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Infant feeding policy joint or North Lincolnshire

  • Northern Lincolnshire and Goole NHS Foundation Trust, women and children’s services.
  • Rotherham, Doncaster and South Humber NHS Trust Health North Lincolnshire 0 to 19 (25 SEND) health and wellbeing service.
  • North Lincolnshire council children’s centres and family hubs.
  • North East Lincolnshire council health visiting and family hubs.

Contents

  1. Purpose and outcomes
  2. Area
  3. Duties
  4. Care standards
  5. Monitoring compliance and effectiveness
  6. Associated documents (NLAG)
  7. References
  8. Consultations
  9. Equality Act (2010)
  10. Freedom to speak up
  11. Appendices

1 Purpose and outcomes

1.1 Purpose

The purpose of this policy is to ensure that all staff from the above service providers understand their role and responsibilities in supporting expectant and new mothers and their partners to feed and care for their baby in ways which support optimum health and wellbeing.

All staff supporting expectant and new mothers and their partners are expected to comply with this policy.

1.2 Outcomes

This policy aims to ensure that the care provided improves outcomes for children and families, specifically to deliver:

  • an increase in breastfeeding initiation rates
  • an increase in breastfeeding rates at 10 days and 6 to 8 weeks
  • amongst mothers who choose to formula feed, an increase in those doing so as safely and responsively as possible, in line with nationally agreed guidance
  • improvements in parents’ experiences of care
  • a reduction in the number of re-admissions for feeding problems
  • an increase in the number of babies who start solid foods to their baby in line with nationally agreed guidance
  • services which promote responsive parent child relationships, irrespective of feeding choice
  • an increase in the number of babies receiving breast milk in the neonatal unit
  • an increase in the number of babies who are discharged home breastfeeding or breast milk feeding from the neonatal unit.

1.3 In Support of this policy

Health visiting and maternity services are committed to:

  • providing the highest standards of care to support expectant and new mothers and their partners to feed their baby and build strong and loving parent-infant relationships. This is in recognition of the profound importance of early relationships to future health and well-being, and the significant contribution that breastfeeding makes to good physical and emotional health outcomes for children and mothers
  • ensuring that all care is mother, and family centered, non-judgmental and that mothers’ decisions are supported and respected
  • all services work together across disciplines and organizations to improve mothers’ or parents’ experiences of care

Neonatal units are committed to:

  • providing the highest standard of care to support parents with a baby on the neonatal unit to feed their baby and build strong and loving parent-infant relationships. This is in recognition of the profound importance of early relationships to future health and wellbeing, and the significant contribution that breastfeeding makes to good physical and emotional health outcomes for children and mothers

Children’s centres and family hubs are committed to providing a high standard of care to families in the area, including:

  • working collaboratively with midwifery and health visiting colleagues and other organizations providing support for parents and young babies
  • supporting mothers to have a positive breastfeeding experience
  • working with families to improve and enhance parenting experience
  • ensuring local needs are met according to best practice for sure start or children’s centre’s

1.4 As part of our support for this policy our organisations will ensure that

  • All new staff are familiarized with this policy within the first seven days of employment.
  • All staff receive training to enable them to implement the policy as appropriate to their role, with new staff receiving this training within six months of commencement of employment.
  • The international code of marketing of breast milk substitutes is implemented throughout the services.
  • All documentation fully supports the implementation of these standards.
  • Midwifery and health visiting teams are responsible for collecting the required infant feeding data, at birth, discharge from hospital, discharge from midwifery service and 6 to 8 weeks. Children’s centre’s or family hubs and medical centre’s (general practice) may also collect data to enable them to monitor breastfeeding rates.
  • Parents’ experiences of care in all areas will be listened to through regular audit, parents’ experience surveys (for example, care quality commission survey of women’s experiences of maternity services), bliss baby charter audit tool for neonatal services, user satisfaction surveys and social media interaction.
  • Parental engagement in both planning and evaluation is encouraged to ensure services in children’s centre’s and family hubs meet their needs.
  • All staff involved with the care of breastfeeding women will adhere to this policy. Any deviation from the policy must be justified and recorded in the mother’s and, or baby’s health-care records. This should be done within professional judgment and context of professional codes of conduct.
  • The parent’s guide to the infant feeding policy will be communicated effectively to all pregnant women and mothers of young babies. This will include a display of the policy in all areas of the maternity unit and community settings which serve mothers and babies. Where a mothers’ or parents’ guide is displayed or distributed in place of the full policy, the full version should be available on request. A statement to this effect will be included in the mothers’ or parents’ guide.
  • In North Lincolnshire the parent’s guide to the policy will be contained in the personal child health record (red book).
  • The policy will also be made available in other formats on request and the use of interpreter services will be employed if translation of the policy is required in alternatives languages.

