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					Trust Policy                All Sites




           BREASTFEEDING POLICY

THIS DOCUMENT IS BASED ON THE BREASTFEEDING POLICY (2004) OF SOUTH
          WORCESTERSHIRE PRIMARY CARE TRUST (SWPCT)

   IT HAS BEEN UPDATED IN LINE WITH BABY FRIENDLY REQUIREMENTS


Lead Clinician: Helena Wood             Professional Practice Facilitator for
                                        Health Visiting
Lead Director     Sandra Rote           Director of Clinical Development and
                                        Lead Executive Nurse


Ratified by Worcestershire PCT Quality and Safety August 2007
Group
This policy should not be used after end of:      August 2009

Links into Healthcare Standard:

Impact Analysis (Race Equality)

Impact Analysis (Mental Capacity Act)
                                CONTRIBUTION LIST

          KEY INDIVIDUALS INVOLVED IN DEVELOPING THIS DOCUMENT

    Name                                     Designation
    Amanda Donovan                           Health Visitor

    Margaret Gorman                          Health Visitor Sure Start

    Julia Greer                              Health Visitor

    Anthea Griffiths                         Midwife          Sure Start

    Karen Marsh                              Health Visitor Sure Start

    Jan Nelson                               Health Visitor


Prior to ratification by WPCT, the WPCT Breastfeeding Policy 2007 was circulated to the
following for comments

 Name                                          Designation
 Dr Liz Altay                                  Consultant in Public Health WPCT
 Marie McCurry                                 Associate Director Of Provider Services
 Mary Hare                                     NCT Bromsgrove
 Community Dieticians                          POWCH
 Ann Hooper                                    SureStart Midwife Redditch

 Chris Poyzer                                  Senior Midwife Worcestershire Acute Hospitals
                                               NHS Trust (WAHT)

 Nisha Sankey                                  Project Manager, SWPCT

 Alison Tilley                                 Community Midwifery Team Leader
 Penny Turton                                  Lactation Consultant, Infant Feeding Advisor,
                                               Worcestershire Acute Hospitals NHS Trust
                                               (WAHT)
 Members of WPCT Health Visiting
 Professional Development Group
 Members of Worcestershire Infant Feeding
 Group
 Saeeda Shah                                   BLINK Counsellor/Parents
 Sue Swinbourne
 Mary Taylor                                   Clinical Governance Coordinator
 Helena Wood                                   Professional Practice Facilitator Health Visiting
                                               W PCT
 Sarah Beresford-Smith                         Community Nursery Nurses and Breast Feeding
 Brenda Webb                                   Support .Redditch
 Debbie Cambridge                              Parents
 Nicola Bate
 Rosalind Dovans




WPCT Breastfeeding Policy                                                         2 of 11
Contents


PRINCIPLES ............................................................................................................................4

AIMS OF THIS POLICY ...........................................................................................................4

IN SUPPORT OF THIS POLICY ..............................................................................................4

SCOPE OF THIS POLICY .......................................................................................................5

POLICY STANDARDS .............................................................................................................5

      Communicating the Breastfeeding Policy .........................................................................5

      Training Health Care Staff.................................................................................................5

      Informing Pregnant Women of the Benefits and Management of Breastfeeding ..............6

      Supporting the Establishment and Maintenance of Lactation ...........................................6

      Supporting Exclusive Breastfeeding .................................................................................7

      A welcome for Breastfeeding Families..............................................................................8

      Encouraging Community Support for Breastfeeding.........................................................8

BREASTFEEDING POLICY MONITORING TOOL..................................................................9

BREASTFEEDING POLICY: APPENDIX 1............................................................................10

REFERENCES.......................................................................................................................11




WPCT Breastfeeding Policy                                                                                                 3 of 11
INTRODUCTION

PRINCIPLES

1.     WPCT believes that breastfeeding is the healthiest way for a woman to feed her
       baby and recognizes the important health benefits now known to exist for both the
       mother and her childa

2.     WPCT believes that all mothers have the right to receive clear, impartial and timely
       information, to enable them to make fully informed decisions about feeding and
       caring for their babies.

3.     WPCT believes in fully supporting mothers in their chosen method of infant
       feeding.

4.     WPCT believes that breastfeeding can become the norm for infant feeding in
       Worcestershire. Breastfeeding is promoted by ensuring that all relevant health care
       staff undertake mandatory training appropriate to their role, and are equipped to
       offer regular and reliable support and encouragement to parents. Breastfeeding is
       further promoted by widespread awareness raising regarding the benefits of
       breastfeeding for parent and child.

AIMS OF THIS POLICY

1.     To ensure that the health benefits of breastfeeding and the potential health risks of
       formula feeding are discussed with all women and their families, so that they can
       make an informed choice about how they will feed their babies.

