Breastfeeding support groups known as breast start groups procedure

1 Introduction

The benefits of breastfeeding are set out in Department of Health, Early years high impact area 3, breastfeeding. The longer a woman continues to breastfeed the greater the benefits to both mother and baby in the short and long term. It links with promoting health and development and the breastfeeding support groups are recommended as a way of reducing isolation; improving relationships in communities and families; and helping mothers to breastfeed for longer.

Following the health visiting implementation plan and 1001 critical days; working within the community level of health visiting service in Doncaster, the aim of the breastfeeding support group (breast start group) is to offer pregnant women and breastfeeding mothers a strong support network in an informal, relaxed and friendly environment which promotes breastfeeding as the best way to feed their baby. Practical advice, reassurance, and support on all aspects of breastfeeding are available from health professionals and trained peer supporters, through building of community capacity. The breast start groups are available to all pregnant women and breastfeeding mothers who would like an additional support network for breastfeeding.

The standard operating procedure (SOP) has been developed to ensure that a consistent and high-quality service is delivered, as well as providing a framework to follow in relation to administrative procedures, governance, and performance monitoring.

2 Aim

The aim is to give guidance and a framework to those healthcare colleagues responsible for the facilitation of Rotherham, Doncaster and South Humber Trust (RDaSH) delivered breast start groups. It should promote consistency in the way these groups are administered and facilitated.

In addition, this document should ensure the delivery of a high standard of service to those accessing the service.

3 Scope

The children’s care group, children, young people and family (CYP and F) 0 to 5 service in Doncaster is committed to promoting breastfeeding amongst pregnant women and partners and those mothers who have given birth.

Breast start groups are delivered through breast start and first friends groups and contribute to the breastfeeding initiative across the Doncaster Borough, and in most cases have very close links with their locality’s family hubs and midwifery services.

4 Link to overarching policy

This standard operating procedure is linked to the infant feeding policy.

5 Responsibilities, accountabilities and duties

5.1 CYP and F management team for the community level

Members of this team will have overarching responsibility for the effective delivery, supervision, and service development of breast start groups within Doncaster.

5.2 Infant feeding co-ordinator

Will ensure:

colleague leading and facilitating breastfeeding support groups are trained to the appropriate breastfeeding friendly initiative (BFI) standard
colleague are kept informed or updated on national and local recommendations about infant feeding
will ensure positive links are maintained between partner agencies
will provide group supervision for the breast start group facilitators on a quarterly basis
will audit quality following the BFI standards on a 3 to 4 monthly basis
ensure communication of relevant information amongst identified facilitators via supervision group
colleague are informed about updates from the 0 to 5 operation group

5.3 Management team at community level

Will ensure:

effective communication links with managers and healthcare professionals
breast start groups are established within their areas and are running on a regular basis in accordance with the SOP
will act as a nominated lead for groups, but not necessarily need to be present at groups
facilitate the ordering of items or resources needed by groups
ensure that the group is operating efficiently and in accordance with the SOP
operational issues are dealt with as necessary
administrative processes are in place on behalf of the breast start group
breast start group sessions are appropriately staffed
additional support and advice is available or accessible from a public health nurse, especially in relation to safeguarding children and maternal mental health
Changes in relation to the breast start group (including change of lead facilitator) are communicated to the CYP and F Leadership team
the management team must have the appropriate level of training in accordance with the BFI standards

5.4 CYP and F lead facilitators

Lead facilitators will be the key colleagues involved with the running and delivery of the breast start groups. Each breast start group may have more than one lead facilitator.

Lead facilitators will:

assess people who use our services needs to provide the appropriate support, advice and guidance
offer information and support in a non-judgemental way to enable mothers to make informed choices
provide supportive material and resources to help strengthen information given
offering up-to-date up information in line with (BFI) standards
be knowledgeable about nutrition and recognition of when a baby is ready for solids, suitable first solids ways to offer solids, encouraging self-feeding and combining solid food with breastfeeding beyond six months
co-ordinate and prepare the venue for each session, including the purchase of any fresh produce (for example, milk for refreshments)
discuss or sign-post to the single point of contact (SPOC) if additional support and advice is required.

5.5 Breastfeeding champions

Will lead on nominated breast start group.
Will support with breastfeeding peer support programme.