2 Area

This joint infant feeding policy applies to staff who work in services in North and North East Lincolnshire who support pregnant and breastfeeding women including:

  • NLaG maternity, gynaecology and paediatric services (registered midwives, registered nurses, health care assistants, medical staff (obstetric and paediatric), student midwives and nurses)
  • RDaSH and North East Lincolnshire health visiting (health visitors, all multi-professional students, nursing associates, nurses, nursery nurses, families first practitioners, family support workers, and adult mental health services and school nursing services for RDASH)
  • North and North East Lincolnshire council paid and volunteer peer supporters, children’s centre and family hub staff

3 Duties

Staffs have the duties and responsibilities as indicated below in section 4.0.

4 Care standards

This section of the policy sets out the care that our service providers are committed to giving each and every expectant and new mother. It is based on the UK committee for UNICEF (UNICEF UK) baby friendly initiative standards for maternity, health visiting, children’s centres and neonatal services and relevant NICE guidance and the healthy child programme.

4.1 NLAG maternity care standards

4.1.1 Pregnancy

All pregnant women will have the opportunity to discuss feeding and caring for their baby with a health professional (or other suitably trained designated person). This discussion will include the following topics:

  • the value of connecting with their growing baby in utero
  • the value of skin contact for all mothers and babies
  • the importance of responding to their baby’s needs for comfort, closeness and feeding after birth, and the role that keeping their baby close has in supporting this
  • feeding, including:
    • an exploration of what parents already know about breastfeeding
    • the value of breastfeeding as protection, comfort and food
    • getting breastfeeding off to a good start

4.1.2 Birth

  • All mothers will be offered the opportunity to have uninterrupted skin contact with their baby at least until after the first feed and for as long as they want, so that the instinctive behaviours of breast seeking (baby) and nurturing (mother) are given the opportunity to emerge.
  • All mothers will be encouraged to offer the first breastfeed in skin contact when the baby shows signs of readiness to feed, the aim is not to rush the baby to the breast, but to be sensitive to the baby’s instinctive process towards self-attachment.
  • When mothers choose to formula feed, they will be encouraged to offer the first feed in skin contact.
  • Those mothers who are unable (or do not wish) to have skin contact immediately after birth will be encouraged to commence skin contact as soon as they are able, or so wish.
  • Mothers with a baby on the neonatal unit are:
    • enabled to start expressing milk as soon as possible after birth (ideally following the Peri-premi passport within the first hour)
    • supported to express effectively

It is the joint responsibility of midwifery and neonatal unit staff to ensure that mothers who are separated from their baby receive this information and support.

4.1.2.1 Safety considerations (skin-to-skin)

Vigilance of the baby’s well-being is a fundamental part of postnatal care immediately following and in the first few hours after birth. For this reason, normal observations of the baby’s temperature, breathing, colour and tone should continue throughout the period of skin-to-skin contact in the same way as would occur if the baby were in a cot (this includes calculation of the Apgar score at 1, 5 and 10 minutes following birth). Care should always be taken to ensure that the baby is kept warm. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern.

