Who can help?
The key to successful breastfeeding is the support you receive. There is an array of supporters available to families and the following tabs will run through WHO CAN HELP. If you cannot find your local area on Local Support Groups you can contact your midwife or health visitor to find out what is provided in your area or local health trusts.
Health professional support
Hospital trusts may differ slightly in their midwifery provision, but the majority of hospitals in England are either fully accredited by UNICEF as a Baby Friendly Initiative (BFI) Hospital, or they are working towards this award. This results in a consistent delivery of infant feeding and relationship building, evidence-based support and information sharing. Your midwife will be able to support you in understanding the importance of connecting with your baby whilst pregnant to aid their development and encourage responsive parenting and ensure breastfeeding gets off to a great start. They will inform you of the importance of skin to skin contact in those early hours and beyond and how to position your baby to ensure they attach at your breast in the best way for effective feeding. They will explain how to hand express your breast milk and give you tips on why this would be beneficial. Finally, they can help show you how you can recognise the signs of effective feeding. Often the midwives will use a Breastfeeding Assessment form to establish how breastfeeding is going and whether additional support is required.
Each hospital will have a different schedule of visits but generally if you have delivered in hospital you will be visited by a community midwife the day after you are discharged. Your midwife may not have time to sit supporting you for very long with breastfeeding, so ask what other support is available. Ask if your area has breastfeeding peer supporters who can visit, or maternity support workers/care assistants (MSWs/MCAs). You should be signposted by your midwife to any breastfeeding groups or breastfeeding clinics that are available.
You may not see your midwife again until you are discharged from midwifery care at around day 10 postpartum. However, if you ever have any concerns you can always contact your local community midwifery team or maternity unit.
Most hospital trusts will have an Infant Feeding Coordinator, they are generally a midwife, who may also be a Lactation Consultant, but not always. They may be able to deal with more complex infant feeding issues and are a great resource of information.
The checks the midwifery team will carry out when they see you on the ward or at home will include:
Breathing, heartrate and temperature if required.
Colour and tone.
Skin colour – including checking for Jaundice.
Urine output – number of wet nappies (see IS IT WORKING?).
Stools – number per day and colour
Feeding – how often and how long
Breasts/Nipples – Any problems
(See IS IT WORKING?)
There are other checks but the above are those related to feeding. You may be asked to attend a postnatal clinic appiontment instead of a home visit where appropriate.
Some maternity units have a team of nursery nurses who support baby’s in transitionary care, where the baby may have some additional needs. For example, baby’s who are at risk of hypoglycaemia, or any other condition that may impact on the neonatal period and are under the care of the paediatric team. They can offer support with breastfeeding, hand expressing and are often experts in assisting mothers with pumping their breast milk, when required.
Maternity Support Worker:
In some trust these are a team of support workers who work alongside the community midwifery teams. In other areas these may be the same as the Maternity Care Assistant, who are based in the hospital (see below). MSWs are trained to support you to position and attach your baby to the breast, to hand express or pump your breastmilk and can carry out a Breastfeeding Assessment Form. They may also be asked to weigh your baby and will often be the person to take your baby’s Newborn Blood Spot Test.
Maternity Care Assistant:
Their role can differ vastly in each maternity unit. In some units, they are able to support with the basics of what good position and attachment is and how to hand express breastmilk.
Maternity Infant Feeding Team:
These teams can differ vastly across the country and across BFI hospitals. There is generally an Infant Feeding Coordinator in most maternity units and they can be a midwife, but their level of midwifery may vary from a band 5 to a senior band 7 position. They will often have the expert qualification of being an International Board Certified Lactation Consultant (IBCLC) which enables them to support breastfeeding dyads with more complex needs. If the hospital is progressing towards a BFI Award or is already accredited the Infant Feeding Coordinator will head up this project and lead in educating all staff and medical staff in the Maternity BFI Standards.
There may be a whole team of Infant Feeding Midwives and they may run a clinic/s. They will be on hand to support and be advocates for women who are faced with challenges to breastfeeding and any infant feeding, but they will expect the midwifery team caring for the mother to take responsibility for support with the basics and carrying out the Breastfeeding Assessment Forms.
These teams may also include Breastfeeding Peer Supporters, who are volunteers who have breastfed their own children and have completed a training course in how to support mothers in a peer-based model, with breastfeeding. They are often the person who can spend the most time with a mother and are a key asset to any Infant Feeding team.
Your health visitor may visit you while you are still pregnant, generally around 28 weeks, but this is not always possible across all trusts. Ask you health visiting team for their particular schedule of contacts. They take over the care of your baby after the midwife has discharged you both, generally around day 11. The majority of Health Visiting Teams are working towards or are awarded with BFI accreditation and therefore ensuring continuity of care, in terms of offering evidence-based information and support in feeding baby and building relationships. They may not be able to spend a lot of time supporting you with breastfeeding but are able to carry out a Breastfeeding Assessment Form and can signpost you to local support groups. They often run breastfeeding support groups alongside their baby weighing clinics. If your local council or trust does not appear on the Local Support tab ask your local Health Visiting team for your local provision.
Breastfeeding Specialist Support
A Lactation Consultant is the highest expertise in the breastfeeding support world and will be a health professional or breastfeeding counsellor. To qualify as an International Board Certified Lactation Consultant (IBCLC) you have to have 1000 hours of relevant breastfeeding clinical practice, have completed 90 hours of study and sat an exam. Recertification then takes place every 5 years and the exam must be sat every 10 years. Lactation consultants can practice within the NHS and they may practice privately. They can add an expert level of understanding and education in issues that occur with the breastfeeding dyad. They can work with you in pregnancy to pre-empt any issues that you may face, maybe due to a health condition you or baby may have. To find a lactation consultant you can search the Lactation Consultant of Great Britain (LCGB) https://www.lcgb.org/find-an-ibclc/
Breastfeeding counsellors are generally linked to charitable organisations, such as La Leche League (LLL), The National Childbirth Trust (NCT), the Breastfeeding Network (BfN) and the Association of Breastfeeding Mothers (ABM). They will have gone through a rigorous training programme to qualify as a counsellor and offer comprehensive support in breastfeeding but are not a health professional. They can work in a paid or voluntary capacity.