The Postcode Lottery of Infant Feeding; a midwife’s personal account
Families who access maternity services come to us trusting that the information and support they recieve will be evidence-based, accurate and designed to give them and their new baby the best possible start in life.
As a midwife myself, I strive to give this to every family in my care, every day. But our ability as midwives to provide this care is very much shaped by our environment; we can only fully support families when the hospitals in which we work have a positive culture and provide high quality education to support us.
Having worked in both Baby Friendly accredited and non-accredited services, I have witnessed, first-hand, how the Baby Friendly programme enables this positive culture and high quality education, making our work to support new parents to feed and nourish their baby much more achievable.
It can seem like a daunting task to implement the Baby Friendly standards – particularly as our NHS becomes increasingly stretched and our workloads continue to grow. But Baby Friendly provides a robust and clear framework for improving outcomes, which is designed not to burden but to empower health professionals to deliver the best possible care, in the most efficient way.
Having worked in many maternity services across the country, I have experienced the transformative impact of going Baby Friendly, as well as the impact of working in environments which do not engage in this evidence based programme. I have witnessed the damaging effect that not engaging has on staff morale due to inadequate education and a lack of support, and in turn the effect this has on the women and their families using the service.
During my midwifery training and career, I have been lucky to receive excellent Baby Friendly training and education. Coming from a background of negative attitudes towards breastfeeding, my mind was opened to how amazing the human body is when I began university. My confidence on placements grew as I recognised how I was learning to help families begin their breastfeeding journey and overcome challenges. While I was at university we were very proud to achieve full Baby Friendly accreditation, and I began my first post as a qualified midwife in a Baby Friendly accredited maternity unit where I consolidated my skills.
When I have worked in Baby Friendly accredited units, the morale around feeding was high; infant feeding leads would be on hand to help us busy midwives on the postnatal ward and we knew that women were receiving the same information consistently. Women were empowered when leaving hospital and this was still apparent in the community when visiting them at home. They truly believed their milk was sufficient and with all their antenatal education and postnatal support, they knew what to expect and to trust their bodies, baby and instincts; just how it should be when becoming a parent.
In contrast, when I have worked in units without Baby Friendly, staff morale and confidence around infant feeding has been low. Women were receiving poor information much of the time, and some received no information or support at all. Staff regularly reported feeling unconfident and incompetent at supporting women in this area and thus avoided it wherever possible. Infant feeding was not seen as a priority and it felt like there was no support from management at these units to help the team to deliver safe and individualised feeding support.
I regularly found myself disagreeing with staff on the wards on things that in my previous hospital would have been a basic standard such as encouraging skin-to-skin in theatre, avoiding 35ml ‘top-ups’ of formula because the staff needed reassurance that the baby was getting something. As a new staff member particularly, it was a real challenge to try to protect a woman’s breastfeeding journey in this low morale environment.
On reflection, I can’t help thinking of all the preceptor midwives who have had high-quality infant feeding education and then began their careers as midwives, to very quickly lose their confidence and skill because the environment in which they’re working doesn’t support them to put their learning into practice. Negative culture is infectious; as a newly qualified midwife you feel pressure to ‘fit in’, and challenging the status quo is very difficult. It doesn’t take long before the culture swoops through an entire ward and ultimately it feels like the women are on the receiving end of this.
As midwives, we are so good at advocating for individualised, safe care during childbirth, listening to what women want and tailoring our care to support their needs and wishes. It seems that this is getting forgotten postnatally when the parent-infant journey has just begun.
In the postnatal care environment we have to prioritise from a long list of jobs every hour, attempting to keep up with the fast and ever-moving conveyor belt. I know the women and their families are very understanding of the conditions we work in and are very grateful for the care they receive from the NHS. However, I also know that they expect us to give them sound, evidence based and non-biased information. They trust that we will support them on their journey to parenthood; they expect and deserve good care.
As a midwifery team, we rely on management to facilitate education and mandatory updates, and to source more support workers to help us navigate this fast-paced environment and enable women and families to get excellent care. I know it is possible, even in maternity care today, because I have seen it work in a Baby Friendly accredited service. I have seen midwives feeling confident, well-educated and supported to deliver high quality infant feeding support to the women in their care, despite the pressures. I have also seen, in non-accredited services, the effects of not having this sense of coherence and framework to follow, leaving midwives feeling unconfident and as if they are failing.
It doesn’t seem fair that women’s experiences of infant feeding support can vary so dramatically depending on where they live. The Infant Feeding Survey (2010) highlighted that 8 out of 10 women stop breastfeeding before they want to. Tackling this requires action across policy, society and healthcare settings, but one key way to make change in the health services is to take full advantage of the Initiative that is there to help us to support women to achieve their goals.
NICE Guidelines and the NHS Long Term Plan (2019) recommend implementation of the Unicef UK Baby Friendly Initiative. As a midwife who has seen environments with Baby Friendly and environments without, I hope that this will be a big enough drive to support all Trusts in England to work towards accreditation, for the benefit of women, families, and my wonderful colleagues too.