  • Staff should have a conversation with the mother and her companion about the importance of recognising changes in the baby’s colour or tone and the need to alert staff immediately if they are concerned.
  • It is important to ensure that the baby cannot fall onto the floor or become trapped in bedding or by the mother’s body. Mothers should be encouraged to be in a semi-recumbent position to hold and feed their baby. Particular care should be taken with the position of the baby, ensuring the head is supported so the infant’s airway does not become obstructed.
4.1.2.2 Notes, mothers
  • Observations of the mother’s vital signs and level of consciousness should be continued throughout the period of skin-to-skin contact. Mothers may be very tired following birth, and so may need constant support and supervision to observe changes in their baby’s condition or to reposition their baby when needed.
  • Many mothers can continue to hold their baby in skin-to-skin contact during perineal suturing, providing they have adequate pain relief. However, a mother who is in pain may not be able to hold her baby safely. Babies should not be in skin-to-skin contact with their mothers when they are receiving Entonox or other analgesics that impact consciousness.
4.1.2.3 Notes, babies

All babies should be routinely monitored whilst in skin-to-skin contact with mother or father. Observation to include:

  • checking that the baby’s position is such that a clear airway is maintained, observe respiratory rate and chest movement and listen for unusual breathing sounds or absence of noise from the baby
  • colour, the baby should be assessed by looking at the whole of the baby’s body, as the limbs can often be discoloured first. Subtle changes to colour indicate changes in the baby’s condition
  • tone, the baby should have a good tone and not be limp or unresponsive
  • temperature, ensure the baby is kept warm during skin contact

Always listen to parents and respond immediately to any concerns raised.

4.1.3 Supporting breastfeeding

  • Mothers will be enabled to achieve effective breastfeeding according to their needs (including appropriate support with positioning and attachment, hand expression, understanding signs of effective feeding). This will continue until the mother and baby are feeding confidently.
  • Mothers will have the opportunity to discuss breastfeeding in the first few hours after birth as appropriate to their own needs and those of their baby. This discussion will include information on responsive feeding and feeding cues.
  • A formal feeding assessment will be carried out using the breastfeeding assessment tool as often as required in the first week, with a minimum of two assessments to ensure effective feeding and the wellbeing of mother and baby.
  • These assessments will include a dialogue or discussion with the mother to reinforce what is going well and, where necessary, develop an appropriate plan of care to address any issues that have been identified.
  • Mothers with a baby on the neonatal unit will be supported to express as effectively as possible and encouraged to express at least 8 times in 24 hours, including once during the night. They will be shown how to express by both hand and pump.
  • Before discharge home, breastfeeding mothers will be given information both verbally and in writing about recognising effective feeding and where to call for additional help if they have any concerns.
  • All breastfeeding mothers will be informed about the local support services for breastfeeding including the Baby Feeding team and local Breastfeeding support groups.
  • For those mothers who require additional support for more complex breastfeeding challenges, the infant feeding lead midwife will be consulted. Mothers will be informed of this pathway.
4.1.3.1 Responsive feeding

The term responsive feeding is used to describe a feeding relationship which is sensitive, reciprocal, and about more than nutrition. Staff should ensure that mothers have the opportunity to discuss this aspect of feeding and should reassure mothers that: breastfeeding can be used to feed, comfort and calm babies; breastfeeds can be long or short; breastfed babies cannot be overfed or ‘spoiled’ by too much feeding, and breastfeeding will not, in and of itself, tire mothers any more than caring for a new baby without breastfeeding. Find out more in UNICEF UK’s responsive feeding info sheet (opens in new window).

4.1.4 Exclusive breastfeeding

  • Mothers who breastfeed will be provided with information about why exclusive breastfeeding leads to the best outcomes for their baby and why it is particularly important during the establishment of breastfeeding.
  • When exclusive breastfeeding is not possible, the value of continuing partial breastfeeding will be emphasised and mothers will be supported to maximise the amount of breast milk their baby receives.
  • Mothers who give other feeds in conjunction with breastfeeding will be enabled to do so as safely as possible and with the least possible disruption to breastfeeding. This will include appropriate information and a discussion regarding the potential impact of introducing a teat when a baby is learning to breastfeed.
  • A full record will be made of all supplements given, including the rationale for supplementation and the discussion held with parents.
  • Supplementation rates will be audited using the continuous audit tool and also intermittently by interviewing women.

