby – I didn't fancy doing it and when I tried it a couple of times I got sore, so I switched to the bottle. This time, after hearing more about it at the local centre, I decided to try it out. Having women there to talk to, both before, and after the birth, has helped me get through it." Breastfeeding mother

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Good training in practice Everyone who comes into contact with mothers and babies should receive appropriate training. This includes all midwives, health visitors, neonatal nurses, obstetricians, general practitioners, paediatricians and dieticians. The ancillary staff, such as receptionists and porters, need also to be aware of the breastfeeding policy and and generally create a welcoming ambience. In-service training should be incorporated into individual plans for continuing professional development, to ensure all staff are included.

Generally, the most effective training is likely to include: • The advantages of breastfeeding and risks of not breastfeeding • The social and cultural barriers to breastfeeding and particular social groups who may

need extra help or targeting for support • How to help mothers achieve effective positioning and attachment and hand expressing • The importance of skin-to-skin contact • Common problems likely to be encountered and their solutions/management • A chance to share and discuss personal attitudes and experiences • Active listening skills - good communication with mothers is essential, and active listening

can help staff make the appropriate response • Different teaching strategies to meet different learning needs • Clinical practice sessions • An element of evaluation and monitoring - to assess how the training affects practice,

and measure whether this helps improve breastfeeding initiation rates.

Reaching lower income groups throughgeneral practice

In Northwest Lancashire, Mary Whitmore, a Breastfeeding Networktutor and trainer, worked with a midwife and health visitor to givebreastfeeding awareness training to general practitioners, practicenurses and ancillary staff.

The training comprised a short, one-hour presentation for GPs andpractice staff in four primary care trust (PCT) areas, covering some of the most deprived areas of the region.

“Our initial survey foundTraining encompassed those priority topics identified by the GPs,such as thrush and insufficient milk. Each practice was provided that many GPs would bewith a resource pack of books and information. interested in training. WeA follow-up questionnaire found that only eight out of 20 GPs know the reality of life had been aware of the local support services before training. for them though, so we70 per cent of GPs said the session influenced their approach to women who were breastfeeding. Participants reported decided that we needed “I have more confidence now when problems arise”, and a flexible approach. We “I will give women more early encouragement and referral to support”. took our presentation to

surgeries at times that suited them. It’s important to design your sessions around the needs of the participants.” Mary Whitmore, Breastfeeding Network tutor, Lancashire

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Education for staffLiz Jones at the University Hospital of North Staffordshire, designed and evaluated a training programme in 2000 following recognition of the lack of specialist skills in neonatal units.

Mothers of pre-term infants experience enormous physiological and emotional challenges which can adversely affect breastfeeding duration. For this reason the training programme was tailored specifically for neonatal staff. The training comprised five two-hour modules.

The results were extremely positive. Staff skills were evaluated before and after training and showed a significant improvement. The content of the training programme was favourably received and staff found the course effective and relevant to their area of practice. The breastfeeding rate is now 79 per cent – a considerable achievement.

Training Healthcare Assistants

With the help of a Department of Health grant, Angela King, Senior Lecturer in Midwifery at the University of Northumbria, started an innovative breastfeeding training course for healthcare assistants in 2001.

The course consisted of 18 hours of teaching and 30 hours of practice supervision with a midwife, over a period of three months, and had the full support of the Head of Midwifery services. The healthcare assistants were selected based on enthusiasm and those most likely to spend significant time in a maternity unit. Prior to this they had received no specific training on breastfeeding or infant support.

The results were encouraging. The midwives were extremely positive about the support the healthcare assistants offered to post-natal women. Mothers were given a questionnaire before they left hospital and again two weeks later. They were very grateful for the contribution the healthcare assistants made to their care and complimented their skills and knowledge. The healthcare assistants themselves said they enjoyed the training, and experienced a high level of job satisfaction as a result.

“For the mother, the ability to do something constructive to help her baby at a time when much care may be out of her hands is enormously powerful. We recommend the implementation of similar specialised breastfeeding courses for staff working in neonatal intensive care throughout the UK.” Liz Jones, midwife and neonatal nurse, University Hospital, North Staffordshire

“Maternity services should wake up to the potential they have within their existing teams. Healthcare assistants provided with appropriate training can make a significant contribution – effectively supporting midwives and ultimately mothers." Angela King, Senior Lecturer in Midwifery, University of Northumbria

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Top tips for training

• Allocate time and budget for training. • Include training in individual professional development plans. • Where possible, use training validated by a recognised body. • Use attendance/completion of training as evidence of professional development. • Where professionals find it difficult to attend external courses, consider taking the training

to them. • Try offering workshops in a health centre, Sure Start Local Programmes, children’s centres

and other early years settings. • Consider scheduling some training days during National Breastfeeding Awareness Week • Monitor how training affects practice and whether breastfeeding initiation rates improve.

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Early Awareness – Antenatal education

Mothers need to know about infant feeding before they can make an informed decision to breastfeed (or not).

Traditional antenatal classes have not been well attended from women in deprived areas. Barriers may include: the length of the established model of antenatal courses (usually five to nine weeks), the cost of private antenatal classes, the timing, location or unavailability of classes in their area. But there are now new methods emerging which are more client-focused in their content and organisation.

Open-door drop-ins that are available to women at any stage of pregnancy “I just couldn’t imagine myself doing it or early parenthood are more relaxed, before I attended the classes. I thought more appealing and less intimidating. you had to take your clothes off Mothers have the chance to discuss feeding choices, air their concerns, or something.” meet new friends, and actually see Breastfeeding mother breastfeeding happening.

Routine antenatal visits to women’s homes provide an opportunity to talk to women about breastfeeding on an individual basis, helping to build a trusting relationship.

Research has also been done into the value of the ‘workshop’ style of antenatal education, looking at psycho-social, psychological and practical aspects of feeding. These projects were often with women from areas which had a strong bottle-feeding culture and who may never have seen a mother breastfeeding before.

The results from these studies are very encouraging. They strongly suggest that this form of antenatal intervention can increase both initiation and continuation rates. The mothers gain confidence to try breastfeeding and learn the skills for effective positioning and attachment, as well as other practical skills.

