Welcome to Bedford Borough Council

 
Our Services A - Z :
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
 
 

Breastfeeding

Introduction

 

Breastfeeding saves lives and protects the health of babies and mothers, and increases children's future life changes

Breastfeeding promotes health and prevents disease in both the short and long term for both infant and mother and plays an important role in reducing health inequalities.  Infants who are not breastfed appear more likely to suffer with conditions such as gastroenteritis and respiratory disease requiring hospitalisation.  In the longer term the child could be at greater risk of having higher levels of blood pressure and blood cholesterol in adulthood and may be at a greater risk of type 2 diabetes and obesity. Breastfeeding is also associated with a reduction in the risk of breast and ovarian cancers for mothers.  (DH, 2007) Additionally there is a positive association between breastfeeding and parenting capability, particularly among single and low income mothers (Gutman L et al, 2009).

 

There is a strong financial case for investing in support for breastfeeding. Low breastfeeding rates lead to an increased incidence of illness which has a significant cost to the Health Service.  A recent report commissioned by UNICEF found a modest increase in rates could save at least £40 million pounds annually, reducing hospital admissions, GP consultations, childhood obesity and cases of Sudden Infant Death Syndrome.

 

Rates in Bedford Borough at initiation and 6-8 weeks have continued to increase since 2008.  Whilst there is a ‘drop-off’ of 30% between the number of women who start to breastfeed and are still breastfeeding 6 weeks later, this has been reduced.

 

Midwives, Health Visitors, Children’s Centre staff and practice staff, all have a key role in ensuring that parents are suitably informed of the benefits of breastfeeding and providing the support to help mothers to breastfeed.  In Bedford Borough both our hospital and community services have achieved the prestigious UNICEF Baby Friendly Accreditation Award.  This ensures consistent, high quality support is given to new mothers in Bedford.

 

There are some groups of women who are less likely to breastfeed (e.g. women from lower socio-economic groups and teenage mothers).  The Family Nurse Partnership (FPN) was introduced in Bedford Borough in 2015 and will offer intensive support to young mothers under the age of 20 years. 

 

Facts, figures, trends

Breastfeeding initiation

Low breastfeeding rates result in increased incidence of illness and significant cost to the Health Service.  A 2012 report commissioned by UNICEF makes a strong financial case for investing in better support services for women to enable them to breastfeed for longer. The findings showed that a moderate increase in breastfeeding rates would result in savings of over £40 million and result in:

 

  • 895 fewer cases of breast cancer
  • Over 9000 fewer babies hospitalised with gastroenteritis and respiratory illness
  • Fewer cases of Sudden Infant Death Syndrome
  • 5% reduction in childhood obesity – saving £1.6 million each year

 

A small increase in IQ that across the population could result in £278 million gains in economic productivity

 

 

Breastfeeding init

 

Breastfeeding continuation

Breastfeeding cont

Source:    NHS England Maternity and Breastfeeding Statistical Work Areas 2014/15 [accessed 26/11/15]

Gaps in the data are due to incomplete data returns.

South Essex Partnership Trust (SEPT) Community Health Services provide the Health Visiting Service in Bedford Borough. Breastfeeding rates are reported again at 6-8 weeks at the routine health review.  We have seen consistent year on year increases in the number of women continuing to breastfeed in Bedford Borough.  In 2008-09, 41% of infants were still breastfed at 6-8 weeks and during 2014-15 the rate had increased to 49.5%. This is above the England rate of 43.8% (regional rates are not available for comparison). The target for Bedford Borough was increased to 50% for 2014/15 (an increase of 2% on the previous target).

 

When comparing initiation rates to rates at 6-8 weeks the “drop-off” (i.e. the number of women who do not continue breastfeeding) has reduced to 30% in Bedford Borough, from 37% in 2009-10. In the most recent Infant Feeding Survey (2010) it reported that breastfeeding prevalence in the UK fell by 12% between birth and one week with a further drop off 14% by 6-8 weeks. 