4.1.5 Modified feeding regimes

  • There are a number of clinical indications for a short-term modified feeding regime in the early days after birth. Examples include preterm or small for gestational age babies and those who are excessively sleepy after birth. Frequent feeding, including a minimum number of feeds in 24 hours, should be offered to ensure safety.
  • Babies on enhanced midwifery care or following hypoglycaemic guidelines will require a modified feeding regime.

4.1.6 Formula feeding

  • Mothers who formula feed will be enabled to do so as safely as possible through the offer of a demonstration and, or discussion about how to prepare infant formula and advised that it is fine to use first milk until baby is a year old.
  • Mothers who formula feed will have a discussion about the importance of responsive feeding and be encouraged to:
    • respond to cues that their baby is hungry
    • invite their baby to draw in the teat rather than forcing the teat into their baby’s mouth
    • pace the feed so that their baby is not forced to feed more than they want to
    • recognise their baby’s cues that they have had enough milk and avoid forcing their baby to take more milk than the baby wants

4.1.7 Early postnatal period, support for parenting and close relationships

  • Skin-to-skin contact will be encouraged throughout the postnatal period.
  • All parents will be supported to understand a new-born baby’s needs, including encouraging frequent touch and sensitive verbal or visual communication, keeping babies close, responsive feeding and safe sleeping practice.
  • Mothers who bottle feed will be encouraged to hold their baby close during feeds and offer the majority of feeds to their baby themselves to help enhance the mother-baby relationship.
  • Parents will be given information about local parenting support that is available including breastfeeding peer support group, adult education services, RDASH and children’s centre or family hubs parenting services through face-to-face contact and sign posting to maternity and partner social media and websites.
4.1.7.1 Recommendations for health professionals on discussing bed-sharing with parents

Simplistic messages in relation to where a baby sleeps should be avoided: neither blanket prohibitions nor blanket permissions reflect the current research evidence.

The current body of evidence overwhelmingly supports the following key messages, which should be conveyed to all parents:

  • the safest place for your baby to sleep is in a cot by your bed
  • sleeping with your baby on a sofa puts your baby at greatest risk
  • your baby should not share a bed with anyone who:
    • is a smoker, including e-cigarettes
    • has consumed alcohol
    • has taken drugs (legal or illegal) that make them sleepy
    • baby born before 37 weeks and, or under 2.5kg

The incidence of SIDS (often called “cot death”) is higher in the following groups:

  • parents in low socio-economic groups
  • parents who currently abuse alcohol or drugs
  • young mothers with more than one child
  • premature infants and those with low birthweight. Parents within these groups will need more face-to-face discussion to ensure that these key messages are explored and understood. They may need some practical help, possibly from other agencies, to enable them to put them into practice

4.2 NLAG neonatal care standards

4.2.1 Supporting parents to have a close and loving relationship with their baby

This service recognises the profound importance of secure parent-infant attachment for the future health and wellbeing of the infant and the challenges that the experience of having a sick or premature baby can present to the development of this relationship. Therefore, this service is committed to care which actively supports parents to develop a close and loving bond with their baby. All parents will:

  • have a discussion with an appropriate member of staff as soon as possible (either before or after their baby’s birth) about the importance of touch, comfort and communication for their baby’s health and development
  • be actively encouraged and enabled to provide touch, comfort and emotional support to their baby throughout their baby’s stay on the neonatal unit and make use of parental stay provision if available
  • be enabled to have frequent and prolonged skin contact with their baby as soon as possible after birth and throughout the baby’s stay on the neonatal unit, see above guidelines for skin-to-skin contact in maternity care standards

4.2.2 Enabling babies to receive breast milk and to breastfeed

This service recognises the importance of breast milk for babies’ survival and health.