Good antenatal education in practice

Accessibility is key to the success of antenatal education and for particular target groups the delivery and content should be tailor-made. Promotional publicity should be directed towards the women you want to reach and the health professionals who have contact with them. Keeping this tight focus will help ensure that women from outside the area or target group do not dominate attendance. It is important to promote breastfeeding as a set of skills that can be acquired and as the right choice for the health of the baby.

The most effective antenatal education is likely to include discussion of: • The benefits of breastfeeding • Pain-free positioning and attachment • The importance of skin-to-skin contact • The value of support from family and friends • How to maintain breastfeeding when mother and baby are separated • How to fit breastfeeding into everyday life

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Community Breastfeeding Classes

In June 2000, Sarah Gill, La Leche League Leader and Lactation “Actually getting the parents Consultant, started Community Breastfeeding Classes in and around the Nottingham area, targeting places of high social deprivation, to the classes was the which had high teenage pregnancy rates and high unemployment. essential part. And the best From her experience, she suspected that many of the problems way proved to be for the that the mothers were calling her with could be prevented through co-ordinators to attend antenatal education in the latter stages of pregnancy. So she pilotedtwo classes of two hours length. antenatal classes and invite As a result, a project was launched to take these classes out women personally.” to communities in Sure Start Local Programmes, children’s centres Sarah Gill, La Leche League Leader and other early years settings. Local midwives, health visitors and and Lactation Consultant, Nottinghamrelevant managers in the area were invited to the launch, and a seminar was given to engage support from local health professionals. Sarah recognised that getting the support of local health professionals was critical to making the project work.

The results speak for themselves. The mothers who attended theclasses and read The Womanly Art of Breastfeeding, with only oneexception, were all still breastfeeding their babies at four months.The success has ensured further funding from the local primary caretrust and the classes are still being provided, reaching out todifferent parts of the city.

Antenatal visits from health visitors In North Hull, an area incorporating two outer urban council estateswith high levels of social deprivation, health visitor Gillian Jessop was involved in a project that looked at introducing antenatal visits in case-load areas where breastfeeding rates were particularly low.

The antenatal health visit consisted of a discussion about the reasonsfor breastfeeding, disadvantages of bottle feeding, practicalities ofbreastfeeding and social issues such as embarrassment and support.

The breastfeeding initiation rates in the health visitor’s case-load rosefrom 14 per cent to 34 per cent over the six-month period that theantenatal visits were implemented. And over 70 per cent of thesebreastfeeding mothers continued to breastfeed for six months or more.There was also good feedback on the antenatal support groupsessions that had been set up, with attendees reporting enhancedknowledge, understanding and confidence.

“It takes time to change attitudes. One mother at the support group watched the video and said it was the first time in her life she’d seen a woman breastfeeding. But if at first you don’t succeed, try, try and try again. Remember the story of the tortoise and the hare! I count every additional breastfed baby as a success.” Gillian Jessop, Health Visitor, Hull

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Reaching adolescent mothersMidwife Julia Savage and colleagues were determined to help adolescent mothers breastfeed in their area of North Nottinghamshire, an area with high levels of deprivation following the closure of the coal mines.

So they relaunched a teenage breastfeeding support group, offering antenatal and postnatal support, listening and discussion, as well as providing information on practical skills.

They also devised a programme of training, to enable all staff coming into contact with young mothers within the hospital and community setting, to promote breastfeeding. To date, over 100 midwives and support staff have received this training.

During the project, breastfeeding initiation rates for all mothers under 20 years old rose from 29 per cent to 46 per cent.

“This area was very badly affected by the closure of the coal mines, and the whole social structure was damaged. Now, things are better. These days, I feel the culture is changing and feeding is changing along with it.” Julia Savage, Midwife, Nottinghamshire

mothers.

Top tips for antenatal education

• Incorporate information about breastfeeding into routine antenatal care with individual

• Issue personal invitations to come to an antenatal workshop or group, so that pregnant women know they will be welcome there.

• Train several people to give the workshops so there will be some continuity of service. • Give your staff designated time to prepare for and give workshops. • Use dolls to help practise positioning and attachment. • Involve fathers and/or significant others, because they influence

a mother’s infant feeding decision. • Consider employing a local voluntary group breastfeeding counsellor to lead the session. • Monitor how antenatal education affects breastfeeding initiation rates.

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The Power of Mother-to-Mother Support

The culture of bottle feeding in some communities is very strong. Mothers' own mothers and grandmothers are likely to have bottle-fed, or to have breastfed for a short time only. Many have never seen breastfeeding, or had the chance to talk about it.

Mother-to-mother support shows that breastfeedinghappens, that it can work, and that any woman canovercome her difficulties to make it an enjoyableexperience. Training women with personal experience of breastfeeding from a particular community to offerfriendship and support to other mothers in their areasmeans support can be extended to women who do not routinely engage with the healthcare system.

A mother with friends who are breastfeeding is morelikely to initiate breastfeeding and the same applies to mothers who were breastfed themselves. In this way,giving women the chance to make friends with otherbreastfeeding mothers can help contribute to a fundamental shift in cultural values that can be passed on across the community and down the generations.

Crucial to making this work are the mothers who areprepared to put in the time and effort to support others.They fall into two main groups. ‘Volunteer counsellors’ or ‘breastfeeding counsellors’ have usually trained for two years or more on a recognised course with one of the voluntary organisations. ‘Peer supporters’ have usually had less intensive training – typically having attended a dozen or so sessions of anhour or two with midwives or health visitors, or with a trainer from one of the volunteer organisations. The curriculum they have followed may be an established one, or it may follow one devised for particular local circumstances. There are several models of training and the field is still evolving.

Both peer supporters and breastfeeding counsellors can work in support groups alongside healthcare professionals. The qualitative results of the projects assessed in the Infant Feeding Initiative show mothers found supporters helped them continue at a time when they were strongly considering stopping breastfeeding.

Mother-to-mother networks are now expanding and connecting with other neighbourhood and community programmes, and may be linked with local Sure Start programmes, children’s centres and other early years settings.

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“My friend did it for a few weeks, and she only gave up because her mother kept pressurising her. When she heard I was pregnant, she said not to listen to other people who try to put you off. She wants to help me.” Pregnant woman

“My mum and my mother-in-law didn’t breastfeed. I want to breastfeed, but it’s as if I’m saying what they did wasn’t good enough.” Pregnant woman


Making the most of mothers’ experience

Evidence suggests that mother-to-mother support is most effective where a proactive approach is taken, rather than just being ‘available’.

