A group of experts has rated breastfeeding support in Scotland as “strong” but highlighted the need for more consistent training for all professionals working with mothers and babies, including nurses.
The Becoming Breastfeeding Friendly (BBF) Scotland committee looked at a range of factors in assessing the quality and effectiveness of breastfeeding provision across the country.
“We need to remove the barriers that cause negativity towards breastfeeding”
Overall the committee, which includes representatives from NHS organisations, government, professional groups, charities and academia, rated provision 2.4 out of 3, concluding there was a “strong” environment for scaling up the promotion and support of breastfeeding.
It went on to make eight recommendations for further improvement to help women breastfeed for as long as they wish.
These include ensuring families have equal access to relevant advice and information on feeding their baby, promoting a supportive environment for women who return to work while breastfeeding, and strengthening breastfeeding messages across Scotland.
The committee’s report – Becoming Breastfeeding Friendly Scotland: report – noted the nation’s breastfeeding rates have improved in recent years, with the proportion of babies receiving “any breastfeeding” increasing from 44% in 2001-02 to 51% in 2017-18.
Meanwhile, the proportion being breastfeed at six to eight weeks has increased from 36% to 42%.
However, these figures “remain relatively low” when compared with other countries and recommended targets with breastfeeding rates lower still among women in deprived areas, said the report.
The BBF Scotland committee called for the creation of a single network of breastfeeding advocates across Scotland and the development of a co-ordinated breastfeeding promotion strategy, bringing together work at local, regional and national level.
It also highlighted the need for ongoing and adequate ring-fenced funding for breastfeeding activities.
“There is clear evidence of the need to deliver co-ordinated and integrated learning outcomes”
When it came to training for professionals, the report flagged up positive progress in meeting training standards for maternity and neonatal services under Unicef UK’s Baby Friendly Initiative.
At university level, Scotland had also “made good progress” with most pre-registration courses for midwives, health visitors and public health nurses already accredited under the Baby Friendly scheme or on their way to gaining accreditation.
However, the report found “associated professions are not covered”, meaning there were inconsistencies in what trainee health professionals were learning.
New post-registration training package had been developed to “update staff and to strengthen understanding and broaden skills and confidence”, but not all professional groups were benefitting.
“For volunteers and peer supporters quality training is available, generally through voluntary sector organisations but again it is not co-ordinated and learning outcomes are not consistent,” said the report.
“There is clear evidence of the need to deliver co-ordinated and integrated learning outcomes at trainee, pre-registration, post-registration and for volunteers,” it added.
It called for a national implementation of “appropriate practice skills and learning outcomes for all roles who care for mothers and babies” including obstetricians, paediatricians and children’s nurses, as well as for a range of support staff and for volunteers.
Appropriate competency frameworks for each type of role should be developed and “underpinned by training and mentorship as well as supervision and monitoring”, said the report.
Source: Andrew Cowan/Scottish Parliament
The development and implementation of training should consider remote and rural working from the outset, with good quality online learning rolled out.
GPs practices should also be encouraged to take up training opportunities, said the report.
The recruitment of regional co-ordinators to oversee training and the expansion of e-learning modules – which is currently under way – should help make this happen, said the report.
“Women will be better supported to breastfeed and overcome barrier through the provision of consistent messages and highly skilled support across settings and staff, both professional and lay supporters,” said the report.
The findings from the BBF Scotland committee were welcomed by health secretary Jeane Freeman, who was visiting a maternity unit run by NHS Ayrshire and Arran during Scottish Breastfeeding Awareness Week.
She said the report acknowledged “the fact Scotland has been working hard to improve the quality of support for breastfeeding”.
“This is an important opportunity to increase our efforts and to consider whether we are all doing enough to enable breastfeeding and to consider what we could do better,” she said.
“We need to remove the barriers that cause negativity towards breastfeeding, and to promote it as a natural and healthy activity, which provides babies with the best nutritional start in life,” she added.
“We have got to make sure that choosing breastfeeding is a realistic and attainable option”
As part of efforts to promote best practice, the Scottish government has announced a new national BFF logo that can be displayed by businesses and organisations.
NHS Ayrshire and Arran is currently testing a model that brings together maternity and health visiting services, infant feeding experts and peer supporters as part of an integrated team.
The service provides mothers with one-to-one care from a breastfeeding peer supporter within 48 hours of a new baby being born, said the health board’s nurse director Professor Hazel Borland.
“This will support new mothers to breastfeed for longer, beginning with those for whom we know it can be more challenging,” she said.
The board also recently launched guidance for staff to make it clear everyone had a role to play in supporting mothers to breastfeed in hospitals and other premises.
Mary Ross-Davie, the Royal College of Midwives’ director for Scotland and a member of the BFF Scotland committee, said the report provided a “bold and welcome” vision for breastfeeding.
However, she said the report made it clear that improving Scotland’s breastfeeding rates was “not a quick, single action fix”.
“It requires investment, planning, determination and the support and co-operation of many different organisations over many years to make it work,” she said.
Ms Ross-Davie went on to highlight the crucial role of midwives and maternity support workers in helping women to start and continue breastfeeding.
“We have to ensure they have the time and resources to give women the best possible support before and in those critical first hours, days and weeks after the birth,” she said.
She added: “Ultimately, it is a woman’s choice about how she chooses to feed her baby and everyone must respect that decision.
“But, we have got to make sure that choosing breastfeeding is a realistic and attainable option for women,” she said. “This report will hopefully take us a long way towards that.”