1. Becoming Baby Friendly in an Ethnically Diverse Hospital
Dr Alison Spiro
Specialist Health Visitor
Making the Natural Normal Conference Feb 21st 2014

2. Themes Background Cultural diversity Meanings of breastfeeding
Action planning
Training
Impact of training
Communication skills
Gaining confidence in professional practice
Peer support at Northwick Park
Antenatal education-Saturday workshops
Neonatal Unit
Improvements in breastfeeding rates

3. Background situation in 2005
Low initiation rates (67%)
Exclusive breastfeeding rates low (32% at 6 weeks)
Mothers and professionals lacking confidence in supporting exclusive breastfeeding
Formula milk was visible and available on the wards
Culturally formula seen by mothers as normal in the UK and a sign of wealth and upward social mobility
Very little joint working between midwives and health visitors.
Mothers being given conflicting advice
Gill Lee had the vision that Northwick Park Hospital could become Baby Friendly and supported me to lead

4. Cultural Diversity
90% of mothers who deliver at Northwick Park Hospital come from ethnic minority groups
Most common ethnicity is South Asian
Harrow and Brent have largest Hindu populations in the UK
Strong cultural imperative to breastfeed
Belief that cultural beliefs and knowledge is transferred in breast milk
Influence of other women in household is strong and hierarchy is observed
Joint households are ideal and older women influence feeding decisions

5. Other Ethnic Groups African mostly Somali
Strong belief in breastfeeding but mix feed
Lack of confidence in colostrum
Focus groups showed that many do not think exclusive breastfeeding is adequate
Intervention: Somali peer supporter meet pregnant women and explain the benefits and offer support post birth
Eastern European –Polish, Romanian
Strong beliefs in breastfeeding but may supplement with teas and use pacifiers

6. Action Planning Harrow LAA grant in 2006 under ‘Every Child Matters’
UNICEF Baby Friendly Action planning jointly with Harrow
Training for health visitors had started in Harrow
Secondment to Northwick Park Hospital
UNICEF x7 facilitated 3-day training for midwives and health visitors
Peer support training started in 2005
Support groups expanded in the community
Brent started a Breastfeeding Strategy Group and began peer support training in 2006 and appointed an Infant Feeding Coordinator

7. Antenatal Conversations
Midwives discuss Breastfeeding at every contact
Bump to Breastfeeding DVD-custom made-used with discussion at 28 weeks
Invitation to Saturday workshops in notes-popular 2x monthly attendees with partners or family members
Targeted antenatal classes- Somali, teenagers, multiple births- peer supporters –Halimo, Julie and Kathryn
Hospital antenatal classes strong focus on breastfeeding
Community classes led by community midwives and peer supporters

8. Breastfeeding Training
Multi-disciplinary-midwives, doctors, health visitors, maternity assistants, neonatal nurses, peer supporters
Initially UNICEF facilitated
In-house 2-day
Informal sharing of experiences
Time-lines and attitudes explored
Communication skills-listening exercises and role play
Hearing the mother’s story
Practical helping strategies through scenarios
Challenging situations-emotional and physical

9. The Team!

10. Impact of Training
Awareness of cultural beliefs and breastfeeding globally
Knowledge of the evidence-base of health benefits
Anatomy and physiology of the breast and how a baby latches and gets good milk transfer
Emotional support and communication skills
Increased self awareness of own attitudes
Challenging breastfeeding situations and how to ask for help
Result: increase in confidence -midwives asked for formula milk to be removed from the wards after one training course
Corina and I have worked as a harmonious team!

11. Breastfeeding Support in the Neonatal Unit
Small Wonders- Best Beginnings-pilot site
Breastfeeding Team established
Aine supports mothers and babies on the unit
Paediatric staff see breastfeeding as a key priority
Peer supporters - Rachel and Zeena and Tamsin
Aine now leads the staff training
Kangaroo care is integrated into routine care plans
Julie –Peer Support Co-ordinator for Harrow, joined the Transitional Care Team in Jan 2014
Aim: to promote exclusive breastfeeding on discharge

12. Gaining Confidence in Clinical Practice
Applying UNICEF 10 steps to the clinical setting
Skin-to-skin for all babies including in theatre after caesarean section
Policies underpin practice and support exclusive breastfeeding- infant feeding, reluctant feeders’, prevention of excessive weight loss, hypoglycaemia
Work with staff and parents to recognise effective milk transfer
Observe and facilitate staff supporting mothers
Work with staff to encourage effective communication skills
Results: confident staff who instil confidence in parents

13. Peer Support in Northwick Park Hospital
Brent employed and Harrow voluntary
Mother-to-mother support on the wards
Empathy easier
Belief in breastfeeding- positive body language and attitude
Supporting breastfeeding skills
Self-aware
Communication skills
Continuity and referral for community support
Assist with teaching antenatal hand expressing

14. Peer Support in the Community

15. Harrow Baby Friendly in 2012

16. Improvement in Breastfeeding Rates

17. Conclusions
Northwick Park Hospital’s midwives, maternity assistants, doctors,nurses and nursery nurses can be proud of the breastfeeding support they give parents
Changes in practice should be sustainable now underpinned by policies
Breastfeeding training needs to continue to address staff attitudes and communication skills
Awareness of cultural practices essential

18. Vision: All Mothers receive high quality Support with feeding their Babies