As one of only three early years settings with full Baby Friendlyaccreditation, Sure Start's Bedlington and District Children's Centre inNorthumberland is proud of the part it plays in helping new mumsbreastfeed.
Last May, following three years of work and preparation, the settingreceived the full accreditation from Unicef, which manages the globalBaby Friendly initiative in conjunction with the World HealthOrganisation.
Sue Hutchinson-Brown, health and family support team manager at thecentre, recalls what was involved. "We signed up to the requirements,and then organised training for every team member who has face-to-facedealings with mums, as we had to ensure that everyone was in a positionto encourage breastfeeding.
"Even employees who only have passing contact with mums are educated onhow to make breastfeeding easier and more comfortable," addsHutchinson-Brown. "And we appointed a key worker to take new staffthrough our breastfeeding policies, as well as being responsible formoving the initiative forward, which was a great benefit."
Staff training
Jackie Ward is a midwife at the centre, and attended a two-and-a-halfday Unicef breastfeeding management course as part of the setting'sdrive to be accredited. "We had a booklet to fill in before the course,with questions on the anatomy and physiology of the breast, and onbreastfeeding scenarios we may come across," explains Ward.
"As for the course itself, everything was covered, from basic scenariosthrough to anatomy, physiology and hormonal changes to why women shouldbreastfeed, and the problems they may face such as mastitis. And at theend we were awarded with a certificate of competence."
The work didn't stop there, though, as the centre also had to undergotwo days of post-training assessment.
In this time, Unicef talks to staff, pregnant women, those whobreastfeed and those who use a bottle, in order to ensure that staffhave done everything they claim to have done, and that all the relevantinformation has been given to mothers.
Now, according to Hutchinson-Brown, breastfeeding is an integral part ofantenatal classes at the centre and "extended families" evenings are runexplaining its benefits. "We also have a young mums group, where weprovide information and support for them on breastfeeding. We've hadwomen who didn't breastfeed their first or second child helped tobreastfeed their third, and women who began by bottle feeding inhospital manage to start breastfeeding three days later."
Part of the reason for this success, believes Hutchinson-Brown, is thatthe Baby Friendly Initiative requires each setting to identify peersupport workers for new mums. "There are about 12 active peer supportersin Bedlington at present," says Hutchinson-Brown. "All of them receivedtraining, initially by La Leche League, but now delivered by our ownteam."
Dawn Richardson is one mum who was helped by the team to breastfeed andwho went on to become a peer support worker. Her husband was notinitially keen on the idea as he thought it too much work, but abreastfeeding workshop opened his eyes to the health benefits andchanged his mind completely.
And as a peer support worker Richardson is now able to help othermums.
"The Baby Friendly award is a good thing because it means that everyoneis given the same information," she says. "In hospital, I found that themidwives gave conflicting advice, whereas being a mum who has breastfedmeans other mums can relate to me, and I can empathise with them."
Amanda Davies is one of the mums Richardson has helped. "At one point,people were telling me that my baby wasn't getting enough milk and thatshe wasn't content. Luckily help was only a phone call away."
Encouragement and support
Other mums are also benefiting from this ongoing support and localbreastfeeding rates are steadily increasing. According toHutchinson-Brown: "The main aim was to encourage, support and help womento enjoy the experience and therefore continue to breastfeed for longer.Local health visitors were telling us that women were reporting thatthere was no support mechanism, and that they were receiving conflictingadvice, so we want to ensure that women who choose to breastfeed receivesupport."
Assessment costs approximately 2,000, while the courses are about300, but rather than concentrate on money, Hutchinson-Brownencouraged staff to look at the bigger picture. "Everyone had tocontribute for it to be a success, and the support of the local healthcentres, midwives, health visitors and the local community wasinvaluable. But in order for breastfeeding to become more popular amassive cultural and attitude shift is needed. That's why local womensupporting each other to breastfeed is vitally important."
Despite the many health benefits of breastfeeding for the mother - alower risk of breast cancer, ovarian cancer, and hip fractures, forinstance - and for their babies - which range from a boosted immunesystem, and a decreased chance of problems like constipation, eczema,and asthma, to reduced likelihood of cot death - breastfeeding rates inthe UK are some of the lowest in Europe, particularly among deprivedfamilies. So while 77 per cent of babies in England and Wales arebreastfed at birth, this rate declines rapidly to only 29 per cent atfour months.
Lack of support is a common reason for stopping, with new mums sayingthey don't receive adequate help with problems such as mastitis, or withgetting the baby latched onto the breast properly. Pressure from newgrandmothers is also extremely common as many of today's grannies didnot breastfeed and were given incorrect information when they hadchildren.