Targeting a particular area can enable mothers in that locality to meet supporters from local neighbourhoods and similar backgrounds, who are able to understand and to some extent share their experiences. Once a group or project is established, further peer supporters can then be recruited from within the group. This makes for sustainable practice with the possibility of expansion.

Peer projects prove positive

Sue Battersby, Midwifery Lecturer at the University of Sheffield, evaluated peer projects in the north of Sheffield, an area with high levels of social deprivation where breastfeeding initiation and continuation rates were lower than the national average.

Here, peer supporters were trained using the La Leche League programme consisting of 24 hours of training over four weeks. Some then became paid workers through the local Sure Start Local Programmes, children’s centres and other early years settings.

Each peer supporter was attached to a GP surgery and attended antenatal classes, which gave her an opportunity to build a relationship with the mothers before the birth. They also paid home visits, organised and facilitated breastfeeding groups and kept in regular phone contact with mothers.

Feedback from the mothers showed that they liked the fact the peer workers came from their own area and they found it easier to talk to the peers rather than the midwives. This feedback proved very motivating for the peers.

The projects have merged and have continued as the BIBS (Breastfeeding is Best Supporters) Project. The team continues to train peer workers even when there are no vacancies on the project, which means breastfeeding awareness is raised and any vacancies can be filled immediately.

The project has generated a ripple effect, with peer supporters helping mothers start other infant feeding support groups. Having started with one group, the area has six. Three of the peer support evaluations are available at the University of Sheffield’s website.9

“In addition to the benefits for the mothers, the peer workers gained significantly in confidence and felt that the experience boosted their future employment prospects. The fact they were paid made them feel valued and this was an important learning point for the project.” Sue Battersby, Midwife Lecturer, University of Sheffield

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Breastfriends for young mothers

The Doncaster Breastfriends project, a peersupport programme with particular focus “When I first had my little girl,on younger mothers, operates in an area where the artificial feeding culture has been I used to feel like I was the onlyentrenched for three generations. one breastfeeding in Edlington, Here, peer supporters were given 20 hours but now with Breastfriends of learning activities spread over several weeks, using an approach based on the NCT I know there are others.” counselling skills training. Dr Mary Smale, Breastfeeding motherongoing consultant for the project, has writtenTraining breastfeeding peer supporters: an enabling approach, a detailed guide with accompanying materials for trainers and would-be trainers aiming to establish their own courses (see resources). The project was co-ordinated by health professionals, with the peer supporters contacting mothers throughclinics, classes, drop-in centres and hospital visits. All gave positive feedback on the project.The qualitative data suggests the Breastfriends programme is likely to increase the number of women who continue to breastfeed.

There are now two other Breastfriends project areas and another proposed, all tied in withlocal Sure Start programmes.

The Baby Café™

In 2000, the Infant Feeding Initiative enabled the Mid Sussex NHS Trust to set up andrun a breastfeeding drop-in centre for one year. The result was The Baby Café. Set upand run by Julie Williams and Catherine Pardoe, members of the local breastfeedinginitiative group, The Baby Café was opened in a health centre which serves a sociallydeprived area.

The informal, relaxed ‘café’ style drop-in was influenced by popular ‘café culture’with quality refreshments and a positive brand image to attract mothers. The lactation consultant and facilitator were always on hand to help with any specificproblems but the emphasis was on mother-to-mother support.

The Baby Café has taken a very proactive approach to attracting mothers,commissioning a distinctive logo, organising a press launch, and distributing postersand advertising fliers to health centres, antenatal clinics, hospitals and libraries. Overthe last four years, 600 women have passed through their doors.

The success of the project has ensured the continuation of The Baby Café, with funding from the local primary care trust. There are now over 20 Baby Cafés aroundthe country, funded by Trusts, local Sure Start Local Programmes, children’s centres,other early years settings and community grants.

“The Baby Café model can be easily replicated. We provide support packs and workshops to help people. We’ve even had interest from New Zealand, Bermuda and Italy!” Catherine Pardoe, Baby Café, Sussex

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“The programme has given the young women with whom we work the confidence to speak out. Not only to help support other young women to defend their wish to breastfeed, but also in other areas of their life. That’s very satisfying to facilitate.” Mary Smale, Breastfeeding consultant, Doncaster.

Top tips for mother-to-mother support projects

• Look to set up peer support outreach work within the community, as well as at health centres. Locate meetings in easy-to-reach places.

• Consider using trained peer supporters in teaching sessions for professionals, as well as to provide support for individual mothers in the community.

• Try to pay peer supporters, it shows how much you value them and encourages retention. It’s important to at least cover their expenses - travel, childcare and telephone.

• Consider training older women. Peer supporters don’t have to be the same age as the mothers in the target group.

• Start the process of putting volunteers through the police clearing system as soon as individuals are recruited. It can be a very time-consuming process.

• Ensure mothers are aware of the range of local support that is available. Provide them with relevant contact details, for example in the form of a sticker for easy reference.

• Explore the opportunities to work in partnership with Sure Start. This government-funded initiative is managed seperately from NHS Trusts and is committed to supporting breastfeeding. They can sometimes provide extra funding for peer support schemes.

• Establish monitoring schemes to ensure you are able to measure how mother-to-mother support affects breastfeeding initiation rates.

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Reaching Out – Access, Outreach and Publicity

The body of evidence from the Infant Feeding Initiative revealed that it is not enough to get a project up and running. In order to engage with disadvantaged groups, projects need to target the priority audiences and involve proactive outreach work.

For whatever reasons, whether it be lack of confidence, language, social or physical barriers or simply lack of commitment, some mothers will not seek out help. So, in order to reach these mothers, breastfeeding support must become proactive and routine.

Local initiatives and projects have to be advertised and promoted through relevant publicity. It is no use advertising antenatal classes in the local health centre if the target audience doesn’t routinely visit the centre. But crucially, what we have learned from the studies is that publicity has to be backed up by personal contact and encouragement. Simply making services and support available is not enough.