5.6 Peer supporters

To volunteer in breast start groups, first friends groups following appropriate training and induction. To link with infant feeding policy RDaSH volunteer policy (see end of document for links).

5.7 Partnership working

The delivery of breast start group models has involved close partnership working with local family hub’s. This is a key factor for success and continues to be strongly encouraged; CYP and F will involve its partners in the delivery of these groups.

6 Training implications

All colleagues who manage, lead, facilitate and, or support breast start groups will be trained in breastfeeding management skills, in accordance with UNICEF baby friendly initiative accreditation. This involves an initial 2-day training and annual updates. Appropriate training will ensure a high quality of support and advice is being given to women and their partners.

Breastfeeding peer support volunteers will undertake a 7-week Solihull breastfeeding peer support training package and then yearly updates following the BFI standards.

Updates in relation to national guidelines and any information from the 0 to 5 operational group will be communicated to relevant colleagues to ensure they are kept as up-to-date as possible.

7 Setting up a breastfeeding group

The establishment of a breast start group must be organised in liaison with the leadership team and infant feeding coordinator in conjunction with effective networking with partner agencies.
The relevant community level lead will need to ensure that there are sufficient resources to staff the group on a regular basis and act as the nominated lead.

The lead facilitator, in partnership with other professionals, will need to consider the following points:

venue
health, safety, fire and security issues (including lone working)
equality impact assessment
infection prevention and control issues
official launch (please refer to section under purchasing resources)
resources, for example, books, leaflets, posters
that material is available in languages translated to meet individual needs as required
furnishing
publicity

7.1 Organising a launch event

An official launch of a newly established breast start group should be considered to gain maximum publicity and encourage attendance. The following points might be useful considerations as part of the planning process:

timing of the event ensuring inclusivity, for example school drop off and pick up times
provision of catering and refreshments
displays and promotional items
guest list
publicity
CYP and F Facebook page and Instagram
access for disable users

7.2 Publicity and communication

It is important that consideration be given to the ways in which an official opening should be publicised, as well as continuing to promote the breastfeeding support group on a regular basis. The use of social media including the health visiting Facebook site, Instagram and website page will support publicising the groups.

The corporate Communications team will be able to offer advice about the official opening, as well as giving guidance about contacting local media. The relevant CYP and F manager must be kept informed of any arrangements made.

The CYP and F leadership team keeps an up-to-date list of breast start groups, including their opening times, venue and relevant contact details. This is distributed to key contacts when updates are made and this information should be cascaded onwards as necessary; therefore, it is important that any changes are communicated to the CYP and F Leadership team.

8 Organisational policies

It is the responsibility of all colleagues involved in the delivery of the groups to make themselves aware of policies and procedures in relation to breastfeeding.

9 Visitors accompanying pregnant and breastfeeding mothers

There may be occasions when pregnant women and breastfeeding mothers are accompanied by friends, relatives, and spouses or partners. These situations will need to be managed by lead facilitators on an individual basis. It is important to ensure that all other pregnant and breastfeeding mothers attending the breast start group are comfortable with the visitors being present.

10 Resources

10.1 Equipment

Consideration must be given to infection prevention and control standards, for example, surfaces that can easily be decontaminated. Equipment and items such as toys must be wipe-able using trust approved 2 in 1 antimicrobial wipes. Any items that cannot be decontaminated safely must be disposed of if contaminated. Advice is always available from the trust Infection Prevention and Control team. Trust colleagues will adhere to the trust hand hygiene procedures, infection prevention and control manual.

10.2 Refreshments and snacks

Requests for basic requirements, for example, tea, and coffee, should be directed to the CYP and F leads at community level. Other items, or those that need to be purchased on a regular basis, for example, milk, soft drinks, should be purchased by the lead facilitator and reclaimed by completing a petty cash form signed by a team leader and taken to petty cash on the Tickhill Road site.

The provision of snacks may be considered in order to promote an environment that is relaxed, supportive and friendly. It is advisable to keep these purchases to a minimum wherever possible, unless other sources of funding are available to purchase them.

Healthy eating and drinking guidelines have been specifically developed in partnership with the Doncaster Bassetlaw Hospital Foundation Trust (DBHFT) dietetics department for use by lead facilitators (appendix A). This is an excellent opportunity to encourage healthy eating and drinking alternatives.