Therefore, this service will ensure that:

  • a mother’s own breast milk is always the first choice of feed for her baby
  • mothers have a discussion regarding the importance of their breast milk for their preterm or ill baby as soon as is appropriate
  • a suitable environment conducive to effective expression is created
  • mothers have access to effective breast pumps and equipment
  • mothers are enabled to express breast milk for their baby, including support to:
    • express as early as possible after birth (ideally following the Peri-premi passport within the first hour)
    • learn how to express effectively, including by hand and by pump
    • learn how to use pump equipment and store milk safely using NHS guidance (opens in new window)
    • express frequently (at least eight times in 24 hours, including at night) especially in the first two to three weeks following delivery, in order to optimise long-term milk supply
    • overcome expressing difficulties where necessary, for example if less than 750ml in 24 hours is expressed by day 10
    • stay close to their baby (when possible) or provide comfort squares, photos of baby or videos when expressing milk
    • use their milk for mouth care when their baby is not tolerating oral feeds, and later to tempt their baby to feed
  • a formal review of expressing is undertaken a minimum of four times in the first two weeks to support optimum expressing and milk supply using the UNICEF assessment tool
  • mothers receive care that supports the transition to breastfeeding, including support to:
    • recognise and respond to feeding cues
    • use skin-to-skin contact to encourage instinctive feeding behaviour
    • position and attach their baby for breastfeeding
    • recognise effective feeding
    • overcome challenges when needed
  • mothers are provided with details of voluntary support for breastfeeding which they can choose to access at any time during their baby’s stay
  • mothers are supported through the transition to discharge home from hospital, including having the opportunity to stay overnight or for extended periods to support the development of mothers’ confidence and modified responsive feeding
  • mothers are provided with information about all available sources of support before they are transferred home

4.2.3 Valuing parents as partners in care

This service recognises that parents are vital to ensuring the best possible short and long-term outcomes for babies and therefore, should be considered as the primary partners in care.

The service will ensure that parents:

  • have unrestricted access to their baby unless individual restrictions can be justified in the baby’s best interest
  • are fully involved in their baby’s care, with all care possible entrusted to them
  • are listened to, including their observations, feelings and wishes regarding their baby’s care
  • have full information regarding their baby’s condition and treatment to enable informed decision-making
  • are made comfortable when on the unit, with the aim of enabling them to spend as much time as is possible with their baby

4.2.4 The service will ensure that parents who formula feed

  • Receive information about how to clean or sterilise equipment and make up a bottle of formula milk.
  • Are able to feed this to their baby using a safe and responsive technique.

4.3 RDASH, North East Lincolnshire Council health visiting and public health care standards

4.3.1 Support pregnant women to recognise the importance of breastfeeding and early relationships for the health and wellbeing of their baby

The services recognise the significance of pregnancy as a time for building the foundations of future health and well-being and the potential role of health visitors to positively influence pregnant women and their families. Staff will therefore make the most of opportunities available to them to support the provision of information about feeding and caring for babies to pregnant women and their families. This will include ensuring that:

  • antenatal core contacts are used as an opportunity to discuss breastfeeding and the importance of early relationship building, using a sensitive and flexible approach, encouraging and demonstrating to the whole family ways to develop a positive relationship with their growing baby in utero
  • members of the health visiting team proactively support and recommend the services provided by other organisations to mothers (for example, antenatal programmes, The Baby Feeding team, North East Lincolnshire’s infant feeding peer support service, children’s centres, family hubs or voluntary organisations, UNICEF-foreign language resources)
  • the service works collaboratively to develop or support any locally operated antenatal interventions delivered with partner organisations

4.3.2 Enable mothers to continue breastfeeding for as long as they wish

  • A formal breastfeeding assessment using the UNICEF breastfeeding assessment tool will be carried out at the ‘birth visit’ to ensure effective feeding and well-being of the mother and baby. This includes recognition of what is going well and the development, with the mother, of an appropriate plan of care to address any issues identified.
  • This assessment will include a dialogue or discussion with the mother to reinforce what is going well and, where necessary, develop an appropriate plan of care to address any issues that have been identified.
  • For those mothers who require additional support for more complex breastfeeding challenges a referral to the specialist service will be made to the infant feeding lead midwife or the Baby Feeding team North East Lincolnshire’s Infant Feeding Peer Support team, see persistent and complex breastfeeding challenges (including tongue-tie) referral process (DCM193), mothers will be informed of this pathway.
  • Mothers will have the opportunity for a discussion about their options for continued breastfeeding (including responsive feeding, expression of breast milk and feeding when out and about or going back to work), according to individual need.
  • The service will work in collaboration with other local services to make sure that mothers have access to social support for breastfeeding.
  • All breastfeeding mothers will be informed about the local support for breastfeeding, including The Baby Feeding team, North East Lincolnshire’s infant feeding peer support service, breastfeeding support groups facilitated by trained peer support volunteers and the breastfeeding welcome here scheme.