 

To better understand when this drop-off is occurring in Bedford, Bedford Hospital and SEPT report rates at 10 days.  Coverage has improved to 95% and data on the Public Health dashboard for 2014-15 indicates that the 10 day rate reported by both Bedford Hospital and SEPT is 65%. 

 

Current activity and services

Baby Friendly Accreditation in Bedford Borough

Evidence shows that Baby Friendly Accreditation can add 10% to breastfeeding uptake rates and adopting Baby Friendly practices enables health professionals to support mothers to continue to breastfeed as long as they wish (UNICEF, 2000). Updated guidance on postnatal care from the National Institute for Health and Clinical Excellence (NICE, 2014) recommends that all maternity care providers should implement the Baby Friendly Initiative as a minimum standard.

 

In January 2015, Bedford Hospital was awarded the Level 3 Full Baby Friendly Accreditation for meeting the highest standards in supporting infant feeding. 

 

SEPT Community Health Services, which provides the 0-19 Team including Health Visiting, achieved full Baby Friendly Accreditation in April 2013.  As a result of collaborative working all of the Children’s Centres in Bedford Borough also achieved full Baby Friendly Accreditation alongside SEPT. 

 

Maintenance of the standards requires ongoing audit and evaluation of practice in preparation for re-accreditation.

 

Implementation of the Healthy Child Programme (pre- birth to 5 years)

 

The Healthy Child Programme (HCP) places significant emphasis on the achievement of increased rates of breastfeeding initiation and continuation.  The HCP was implemented in Bedford in 2009.  An Integrated Commissioning and Delivery Toolkit was developed in 2014 and effectively sets out the responsibilities of all the key providers of the HCP including Midwives, Health Visitors, Children’s Centre staff and practice staff.  Promoting and supporting breastfeeding is a priority at each the universal touchpoints from pregnancy to the first 6 months.

Examples of effective local practice to promote and support breastfeeding include:

  • Support provided by Midwives throughout pregnancy on infant feeding options and the value of breast milk
  • An antenatal visit by a Health Visitor at around 32 weeks of pregnancy.  This is currently offered on a targeted basis and provides a valuable opportunity to discuss the benefits of breastfeeding and the support that is available
  • Development of an integrated antenatal programme “Bump, Birth and Baby Stuff”.  It is delivered by Health Visitors, Midwives and Children’s Centres over 6 weeks and has been developed in line with the Department of Health programme “Pregnancy, Birth and Beyond”.
  • Ongoing audit and evaluation of breastfeeding assessment and support offered, at each of the key touchpoints, to maintain Baby Friendly standards.
  • Breastfeeding training for GPs and practice staff across Bedford Borough
  • Coordinators in Children’s Centres to ensure staff are compliant with breastfeeding management training for Children’s Centre staff
  • Baby Brasseries in Children’s Centres in Bedford Borough. Baby Brasseries offer informal, café style breastfeeding support groups for all new mothers. They are attended by either a member of the 0-19 Team or a trained Children’s Centre worker, as well as a Bedfordshire Breastfeeding Buddy (see below).  Sessions are held on different days and at different times across the Children’s Centres.  More information can be found at

http://www.sept.nhs.uk/our-services/bedfordshire-and-luton/bedfordshire-community-health-services/childrens/health-visiting/baby-friendly/baby-brasseries/

  • Bedfordshire Breastfeeding Buddies (BBBs).  These are peer supporters and volunteers for SEPT Community Health Services. They have completed the same breastfeeding training as the 0-19 Teams and Children’s Centre staff and keep up to date with the latest information on breastfeeding.  The BBBs volunteer at Baby Brasseries, antenatal groups or Child Health Clinics. They offer mothers emotional and practical support with breastfeeding and model breastfeeding as an everyday part of life.  By promoting breastfeeding within their own community they can offer an alternative approach to reach mothers who wouldn’t have considered breast feeding.
  • Breastfeeding Welcome Award - The Award is another example of collaborative working between Bedford Borough Council (Environmental Health Department) and SEPT Community Health Services, Bedfordshire. The award is given to establishments who understand how important breastfeeding is and have committed to welcoming mothers and babies who breastfeed.  A ‘Breastfeeding Mums Welcome’ sticker is displayed by all premises that are signed up to the award.  