2.     To create an environment where more women choose to breastfeed their babies,
       and where more women are given sufficient information and support to enable
       them to breastfeed exclusively for 6 months, and then as part of their infant's diet
       for as long as they both wishb

3.     To enable all healthcare staff that have contact with breastfeeding women, to
       provide full and competent support through specialized training in all aspects of
       breastfeeding management.

4.     To encourage delivery of a seamless service, through liaison with allied agencies
       who support breastfeeding women.

5.     To promote the development of a breastfeeding culture throughout the local
       community.

Progress towards achievement of these aims will be assessed on an annual basis.

IN SUPPORT OF THIS POLICY

As a condition of their employment all practitioners and volunteers will be required to
adhere to this policy to avoid conflicting advice being given to parents. Any deviation from
this policy by health practitioners must be justified and recorded in the mother's and/or
baby's health care records. This should be done in the context of professional judgment
and codes of conduct. It is the responsibility of all health care professionals to liaise with
others should concerns arise about the baby's health.




WPCT Breastfeeding Policy                                                              4 of 11
All practitioners and volunteers will be made aware of the good practice guidelines for the
support of breastfeeding in special situations, and for the management of common
complications, agreed by the Worcestershire Infant Feeding Group.

WPCT, will commission a review of the policy and guidelines every two years.

WPCT will commission an annual audit of compliance with this policy.

Advertising of breast milk substitutes, feeding bottles, teats and dummies (all of which are
potentially detrimental to breastfeeding) or their manufacturers and suppliers, will not be
permitted on WPCT premises or in printed material produced by WPCT c No literature
provided by manufacturers of breast milk substitutes will be distributed by WPCT.

Only relevant educational materials approved by the Worcestershire Infant Feeding Group
will be used within WPCT.

Health Visitors Teams will ensure that parents who have made a fully informed choice to
feed their baby using breast milk substitutes are competent to do so, by demonstration if
necessary, during the postnatal period. No routine group instruction on the preparation of
artificial feeds will be given in the antenatal period, as this has the potential to undermine
confidence in breastfeeding.



SCOPE OF THIS POLICY

This policy applies to all health visitors and community nursery nurses working with
families and young children, and directs the care of all pregnant women and women with
young babies who come into contact with the health visiting teams of WPCT

POLICY STANDARDS

Communicating the Breastfeeding Policy

1.1    This policy is to be communicated to all health care staff through the established
       induction and orientation programme within the first month of employment via the
       named Breastfeeding Key Worker for their base and thereafter through mandatory
       annual updates. It will be available at all health visitor bases and via the WPCT
       website.

1.2    All new staff having contact with pregnant women and mothers will be orientated to
       the policy as soon as their employment begins. This is a mandatory requirement.

1.3    Information about this Policy will be displayed in all Trust premises, where a full
       copy will be available for reference. The policy will be made available to non-
       English speakers via the local interpreter scheme, and this document can be made
       available in large print, Braille, audio or other languages by contacting LTA
       Communication on 01386 872 776.

Training Health Care Staff

2.1    Midwives and health visitors have the primary responsibility for supporting
       breastfeeding women and for helping mothers to overcome related problems.




WPCT Breastfeeding Policy                                                              5 of 11
2.2    The responsibility for ensuring training is in place for health visiting teams, lies with
       Worcestershire Infant Feeding Group, which will develop and provide in-house
       training for health visitors community nursery nurses and reception staff and will
       audit the uptake, monitor feedback, and publish results on an annual basis.

2.3    All members of health visiting teams will receive standardized initial training in
       Breastfeeding Management. Thereafter, all members of health visiting teams will
       attend a 2-yearly, 1-day breastfeeding update.
2.4    All professional and reception staff with contact with pregnant women will receive
       training in breastfeeding management at a level appropriate to their professional
       group.
2.5    New staff will receive training within six months of taking up their posts as part of
       their local induction programme.

2.6    All teaching materials including written curricula will reflect the WHO/UNICEF
       Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in
       Community Settings. (Appendix 1)

Informing Pregnant Women of the Benefits and Management of Breastfeeding

3.1    It is the responsibility of professional staff employed by WPCT to ensure that all
       pregnant women are aware of the benefits of breastfeeding and the potential
       health risks of formula feeding.

3.2    The physiological basis of breastfeeding should be clearly and simply explained to
       all pregnant women, together with good management practices and some of the
       common experiences they may encounter. The aim should be to give women
       confidence in their ability to breastfeed.

3.3    All pregnant women will be given an opportunity to discuss infant feeding on a
       one-to-one basis with a midwife or health visitor, to enable them to make a fully
       informed choice as to how they will feed their baby.

