Commissioning Local Breastfeeding Support Services, published in October last year by the Department of Health and Department for Children, Schools and Families, aims to assist commissioners and primary care trusts in “providing coherent services that will promote breastfeeding and reduce inequalities”, as set out in Healthy Lives, Brighter Futures – the strategy for children and young people’s health, and to work with local children’s trust partners in delivering public service agreement 12.

 It aims to:

  • consolidate the case for breastfeeding care and support as an integral part of local strategies to improve child health and reduce health inequalities
  • signpost commissioners to sources of policy, practice and evidence
  • set out some key considerations in relation to world class commissioning competencies within the three phases of the commissioning cycle

The publication reiterates that breastfeeding is one of the top 10 health outcomes most frequently prioritised by PCTs in their strategic plans.

Key messages from Commissioning Local Breastfeeding Support Services:

  • Breastfeeding saves lives and protects the health of mothers and babies both in the short and long term.
  • More mothers are breastfeeding, but continuation rates in the UK remain among the lowest worldwide.
  • Breastfeeding services are a cost-effective intervention, contributing to savings from reduced hospital admissions for gastrointestinal and respiratory infections.
  • Prevalence of breastfeeding at six to eight weeks is a key indicator of child health and wellbeing and is included in PSA 12. The government aims to increase breastfeeding rates so that they are as high as possible.
  • Breastfeeding rates at six to eight weeks are monitored through Vital Signs, and all PCTs are required to report progress on a quarterly basis.
  • Commissioning services that will provide sustainable, high quality, universal support, as well as targeted support for mothers who are least likely to breastfeed and who are at risk of poor health outcomes, is central to delivering better long term outcomes for all children.

The Breastfeeding Network is active across the UK, working in partnership with PCTs, Sure Start and health boards in Scotland through the three phases of the commissioning cycle, seeking to meet the world class commissioning competencies that underpin them.

Leadership and collaboration

  • Effective leadership – at national, regional and local level – is essential to raise breastfeeding prevalence. All BfN helpers and supporters are trained by our own tutors – many of whom have years of experience supporting mothers to breastfeed. All tutors are themselves supervised. These are women very visible in their own communities, who believe in working collaboratively.
  • The BfN is a collaborative organisation: its supervisors, tutors, supporters and helpers understand children’s services (many work in education), health professionals (many are midwives or health visitors). By definition of working voluntarily, all are community minded. Our volunteers, more than 600 in all, come from a wide range of ethnic and social backgrounds, but have an essential characteristic in common: all are mothers who have breastfed.
  • The services we provide are multifaceted, responding to the diverse needs of the population. The key is to target support to mothers and babies in different settings.

Assessing need and strategic planning

  • BfN volunteers, led often by paid coordinators, work to improve breastfeeding prevalence and reduce health inequalities by working in their own communities. They know their local population, are familiar with service provision and are able to work constructively with health professionals to address service gaps, constantly reflecting on achievements and assessing evidence of what works.
  • BfN helpers and supporters work closely with GPs, health visitors and other clinical and community partners to achieve a reliable baseline assessment, and co-operate when it is necessary to put new systems in place to provide robust data.
  • BfN tutors work with commissioners to assess workforce capacity and capability, and deliver training to meet skills gaps in relation to enabling and supporting mothers to breastfeed
  • BfN helpers and supporters constantly collect feedback from service users, recognising that it can be the most powerful evidence to support future local commissioning decisions.

Shaping local breastfeeding services

  • BfN volunteers and paid coordinators work with commissioners to review the contribution of their local services to increasing breastfeeding prevalence, to see the extent to which these services are engaging with and having a positive impact on groups where breastfeeding prevalence is particularly low.
  • In line with government policy and NICE guidance, BfN work promotes the adoption and implementation of the UNICEF Baby Friendly Initiative as the best evidence-based vehicle to raise levels of breastfeeding prevalence.

Improving performance, monitoring outcomes

  • BfN volunteers, in collaboration with tutors, are trained to question whether services are having a positive and measurable impact on outcomes and reducing health inequalities

Case study: Basingstoke - training teenagers to support other young mothers to breastfeed

Just over seven years ago a BfN volunteer started working jointly with NHS staff to provide a weekly breastfeeding clinic in Basingstoke hospital, supported by BfN home visits. This was complemented by a weekly community drop-in at a mother and toddler group.

The weekly drop in became twice weekly as the mother and toddler group expanded, giving mothers a specifically three times a week opportunity to access breastfeeding support. During this time another BfN supporter qualified, and a third also became available to initiate a second drop-in. It took place in tandem with a health visitor weighing clinic.

