VOL: 97, ISSUE: 26, PAGE NO: 38
Valerie Finigan, BA, SEN, RGN, RM, DipMidwifery, is community midwife and infant feeding adviser, Oldham NHS TrustThe intensive marketing of infant formula milk has had a detrimental effect on mothers' choice, with many unaware of the risks associated with this feeding method (Minchin, 1998). The practice of providing low-cost formula milk at health clinics continues and is justified because it benefits women on low incomes. But this condones the health service's provision of a perk for bottle-feeding mothers with no equivalent for those who breastfeed (Unicef, 2000).
The intensive marketing of infant formula milk has had a detrimental effect on mothers' choice, with many unaware of the risks associated with this feeding method (Minchin, 1998). The practice of providing low-cost formula milk at health clinics continues and is justified because it benefits women on low incomes. But this condones the health service's provision of a perk for bottle-feeding mothers with no equivalent for those who breastfeed (Unicef, 2000).
If mothers attend health clinics only to purchase cheap formula milk, perhaps it is time to look at how preventive health care is marketed.
In reality, many professionals are not promoting, protecting and supporting breastfeeding (UKCC, 1993).
The role of infant feeding advisers aims to readdress this by training health care teams and mothers in breastfeeding management and by working towards public health targets for healthy mothers and babies (Department of Health, 1999). Some midwives argue that a new combined role of infant feeding adviser/midwife may fragment care and erode the midwife's role.
But studies show that the support given enhances a woman's breastfeeding experience, promoting positive outcomes (Anderson, 1999; Jones and West, 1985). However, the Winterton Report (House of Commons Health Committee, 1992) notes that postnatal care is currently delivered in a fragmented, inappropriate way.
Breastfeeding management includes the correct positioning and fixing of the baby at the breast, the hand-expressing of breast milk and dealing with simple problems. In principle, it can be taught to anyone. But some problems, such as feeding premature babies, are more complex. This work is time-consuming and needs to be done by a knowledgeable, skilled practitioner.
Such areas fall within the remit of the infant feeding adviser (Box 1). Biancuzzo (1999) states: 'Infant feeding advisers are not only competent in breastfeeding management but are also expert managers. The skills required for this post are vast.'
The infant feeding adviser role is new to Oldham NHS Trust and is based on a job-share of 60 hours a week, 45 of which are dedicated to maintaining good practice in the hospital setting and disseminating this to community services. The trust participates in the Sure Start 2000 Initiative, a government project that aims to address health care inequalities by promoting healthier lifestyles, beginning with breastfeeding (Sciacca et al, 1995).
The trust also runs a breastfeeding reassurance and guidance group that gives mothers access to peer and professional support.
The feeding adviser role was created to enhance best practice and help primary health care teams to implement the seven-point community baby-friendly programme (Unicef, 2000; Box 2).
The midwife's role
Breastfeeding is high on the public health agenda and many refresher courses are on offer. However, NHS trusts have finite budgets and it is expensive to send staff on training programmes.
These are difficult times for midwives (Beech, 2000). The definition of what a midwife is and does, and where her skills and authority lie, is being altered dramatically. Midwives are deemed to be 'expert' only when they are involved in high-tech interventions. Suturing, venepuncture and instrumental deliveries have become part of their role in some trusts.
The supportive, caring part of midwifery appears to have lost its attraction.
Many midwives feel that the hierarchical demand for a more academic midwife combined with poor staffing levels is culminating in an inability to provide a good standard of care.
The lack of a career structure and constant threat of reprisals mean midwives will not speak up about what is wrong with the profession. Some fear that role-sharing will reduce their status, having an impact on their clinical ability and grading. And sometimes senior midwives may try to sabotage change to protect their status. Poor communication, fear of change and professional jealousy prevent midwives from moving forward and changing services.
Now mothers are informed of the benefits of breastfeeding, most are keen to learn the necessary skills and need support to do so. Morally, services must meet this need. Box 3 outlines the management of change that took place at Oldham to enable such a service to be developed.
Oldham NHS Trust supports the role of infant feeding advisers, seeing it as a quality service development. The trust accepts that the project must now expand into the community. It is time to move midwifery forward, taking what was good from the past, such as baby-friendly initiatives in hospitals, and bringing these to the community. To achieve this, we must acknowledge skill deficits and work to replace them. Negative attitudes to breastfeeding in midwives and health visitors must be addressed. One way to do this may be to have more multidisciplinary infant feeding advisers.