SWMMNN Infant Feeding Policy: Neonatal Unit

Purpose

This Infant Feeding Policy is to ensure that all staff working with Mothers and babies on the neonatal unit understand their role and responsibilities in supporting parents to feed and care for their baby in ways that support optimum health and well-being.

This includescommitting to the following minimum standards of care:

1.That Parents are supported to have a close and loving relationship with their baby;

2. That Babies are enabled to receive breastmilk and to breastfeed when possible;

3. That Parents are valued as partners in care.

These standards of care recognise the importance of early and secure, parent-infant relationships, to the future health and well-being of the infant, given the specific challenges that arise from the experience of having a sick or premature baby. The standards recognise the significant contribution that breastfeeding makes to good physical and emotional health outcomes for these infants and their mothers. They ensure that all care is mother/family-centred and non-judgemental. The standards also ensure that parents’ decisions are supported and respected with the overall aim of improving parents’ experiences of neonatal care.

All staff are expected to comply with this policy.

Outcomes:

This policy aims to ensure that the care provided improves outcomes for infants and their families, specifically to deliver:

  • Increases in the number of babies receiving breastmilk whilst on the neonatal unit
  • Increases in breastfeeding initiation rates whilst on the neonatal unit
  • Increases in the number of babies who are discharged home from the neonatal unit, breastfeeding or breastmilk feeding
  • For those Mothers choosing to formula feed their baby: Increases in the proportion of these Mothers reporting that they have received support to formula feed as safely as possible in line with Department of Health guidance
  • Improvements in parents’ experiences of care on the neonatal unit.

The service will ensure that:

  • All new staff are familiarised with the policy within one week of commencing their employment.
  • All staff receive training to enable them to implement the policy as appropriate to their role.
  • New staff receive this training within 6 months of commencement of employment.
  • The International Code of Marketing of Breastmilk substitutes is implemented throughout the service.
  • All documentation fully supports the implementation of these standards.
  • Parents’ experiences of care will be listened to through: regular audit using the Babyfriendly Initiative Audit Tool, parents’ experiences surveys e.g.Care Quality Commission, Bliss Baby Charter Audit tool, Family & Friends Test etc.

Care Standards:

A) Support Parents to have a close and loving relationship with their Baby:

  1. Enable parents to spend as much time as possible with their baby by ensuring: Parents are made comfortableand offeredunrestricted access to their baby unless restrictions can be justified in the best interests of the baby or parents of other babies on the unit;
  1. Encourage & enable parents to provide comfort and emotional support for their baby:
  • By providing parents with written information,in the form of BLISS leaflets, and verbal information from staff, about the importance of regular skin to skin contact (kangaroo care) and positive touch as soon as possible after the baby’s admission to the unit;
  • By encouragingparents to spend prolonged periods of time (at least an hour at a time) in kangaroo care as soon as possible after birth and then as often as their baby’s condition allows, throughout their baby’s stay on the unit;
  • By showing parents how they can comfort their baby if distressed by using containment holding, positive touch and non-nutritive sucking on a dummy.
  1. Encourage parents to communicate with their baby and to understand their baby’s emerging behavioural cues:
  • By providing parents with written information in the form of BLISS leaflets and verbal information from staff about recognising and responding to their baby’s behavioural cuesand their emerging feeding skills;

B) Enable babies to receive breastmilk and to breastfeed where possible

4.To facilitate parents in their understanding of the importance of breast milk for the health and development of sick and preterm babies,staff will ensure that:

