Support from the Start

Breastfeeding Pathways

The Support from the Start Breastfeeding Pathway (2010) identifies the strategies and programmes in place to support breastfeeding up to 8 weeks in East Lothian. This pathway identifies current programmes and those in development as well as areas of opportunity which could be explored further to support breastfeeding. Through consultation with various stakeholders, “Key Decision Times” identify areas that can be focused on to maximize limited resources.

This is a multi-purpose pathway which can be used to identify gaps in the current service and used on a practical level to access current policies, resources and stakeholders involved with supporting breastfeeding. It is a dynamic document and is intended to be amended and updated. When accessed online, links to documents and websites will be easily available.

Summary

To support breastfeeding in East Lothian, fourkey areas of work were identified: Culture, Antenatal support, Support at Birth-first 48 hours and Support in the postnatal period.

Culture:

The effect that culture and society have on our attitudes towards breastfeeding can not be underestimated. This is a significant but vast area with many influences beyond the scope of this pathway. However, the Breastfeeding Friendly Premises Awards, Nursery award and Breastfeeding Awareness project for schools are examples of local interventions which aim to normalize breastfeeding in our community and promote positive culture change.

Gaps

  • A visible breastfeeding friendly culture demonstrated in target areas of East Lothian
  • Normalization of breastfeeding to infants and young children
  • Sustainable social marketing campaigns in target areas

Antenatal support:

Most antenatal support is available through maternity and GP services. The Breastfeeding Pathway-Antenatal is currently being amended and will be finalized in May 2010. The resources given to women identified in the antenatal pathway have been imbedded in this document.

Gaps

  • Partnership working with East Lothian General Practitioners to identify areas of opportunity in their practice to support and encourage breastfeeding
  • Accessible and affordable antenatal classes to parents in target areas

Birth

The NHS Lothian Breastfeeding Pathway also identifies the level of care and support needed at birth and within the first 48 hours. This pathway is informed by the UNICEF Baby Friendly guideline which promotes skin to skin contactand breastfeeding within the first hour along with competent and consistent breastfeeding support. As these services are primarily clinical and provided by midwives at hospital or at home for a homebirth, East Lothian specific services do no generally apply.

Postnatal support

Postnatal support again relies on specialist, individual tailored breastfeeding support which spans a variety of issues and challenges.

Although this support has been traditionally available in East Lothian, further investigation is needed to assess if a consistent level of service is being offered in all areas of East Lothian, in particular, the target areas.

Gaps

  • Accessible and convenient peer support groups in target areas
  • Accessible and convenient specialist breastfeeding clinics in target areas
  • Knowledge of current breastfeeding back to work policies

Recommendations

From this mapping exercise, the following recommendations will address the gaps identified through this process

Culture

  • A 25% increase in participation of the Breastfeeding Friendly Premises Awards in all target areas[1], specifically council fundedpremises such as recreation centers, libraries and health centers
  • Aim to have all schools and nurseries in target area certified as a breastfeeding friendly premise by April 2011
  • Continue to develop school-based curriculum in partnership with the National Childbirth Trust with all schools in target areas to teach developed curriculum by April 2011
  • Promote the Breastfeeding Friendly Premises “Gold Award” to all businesses in target area to help foster a friendly environment for breastfeeding mothers returning to work.

Antenatal

  • Monitor the implementation of the NHS Lothian Breastfeeding Antenatal Pathway in target areas to assess any changes in breastfeeding rates
  • Establish and maintain accessible and affordable antenatal classes in target areas.
  • Foster partnerships between general practitioners that ensure that they are well informed about NHS Lothian Antenatal Pathway and can refer appropriately.

Birth and first 48 hours after birth

  • Monitor the implementation of the NHS Lothian Breastfeeding Birth and Postnatal Pathway to ensure that consistent support is offered to East Lothian women by midwives in hospital, breastfeeding clinics (at hospital), Peer support, community midwifery visits(after discharge at hospital or after homebirth)

Postnatal

  • Assess accessibility of Peer Support breastfeeding groups in target areas
  • Assess accessibility of Breastfeeding Support Specialist Clinics in target areas
  • Currently “Breastfeeding and returning to work” booklet given at first prenatal appointment; assess effectiveness of this intervention.

[1]Target areas are: Wallyford, Whitecraig, Prestonpans and Tranent