3.4    Parents will be fully supported in their chosen method of infant feeding, whatever
       their decision.

3.5    All materials and teaching will reflect the WHO/UNICEF Seven Point Plan for the
       Protection, Promotion and Support of Breastfeeding in Community Settings.
       (Appendix 1)

Supporting the Establishment and Maintenance of Lactation

4.1    All mothers should be encouraged to hold their babies in skin-to-skin contact as
       soon as possible after delivery in an unhurried environment, and to offer the first
       breastfeed when mother and baby are ready, normally within the first hour after
       delivery. In practice, the responsibility for this lies with WAHT.

4.2    Midwives and health visitors should ensure that mothers are offered the support
       necessary to acquire the skills of positioning and attachment and hand expression
       of breast milk.

4.3    Hand over of care from midwife to health visitor will follow established procedure,
       with health visitors usually making their first visit at 11-14 days post-natal. The
       health visitor will offer support to a breastfeeding mother, in negotiation with her
       and in response to identified need


WPCT Breastfeeding Policy                                                                6 of 11
4.4    Health professionals should ask about the progress of breastfeeding at each
       contact with a breastfeeding mother. This will enable early identification of any
       potential complications and allow appropriate information to be given to prevent or
       remedy them.

4.5    It is the responsibility of those health professionals caring for her to ensure the
       mother is given help and encouragement to express her milk and to maintain her
       lactation during periods of separation from her baby.

4.6    Mothers will be encouraged to keep their babies near them day and night. This
       enhances milk production, encourages bonding and mothers recognition of her
       baby’s feeding cues and needs. They will be given appropriate information about
       the benefits of and contraindications to bed-sharing.

4.7    Baby lead/demand feeding must be promoted for all healthy babies as this practice
       stimulates lactation. The importance of night feeds for milk production must also
       be explained to mothers.

4.8    Parents wishing to use artificial teats or dummies should be advised of their
       potentially detrimental effects on breastfeedingd, to enable them to make a fully
       informed choice.

4.9    The potential consequences of the use of nipple shields should be explained to
       motherse, and their use discouraged except for a limited period in extreme
       circumstances. Mothers will be offered additional support from an appropriately
       trained staff member during the period that nipple shields are used.

4.10   All breastfeeding mothers returning to work will be given information, which will
       support them to continue breastfeeding and maintain lactation at this time.

Supporting Exclusive Breastfeeding

5.1    During the first 6 months, breast milk is sufficient to meet a baby’s nutritional
       needs; additional water or artificial feeds are not required and will not be
       recommended by members of staff. However, parents will be supported to make
       an informed choice in this matter based on their baby’s particular health needs by
       an appropriately trained health or medical professional.

5.2    The potentially detrimental effects of supplementation on breastfeeding and the
       associated implications for health should be explained to parents, so that if they
       elect to supplement their baby’s breast feeds with formula milk they are able to
       make a fully informed choice to do so.

5.3    All mothers should be encouraged to breastfeed exclusively for the first 6 months
       and to continue breastfeeding for at least the first year of life. All weaning
       information should reflect this ideal.

5.4    In support of this policy, data on infant feeding showing the prevalence of both
       exclusive and partial breastfeeding will be collected using the Personal Child
       Health Record (PCHR) at the following stages:

       •   first feed following delivery

       •   type of feeding on discharge from hospital




WPCT Breastfeeding Policy                                                          7 of 11
        •   Health visitor new birth visit

        •   2, 3 and 4 months post delivery, at immunisation contacts.(plus MMR contact).

A welcome for Breastfeeding Families

6.1     Breastfeeding will be regarded as the normal way to feed babies and young
        children.

6.2     Mothers will be enabled and supported to feed their infants throughout the Trust
        premises

6.3     Comfortable facilities will be made available for mothers who prefer privacy.

6.4     Signs in reception and waiting areas of Trust premises will inform users of this
        policy.

Encouraging Community Support for Breastfeeding

7.1     WPCT supports co-operation between health care professionals and voluntary
        support groups whilst recognizing that health care providers have their own
        responsibility to promote breastfeeding.

7.2     Information about local sources of breastfeeding support will be compiled and
        regularly updated by the Worcestershire Infant Feeding Group. This information
        will contain contact details of support groups and voluntary breastfeeding
        counsellors, as well as general information about contacting the midwifery and
        health visiting services. It will be issued to all mothers, circulated to GP premises
        for information, and routinely displayed in all public areas of the Trust premises.

7.3     Breastfeeding mothers and local voluntary groups with an interest in breastfeeding
        will be invited to contribute to the further development of this policy, and to local
        initiatives to support breastfeeding, through involvement in the Worcestershire
        Infant Feeding Group.

7.4     Members of health care team should use their influence wherever and whenever
        possible to encourage a breastfeeding culture in the local community.