10.3 Use of reference materials

The use of materials, such as books, public health leaflets, and posters, are good ways of promoting the breastfeeding message and are good sources of information. Consideration should be given to having these available during all breast start group sessions. Ensuring that the materials are culturally appropriate and include diverse couples, for example, same sex.

To ensure compliance with the UNICEF BFI accreditation, health colleagues must not be shown to support any branded products. Where there is any doubt, lead facilitators must consult with the infant feeding co-ordinator.

11 Health and safety

11.1 Health and safety consideration at venue

The environment in which breast start groups are held must be as safe as practicably possible.

For all venues a current fire risk assessment must be in place. This can be obtained from the responsible person for the premises.

These risk assessments will need completing where groups are being held in venues other than family hubs.

When a venue for a breast start group has been identified, the lead facilitator must make contact with the corporate Health and Safety team, to arrange for a risk assessment to be carried out.

11.2 Weekly checks

Lead facilitators must conduct regular checks of their environment before each breast start group session. It will provide assurance that key aspects of the environment are as safe as possible for those attending. Lead Facilitators must use the weekly hazard identification checklist devised for breast start groups. (appendix B).

Completed forms must be retained for audit purposes and collated by the Leadership team.

If any significant changes occur to the environment in which breast start groups are held, the lead facilitator must carry out a full hazard identification check, using appendix C.

11.3 Annual checks

Lead facilitators or infant feeding co-ordinator must conduct a full health and safety check of the breast start group environment on an annual basis. This will ensure that environments that have changed over a 12-month period are being fully assessed for health and safety purposes. The annual hazard identification checklist (appendix C) must be used.

Annual checks should be conducted at the beginning of the financial year, for example, beginning of April.

Completed forms must be retained for audit purposes.

The infant feeding co-ordinator is responsible for reviewing these to ensure all venues remain suitable.

11.4 Hot drinks

Lead facilitators should be aware of the risks around the serving of hot drinks. There are some useful guidance notes within the annual hazard identification checklist (appendix C).

The breast start group’s host organisation (for example, family hub) may have its own policies, and these will take precedence with regard to the provision of hot drinks.

11.5 Management during episodes of infectious disease prevalence

During periods of time when the risk of spread of infectious disease is high within the community, there may be a cease of the face-to-face sessions. The support will be offered virtually. Or there may be aspects of the group that need consideration such as: the size of the group, availability of drinks and food, increase in the infection prevention and control (IPC) equipment available, including personal protective equipment (PPE). Working closely with the family hubs and their risk assessments and processes to ensure effective IPC measures are in place.

12 Data collection and performance monitoring

12.1 Performance monitoring

Lead facilitators must maintain clear and accurate records for their breast start groups. Attendees will be recorded in SystmOne. The family hub collates their own attendance sheets for those attending their building. No health information is shared from the health teams to the family hub. If this was required then consent and aspects of general data protection regulation (GDPR) will need to be considered.

The type of data and information being collected will be subject to change and data collection templates will need to be amended accordingly. On these occasions, new templates will be distributed to all lead facilitators.

Group supervision of lead facilitators will be offered on a quarterly basis (this may be face to face or as virtual meeting).

12.2 Evaluation exercises

Audit and evaluation will be carried out following the BFI quality standards on a 3 to 4 monthly basis by the infant feeding co-ordinator to contribute to the report to ensure that the team is delivering an efficient, quality service and meeting the needs of its service users, as well as identifying areas where provision can be improved.

12.3 Your opinion counts

RDaSH has a corporate method of collecting the views and comments from service users via the feedback form called your opinion counts. Lead facilitators must ensure that those attending breast start groups have access to your opinion counts forms and, or the electronic link.

13 Non breastfeeding mothers

The focus of the breast start group encompasses the full range of breastfeeding experiences, including exclusive breastfeeding, combining breastfeeding with complementary foods or combining breastfeeding with formula feeding and to overcome any difficulties that may be experienced.

Mothers not requiring support with breastfeeding related issues may attend a breast start group session. On these occasions, mothers should be made to feel welcome and supported in a non-judgemental manner but the appropriate information or advice should be given and signposted elsewhere for the kind of support they may be seeking.

