Why set up a breastfeeding support programme?
Audit undertaken by the Reddish Team of Midwives over a 6 month period (Sept 2003 – Feb 2004) showed that 33% of women breastfeed in the Reddish area 10 days after giving birth. However the Health Visitors audit revealed 28% of women were breastfeeding on their first visit at day 14. The latter clearly highlighted a 5% reduction in breastfeeding over a 4-day period when the midwifery contact was reduced. This was alarming and action needed to be taken to improve breastfeeding rates in the area. However evidence has shown that an effective method of improving these rates is to initiate community peer support. The midwife team leader consulted with the consultant midwife for public health about the possibility of setting up a peer support group for breastfeeding mums. Thereafter the vision was discussed with mothers who were positive about breastfeeding, even though they themselves had some problems in the initiation of breastfeeding in the early days.
Consequently an action group was set up consisting of a consultant midwife, a team midwife, a public health nurse health visitor and a community development worker. As a helpful tool, the group used evidence-based advice from Thurrock Primary Care Trust's guidance on ‘Developing a Breastfeeding Supporters' Programme'.
Recruitment
In order to recruit breastfeeding mums to be volunteers onto the programme, the midwife and health visitors spoke personally to mothers, A4 size colour posters were also placed in public clinics, GP surgeries, community buildings, shopping areas and young mums' groups. Twelve women (aged 18 to 35+ years old) with personal experience of breastfeeding were keen to volunteer and these women were recruited personally by the midwives during postnatal visiting contacts. At this time the professionals took the interested womens' names and contact details. The women were sent a letter followed by a phone call inviting them to the Launch of the Breastfeeding Support Group on July 8 th 2004.
Holding an informal session
A room was booked at the local community centre, refreshments were provided and a crèche was set up. Health visitors and other clinicians were invited, the team midwife and the consultant midwife led the discussion on reasons for becoming a breastfeeding supporter, what volunteers would be expected to do, and what volunteers could expect from the programme. The agenda for the meeting also covered topics such as: promoting breastfeeding in the community, meeting women in pregnancy, having a drop-in group, working with a health visitor professional, chatting informally about breastfeeding to mothers and taking over and controlling groups. This was a very informal session and provided prospective supporters with an insight into the training involved to become a supporter and the future vision for the volunteer peer supporter. Those who chose to take part in the programme reported that they did so to promote the numbers of women breastfeeding as well as to highlight the benefits of it to mothers and to dispel media myths.
Training
Following the Launch, a 6 week taster course commenced in September 2004. (Sessions cost £145 each to run with a total cost of £870). All the volunteers were sent letters followed by telephone contact prior to the training. The midwife team predominantly delivered the 6 week programme, and this was shared between the team midwife and the midwife team leader.
The course consisted of the following:
- Session 1 - Introduction (sharing experiences, working as a group, course aims and objectives). Each volunteer was issued with an A4 sized ring binder to enable them to collect and store handouts and information from each session. This was essential in order to equip the volunteers with the skills and information to enable them to carry out their peer support role effectively and efficiently.
- Session 2 - The Benefits of Breastfeeding (to mothers, babies, society and the environment).
- Session 3 - How Breastfeeding Works (the structure of the breast, how milk is produced and useful tips to share with mothers).
- Session 4 - Common Breastfeeding Problems: some useful tips.
- Session 5 Opportunities to Promote Breastfeeding in the local community.
- Session 6 - Where to Now? (This provided opportunity to reflect on the course content and how the Thurrock Breastfeeding Support programme can offer further support).
The group democratically decided to name the group BRAS (Breastfeeding Reddish and Stockport). The consultant midwife presented the certificates of attendance.
Evaluations
Evaluation forms were handed out weekly during the 6 week taster session and out of possible 42 evaluation forms, 71% were returned. Forms were designed to be easy to read and often contained pictures for women to choose when evaluating the course content. The volunteers expressed that they would have liked more group work, facts and figures and invited guest speakers. On the whole, the women enjoyed the course and found the breastfeeding and breast structure facts and figures useful, they felt the group leaders were enthusiastic and the interaction with other mothers informative.
Application forms
At the end of the 6 week taster session, 8 women were keen to continue the training. These women were invited to complete application forms. The Voluntary Services Manager at Stockport Hospital gave the midwife team leader hospital application forms which she amended in accordance with the breastfeeding role, i.e. she added sections on reasons for wanting to be a breastfeeding supporter, what volunteers felt they could offer, how long they would be prepared to undertake the role, and how many hours a week they could offer). It was important to take the suggestions from the evaluations into consideration and integrate them into the 16 week training programme.