4.3.3 Exclusive breastfeeding

  • As described in NLAG maternity standards see 4.1.4 with the exception of recording and auditing supplementation rates.

4.3.4 Modified feeding regime

  • As described in NLAG maternity standards see 4.1.5

4.3.5 Support for formula feeding

At the birth visit mothers who formula feed will have a discussion about how feeding is progressing. Recognising that this information will have been discussed with maternity service staff, but may need revisiting or reinforcing; and being sensitive to a mother’s previous experience, staff will check that:

  • mothers who are formula feeding have the information they need to enable them to do so as safely as possible. Staff may need to offer a demonstration and, or discussion about how to prepare infant formula and told that it’s appropriate to use first stage milk until baby is one year old
  • mothers who formula feed understand about the importance of responsive feeding and how to:
    • respond to cues that their baby is hungry
    • invite their baby to draw in the teat rather than forcing the teat into their baby’s mouth pace the feed so that their baby is not forced to feed more than they want to
    • recognise their baby’s cues that they have had enough milk and avoid forcing their baby to take more milk than the baby wants

4.3.5 Support mothers to make informed decisions regarding the introduction of food or fluids other than breast milk

Mothers are enabled to introduce solid foods in ways that optimise their baby’s health and wellbeing, following recommendations from Start4life-weaning:

  • that solid food should be started at around six months
  • babies’ signs of developmental readiness for solid food
  • how to introduce solid food to babies
  • appropriate foods for babies

4.3.6 Support for parenting and close and loving relationships

  • All parents will be supported to understand a baby’s changing developmental abilities and needs and to respond to these needs (including encouraging frequent touch and sensitive verbal or visual communication, keeping babies close, responsive feeding and safe sleeping practice, see NLAG maternity standards).
  • Mothers who bottle feed are encouraged to hold their baby close during feeds and offer the majority of feeds to their baby themselves to help enhance the mother-baby relationship
  • Parents will be given information about local parenting support that is breastfeeding peer support group, adult education services, RDASH and children’s centre or family hubs, North East Lincolnshire family hubs, parenting services through face-to-face contact and sign posting to maternity and partner social media and websites.
  • See NLAG maternity care standards for recommendations for health professionals on discussing bed-sharing with parents.
  • See NLAG maternity care standards for recommendations for health professionals on discussing bed-sharing with parents.

4.4 North Lincolnshire council and North East Lincolnshire council children’s centre or family hub offer care standards

Support pregnant women to recognise the importance of breastfeeding and early relationships to the health and well-being of their baby:

  • the services delivering the offer recognise the importance of pregnancy as a time to build the foundations of future health and wellbeing and the role children’s centres or family hubs offer play in supporting this
  • the Baby Feeding team work jointly with maternity and health visiting services to deliver antenatal classes to pregnant women as part of a multi-agency programme
  • pregnant women will be referred to the children’s centre or family hub by maternity or health visiting services if there is a need for targeted support around feeding and caring for baby. This may be provided by family support staff or the baby feeding support team
  • all classes and information provided reflect the baby friendly standards and comply with the code

Protect and support breastfeeding in all areas of the service:

  • mothers are welcome to breastfeed in all areas of our children’s centres and family hubs and comfortable facilities are provided.
  • breastfeeding mothers are informed of all services provided to support continued breastfeeding. This includes the provision of breastfeeding peer support groups in our centres or hubs and the local community facilitated by trained volunteers peer supporters, face to face contact by the baby feeding team in hospital, telephone support and home visits. Breast pump hire is also available through the Baby Feeding team
  • a clear referral system is in place to ensure that additional help is provided for breastfeeding mothers who require this
  • breastfeeding is valued by staff within the centres or hubs, and mothers are encouraged and praised for providing any breast milk
  • all mothers regardless of feeding method are supported to introduce solid food at around six months of age in accordance with World Health Organization and Department of Health guidelines
  • no advertising of breast milk substitutes, bottles, teats or dummies is permitted within the any of our children’s centres or family hubs

