CENTRAL SURREY HEALTH BREASTFEEDING POLICY

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1 CENTRAL SURREY HEALTH BREASTFEEDING POLICY PRINCIPLES To ensure that all children receive a chance to grow and develop to their fullest potential, it is not enough simply to make breastfeeding possible; it must be vigorously protected and supported by appropriate public policies and supported by health systems and families. Breastfeeding: Foundation for a Healthy Future. UNICEF Central Surrey Health believes that breastfeeding is the healthiest way for a woman to feed her baby and recognises the important health benefits now known to exist for both the mother and her child. (1) All mothers have the right to make a fully informed choice as to how they feed and care for their babies. The provision of clear and impartial information to all mothers at an appropriate time is therefore essential. Health care staff will not discriminate against any woman in her chosen method of infant feeding and will fully support her when she has made that choice. This policy is designed to ensure good professional practice, not to dictate the choices of mothers. AIMS 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 wish.(2). To encourage liaison with other health care facilities and delivery of a seamless service, together with the development of a breastfeeding culture throughout the local community. To enable all health care staff who have contact with breastfeeding women to provide full and competent support through specialised training in all aspects of breastfeeding management. To ensure all health professionals give consistent, evidence based advice and maintain competence. (Accountability for Practice; Code of Professional Conduct: Nursing and Midwifery Council (NMC) 2002) - 1 -

2 IN SUPPORT OF THIS POLICY It is crucial that all staff adhere to this policy to avoid conflicting advice. Any deviation from the policy 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 judgement 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. Guidelines for the support of breastfeeding in special situations and the management of common complications will be drawn up and agreed by a multi-disciplinary team of professionals with clinical responsibility for the care of mothers and babies. The policy and guidelines will be reviewed annually. Compliance with the policy will be audited on an annual basis. No advertising of breast milk substitutes, feeding bottles, teats or dummies is permissible in this Trust/health centre. The display of logos of manufacturers of these products on all items is also prohibited, for example calendars, stationary, posters, pens, cups, diary covers, tape measures, baby age, calculators and conversion charts. (3) Breastmilk substitutes will not be sold by facility staff or on health care premises. No literature provided by manufacturers of breast milk substitutes is permitted. Educational materials for distribution to women or their families must be approved by the lead professionals. A nominated professional will be assigned responsibility for meeting with representatives from the manufacturers. Parents who have made a fully informed choice to feed their babies artificially should be shown how to prepare formula feeds correctly, either individually or in small groups, in 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. THE POLICY 1. Communicating the Breastfeeding Policy 1.1 This policy is to be communicated to all health care staff who have any contact with pregnant women and mothers, including those employed outside the facility. All staff will receive a copy of the policy. 1.2 All new staff will be orientated to the policy as soon as their employment begins The policy will be available for inspection in all areas of Trust premises/ clinics/ parts of the health centre, and a parent s guide to the policy will be displayed (See appendix 1) - 2 -

3 1.3. This policy should be read in conjunction with the Surrey Infant and Child Feeding Guidelines 2007, available at 2. Training Health Care Staff 2.1 Midwives and health visitors have the primary responsibility for supporting breastfeeding women and for helping them to overcome related problems. 2.2 All professional, clerical and ancillary staff who have contact with pregnant women and mothers will receive training in breastfeeding management at a level appropriate to their professional group. New staff will receive training within six months of taking up their posts. 2.3 The responsibility for providing appropriate training lies with the lead professional for Central Surrey Health, who will audit the uptake and efficacy of the training and publish results on an annual basis. 3. Informing Pregnant Women of the Benefits and Management of Breastfeeding 3.1 Every effort must be made to ensure that all pregnant women are aware of the benefits of breastfeeding and of the potential health risks of formula feeding. 3.2 All pregnant women should be given an opportunity to discuss infant feeding on a one-to-one basis with a midwife and health visitor. Such discussion should not solely be attempted during a group parent education class. 3.3 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. 3.4 All materials and teaching should reflect the WHO/UNICEF Ten Steps to Successful Breastfeeding and Seven Point Plan. 3.5 Health professionals should be aware of and encouraged to include fathers/ partners/ families in information and training on breastfeeding 4. 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. 4.2 Health visitors will ensure that mothers know how to correctly position and attach their babies for breastfeeding, and know how to hand express their breast milk effectively. 4.3 It is the responsibility of those health professionals caring for her to ensure that a mother is given help and encouragement to express her milk and to - 3 -