7.5     WPCT in partnership with WAHT and Sure Start Children’s Centres, will work with
        local breastfeeding support groups to raise community awareness of the
        importance of breastfeeding and to encourage the provision of facilities for
        breastfeeding mothers and infants through liaison with local businesses, local
        authorities, community groups and the media.

7.6.1   Opportunities to influence or contribute to educational programmes in local schools
        (e.g. as part of the role of school nurses) will be explored where workload permits.

7.6.2   WPCT and WA.HT will work together, with Sure Start Children’s Centres               to
        achieve UNICEF Baby Friendly Status work commencing July 2007.




WPCT Breastfeeding Policy                                                               8 of 11
BREASTFEEDING POLICY MONITORING TOOL

  Standard           Description                            Target %                         Monitoring by                           Exceptions
  1.                Policy information is displayed in 100%            Survey by Infant Feeding Group involving the local None
  Policy            all Trust premises routinely                       community
  communication     accessed by mothers and
                    babies

  2, 4.              Initial training for health visitors   100%       Monitoring carried out by Infant Feeding Group, ensuring None
  Training and       and health visiting team               within 9   compliance, and reporting on numbers of staff trained to HV
  providing          members                                months.    Education Working Group on an annual basis
  informed
  support            2 yearly update sessions                          Monitoring carried out by the Infant Feeding Group who will
                                                                       ensure compliance and report numbers of staff trained
                                                                       annually to the Infant Feeding Group
  3.                 Breastfeeding literature, clinical 100%           Monitoring carried out by Infant Feeding Group, and local None
  Information        equipment and pens do not                         community mothers through a review of literature available
                     advertise   manufacturers       of                in WPCT premises on an annual basis.
                     formula milk, feeding bottles,
                     teats or dummies.

  5.                 WPCT      is  committed     to 100%               Breastfeeding data is collected using the PCHR and None
  Supporting data    supporting child health by                        collated by the child health department
                     encouraging breastfeeding and
                     improving local breastfeeding                     The Infant Feeding Group monitors this Information.
                     rates

  6.                 Signs in all public areas of 100%                 Survey by Infant Feeding Group                                None
  Breastfeeding      premises used for Trust actives
  welcome            will inform users of this approach

  7.                 Information about local sources 100%              Survey by local breastfeeding mothers, coordinated by an None
  Encouraging        of breastfeeding support to be                    appropriately supported volunteer, who will report to the
  community          displayed in all WPCT premises                    Infant Feeding Group
  support for
  breastfeeding


WPCT Breastfeeding Policy                                                                                                               9 of 11
BREASTFEEDING POLICY: APPENDIX 1



                 UNICEF Baby Friendly Seven Point Plan
        for the protection, promotion and support of breastfeeding
                     in community health care settings
                         All providers of community health care should:


   1.             Have a written breastfeeding policy that is routinely communicated to all
                  healthcare staff


   2.             Train all staff involved in the care of mothers and babies in the skills
                  necessary to implement the policy


   3.             Inform all pregnant women about the benefits and management of
                  breastfeeding


   4.             Support mothers to initiate and maintain breastfeeding


   5.             Encourage exclusive and continued breastfeeding, with appropriately
                  timed introduction of complementary foods


   6.             Provide a welcoming atmosphere for breastfeeding families


   7.             Promote co-operation between healthcare staff, breastfeeding support
                  groups and the local community




WPCT Breastfeeding Policy                                                                10 of 11
REFERENCES

a
 Standing Committee on Nutrition of the British Paediatric Association (1994): Is breastfeeding
beneficial in the UK? Arch Dis. Child, 71: 376-80.
b
  In May 2003, the Department of Health adopted the World Health Organization recomendation
that babies be exclusively breastfed for the first 6 months of their lives.
c
   The Infant Formula and Follow-on Formula Regulations 1995 stipulate a legal
requirement that infant formula advertising should be restricted to baby care publications
distributed through the health care system. There is no legal requirement for Trusts in the UK
to comply with the International Code of Marketing of Breast milk Substitutes (WHO,
Geneva, 1981). However, the requirements of the Baby Friendly Initiative are based on the
International Code, which aims 'to contribute to the provision of safe and adequate nutrition for
infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of
breast milk substitutes, when these are necessary, on the basis of adequate information and
through appropriate marketing and distribution.' Articles 5 and 6 of the Code state that no
promotion of breast milk substitutes, bottles or teats should occur.
d
    Woolridge M W. The anatomy of infant sucking. Midwifery 1986; 4: 164-171.
e
 La Leche League International: The Breastfeeding Answer Book; Franklin Park, Illinois,
1991




WPCT Breastfeeding Policy                                                              11 of 11

				
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