 

Family Nurse Partnership (FNP)

The FNP is a structured intensive home visiting programme of support for first time mothers under 20 years delivered from early pregnancy to age two years.  Introduced in the US it has shown significant benefits for vulnerable, young families improving antenatal health and parenting practice and behaviour. In terms of breastfeeding, higher numbers of young mothers initiate breastfeeding than the national rate for the same age group (FNP = 63%, UK under 20s = 53%).  FNP is being introduced in Bedford Borough in February 2015 and will have the potential to support 50 young mothers in Bedford Borough.

 

National and Local Strategies

National Strategies:

  • The Healthy Child Programme (DH, 2009) places significant emphasis on the achievement of increased rates of breastfeeding initiation and continuation, which will contribute specifically to improving breastfeeding & obesity outcomes.
  • The Public Health Outcomes Framework (DH, 2012) includes a measure of breastfeeding rates at initiation and 6-8 weeks.
  • The revised Ofsted framework for the inspection of Children Centres measures continuation of breastfeeding at 6-8 weeks after birth (Ofsted, 2013).
  • Healthy Lives, Healthy People: Our strategy for public health in England (DH, 2010) highlights the importance of ‘starting well’ through early intervention and prevention such as breastfeeding support.
  • Maternity and Early Years – making a good start to family life (DH, March 2010)
  • Maternity Matters (DH, 2009)

 

NICE Guidelines

  • NICE Guidance on Postnatal Care CG37 (December 2014)
  • NICE Guidance on Maternal and Child Nutrition (March 2008)

 

Local strategies

 

Increased breastfeeding prevalence is a key outcome that underpins Bedford Borough’s overall strategic priority to provide the best start in life for children aged pre-birth to 5 years. Breastfeeding initiation and duration at 6-8 weeks in Bedford Borough are monitored quarterly to measure progress.  The following local strategies are linked to achieving this outcome:

 

  • Bedford Borough Health and Wellbeing Strategy (2014)
  • Bedford Borough Public Health Strategy 2013/14
  • Bedford Borough Partnership Framework for Bedford Borough’s Children, Young People and Families 2014-2017.
  • Bedford Borough Early Years Strategy – Securing Firm Foundations 2015-18
  • Bedford Borough Early Help Strategy 2015-18

 

What is this telling us?

  • Evidence to support the benefits of breastfeeding to both mother and child is well established.  
  • In Bedford Borough more women are choosing to start breastfeeding and Bedford Hospital has a higher than average percentage of women who initiate breastfeeding, but the number who then stop in the early weeks is higher than average.  Unicef report that 90% of women who stop breastfeeding in the first 6 weeks give up before they want to.
  • Ensuring every woman has good quality support, particularly in the early days, is crucial in order to support those women who want to continue to breastfeed, and to reduce the drop off rate. 
  • Access to well-trained health professionals, good quality social support and positive promotion of breastfeeding to improve understanding and acceptance are all key elements of this support. Baby Friendly Standards ensure a consistent evidence based practice for both hospital and community settings. Latest NICE Guidance on antenatal care (2014) recommends implementing an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard. It should be delivered and coordinated across all providers, including hospital, primary, community and children's centre settings.

 

 

What are the key inequalities?

