The First 1000 Days Seána Talbot, Sure Start Coordinator

Pregnancy, birth & the transition to parenthood NCT Maternity Services Liaison Committees (MSLC) Strategy Groups GAIN guidelines Commissioning

Maternity Units 8 consultant units – 90% of births 6 MLUs (3 alongside, 3 freestanding) Fewer than 1% of babies born at home RJMS Mater Lagan Valley

Lead professional GP /Consultant Obstetrician ‘shared care’ Midwife Medical v social model

Type of Birth Normal birth Instrumental birth Caesarean section Emergency Elective Trauma / perception

Caesarean birth World Health Organisation 10-15%

Place of Birth Hospital 90% Midwife-led unit ‘Birth Centre’ 9% Home 1% Actual v perceived risk Birthplace Study NPEU 60,000 births Outcomes good

Why more interventions? Medical model – surgical Mid-wife = with woman Ritual and routine Oxytocin v adrenaline Fear & tension Culture – varies between units

Achieving a positive birth Midwife Home or midwife-led unit Preparation, information Avoid induction/augmentation The right birth partner Choice of pain management Eating and drinking Privacy, dignity, respect

Transition to Parenthood Infant mental health Maternal mental health Bond with the bump Skin-to-skin Delayed cord clamping Expectations Support Breastfeeding

Risks of formula feeding Large, good quality, well controlled studies and good quality systematic reviews demonstrate that in developed countries, not breastfeeding significantly increases the risk of gastro-intestinal disease (1, 2), lower respiratory tract infection (1,2), and sudden infant death syndrome for infants (1); necrotising enterocolitis for preterm infants (3); childhood cancers (4) and maternal breast cancer (4).1, The epidemiological evidence supported by related physiological and immunological evidence suggests that not breastfeeding is likely to increase the risks of illnesses including Type 2 diabetes (5), coeliac disease (6), otitis media (1), obesity (7), and indicators of future cardiac disease (8) in the child, and ovarian cancer in the mother (1) Increasingly strong evidence indicates a significant impact on cognitive and behavioural outcomes for the child (9).9

Risks of formula feeding No other health behaviour has such a broad spectrum and long-lasting impact on population health, with the potential to improve life chances, a key policy priority (10), as well as survival and health.10

Inequality Not breastfeeding is both an outcome and a cause of health and social inequality. It is an outcome of inequality because (i) low income families have the lowest rates of breastfeeding; (ii) there is a marked inter- generational effect that perpetuates these low rates (13) (iii); the long-term health and development of the child is affected by whether or not she/he is breastfed and (iv) the social patterning of infant feeding results in the greatest burden of ill health and adverse effects falling on the poorest families.13 At the same time, breastfeeding provides a solution to this longstanding problem, and is in itself an intervention to tackle inequalities in health; a child from a low income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula fed (14). 14

Breastfed baby (Social class 5) is more healthy than Bottle-fed baby (Social class 1) Dundee Infant Feeding Study Seven year follow-up, 1998 Breastfeeding and Health Inequalities

Research on attitudes to breastfeeding undertaken in Northern Ireland in 1999 indicates that the reasons why respondents did not breastfeed include: never considered breastfeeding as an option; bottle-feeding seen as more convenient; felt too embarrassed to breastfeed; mothers said they or their baby were too ill; lack of confidence in their ability to breastfeed; and lack of support and encouragement to breastfeed.

The First 1000 Days Foundation for mental & physical health Lifelong impacts Upstream