Joint working between the BfN and the NHS has been key to the increase of breastfeeding support in Basingstoke. It was a joint approach to the Teenage Pregnancy Partnership which led to their funding a breastfeeding helpers’ course a year ago. 

Following this funding the five newly established children’s centres commissioned the BfN to train their family support outreach workers about breastfeeding alongside a group of mothers as breastfeeding network helpers. The latter would be able to volunteer at the centres. This also tied in with the teenage breastfeeding helpers who were able to link up with the newly established young parents groups at the children’s centres.

The BfN team is led by three volunteer supporters, with another two supporters working within the NHS applying BfN principles in their professional roles. The former coordinate the drop-ins, the latter work in the NHS, one as the Baby Friendly lead midwife, and the second within the neo-natal unit. The volunteer BfN helpers work within the children’s centres and drop-ins giving peer support to other mothers, usually accompanied by their own pre-school children.

Two of the supporters are trained tutors and supervisors. The long-term aim is to maintain a sustainable level of breastfeeding support in Basingstoke, by training helpers as supporters, then to tutor and supervisor level. Tutors can train more helpers, and supervisors are essential at all levels of training to ensure all BfN volunteers are able to reflect, receive encouragement and education, and offer scientifically based information about breastfeeding to those enquiring.

At present, there is a seven day breastfeeding peer support service for breastfeeding mothers up to 28 days, jointly between the BfN, NHS and children’s centres. From 28 days the service is completely community based, both supported by the National Breastfeeding Helpline open 9.30am-9.30pm.

Case study: Ayrshire – unique buddying scheme to support breastfeeding in a rural and urban area

Just four years ago, the Breastfeeding Network had four supporters and a handful of helpers in Ayrshire. There was one breastfeeding group in Ayr, which saw approximately 100 mothers a year. 

When NHS Ayrshire and Arran started working on its infant feeding strategy, as the only active breastfeeding support organisation in the area we were happy to offer our help. Later, it was announced that funding was being made available to NHS boards to help them meet the HEAT target for breastfeeding. 

We put together a successful bid to run several breastfeeding centres, train more peer supporters and extend our services in the maternity hospital to four hours a day, seven days a week.

Today we have more than 30 trained mothers in Ayrshire. Eight of these are supporters  who can help with more complex breastfeeding issues and staff the National Breastfeeding Helpline and BfN Supporterline. We run six breastfeeding centres, located all over Ayrshire, where we project we will come into contact with 1,000 mothers this year. Since we began hospital visiting in March 2009, we have seen 849 mothers.

Along with our regular inputs at NHS antenatal sessions and breastfeeding workshops, we are also developing innovative ways of targeting mothers in areas of low breastfeeding rates with café evenings and a buddying scheme.

Our service level agreement with the NHS means that we are key partners in the campaign to make a difference to breastfeeding rates in Ayrshire. Along with the NHS, we are continuously monitoring and evaluating our work to ensure that we are contributing effectively to this agenda.

Case study: Tower Hamlets – supporting breastfeeding in a multi-racial community

Since 2006 paid breastfeeding support workers have been providing a borough-wide service in Tower Hamlets. Ten workers, who have all been trained to at least breastfeeding helper level by the Breastfeeding Network (some are supporters and some are tutors), meet mothers in antenatal classes and clinics, on postnatal wards, in breastfeeding drop-ins and at groups where breastfeeding support is offered alongside other activities like baby massage.

Most of the team’s work is done through home visits. 

All first time mums are contacted to be offered a visit within around 48 hours of discharge from hospital, and all other mothers are able to access the service by self-referral or referral from a health or children’s centre worker. The team comprises local mothers who speak the main community languages (English, Sylheti/Bengali and Somali) and can give genuine peer support to mothers who are breastfeeding.

The work of the paid team is complemented by a number of BfN-registered volunteers who run a specialist breastfeeding drop-in, help at a number of classes and clinics, and visit mothers in hospitals, including at the weekend.

This peer support programme is part of a joined-up strategy with the local hospital and community NHS trusts who are working towards Baby Friendly accreditation, and with the borough’s 21 Sure Start children’s centres.

Breastfeeding Network key themes

  • Eleven years’ experience focusing on areas where breastfeeding is unlikely to be the norm
  • Flexible provision of breastfeeding support tailored to local demand and preferences
  • Peer support training is accredited and externally verified by OCN
  • Cost effective way to comply with new guidance