14 Breast start group lead facilitators supervision group

Lead facilitators will attend group supervision on a quarterly basis (either face to face or virtual). It will be chaired by the infant feeding co-ordinator and supervision documentation completed for the group and reported onto the staff portal for RDaSH colleagues.

The purpose and role of this group will be detailed within the supervision contract, but its main aims will be to:

give an opportunity for the sharing and giving of information around breastfeeding issues
discussing, debating and agreeing good practice
to ensure consistent practice within all groups
contributing to the initiatives around the breastfeeding agenda

15 Breastfeeding awareness week

The department of health is keen to promote breastfeeding by leading breastfeeding awareness week.

Lead facilitators are urged to promote this calendar event within their groups. Consideration may be given to organising a special celebration to support this nationally-led campaign. This may be leading on something within their own groups, or a joined up event with other groups.

It is advisable to organise any activities well in advance to help with any ordering, advertising etc that may be required.

16 References

17 Appendices

17.1 Appendix A Breast start groups food and drink guidelines

17.1.1 Aim

The following guidelines aim to ensure the provision of food and drink in Doncaster breast start groups is in line with local policies, guidelines and evidence in respect of healthy eating and health and safety messages.

17.1.2 Background information

A breast start group is a drop-in group, generally open once a week. It aims to provide support to all pregnant or breastfeeding mums and partners on all aspects of breastfeeding and its impact on daily life.

It is recommended that breast start groups provide a comfortable, relaxed environment where women, and those supporting them, can relax with each other and receive any necessary help and support with breastfeeding. This environment involves the serving of refreshments including hot drinks. Lead facilitators must provide a safe environment for those attending, including young children accompanying their mothers. Where the host venue has its own food and drink policy, this should take precedence.

17.1.3 Guidance on drink provision

17.1.3.1 Adults

Breastfeeding mothers have increased fluid requirements and must consume sufficient fluid to prevent against dehydration (FSA, 2009). It is therefore important that suitable fluids are available during breast start group sessions. Water should be available at all times.

Water, semi–skimmed milk and pure fruit juices are all appropriate drinks to be offered during a breast start group session.

Fruit juice drinks, fizzy drinks and squashes contain high levels of sugar and are not recommended to be served.

Drinks such as tea, coffee and hot chocolate containing caffeine which passes directly into breast milk. Therefore breastfeeding women should be advised to take these drinks occasionally in moderation.

The provision of hot drinks must be balanced with the health and safety risk of hot drinks to babies, children, breastfeeding mums and their supporters (appendix B weekly identification checklist and appendix C annual hazard identification checklist). A risk assessment should be completed when serving hot drinks. Parents or carers should be made aware that they are responsible for the safety of their own children at all times.

The local policy of the host venue regarding drink provision should take precedence.

17.1.3.1 Infants and children

Breastfeeding mothers may be accompanied by older children to the group who require a drink. Water should be available at all times.

Exclusive breastfeeding is recommended for the first six months of an infant’s life. Breastfed babies do not usually require any additional fluid; however, tap water which has been boiled then cooled can be given. From six months of age tap water does not need to be boiled.

From 12 months of age, full fat cow’s milk can be given as a drink. Semi-skimmed milk can be given as a drink from two years of age.

Children should be encouraged to use a suitable drinking vessel. A free flow cup should be introduced from six months of age, to replace a feeding bottle by 12 months of age. A free flow cup or beaker should be used from the age of one year.

Baby juices, juice drinks, fizzy drinks, other drinks and squashes are not suitable to offer due to the sugar and acid content that can be damaging to teeth. Reduced sugar squashes, diet fizzy drinks, low-calorie and no added sugar drinks contain artificial sweeteners that are not designed for young children. Also, like the full sugar versions they have a high acid content so are still damaging to teeth and not recommended for young children.

Tea and coffee should not be given to young children due to the caffeine and tannin content that act as a stimulant and inhibits the absorption of iron.

17.1.4 Guidance on food provision

17.1.4.1 Adults

As part of the breast start group environment, snacks may be provided. Breastfeeding women are recommended to consume a healthy balanced diet, in line with the Eat well plate and general healthy eating guidelines (FSA, 2009). Nutritious snacks can contribute to the increased energy and calcium requirements of breastfeeding women.