  • Mothers have a discussion regarding the importance of breast milk for their preterm or sick baby during the ante-natal period and as soon as possible after birth;
  • Mother’s own breast milk is always the first choice of feed for her baby;
  • In situations where there is insufficient breast milk available,the use of formula milk or donated breast milk remains a clinical decision and should be given only with informedconsent from the parents and with full support for the Mother to establish her own milk supply;
  • The use of intravenous fluids,whilst either waiting for sufficient volumes of breastmilk or whilst waiting for the baby to be able to breastfeed effectively, remains a clinicaldecisionthat should be discussed fully with the parents.
  1. To enable Mothers to express breast milk for their baby, staff will ensure that:
  • The Mother will receive support either from her midwife or from her baby’s nurse, to hand express her colostrum– ideally within the first 6 hoursafter birth, in order to initiate milk supply and provide colostrum for trophic feeding;
  • Expressing will then continue at least eight times in 24hrs including once in the night, with no intervals longer than 6hrs- especially during the first two weeks, in order to optimise long-term milk supply;
  • Sufficient numbers of breast pumps are available for Mothers to use when visiting their babies on the unit as well as to ensure that all mothers can continue to express at home whilst their baby remains on the unit;
  • Mothers are fitted with a funnel of appropriate size/comfort and are shown how to use the electric breast pump effectively after the first 24-48hrs or once the colostrum is increasing in volume.
  • Mothers can express by hand or pump at their baby’s cotside or have access to a private and comfortable expressing room;
  • Mothers are supported to use the pump effectively and to store milk safely when at home;
  • Mother’s milk supply is monitored at least 4 times in the first two weeks (refer to SWMNN ‘Tube to Breastfeeding’ guideline) and the Mother is referred to an Infant Feeding Advisorif there are issues of low milk supply(expressing less than 350mls in 24hours by day 7) or other breastfeeding or expressing challenges.
  1. To provide support for Mothers during the transition to breastfeeding(refer to SWMNN ‘Tube to Breastfeeding’ Guideline),staff will ensure that:
  • Mothers are encouraged to use their expressed milkfor mouth care and for flavouring a dummy during tube feeding;
  • Mothers are encouraged to observe for early signs of interest in the breastespecially when she is in skin to skin contact with her baby;
  • Mothers are supported with effective positioning and attachmentof baby at the breast whenever feeding cues are shown;
  • TheMother is offered help and support to recognise the effectiveness of herbreastfeeding (see Appendix: Breastfeeding Assessment Chart) with appropriate referral to an Infant Feeding Advisor if breastfeeding challenges arise;
  • Mothers are provided with details of voluntary support for breastfeeding and pump hire,which they can access at any time during their baby’s stay;
  • Mothers have the opportunity to stay overnight or for extended periods to support their confidence in breastfeeding and the transition to modified responsive feeding;
  • Where a community outreach team is available: A full discussion with the Neonatal Community Outreach Team (NCOT) is recommended to ensure a smooth transition to full breastfeeding once the Mother and baby are discharged into NCOT care;
  1. To ensure Parents who formula feed are supported with the transition from tube to bottle feeding(refer to SWMMNN Bottle Feeding Guideline),staff will ensure that:
  • Parents are encouraged to spend as much time as possible in skin to skin contact with their baby throughout their stay;
  • Parents are facilitated to recognise behavioural cues and are supported to offer a bottlefeed at these cues using an elevated side-lying position. Parents are facilitated to recognise signs of stress during a feed and to respond accordingly;
  • Written and verbal information is givento parents on how to clean and sterilise bottle feeding equipment and how to make up powdered milk feeds safely at home using the Department of Health’s publication: ‘Guide to Bottle Feeding’;
  • Parents have the opportunity to room-in with their baby prior to discharge home, to help establish feeding and to increase their confidence with caring for their baby 24 hours a day.
  • Where a community outreach team is available: A full discussion with the Neonatal Community Outreach Team (NCOT) is recommended to ensure a smooth transition to full bottlefeeding once the baby is discharged into NCOT care.

C) Value Parents as Partners in Care

  1. In order that Parents are valued as Primary Partners In Care, staff will ensure that:
  • Parents are offered an “admission pack” containing Bliss booklets and leaflets about how the unit operates and what to expect in the coming days and weeks; this pack includes the DVD ‘Small Wonders’ which parents are encouraged to watch on the unit and at home to help them adjust to life on a NNU;
  • Parents are encouraged to attend ward rounds to gain full information regarding their baby’s condition and treatment to enable them to make informed decisions where needed;
  • Parents observations, feelings and wishes regarding their baby’s care will be listened to by staff and appropriate support and responses made;
  • Parents are encouraged to be fully involved in their baby’s care, with all care entrusted to them where and whenever possible.

Monitoring Implementation of the Standards:

Compliance with this policy will be audited at least once per year using the Babyfriendly Audit Tool (2013 edition). Audit results will be reported to the Head of Neonatal Unit Service and an action plan will be agreed with the Neonatal Unit Manager and Infant Feeding Advisor, to address any identified areas of non-compliance.

Outcomes will be Monitored by:

  • Annual Breast milk feeding rates
  • Annual Breastfeeding rates
  • Annual Breast milk feeding rates for Babies born under 33 weeks gestational age during stay on the NNU and at discharge home.

Outcomes will be reported to:

Head of Neonatal Unit Service

Unit managers

Medical Director of the Neonatal Service

Neonatal Unit Staff

Appendix