Certain projects have developed and “Many women, particularly those whotargeted particular hard-to-reach mothers by including fathers and are less motivated and less socially skilled, grandmothers, going into schools find it difficult to initiate contact with a and prisons and by encouraging public facilities to become baby comparative stranger and wait for help friendly. to be offered.”

Carol Campbell, British Medical Journal 7 Feb 2004 Teenage mothers-to-be require special attention and relevant tailored interventions. Statistics show that in the UK only 46% of teenagers initiate breastfeeding.8 The mothers of teenagers often have an important support role and should also be targeted by education programmes.

If you feel that your programme is not reaching those most in need then speak to your target group and ask for their advice. They will know best what information they want to hear about, where and when. You’d be surprised by some of the simple solutions you could put into place: switching the venue for a support group so women don’t have to walk too far alone, or changing the start time.

It is only by learning from women themselves, and the innovative practices to date, that we will get the message out to some hard-to-reach groups. Making the effort will mean positive benefits for many mothers and babies and reap health dividends for years to come.

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An integrated approach Integrating techniques of effective targeting, outreach and publicity into your breastfeeding projects is good practice. No matter how good the project is, it will fail if you don’t get people through the door, on the phone, or if your target group feels ‘it’s not for us’.

• An assessment of needs will help you. Work out what barriers exist to access – it could be language, geography, social attitudes or all of these.

• Get local healthcare professionals to understand and support your programme so they can promote it without pressure.

• Consider appointing a designated lead worker with a special interest; for example, a teenage pregnancy worker.

• Work with professionals from other disciplines and employment areas, in order to reach your group. For example, local authority education departments, Sure Start Local Programmes, children’s centres and other early years settings. Social services and community groups.

Getting fathers on board

Evidence shows that a father's support can be crucial to a “My partner’s breastfed mother's decision to start and continue to breastfeed. Consider devising specific outreach work to involve men and ensure that both our kids – she’s still existing programmes welcome them alongside women. For example, feeding the little one –schedule your antenatal classes to enable fathers to attend the sessions covering the benefits of breastfeeding. Include examples and I’ve become a bit of of the ways in which fathers can bond with their child during breastfeeding. an expert. At work, I end

up answering a lot ofLorraine Best, Midwifery Lecturer and Public Health Specialist at the University of Sheffield, has run a tailored programme to reach men. questions, from the men A forum theatre production was devised, which explored both 'being and the women.”a dad' and breastfeeding education. The wider focus on fatherhood was felt to be critical in order to ensure the workshop would be A proud father seen as appealing and relevant to men. Delivered by local male and female volunteers and a theatre activist, the programme visited a pub, an amateur football club, an antenatal class and year 11 classes at three local secondary schools.

The resulting video of interviews with fathers, young men and “It’s critical to consider women discussing key antenatal and feeding stages from a male perspective generated enough promising material for the working how you can reach fathers group to plan a more professional production for the future. with messages about the

benefits of breastfeeding. In the past men were less likely to get involved with babies and feeding. That’s changing, so it’s important partners are also targeted.” Lorraine Best, Midwifery Lecturer and Public Health Specialist, University of Sheffield

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Taking breastfeeding education into schools

Professor of midwifery, Mavis Kirkham, took the Breastfriends peer support project into schools.

“It was a question of crawling into small gaps in the curriculum with the topic. What we could do was very limited – there is no real space for breastfeeding – but we did get it in under citizenship in one junior school. The midwife on our team was asked to wear a uniform, and to talk to the children about her job and her qualifications before we were even allowed to bring up breastfeeding!”

Another more successful series of sessions was with a large comprehensive in a deprived area where the head of Personal Social Health Education (PSHE) really supported the project.

Supporting mothers in prison

Sinead Farrell, Midwifery Team Leader at London's Whittington hospital, “Mothers in prison oftenprovides maternity services for women at Holloway prison, where a unit houses up to 17 mother and baby pairs for women with babies aged don't feel good about up to nine months. themselves as mothers, Breastfeeding workshops were delivered on a monthly basis and mothers so breastfeeding can were provided with breast pumps and fridges to store their milk. restore some of their The team also arranged training for prison officers working on the self-respect and enhance mother and baby unit. Many of the staff don't have children themselves but they are in a key position to support the messages given by the the relationship with midwives when they aren’t there. their babies.”

Sinead Farrell, Midwifery Team As a result of their work there, the breastfeeding initiation rate increased from 57 per cent beforehand, to 78 per cent during the project. The Leader, Whittington Hospital, London women also increased the length of time they continued breastfeeding.

The Breastfeeding Friendly Award Scheme

A key factor in deciding not to breastfeed or continue to breastfeed has been identified by mothers as a lack of public facilities and unsupportive attitudes in public places. The Breastfeeding Friendly Award has been developed by a range of agencies wanting to promote, protect and support parents’ choice to breastfeed their infants. So a pilot project was started in Hull and East Riding to encourage public premises and retailers to welcome and support breastfeeding mothers through an award scheme.

Part of the inspiration was a similar national scheme run by NCT calling for national retailers to support breastfeeding. Called ‘You CAN do it here’, it stipulates three criteria for retailers to fulfill in order to be designated as breastfeeding friendly. Successful retailers are then encouraged to display stickers to promote their facilities to mothers.

In Hull and East Yorkshire, this idea was developed further, into the Breastfeeding Friendly Awards. In order to qualify for the award, premises were required to have a written breastfeeding policy, a minimum of 70 per cent of staff who demonstrate breastfeeding awareness on assessment and an agreement that breastfeeding mothers would not be discriminated against.

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”Women find the lack of public facilities a key barrier to breastfeeding. Efforts to provide a welcoming environment help mothers and change the attitudes of people on the high street in general – staff and customers.” Isabel Carrick, Health Promotion Specialist, Hull and East Yorkshire

Health Promotion Specialist, Isabel Carrick, regularly produces a guide that lists all thepremises that have joined the scheme. This is distributed to a wide range of premisesincluding all Awards holders, all maternity hospitals, and, via health visitors, Sure Start LocalProgrammes, children’s centres and other early years settings, libraries, tourist informationcentres and children’s information services. This acts as an incentive for premises to becomebreastfeeding friendly and get listed in the leaflet.

