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

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

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

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

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

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

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- 20-30 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

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

The Team!

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!

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

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

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

Peer Support in the Community

Harrow Baby Friendly in 2012

Improvement in Breastfeeding Rates

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

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