To support local and national healthy eating guidelines, the following snacks are recommended to be served in groups:

17.1.4.2 Fruit

Fresh and tinned fruit in natural juice:

apples
bananas
pears
oranges
kiwi fruit
strawberries
mango
melon
grapes
nectarines
peaches
pineapple

Note, dried fruit has high sugar content and due to its sticky nature can be damaging to teeth. It is therefore recommended that it isn’t consumed as a snack on a regular basis but taken as part of a main meal. It can also be a choking hazard in young children.

17.1.4.3 Vegetables

All vegetables, eaten raw or lightly cooked:

carrots
cucumber
celery
tomatoes
peppers

11.1.4.4 Starchy foods

Breads or toast.
Crumpets.
English muffins.
Scones Teacakes.
Fruit bread.
Bread sticks.
Plain popcorn.
Oat cakes.
Crackers.
Rice cakes.
Pitta breads.

Note, offer reduced fat spread rather than full fat spreads or butter and choose high fibre varieties where possible.

17.1.4.5 Other

Yoghurt.
Fromage Frais.
Cheese.
Cheese spread.
Cottage cheese.
Humus.
Salsa could be, for example, made into sandwiches, or served with pitta bread, or vegetable sticks.

Note, offer reduced fat varieties.

It advised not to provide foods high in fat and, or sugar (such as cakes, biscuits and crisps). These provide little nutritional value and are not in line with healthy eating guidelines for adults or children.

The local policy of the host venue regarding food provision should take precedence.

17.1.4.6 Infants and children

Young children under two years have high energy and nutrient requirements compared to their body size. It is therefore recommended that they consume a nutrient dense diet including full fat dairy products for example, milk, yoghurts, cheese and full fat spreads and low fibre foods for example, white bread.

An adult style healthy eating diet for example, low fat or high fibre isn’t suitable for children under two years and some snacks provided in groups may not be suitable for young children. If babies or older siblings are given a snack, it is the responsibility of the parent or carer to ensure that it is an age and texture appropriate food and suitable for their child to eat. Infants and children should be always supervised by the parent or carer.

17.1.4.7 Special cultural or festival celebrations

It is recognised that on such occasions for example, Christmas, Mawlid, birthday of the prophet, Pongal, Hindi festival, the group may wish to hold a celebratory event. At such an event, a balance of healthy and less healthy options may be provided that are culturally sensitive, if agreed upon by that setting.

17.1.4.8 Allergies

It cannot be guaranteed that food and drink served in breast start groups is free from food allergens including nuts, milk, gluten etc. Therefore, staff facilitating breast start groups will pro-actively address this at the start of each session, to ask those attending to declare any known allergies. It remains the responsibility of the individual to ensure any food they consume is appropriate for themselves and their infants or children.

17.1.4.9 Food safety and hygiene

All colleagues associated with the preparation and serving of food must be aware of, and carry out good food hygiene practices. Key colleagues involved in the preparation and serving of food must hold a current food hygiene certificate. Named leads and facilitators of the breast start groups have a responsibility to ensure they hold a current certificate, and their line managers have a responsibility to ensure appropriate checks are in place.

Named leads and facilitators will ensure that users of the breastfeeding support groups are aware of hygiene standards as part of their induction to the group.

17.1.4.10 References

Doncaster and Bassetlaw Infant Feeding Good Practice Guidance (2004/05) Edition This guidance is currently under review (September 2018, no date available for expected publication).
Food Standards Agency (2009). Breastfeeding your baby, what to eat?

17.2 Appendix B Weekly hazard identification checklist

Appendix B Weekly hazard identification checklist (staff access only) (opens in new window)

17.3 Appendix C Annual hazard identification checklist

Appendix C Annual hazard identification checklist (staff access only) (opens in new window)

Document control

Version: 6.
Approved by: Clinical policies review and approval group.
Date approved: 7 May 2024.
Name of originator or author: Community practice educator and infant feeding co-ordinator.
Name of responsible individual: Clinical review and approval group.
Date issued: 21 May 2024.
Review date: 31 May 2027.
Target audience: All colleagues responsible for leading, facilitating and supporting breastfeeding support groups (breast start groups).

Page last reviewed: November 15, 2024
Next review due: November 15, 2025

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