Now there are 82 accredited premises in the area and follow-up monitoring has reported an increase in breastfeeding mothers. Hull City Council has even provided local libraries with extra funding to provide mothers with comfy chairs. The Breastfeeding Friendly Award scheme is continuing with support from Health Promotion Specialist.

National Breastfeeding Awareness Week Co-ordinated in England by the Department of Health, this campaign takes place in May every year. It aims to raise public awareness about the benefits of breastfeeding by producing a range of engaging materials and undertaking media activity. In 2005, younger mothers, low-income families and fathers are the primary target.

in some branches.

English is not their first language.

It is a key component of several studies in the Infant Feeding Initiative.4

Top tips for access, outreach and publicity

• Get involved in Breastfeeding Awareness Week each May, and use the opportunity to promote your project or breastfeeding policy.

• Display Breastfeeding posters and stickers, most importantly in health centres, GP surgeries and other primary care trust premises.

• Approach other public places where women are likely to visit with their babies, for example, sports centres, benefit offices and libraries.

• Try to get local retailers involved. For example, Mothercare supported National Breastfeeding Awareness Week 2004 by hosting breastfeeding talks for mothers

• Make employers aware of what they can do to support breastfeeding women. Let them know breastfed babies are less likely to mean the mother needs to be absent from work to care for a sick child.

• Establish a relationship with your local media and keep them informed of your activities. • Seek out hard-to-reach groups proactively – develop links with schools and prisons. • Conisder translating promotional materials into other languages to reach women for whom

• Study the research available that establishes the needs of particular hard-to-reach groups.

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Reaching Out – Access, Outreach and Publicity

The Government made a commitment in the NHS Plan to increase support for breastfeeding. As set out in the NHS Improvement Plan, prevention of disease and tackling inequalities in health will need to assume a much greater priority in the NHS. The White Paper on improving health sets the framework for action to improve diet and nutrition.

Healthy Start – The Welfare Food Scheme is being reformed to provide eligible pregnant women, breastfeeding mothers and young children with vouchers that can be exchanged for fresh fruit, vegetables, milk or infant formula. A communications and training programme for health professionals will be introduced in parallel to the scheme.

The National Service Framework for Children, Young People and Maternity Services – the NSF recommends NHS Trusts adopt the practices and policies found in this good practice guide as a minimum standard for their breastfeeding support.

The Priorities and Planning Framework 2003-06 – the PPF requires an increase in breastfeeding initiation rates by 2% points per year, with a particular focus on women from disadvantaged groups.

Sure Start – through the services being provided from children’s centres and local programmes, Sure Start is prioritising the need to increase breastfeeding rates.

The National Standards, Local Action 2006-08 – encourages all Primary Care Trusts to work in partnership with Local Authorities to increase breastfeeding initiation and duration rates targeting those with the highest need.

Local Delivery Plans 2005-2008 – the NHS performance management framework and associated NHS Local Delivery Plan (LDP) lines have a significant role to play in helping the NHS to drive health improvement at a local level, and also in improving the quality of local data on key health of the population target areas - such as reducing infant mortality. The Department of Health requires the NHS to collect data on the number of mothers initiating breastfeeding for the period 2005-08.

"I am pleased to support this helpful and informative guide. I hope very

the practices and policies found in this good practice guide as a minimum

much that all NHS Trusts will adopt

standard to increase support for breastfeeding." Professor Al Aynsley-Green, National Clinical Director for Children

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27

Endnotes 1 Infant feeding 2000

2 Department of Health (2000) The NHS Plan: Improving Health and Reducing Inequality:

3 Department of Health (2002) Priorities and Planning Framework 2003-2006

4 Department of Health (2003) Infant Feeding Initiative: A Report Evaluating the Breastfeeding Practice Projects 1999-2002.

5 Department of Health (2000) .

6 Information about data collection is available at

7 The effectiveness of public health

8 The effectiveness

9

Note: almost all Department of Health documents can be downloaded from the web,

Department of Health (2002) and Planning Framework 2003-2006

Department of Health (2003) Infant Feeding Initiative: A Report Evaluating the Breastfeeding Practice Projects 1999-2002.

Department of Health (2000) . An essential tool for data collection beyond initiation. Its formulation is consistent with the five-yearly UK infant feeding

. 3 (10): 544-547.

Journal of Human Lactation 19 (4): 391-401.

Hale TW (2004) Medications and Mothers’ Milk:

Mohrbacher N, Stock J (2003) The Breastfeeding Answer Book

or telephone 0845 456 1866

.

public services.

The effectiveness of public health Health Development

The effectiveness

Hamlyn B, Brooker S, Oleinikova K, Wands S (2002) , The Stationery Office.

www.nhs.uk/nationalplan/npch13.htm.

Improvement, Expansion and Reform: The Next Three Years’ . www.dh.gov.uk/planning2003-2006/index.htm.

Local Infant Feeding Audit Tool (LIFA)www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/InfantFeeding/fs/en.

www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/InfantFeeding/fs/en

Protheroe L, Dyson L, Renfrew MJ, Bull J, Mulvihill C (2003) interventions to promote the initiation of breastfeeding: Evidence Briefing. Health Development Agency.

Renfrew MJ, Wallace L, D'Souza L, McCormick F, Spiby H, Dyson L. (2004) of public health interventions to promote the duration of breastfeeding: Evidence Briefing. Health Development Agency.

University of Sheffield website: www.sheffield.ac.uk/surestart.

Resources – Useful papers and books

many of them from: www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics

Improvement, Expansion and Reform: The Next Three Years Priorities . www.dh.gov.uk/planning2003-2006/index.htm.

Local Infant Feeding Audit Tool (LIFA)

survey. It is available on the Department of Health website (see above)

Dykes (1995) Valuing breastfeeding in midwifery education. British Journal of Midwifery

Dykes F, Hall Moran V, Burt S, Edwards J, Whitmore M (2003) Adolescent mothers and breastfeeding experiences and support needs: an exploratory study.

a Manual of Lactation Pharmacology, Pharmasoft Publishing LP. Available from [email protected] or telephone 0845 456 1866

, La Leche League International. This is published in book form and updatable CD Rom. Available from [email protected]

National Assembley for Wales (2001) Investing in a Better Start: Promoting Breastfeeding in WalesA policy overview of current and future strategies for all levels of healthcare, educational and

Protheroe L, Dyson L, Renfrew MJ, Bull J, Mulvihill C (2003) interventions to promote the initiation of breastfeeding: Evidence Briefing. Agency. A review of the evidence base. www.hda.nhs.uk/Documents/breastfeeding_evidencebriefing.pdf

Renfrew MJ, Wallace L, D'Souza L, McCormick F, Spiby H, Dyson L. (2004) of public health interventions to promote the duration of breastfeeding: Evidence Briefing. Health Development Agency. A review of the evidence base. www.had.nhs.uk/Evidence.