A generational problem
Professor Mary Renfrew is director of the Mother and Infant ResearchUnit at the University of York. Her work involves researching what isneeded to ensure that the UK begins to catch up with its Europeancounterparts.
"We've had lower breastfeeding rates for longer, so it has now become agenerational problem," explains Renfrew. "Women can't rely on theirmothers for advice, and recognising this is important. We need to lookat ways of changing attitudes, like helping mothers breastfeed inpublic, and tackling the image of breastfeeding, especially with youngpeople."
Renfrew would also like to see changes in the way breastfeeding ratesare monitored. "We need to link hospital and community data, while aclearer definition of what constitutes partial breastfeeding isrequired," she says. "And England needs to have a national breastfeedingco-ordinator like in other parts of the UK."
In the absence of such changes, the Baby Friendly initiative is fillingan important gap. But even with its support, settings still face sometough challenges. At Sure Start Peterlee, which received full BabyFriendly accreditation in November 2003, staff have found that a changein who supports new mums can affect breastfeeding rates, with numbersdropping off once the midwives' visits have ended, for instance.
According to Jan Wilson, midwife co-ordinator at Peterlee, who leads onthe initiative: "Prior to full accreditation our breastfeeding rate was23 per cent at six weeks. Initially, on receiving full accreditation, itwent up to 53 per cent, but then dropped again and has stayed at the midto late forties. Results are very dependant on our motivation. Sometimeswe can become a bit jaded, so we have updates regularly - a kind ofinformal study day, which we find beneficial."
However, while progress is slow, it is also steady as whole familiesbegin to change their views. Wilson talks of one family of five sisterswho have benefited. "The first two sisters bottle fed. But the thirddecided to give breastfeeding a try and was successful. This encouragedthe others, and we saw a domino effect, as the sisters who had bottlefed their first children breastfed their next babies."
And Dawn Richardson certainly thinks the Baby Friendly initiative is agood idea. "The support I received was good and I'm pleased to be partof the scheme," she concludes. "All we need now is people to just tryit; to just give it a go."
FURTHER INFORMATION
For more information on the Baby Friendly initiative, please go towww.babyfriendly.org.uk
THE BABY FRIENDLY INITIATIVE EXPLAINED
The Baby Friendly initiative is a global campaign run the by the WorldHealth Organisation and Unicef. Set up in 1991, it now runs in more than120 countries, and aims to give all parents the correct information andadvice about feeding their baby, and ensure that they receive thenecessary support.
The initiative provides NHS trusts, other health care facilities, highereducation institutions, and early years settings with a framework forthe implementation of best practice. Organisations interested inembarking on the accreditation process first sign up to a Certificate ofCommitment, which indicates that they're working towards assessment andfull accreditation.
There is also an action plan visit, when the organisation completes adata sheet and questionnaire, devises a plan of action, and sets up aformal mechanism for recording. And teaching packs are provided, withtraining made available to all staff in the form of courses, workshopsand conferences.
Full accreditation is given after a formal two-day assessment process.Structured interviews are undertaken with health care professionals,managers, receptionists, mothers and pregnant women, and assessors makeobservations as well as reviewing policy, training curricula andinformation materials. All facilities are reassessed 24 months after theinitial award.
At present, only 43 UK maternity hospitals have full Baby Friendlyaccreditation, and seven community health care facilities. However, afurther 72 hospitals have signed up to a Certificate of Commitment, ashave 21 health care facilities.
In fact, the incidence of Baby Friendly hospitals differs widelydepending on where in the UK you live. Only 10 per cent of hospitals inEngland are Baby Friendly, while 34 per cent of Welsh and Northern Irishhospitals are, as are 58 per cent in Scotland. And even within Englandareas differ hugely; women are much more likely to give birth in a BabyFriendly hospital if they live in the North East as opposed toLondon.
FACT FILE
The initial incidence of breastfeeding rates in 2005 were:
- 77 per cent in England and Wales, up from 71 per cent in 2000
- 70 per cent in Scotland, up from 63 per cent in 2000
- 63 per cent in Northern Ireland, up from 54 per cent in 2000
The number of mums breastfeeding at six months in 2000 were:
- 22 per cent in England and Wales, which is no change from 1995
- 24 per cent in Scotland, up from 19 per cent in 1995
- 10 per cent in Northern Ireland, up from eight per cent in 1995
SOURCE: Unicef UK.