Support parents to have a close and loving relationship with their baby:

  • all our children’s centres and family hubs promote responsive parenting and parents are encouraged to respond to their baby’s needs for love, comfort and security
  • all materials and classes provided for parents reflect this philosophy
  • parents who have decided to bottle feed are encouraged to do so responsively and information is provided to support this.

5 Monitoring compliance and effectiveness

5.1 General monitoring compliance and effectiveness

The arrangement for monitoring compliance with this policy and the mandatory training is a requirement within all organisations supporting this policy.

The policy will be audited at least annually using the UNICEF UK baby friendly initiative audit tool.

Compliance with the policy will be monitored annually via reports, audits and training databases.

Breastfeeding initiation rates are monitored via the maternity dashboard and are discussed monthly at obstetrics and gynaecology clinical governance meetings.

Neonatal services will monitor monitoring breast milk feeding rates and breastfeeding rates.

The Public Health Directorate will also monitor breastfeeding initiation and prevalence rates.

The readmission to hospital of babies with breastfeeding problems and excess weight loss is audited annually and the results are presented at the relevant audit meetings within the women and children’s group.

5.2 Monitoring compliance and effectiveness

The arrangement for monitoring compliance with training is a mandatory requirement and will be monitored by each service ensuring staff or managers attend training and are compliant with the locally agreed requirements. All team managers will monitor staff attendance and follow up any outstanding staff training requirements.

The breastfeeding initiation and continuation rates will be monitored by all organisations that form part of this policy. Breastfeeding rates will also be discussed at the Northern Lincolnshire turning the curve meetings and the action plan amended where rates are dropping. The infant feeding guardian will be informed of compliance and effectiveness via quarterly reports.

If a baby is re-admitted to hospital with a feeding problem in the first 28 days of life an incident report form will be completed by NLAG. Circumstances leading to the admission will be investigated by the infant feeding lead midwives and findings will be shared with the governance team. An action plan will be developed to address the issue.

6 Associated documents (NLAG)

  • Guideline for safe preparation of artificial formula feeds (DCG232).
  • Guideline for the management of new-born babies reluctant to feed (DCG273).
  • Referral process for persistent and complex breastfeeding challenges (including tongue tie) (DCM193).
  • Newborn babies weighing guideline (DCG073).

7 References

8 Consultations

  • Northern Lincolnshire and Goole NHS Foundation Trust Obstetrics and Gynaecology Clinical Governance Group.
  • Northern Lincolnshire and Goole NHS Foundation Trust Paediatric and Neonatal Clinical Governance Group.
  • Northern Lincolnshire BFI Group.
  • Clinical Governance Care Trust Plus.
  • RDaSH policy forum.

9 Equality Act (2010)

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

Northern Lincolnshire and Goole NHS Foundation Trust is committed to promoting a pro-active and inclusive approach to equality which supports and encourages an inclusive culture which values diversity.

The trust is committed to building a workforce which is valued and whose diversity reflects the community it serves, allowing the trust to deliver the best possible healthcare service to the community. In doing so, the trust will enable all staff to achieve their full potential in an environment characterised by dignity and mutual respect.

The trust aims to design and provide services, implement policies and make decisions that meet the diverse needs of our patients and their carers the general population we serve and our workforce, ensuring that none are placed at a disadvantage.

We therefore strive to ensure that in both employment and service provision no individual is discriminated against or treated less favourably by reason of age, disability, gender, pregnancy or maternity, marital status or civil partnership, race, religion or belief, sexual orientation or transgender (Equality Act 2010).

