I wrote yesterday about the cost savings that maternity hospitals can make by investing in supporting breastfeeding. The calculations have been done by the UK National Institute for Clinical Excellence (NICE). The guidance for hospitals calling for UNICEF Baby Friendly procedures to be followed as minimum standards has force within the UK and parents should expect to receive the support set out, whether breastfeeding or formula feeding. A brochure for parents explains:
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NICE produces advice (guidance) for the NHS about preventing, diagnosing and treating different medical conditions. The guidance is written by independent experts including healthcare professionals and people representing patients and carers. They consider the best available evidence on the condition and treatments, the views of patients and carers and the experiences of doctors, nurses and other healthcare professionals working in the field. Staff working in the NHS are expected to follow this guidance.
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So what can parents expect and can demand if they are disappointed? You can download the brochure by clicking here:
http://www.nice.org.uk/nicemedia/pdf/CG37publicinfo.pdf
This covers the first 6-8 weeks after the birth and covers much more than infant feeding. But here are some key passages on infant feeding:
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Within the first hour of giving birth you should not be separated from your baby. You should be encouraged to have skin-to-skin contact with your baby and offered support to help you and your baby start breastfeeding.
The benefits of breastfeeding and colostrum should be explained to you. Colostrum is the first milk and gradually changes over time. It is rich in fats and protein, and helps protect babies against infection.
You should be offered advice on how to best position your baby and yourself for breastfeeding. This will help to ensure your baby attaches correctly and that you are both comfortable. You should be reassured that you may experience brief discomfort when you start a breastfeed, but this should not persist.
If you have had a caesarean section, pain-killing injections or anaesthetic, or a delay before being with your baby, you should be offered extra support to help you start breastfeeding. If you give birth in hospital and go home soon after, you should be reassured that you will still be able to breastfeed successfully.
You should be shown how to express breast milk by hand, and if you have been separated from your baby you should be shown how to use a breast pump to help encourage your milk supply. Your healthcare professional should also give you information on how to store and freeze breast milk.
If you are going to feed your baby with formula milk, you should be advised on how to prepare and store formula and how to clean and sterilise bottles and teats.
Milk for your baby (breast milk and formula milk) should not be warmed in the microwave as it can become dangerously hot.
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If a mother is breastfeeding then:
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Your healthcare professional should ask you about breastfeeding at every contact. You should be offered advice and support if you have any concerns (see page 15). For example, if you find breastfeeding painful your healthcare professional should work with you to find the right position for you and your baby and ensure your baby is attaching properly.
You should be encouraged to breastfeed your baby as often and for as long as he or she wants. This will help your body produce enough milk.
Your baby will stop feeding when he or she is satisfied; this may be after feeding on both breasts or just one breast. You should not be advised to give your baby a top-up of formula milk if you are breastfeeding.
Questions you might like to ask your healthcare team
• How can I get some help with breastfeeding?
• Is there a breastfeeding support group in my area?
• How can I make sure my baby is getting enough milk?
• How can I increase my milk supply?
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And:
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Your healthcare professional should review your breastfeeding experience each time they talk with you. If you or your healthcare professional has any concerns – for example, that your baby is not getting enough milk, or you are experiencing pain – these should be discussed. If you think your baby is not getting enough milk you may be advised to increase your milk supply by feeding more regularly or to use expressed breast milk in a cup (or bottle).
You should be encouraged to discuss any concerns you may have about breastfeeding with your healthcare professional or support worker (some common concerns are listed on page 15). Your healthcare professional should work with you to help you breastfeed successfully.
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If using formula, health workers should help with information on mixing up formula to reduce the risks of possible intrinsic contamination with harmful bacteria. As I have written previously, most baby food companies are failing to warn on labels that powdered infant formula is not sterile and the necessary steps to reduce the risks. See:
http://boycottnestle.blogspot.com/2007/02/powdered-infant-formula-is-not-sterile.html
You can find the brochure for parents and other relevant NICE guidance documents for health professionals and policy makers at:
http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10988
While only 52 out of 317 maternity hospitals in the UK are accredited as Baby Friendly by UNICEF, parents still have the right to demand the support set out above and to complain if they do not receive it.
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