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Royal College of Obstetricians and Gynaecologists (2001) Modernising Maternity Care:

Cochrane Database of Systematic Reviews

Smale M (2004)

UNICEF (2001) Implementing the Baby Friendly Best Practice Standards

UNICEF (2003) Antenatal checklist

.

.

Deacon C (2002) Breastfeeding for Beginners

Department of Health (2004) Breastfeeding

La Leche League (2004) La Leche League (GB) at [email protected] or telephone 0845 456 1866

Having it All: a woman's guide to combining breastfeeding and work.

MIDIRS (2003)

(2004) Bestfeeding: getting breastfeeding right from the start £9.99.

Evidence-based illustrated book for mothers with detailed information about the practicalities

UNICEF (2003)

UNICEF (2003). This leaflet for new mothers is available in English and a

UNICEF (2003) Sharing a bed with your baby

, video that builds peer supporters

Renfrew, Woolridge, Ross-McGill (2000) Enabling Women to Breastfeed, TSO, London. A review of studies (up to1997) about sustaining breastfeeding, including practice recommendations. Essential reference book when drawing up policies and protocols.

A Commissioning Toolkit for Primary Care Trusts in England Sikorski J, Renfrew MJ, Pindoria S, Wade A. (2004) Support for breastfeeding mothers.

, The Cochrane Library.

Training Breastfeeding Supporters: An Enabling Approach. WICH Research Group, University of Sheffield. To order the package contact: Vicky Mathers, WICH Research Group, School of Nursing and Midwifery, University of Sheffield, Winter St., Sheffield S3 7ND. Tel: 0114 222 8301. Email: [email protected] or telephone 0117 222 8301

. Sample breastfeeding policies for hospitals and the community from the UNICEF Baby Friendly Initiative (BFI). £5 from BFI or visit www.babyfriendly.org.uk/guidance.asp

available to download from www.babyfriendly.org.uk/pdfs/anchecklist.pdf

World Health Orgnanisation (1998) Evidence for the Ten Steps to Successful Breastfeedingwww.who.int/reproductive-health/docs/breastfeeding.pdf

World Health Organisation (2002) Global Strategy for Infant and Young Child Feedingwww.who.int/nut/publications.htm#gs_inf

Resources – For parents

. NCT, Thorsons.

. A5 colour leaflet with large pictures to illustrate correct breastfeeding technique. Available from www.breastfeeding.nhs.uk ref 316 36

The Womanly Art of Breastfeeding. The book can be ordered from

Maternity Alliance (2003) For women wanting to continue breastfeeding their baby after their maternity leave ends. Available from Maternity Alliance for £2.50 + 50p p&p.

Informed Choice for Women: Feeding your baby – breast or bottle. MIDIRS leaflet for women with corresponding leaflet for health professionals. Available as pdf file from www.infochoice.org

Renfrew MJ, Fisher C, Arms S. (3rd edition). Celestial Arts, Berkely, California. Distributed in the UK by Airlift Press.

of breastfeeding.

Feeding your new baby. This leaflet for pregnant women is available in English and a range of other languages. It can be printed at www.babyfriendly.org.uk/leaflets. An English version is included in the Baby Welcome pack. Copies can also be purchased from UNICEF.

Breastfeeding your baby. range of other languages. It can be printed at www.babyfriendly.org.uk/leaflets. An English version is included in the Baby Welcome pack. Copies can also be purchased from UNICEF.

. This leaflet for parents can be printed from a pdf file on the Baby Friendly website www.babyfriendly.org.uk.

Resources – Videos and teaching aids

Birth International (2000) Breastfeeding – the baby’s choiceconfidence in the abilities of babies – showing how the baby rests, searches for and finds the breast; 9 mins; Anne-Marie Widstrom; £50; available from Birth International Ace Graphics PO Box 173, Sevenoaks TN14 5ZT (their ref: VT028). Telephone (01959) 524 622


29

Breastfeeding – a Gift for Life. This video shows several practices

and in the bath at one day old, as well as conversations with Asian women; £35; available

Help yourself to Breastfeed

NCT Breastfeeding step by stepblack&white line drawings of the photos to eliminate class and ethnic clues; show baby Eleanor

NCT

Queens Park Hospital (2002)

i

UNICEF (1999) Becoming Baby Friendly

Something to be proud of. This is a 14-minute video, featuring peer supporters

Institute of Child Health, London – A 4-week masters level policy and practice course in

La Leche League also run training courses for midwives, doctors and health visitors that can

NG2

Francesca Entwhistle

Bradford NHS Trust (2002) consistent with BFI guidelines including skin-to-skin contact, breastfeeding after a Caesarean

from Janette Westman on [email protected]

Doncaster Breastfriends (2002) . Video with peer supporters from the Doncaster Breastfriends scheme talking about social and personal issues in areas where breastfeeding is not considered to be normal; Approximately 30minutes length. £40 + £5 postage and packing. Order form from [email protected], or telephone 0117 222 8301

. Set of A4 encapsulated cards, A2 poster and/or tear-off pad with

going to the breast with accompanying simple descriptions; poster £7, set of 8 cards £15-50, tear-off pad of 50 sheets £5-50; + 10% p&p. Contact NCT Maternity Sales.

You CAN do it Here! Pack enabling local groups to produce your own directory of breastfeeding friendly facilities. Available from [email protected]

Breastfeeding Your Baby. Video provides information on the benefits and management of breastfeeding. Available in Urdu & English, Bengali & English or Gujarati and English. Can be ordered from Mrs Quinn's Office, Women's Health Services, Tower V ew Offices, Queens Park Hospital, Blackburn BB2 3HH at price £12.50 each including p&p (cheques to Blackburn, Hyndburn & Ribble Valley Health Care NHS Trust).