4 maintain her lactation during periods of separation from her baby. For example, when her baby is in a neonatal unit, or otherwise hospitalised, or when the mother is returning to work. 4.4 Mothers should be encouraged to keep their babies near them so that they can learn to interpret their babies needs and feeding cues. Baby-led (demand feeding) should be promoted for all health babies. The importance of night feeding for milk production should also be explained. Keeping mothers and babies together at night is beneficial for mother-baby relationships as well as for breastfeeding. Mothers will be given appropriate information about the benefits of and contra-indications to bed sharing. 4.5 Midwives and health visitors will ensure that a women s breastfeeding history is discussed as part of the handover of care. 4.6 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. 4.7 Health care staff should not recommend the use of artificial teats or dummies during the establishment of breastfeeding. Parents wishing to use them should be advised of the possible detrimental effects on breastfeeding to allow them to make a fully informed choice. 4.8 Nipple shields should not be recommended except in extreme circumstances and then only for as short a time as possible. The potential consequences of their use should be explained and the mother should receive the support of an appropriately trained professional throughout. 4.9 All staff returning to work should be supported to continue breastfeeding. 5. Supporting Exclusive Breastfeeding 5.1 For the first 6 months, no water or artificial feed is to be recommended for a breastfed baby, unless clinically indicated. (2) Parents who elect to supplement their baby's breastfeeds with formula milk should be made aware of the potential health implications and of the harmful impact supplementation may have on breastfeeding, so as to allow them to make a fully informed choice. 5.2 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. (2) 5.3 Data on infant feeding showing the prevalence of both exclusive and partial breastfeeding will be collected at all screening and health care reviews

5 5.4 All health care staff should promote the Healthy Start Initiative by informing pregnant women and their families about the scheme and how to get an application form and use this opportunity to discuss healthy eating and breastfeeding. 6. Providing a Welcome for Breastfeeding Families 6.1 Breastfeeding should be regarded as the normal way to feed babies and young children. 6.2 Mothers should be enabled and supported to feed their infants in all public areas of Trust premises. 6.3 Comfortable facilities will be made available for mothers who prefer privacy. 6.4 Signs in all public areas of the facility will inform users of this policy (see appendix 1). 7. Encouraging Community Support for Breastfeeding 7.1 Central Surrey Health supports co-operation between health care professionals and voluntary support groups whilst recognising that health care facilities have their own responsibility to promote breastfeeding. 7.2 Telephone numbers (or other means of contact) for breastfeeding drop-in clinics, infant feeding advisors, community midwives, health visitors and voluntary breastfeeding counsellors will be issued to all mothers and will be routinely displayed in all public areas. 7.3 Breastfeeding support groups will be invited to contribute to further development of the breastfeeding policy through involvement in appropriate meetings. 7.4 Members of the health care team should use their influence wherever and whenever possible to encourage a breastfeeding culture in the local community. 7.5 Healthcare providers will work with local breastfeeding support groups to raise society's awareness of the importance of breastfeeding and to encourage the provision of facilities for breastfeeding mothers and infants through liaison with local businesses, authorities, community groups and the media. 7.6 Opportunities to influence or take part in educational programmes in local schools (e.g. as part of the role of school nurses and health visitors) will be explored

6 1. Standing Committee on Nutrition of the British Paediatric Association (1994): Is breast feeding beneficial in the UK? Arch Dis Child, 71: In May 2003, the Department of Health adopted the World Health Organisation's recommendation that babies be exclusively breastfed for the first 6 months of their lives. 3. 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 Breastmilk 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 breastmilk 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 breastmilk substitutes, bottles or teats should occur. This policy has been devised using The UNICEF UK Baby Friendly Initiative Sample Policy February

7 Appendix 1 CENTRAL SURREY HEALTH A Parents Guide to our Breastfeeding Policy AIMS Central Surrey Health supports the right of all parents to make informed choices about infant feeding. All our staff will support you in your decisions. We believe that breastfeeding is the healthiest way to feed your baby and we recognise the important benefits which breastfeeding provides for both you and your child. We therefore encourage you to breastfeed your baby. WAYS IN WHICH WE WILL HELP MOTHERS TO BREASTFEED SUCCESSFULLY All the staff have been specially trained to help you to breastfeed your baby. During your pregnancy, you will be able to discuss breastfeeding individually with a midwife or health visitor who will answer any questions you may have. A midwife will be available to explain how to put your baby to the breast correctly and to help with feeds in the early days. A health visitor will provide support later on. We will show you how to express your breastmilk and we will give you a written sheet about this. We will give you information and advice about bed-sharing and infant safety. We will encourage you to feed your baby whenever he or she seems to be hungry. We recommend that you avoid using bottles, dummies and nipple shields while your baby is learning to breastfeed. This is because they can make it more difficult for your baby to learn to breastfeed successfully and for you to establish a good milk supply. Most babies do not need to be given anything other than breast milk until they are 6 months old. If for some reason your baby needs some other food or drink before this, the reason will be fully explained to you by the staff. We welcome breastfeeding on our premises. If you would prefer somewhere private, please ask a member of staff. We will give you a list of people who you can contact for extra help and support with breastfeeding, or who can help if you have a problem. This is your guide to the breastfeeding policy. Please ask a member of staff if you wish to see the full policy. This Policy has been devised using material taken from UNICEF UK Baby Friendly Initiative