Funding
As funding was not available for the 16 week course, Stockport NHS Foundation Trust gave £360 for fees which was added to £600 received from local impact monies (community-based money for under-privileged communities). The Borough Council provided a free room. The women agreed to close the crèche as it was rarely used.
Further Training
All the volunteers were notified two weeks in advance of the 16 week course (which began on November 4 th 2004). Interviews were carried out in the first two weeks. Thereafter the applications were returned to the Voluntary Services manager. The 16 week programme provided an opportunity to revisit the initial information and explore it in depth. However the women's requests highlighted in the evaluations had to be accommodated and balanced with the actual delivery of the set programme. Hence the content consisted of the following sessions:
- 1 - Introduction and Benefits of Breastfeeding
- 2 - Promoting Breastfeeding in the Community. This involved group work and the prospective volunteers decided to carry out projects as part of the course researching attitudes to breastfeeding. Projects covered by the women were: attitudes of women to breastfeeding, and attitudes of men towards breastfeeding. One volunteer also created a website with information on breastfeeding.
- 3 - Enabling and Supporting Breastfeeding.
- 4 - How the Breast Works (milk production, positioning, demand and supply).
- 5 - Hospital Visit. On the 2 nd Dec 2004 the women visited the maternity hospital to view the maternity services, meet the managers and staff as well as the Voluntary Services Manager. Prior to this organised visit, the midwife communicated with all wards and departments inviting staff to meet the volunteers. During this visit the women completed police check forms and visited the Occupational Health Department.
- 6+7 - Early days of Establishing Breastfeeding: Common Issues and Difficulties. This consisted of group work, role-play, and working through scenarios that may be encountered during the home visits.
- 8 - Preventing and Coping with Mastitis
- 9 - Visit by Local Health Visitors Discussing their Role
- 10 - Doing a Breastfeeding Support Visit. This involved discussion scenarios and group work
- 11 - Visit from the National Childbirth Trust Facilitator (who is responsible for running a Breastfeeding Supporters Group in another area within Stockport).
- 12 - Role-play: Exploring and Appreciating the Importance of Interpersonal Skills.
- 13 - Programme Boundaries and Volunteer Agreements
- 14 - Presentation of Project Work by the Volunteers and Presentation of Certificates by the Consultant Midwife for Public Health.
Six women completed the course. Those who had dropped out did so due to other commitments or because they changed location.
The future for the programme
The ‘BRAS' wanted to continue to meet following the training so they currently meet weekly from 12.30pm – 2.30pm and facilitate a Parent and Toddler Group, where prospective mums and people of all backgrounds can obtain information and support regarding breastfeeding and other relevant issues. The Well Baby Clinic commences in the local health centre afterwards so it is hoped that a working relationship for mutual benefit between these groups can be nurtured.
Since April 2005, 6-8 mums have come to meet BRAS and it is hoped that in future the BRAS can make home visits, contribute to the local parent education programme as well as meeting groups of mums in the community centre. In order to make the group sustainable, the health and safety aspect of home visits and the financial issues need to be considered. It has been established that the group also requires a key worker, and two staff are needed to support the group.
Discussion around the length of the training programme is also taking place, as it is felt that 6-8 weeks may reduce the dropout rate of volunteers. An existing peer support volunteer is happy to join the working party in developing the programme. Volunteers have purchased some pillows, mats, and books and are keen to develop and increase the breastfeeding rates in the local community and within Stockport. The peer supporters have created a poster inviting women and men from the local community to join them every Thursday at the community centre. Posters will be displayed in public places throughout Stockport as well as in the local chemists and libraries.
On International Women's Day 'BRAS' went to Boots the chemist to provide research information, raise the profile of breastfeeding and change societal opinion.
A rolling training programme of 6-8 weeks duration would do much to raise the profile of breastfeeding within the area. The Reddish Team midwives, the Primary Care and the Foundation trusts are very appreciative of the dedication and commitment of the BRAS group.
For further information please contact:
Eileen Maloney
Midwife Team Leader, Reddish Team
Stockport NHS Foundation Trust
Women and Children's Services
Stepping Hill Hospital
Poplar Grove
Stockport
SK2 7JE
Tel: 0161 419 5282/5551
Mobile: 07876230812