Whilst overall rates in the UK have increased in recent years the greatest increases are amongst older mothers, mothers form higher socio-economic groups and mothers with higher educational levels (DH, 2009). As deprivation increases women are less likely to breastfeed. Initiation and duration rates for breastfeeding are lowest amongst families from lower socio-economic groups, those with low educational achievement, and teenage mothers, who are half as likely as older mothers to initiate breastfeeding.  Lower rates in these groups result in poorer health outcomes for the mother and child, adding to inequalities in health and continuing the cycle of deprivation (NICE, 2008).  Many young mothers lack access to key sources of information and advice including antenatal classes, peer support programmes, friends, family and other support networks.

 

 Breastfeeding rates at 6-8 weeks were compared in the 20% least deprived and 20% most deprived areas in Bedford during 2012-13, 2013-14 and 2014-15 (see Graph 3).  Whilst last year the data indicated that rates are consistently lower in the most deprived areas, and the gap appeared to be widening, the data for 2014-15 is more encouraging and shows that this gap has reduced, particularly in Q1 and Q4.  

 

Breastfeeding deprived

Source: The New Public Health Dashboard [accessed 02/12/2014]

 

What are the unmet needs/gaps?

  • The antenatal visit by a Health Visitor is not yet offered to all women in Bedford, offer and take up should be monitored and the offer rolled-out on a universal basis.
  • An integrated antenatal educational programme available and accessible to all pregnant women
  • Continued targeted support, alongside the universal offer to engage mothers who are least likely to initiate and continue to breastfeed. 

 

Recommendations

  • Maintenance of full Baby Friendly Accreditation by Bedford Hospital, Bedfordshire Community Health Services and Children’s Centres.  The Baby Friendly Initiative has been shown to be effective at reaching mothers from disadvantaged backgrounds and increasing the likelihood of them breastfeeding for longer (Sustain, 2015).
  • Develop integrated working across maternity, health visiting and Children’s Services to roll out the Bump, Birth and Baby Stuff antenatal educational programme and promote take up to all pregnant women
  • Continue rollout of an antenatal appointment with a Health Visitor for all women in Bedford at 28-32 weeks of pregnancy to provide advice and information on how to breastfeed
  •  Ensure consistent information is given to all women e.g. through the Red Book and information at Children’s Centres, to enable them to easily find and access the range of local postnatal support available to them when they need it
  • Continue to train peer supporters to provide effective mother-to-mother level support, particularly amongst those groups less likely to breastfeed
  • Commissioners to set targets and monitor breastfeeding rates at initiation, 10 days and 6-8 weeks and make use of local data that can identify where there are significant differences in rates to ensure support can be targeted.

 

This chapter links to the following chapter in the JSNA:

Teenage pregnancy

 

References

Department for Health (2007) Implementation plan for reducing health inequalities in infant mortality: a good practice guide

Department of Health (2009) Healthy Child Programme; Pregnancy and the first five years of life

Department of Health (March 2010) Pregnancy and Early Years – making a Good Start to Family Life

Department of Health (2012) Improving outcomes and supporting transparency Part 1A: A public health outcomes framework for England, 2013-2016

Department of Health (2010) Healthy Lives, Healthy People: Our strategy for public health in England

Department of Health (2007) Maternity Matters: Choice, access and continuity of care in a safe service

Gutman L et al (2009) Nurturing parenting capability – the early years, London:Institute of Education, Centre for Research on the Wider Benefits of Learning

Health and Social Care Information Centre, IFF Research (2012) Infant Feeding Survey 2010:Summary

National Institute for Health and Clinical Excellence (2006) Promotion of breastfeeding initiation and duration – evidence into practice briefing

http://www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_final_version.pdf

NICE (2014) Guidelines on postnatal care

NICE (2008) Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households PH11

Renfrew, M et al. (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK

Sustain (2015) Beyond the Foodbank: London Food Poverty profile 2015

UNICEF http://www.unicef.org.uk/Documents/Baby_Friendly/Infosheets/4/effectiveness_infosheet.pdf. [Accessed 31/7/2013]

 

Back to top

For a PDF version of this chapter, please click here