10 Freedom to speak up

Where a member of staff has a safety or other concern about any arrangements or practices undertaken in accordance with this policy, please speak in the first instance to your line manager. Guidance on raising concerns is also available by referring to the freedom to speak up policy for the NHS (DCP126) which has been adopted by the trust in line with national guidance. Staff can raise concerns verbally, by letter, email or by completing an incident form. Staff can also contact the trust’s freedom to speak up guardian in confidence by email to nlg-tr.ftsuguardian@nhs.net or telephone 07892 764607. More details about how to raise concerns with the trust’s freedom to speak up guardian can be found on the trust’s intranet site.

The electronic master copy of this document is held by document control, Directorate of Corporate Governance, NL and G NHS Foundation Trust.

11 Appendices

12.1 Appendix A Parents’ guide to joint hospital or community breastfeeding policy

12.1.1 Aims

We support the right of all parents to make informed choices about infant feeding. All our staff will support you in your decisions. We believe that breastfeeding is the healthiest way to feed your baby and we recognise the important benefits which breastfeeding provides for both you and your child. We therefore encourage you to breastfeed your baby.

12.1.2 Ways in which we will help mothers to breastfeed successfully

All staff have received training appropriate to their roles in order to support you to breastfeed your baby. During your pregnancy, you will be able to discuss breastfeeding individually with a midwife or health visitor who will answer any questions you may have.

We recommend that you hold your new baby against your skin as soon as possible after birth. The staff will not interfere or hurry you but will be there to support you and to help you with your first breastfeed. A trained member of staff will be available to explain how to put your baby to the breast and to help with feeds in the early days.

The health visiting team will provide support later on. Appropriately trained staff will show you how to express your breast milk and we will give you written information about this.

We recommend that you keep your baby near you whenever you can so that you can get to know each other.

If any medical procedures are necessary in hospital, you will always be invited to accompany your baby.

We will give you information and advice about how to manage night feeds once you are at home. We will encourage you to feed your baby whenever he or she seems to be hungry and we will explain to you how you can tell that he or she is getting enough milk.

We recommend that you avoid using bottles, dummies and nipple shields while your baby is learning to breastfeed. This is because they can make it more difficult for your baby to learn to breastfeed successfully and for you to establish a good milk supply.

Most babies do not need to be given anything other than breast milk until they are six months old. If for some reason your baby needs some other food or drink before this, the reason will be fully explained to you by the staff. We will help you to recognise when your baby is ready for other foods (normally at about six months) and explain how these can be introduced.

We welcome breastfeeding on our premises. We will give you information to help you breastfeed when you are out and about. We will give you a list of people and organisations or groups who you can contact for extra help and support with breastfeeding, or who can help if you have a problem.

This is your guide to the breastfeeding policy. Please ask a member of staff if you wish to see the full policy.

12.2 Appendix B Breastfeeding for patient admitted to general ward at SGH, DPOW or Goole

12.1 Admission

  • Woman requiring admission to hospital who is also breastfeeding her baby or child and is not being admitted to the maternity unit.
  • Establish if there is any support needs or help with breastfeeding whilst in hospital.

12.2 Contact

  • Ring CDS or ward 26, SGH and Goole extension 302270, maternity co-ordinator, DPoW extension 307807, in first instance for help or support or assistance.

Document control

  • Version: 2.6.
  • Unique reference number: DCP023.
  • Approved by: Obstetrics and gynaecology governance or Northern Lincolnshire women’s and children’s board or health improvement partnership or Clinical Governance Care Trust plus.
  • Date approved: 28 March 2023.
  • Name of originator or author: Alison Jollands, Public Health Coordinator, NLC, Maternity and Early Years NLC or Paula Cafferty, Team Leader, RDASH or Associate Chief Nurse for Midwifery, Gynaecology and Breast Services.
  • Name of responsible individual: Associate chief nurse for midwifery, gynaecology and breast services or Alison Jollands, Public Health Coordinator, North Lincolnshire council or Paula Cafferty, Team Leader, RDASH or Janet Burrows Head of Children’s Health Provision (NELC).
  • Date issued: 15 April 2023.
  • Review date: April 2026.
  • Description of change: Minor changes.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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