. Produced by UNICEF this video explains Baby Friendly accreditation and the rationale behind it. 20minutes Length. It costs £60 and can be ordered from www.babyfriendly.org.uk/resource.asp

Welford H (2003) and fathers talking about feeding. It costs £10 available from NCT Maternity Sales alongside other materials for mothers and for health professionals, including books and leaflets. For catalogue, see www.nctms.co.uk

Resources – Courses for health professionals

Breastfeeding Management. Caters for policy makers and health professionals from around the world. Contact: www.ich.ucl.ac.uk

La Leche League Great Britian – Run comprehensive 5 day courses for health professionals covering breastfeeding management and setting up of peer counsellor projects. These courses are followed by a three years support package to ensure the success of the resultant peer counsellor groups.

be tailored to the specific requirements of the health professionalsinvolved. La Leche League Great Britian, PO Box 29. West Bridgford, Nottingham 7NP. Telephone & fax 0845 456 1844

Lister Hospital, Stevenage – Two 6-hour workshops for midwives, health care assistants and neonatal nurses covering BFI best practice and a minimum of 1-hr induction session for obstetric and paediatric staff

NCT - Provide training days under its NHS-ConNeCT training scheme, which can be tailored to the needs of the NHS Trust. Contact: [email protected] or 020 8993 3441

The Breastfeeding Network - Provide training for GPs, alongside a resource pack and guidelines about breastfeeding written specifically for GPs. Contact: www.breastfeedingnetwork.org.uk

UNICEF UK - BFI provides a 3-day training course on site, or at various venues in the UK. BFI also provides a 2-day training course for support workers and health professionals who provide non-clinical breastfeeding support (relevant for Sure Start workers for example). Contact: The UNICEF UK Baby Friendly Initiative at Africa House, 64-78 Kingsway, London WC2B 6NB. Telephone 020 7312 7652. Fax 020 7405 2332

University Hospital of North Staffordshire – Have developed a specialist pre-term breastfeeding and milk expression course for neonatal staff. Contact: Liz Jones

University of Hertford – Courses for pre-registration and healthcare assistant training. Contact:


Association of Breastfeeding Mothers

0870 401 7711 (counseling helpline) E-mail: [email protected]

how to become a counsellor and a link-up system to find other

BBC Online

Bliss - The Premature Baby Charity 68 South Lambeth Road, London SW8 1RL

E-mail: [email protected]

Breastfeeding Network

Supporterline: 0870 900 8787

Community Practitioners and

Email: [email protected]

practitioners as well as publications and an online bookshop.

in this country focusing solely on all aspects of living

campaign news, gives information about speech & language

FathersDirect Herald House, Lambs Passage, Bunhill Row London EC1Y 8TQ

Fax: 020 7374 2966

Food Standards Agency

news items as well as specific advice on issues such as diet and health, hygiene and labelling.

Gingerbread

languages including Bengali, Gujarati and Arabic.

Health-news.co.uk

on all television channels and information on local events.

Baby Feeding Law Group

Baby Milk Action

Baby Milk Action gives you insight into the politics

the world with particular emphasis on developing countries.

Lactation Consultants Great Britain

See website for details of qualifying as a lactation consultant & further contact details.

La Leche League

Helpline: 0845 120 2918 E-mail: [email protected]

For publications: [email protected]

support, information and education. Monthly support

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Resources – Useful organisations and websites

PO Box 207, Bridgwater TA6 7YT

Website: www.abm.me.uk ABM breastfeeding counsellors offer information and support through a 24 hour telephone helpline. The website includes an online magazine, a list of recommended books, information on

breastfeeding mothers in a specific area.

www.bbc.co.uk/health/parenting www.bbc.co.uk/health/womens Both these routes lead to same section on breastfeeding. The site contains articles covering many different aspects of breastfeeding and has a strong ‘ask the expert’ section.

Tel: Freephone 0500 618 140 (parent support line)

Website: www.bliss.org.uk Bliss runs a parent support line Monday-Friday 10am-5pm to offer help and support to parents, relatives and friends of anyone with a baby who is in, or has been in, neonatal care. The website hosts a message board allowing parents in similar situations to contact one another. It also features leaflets, research findings and dates for forthcoming study days.

PO Box 11126, Paisley PA2 8YB

Email: [email protected] Website: www.breastfeedingnetwork.org.uk The Breastfeeding Network offers independent support and information about breastfeeding. The website hosts a list of BfN Breastfeeding Centres and information on a range of topics including thrush and evidence for colic treatments. The supporterline is open from 9.30am to 9.30pm and connects callers to their nearest Breastfeeding Supporter.

Health Visitors’ Association 40 Bermondsey Street, London SE1 3UD Tel: 020 7939 7000

Website: www.msfcphva.org The CPHVA website provides access to information on community nursing, public health and primary health care. Non-members are able to access information on the website about CPHVA committees and special interest groups (SIGs), details of forthcoming conferences and events, education and careers information for community

Members can also access professional briefings, respond to consultations or share information using the bulletin board.

Down’s Syndrome Association Langdon Down Centre 2a Langdon Park, Teddington TW11 9PS Tel: 0845 230 0372 Email: [email protected] Website: www.downs-syndrome.org.uk Down’s Syndrome Association is the only organisation

successfully with Down’s syndrome. The website provides information for new parents and also has a section with literature for people with Down’s Syndrome. It reports

therapy, health, education and welfare as well as updates on training events, seminars and conferences.

Tel: 020 7920 9491

email: [email protected] Website: www.Fathersdirect.com This organisation focuses on issues relating to childcare, paternity leave and puts fathers in a position where they are informed about breastfeeding and can offer support to their partners.

Aviation House, 125 Kingsway, London WC2B 6NH Switchboard: 020 7276 8000 Website: www.food.gov.uk The Food Standards Agency is an independent food safety watchdog set up by an Act of Parliament in 2000 to protect the public's health and consumer interests in relation to food. The website contains a news centre with information about relevant

7 Sovereign Close, Sovereign Court, London E1W 2HW. Tel: 020 7488 9300 E-mail: [email protected] Website: www.gingerbread.org.uk This is the leading support organisation for lone parent families in England and Wales. It has leaflets translated into several other

Website: www.health-news.co.uk The website has a useful listing of health programmes

Website: www.babyfeedinglawgroup.co.uk The group works to protect infant health and mothers’ rights through improved legislation.

