Blackpool Breastfeeding Peer Support – some facts and figures
The service has been highlighted by the National Institute for Health and Care Excellence (NICE) as an example of how its guidance could be implemented.
The Breastfeeding Network is commissioned to deliver a systematic and integrated peer support service for breastfeeding mothers in Blackpool to tackle low breastfeeding rates. This service demonstrates how parts of statement 5 (of QS37 Postnatal Care) could be implemented. It is a locally developed service that has contributed to the gaining of Community Baby Friendly accreditation across primary, community and children centre settings in 2011. Peer supporters’ skills and knowledge, as well as those of the health visiting team, are assessed by external Baby Friendly assessors as part of the accreditation process as is the care that women receive. It has also been evaluated by researchers at the University of Central Lancashire. Outcomes are monitored by breastfeeding rates at 6-8 weeks for women who engage with the service, and for Blackpool as a whole, as well as women’s experiences of the service.
The service targets women least likely to breastfeed at antenatal clinics, particularly the complex social needs and diabetes clinics in the hospital, and the clinics held in the Better Start wards in the community.
Community peer supporters not only delivered infant feeding workshops for the local Parentcraft offering, but also targeted women least likely to breastfeed by attending antenatal clinics in the two major hub Children Centres.
In order to access women who are less likely to attend workshops, the peer supporters have developed a prize quiz which they use to engage in conversations with pregnant women who are awaiting antenatal appointments.
Peer support on hospital wards
This service resulted from feedback from mothers using existing peer support in the community.
Before the implementation of the PS programme there were two breastfeeding groups led by PS organisations in Blackpool. Feedback from mothers at the groups was that they would have loved to have had the PSs on the hospital ward, to listen and sit with them, and to have received less conflicting information from health care staff.
There is now seven day cover for the postnatal ward and delivery suite, with neonatal and children’s ward cover as required day to day.
Premature babies benefit hugely from breastmilk. It reduces the risk of the deadly disease NEC (necrotising enterocolitis) by 10 times. Around half of babies who get NEC will die. Unicef UK calculates that improved breastfeeding and access to donor milk would save the lives of around 270 premature babies each year in the UK. Star Buddies targets extra help for babies on neonatal unit.
More vulnerable babies on the neonatal unit were to be supported with a dedicated neonatal peer supporter who could provide emotional support as well as help with the practical skills of hand expressing and pumping.
A dedicated neonatal star buddy was appointed after requests from women and from staff, as women with babies in the neonatal unit can feel disempowered and can struggle to express and to establish breastfeeding. The neonatal peer supporter hours have been very well received.
Diabetic mothers and other medical issues
Breastfeeding reduces the rate of type 2 diabetes in mothers, especially for those who have gestational diabetes. Babies born to these mothers are at risk of low blood sugar but this can be managed through antenatal expression of colostrum, which is a special service provided by the Star Buddies programme. Babies with health problems who have to be admitted to hospital recover more quickly and have better outcomes. SBs provide additional assistance to these mothers to keep breastfeeding. Although these groups represent a small number of mothers and babies, the overall cost savings in both the short and long term of this special support is likely to be huge as hospital stays and long-term health problems are so costly.
Hospital peer supporters were tasked with working closely with the diabetic midwife so that diabetic mothers received additional support. They were also asked to hold informal conversations about infant feeding with pregnant women admitted to the ward with problematic pregnancies and to where possible support any mothers of breastfed babies admitted to the paediatric ward.
A study undertaken in 2015 shows that this intervention has vastly increased the rates of breastfeeding initiation and prevalence of breastfeeding at transfer into community care amongst the women with diabetes from 58% in the general population to 77.8% in this group.
Meets NICE guidelines
Whilst on the postnatal ward women are offered the community service. A community peer supporter then contacts her within 48 hours, and often within 24 hours of her discharge from the hospital, and makes proactive contact for 8 weeks and beyond, including via phone, text, group and home visits.
Unicef UK Baby Friendly Initiative
Peer support in the hospital and community is integral to the Baby Friendly accreditation. Blackpool community first succeeded in achieving full Baby Friendly status in October 2011 and continued its good practice, achieving re-accreditation in April 2014. The community service is due for re-accreditation this year, but with the loss of both peer support and the Infant Feeding Lead, this substantial investment in BFI accreditation would be wasted.
Breastfeeding at 6-8 weeks have continued to increase each year from 18% in 2008/9 to 27.5% in 2012/13 despite initiation rates remaining static recently. Feedback from mothers has been overwhelmingly positive.
This represent a 50% increase in the breastfeeding rates at 6-8 weeks.
The breastfeeding initiation rate has risen over the five year period [2010-2015] but remains significantly lower than the North West and England rates. The 2014/15 Blackpool rate is 61.5% compared to 64.6% in the North West and 74.3% in England as a whole. [JSNA]
Breastfeeding initiation in Blackpool is now 61.5%, lower than the England average 74.3% but higher than in 2010 (57%).
The 2011/12 Blackpool rate was 26.6% compared to 33.1% in the North West and 47.2% in England as a whole.
Despite these increases, the rate of breastfeeding continuation is half the rate of England as a whole. If the service is to end it will inevitably fall even lower. [Current rates not known as data has not been sufficiently quality for last several years. This is a problem in around half of LAs, so not unique to Blackpool. BfN collect data so ought to know the rates for the women they see at least.]
Wider activities to support breastfeeding in the community
The inclusion of the PS service in all aspects of the work to implement Baby Friendly standards, including recruitment of businesses to a local ‘Welcome Breastfeeding Scheme’, has helped integration of the service.