SPSP Perinatal and SPSP Paediatric Programmes perinatal learning session: April 2025

Perinatal breakout session – Perinatal approach to breastfeeding and the links to inequalities

Aims

  • Hear from NHS Tayside on the challenges, successes and quality improvement activity related to breastfeeding throughout the perinatal journey
  • Opportunity to network and build new connections.

Arbroath breastfeeding support

Presented by Gillian McMillan, Infant Nutrition Coordinator, NHS Tayside.

Summary

Aim

The aim of the Arbroath breastfeeding support project was to reduce the attrition in breastfeeding rates at the health visitor’s first visit by 1% by October 2024.

Background

Before the project, the attrition rate in Arbroath was 18.10%. The Arbroath area has high levels of child poverty, areas of high deprivation, a birth rate of approx. 200 per year and a 63% breastfeeding initiation. The breastfeeding initiation rate is below the national average (67.8%) and the NHS Tayside average (69.2%).

Test of change

Funding was provided which enabled a part-time breastfeeding support worker (BFSW) to provide face-to-face and phone support to pregnant and breastfeeding women in Arbroath for the duration of the project. The multi-disciplinary team worked to provide evidence-based advice and reduce conflicting information. The BFSW built strong relationships with midwives, health visitors and family nurse practitioners.

Improvement tools

The ‘Action 4 Breastfeeding’ toolkit was used as a template for the project and adapted to suit the local context in Arbroath.

Impact

  • Ninety-seven in-person visits and 455 calls were completed during the project. This resulted in a total of 123 women who were supported.
  • Reduction in breastfeeding attrition by 9.51% at the health visitor’s first visit.
  • Reduction in attrition by 10.77% at the health visitor’s 6–8-week visit.
  • 59% of the women supported were from Scottish index of multiple deprivation (SIMD) 1 & 2.
  • 17% of the mothers that were supported were under 25.

Preterm breastfeeding beyond the neonatal unit

Presented by Lorna McKerracher, Consultant, NHS Tayside.

Summary

The benefits of breastmilk for preterm and late preterm babies were explored, including the reduction in sepsis and necrotising enterocolitis, as well as reducing mortality and improving neurodevelopmental outcomes. The presentation outlined the health inequalities associated with prematurity and the impacts of not breastfeeding as well as common lactation issues for mums of preterm babies in the neonatal unit. Attendees were tested on their lactogenesis knowledge in an interactive quiz.

Lorna described several lactation challenges which neonatal units routinely face, including delays in initiating or continuing expressing, alternative milk (donor breastmilk or formula) offered too early or how poor fitting breast pump flanges are associated with discomfort, trauma & low milk yield.

The presentation also described the work with Ninewells preterm breastfeeding protection clinic including the impact so far and the lessons learnt and ended with a discussion on cue-based feeding & home nasogastric tube (NGT) feeding.

Lorna’s take home messages for attendees included:

  • Supporting longer term breastfeeding in preterm infants requires early, collaborative and proactive multi-disciplinary input, and specific lactation support throughout the neonatal admission and beyond.
  • Late preterm babies are physiologically immature and are at risk of faltering growth post discharge
  • The NG Tube is our friend and should not be rushed out.
  • Failure to anticipate and address low milk supply in mums of preterm babies will shorten the breastfeeding journey.