23 St.Andrew's Street, Cambridge CB2 3AX, UK. Tel: 01223 464420 Website: www.babymilkaction.org

of breastfeeding. They highlight breastfeeding issues across

Website: www.lcgb.org

PO Box 29, West Bridgford, Nottingham NG2 7NP

Website: www.laleche.org.uk Tel: 0845 456 1866

La Leche League aims to help breastfeeding mothers through

meetings, where women can meet other breastfeeding mothers and trained breastfeeding counsellors, are run throughout Great Britain. La LecheLeague publish the 'Breastfeeding Answer Book', the standard reference text for breastfeeding counsellors, as well as many other specialist breastfeeding resources. They also provide a 24-hour helpline.


31

Maternity Alliance

as employees and on health inequalities. The website allows

Multiple Births Foundation Hammersmith House Level 4, Queen Charlotte's & Chelsea Hospital, Du Cane Road, London, W12 0HS


Acton, London W3 6NH


NHS Breastfeeding website

NHS Direct online

This is the NHS's main health advice and information website. The website's self-help guide gives advice on what to do for a variety of baby's symptoms and the health encyclopaedia

Royal College of Midwives

and infant feeding.

SureStart

start in life for every child by bringing together: early education,

Thurrock Community Mothers Programme



UKAMB (UK Association for Milk Banking)


UNICEF Baby Friendly Initiative

Email: [email protected] k

enabled and supported to make informed choices about how

Baby Friendly Initiative is commissioned by various parts of the

Friendly Initiative is commissioned by various parts of

Third Floor West, 2-6 Northburgh Street, London EC1V 0AY Tel: 020 7490 7639 E-mail: [email protected] Website: www.maternityalliance.org.uk Maternity Alliance provide information on women’s rights

both mothers and health professionals to access a range of information as well as a news section updating any relevant political developments or changes to the law. The site also has details about membership, relevant publications, forthcoming events and conferences.

Telephone: 020 8383 3519

Website: www.multiplebirths.org.uk The Multiple Births Foundation is a resource for professionals and families alike, and aims to improve the care and support of multiple birth families through the education of all relevant professionals. It is based at Queen Charlotte's & Chelsea Hospital in West London. The website provides information for parents and health professionals as well as an online shop for relevant literature.

National Childbirth Trust Alexandra House, Oldham Terrace,

Tel: 0870 7703236 Breastfeeding Line: 0870 444 8708

Website: www.nctpregnancyandbabycare.com The NCT cover many aspects of birth and parenting and have lots of information on how to breastfeed. You can order the NCT Book of Breastfeeding on line. There is a dedicated breastfeeding line from 8am to 10pm 7 days a week.

Website: www.breastfeeding.nhs.uk The NCT covers many aspects of birth and parenting and has lots of information about breastfeeding. The website covers a wide range of practical and emotional information about parenting generally, andbreastfeeding specifically. There is a dedicated breastfeeding line from 8am to 10pm seven days a week.

Website: www.nhsdirect.nhs.uk

covers a number of topics including breastfeeding.

15 Mansfield Street, London W1G 9NH Tel: 020 7312 3535 E-mail: [email protected] Website: www.rcm.org.uk Has an excellent information centre on its website with information on professional and social issues such as HIV

Sure Start Unit, Department for Education and Skills and Department for Work and Pensions Level 2, Caxton House, Tothill Street, London SW1H 9NA Tel: 0870 0002288 Website: www.surestart.gov.uk Sure Start is the Government's programme to deliver the best

childcare, health and family support. The website provides details of Sure Start programmes in local areas, as well as information about securing childcare and starting local health networks for professionals.

23-25 Calcutta Road, Tilbury, Essex, RM18 7QT Tel: 01375 858512

Website: www.communitymothers.org.uk Thurrock Community Mothers Programme is an innovative support programme where experienced mothers (called Community Mothers) offer informal support and useful information to other local parents with young children.

Twins and Multiple Birth Association 2 The Willows, Gardner Road, Guildford, Surrey GU1 4PG Tel: 0870 770 3305 Twinline: 0800 138 0509

Website: www.tamba.org.uk The Twins and Multiple Births Association, Tamba, is a nationwide UK charity providing information and mutual support networks for families of twins, triplets and more. The website contains information about contacting a local twins club, events and holidays organised through the organisation and information for health professionals. Twinline is a helpline for families or professionals needing support and is open from 7pm to 10pm every weekday, and 10am to 10pm on Saturdays and Sundays, all year round.

World Health Organization Website: www.who.int If you are interested in the bigger picture you can access statistics and policy documents on breastfeeding at the World Health Organization site.

Tel: 020 8383 3559

Web: www.ukamb.org UKAMB has been established to provide a forum for the exchange of information about milk banking, set standards for the practice of milk banking, regularly review guidelines for milk banking and promote milk banking so that more milk donors come forward.

Tel: 020 7312 7652

Web: www.babyfriendly.org.uThe Baby Friendly Initiative is a global programme of UNICEF and the World Health Organisation which works with the health services to improve practice so that parents are

they feed and care for their babies. Health care facilities which adopt practices to support successful breastfeeding receive the prestigious UNICEF/WHO Baby Friendly award. In the UK, the

health service to provide advice, support, training, networking, assessment and accreditation.

Health care facilities which adopt practices to support successful breastfeeding receive the prestigious UNICEF/WHO Baby Friendly award. In the UK, the Baby

the health service to provide advice, support, training, networking, assessment and accreditation.


“Over the past 20 years, the impact

good practice we stand an even better

mothers and babies for years to come” Chris Beasley

© Crown Copyright 2004 Produced by COI for the Department of Health 265114 1p 70k Nov04 (CWP)

of programmes and initiatives supporting breastfeeding has built up a critical mass. We need to ensure this process continues with the widespread adoption of a coordinated approach, and consistent messaging. By raising the standards of

chance of improving the health of

Chief Nursing Officer

Supported by: Association for Breastfeeding Mothers, Breastfeeding Network, Community Practitioners' and Health Visitors' Association, La Leche League, National Childbirth Trust, Royal College of Midwives, Sure Start, UNICEF UK Baby Friendly Initiative.