Frances Forsyth looks behind the scenes of the Islington Breastfeeding Peer Support service

A group of mothers sit in a local children’s centre, talking about breastfeeding. So far, so ordinary. But these mothers are here without their children, taking an introductory training course run by the Islington Breastfeeding and Weaning Peer Support Programme. The course aims to give them the skills and knowledge to help other mothers overcome problems with breastfeeding. The atmosphere turns to quiet concentration as the trainees absorb facts and figures about breastfeeding rates in the UK.

“To me, this is the saddest statistic,”says the course tutor, pointing out that 90% of mothers who stopped breastfeeding in the first two weeks of their baby’s life say they had wanted to continue for longer. “If there’s one single statistic that shows why mothers need good breastfeeding support, this is it.”

It’s important for breastfeeding support to be available for anyone who needs it but, as the tutor explains, it is especially vital for those mothers who face such a struggle in the early days and weeks that they feel they have no choice but to stop. It is not about pressurising people or telling them what they should or should not do, but about giving parents unbiased information so that they can make choices of their own, and, most importantly, giving them practical help and support if they run into difficulties.

Figures from 2010 show that during pregnancy 75% of mothers had decided they would breastfeed, 17% had decided they would not breastfeed, and 8% had not made up their minds. With effective support for those who want and need it, breastfeeding can become well established in the early days and weeks of a baby’s life, so that mothers who choose to breastfeed can do so for as long as they wish, stopping only when they feel the time is right for them and their baby.

Of course, some mothers breastfeed with no difficulty at all, but problems are still fairly commonplace. The 2010 UK Infant Feeding Survey found that 29% of mothers experienced problems with breastfeeding while still in hospital or birth centre after the birth, and another 30% went on to experience problems within the first few days or weeks of returning home. In total, 12% of mothers started breastfeeding and then stopped within the first week.

The most common reasons for stopping in the first week of a baby’s life were the baby not latching on or “rejecting” the breast (cited by 33% of mothers who stopped); the mother having painful breasts or nipples (22%); and fears that the baby was not getting enough milk (17%).

These problems can be extremely distressing, but with the right support they can frequently be overcome – or better still, avoided altogether. And although more than 80% of mothers who experienced problems said they were offered some help or support either in hospital or at home, those mothers who did not receive support were almost twice as likely to have stopped breastfeeding within the first two weeks.

Breastfeeding in the UK
Breastfeeding rates in the UK are steadily rising. The 2010 Infant Feeding Survey showed that more mothers were breastfeeding, and continuing for longer, than at any point since the survey began in 1975. In 2010, the initial breastfeeding rate increased to 81%, from 76% in 2005. This includes all mothers who “initiated” breastfeeding, i.e. who ever put their baby to the breast or fed expressed breastmilk. More than half (55%) were breastfeeding at 6 weeks, an increase from 48% in 2005. One in three mothers was breastfeeding when their baby was aged six months, compared with one in four in 2005. London has the highest breastfeeding rates in the UK. Here, 94% mothers initiated breastfeeding, and 51% were breastfeeding at 6 months.

Rates for exclusive breastfeeding (that is, feeding nothing but breastmilk) are lower, and decrease sharply in the first weeks of the baby’s life. Although 69% of mothers in the UK began exclusively breastfeeding their baby at birth, by one week, less than half of all mothers (46%) were exclusively breastfeeding. This figure went down to around a quarter (23%) by six weeks and to 17% by 4 months. Nevertheless, this is an increase from 2005, when 65% of mothers exclusively breastfed their baby at birth and 13% were exclusively breastfeeding at 4 months.

The UK has higher breastfeeding rates than the USA, but lower than Australia and Canada. All lag behind Scandinavia. In Norway, for example, 98% of babies were being breastfed at age 1 week and 80% were still receiving breastmilk at age 6 months (2009 figures).

What help is available locally?
Note: this article focuses on at breastfeeding support in the borough of Islington, which covers more than half the TPPSG area. Dedicated breastfeeding support is also available in Camden and Haringey – see links at the end of the article.

Since 2007, the Islington Breastfeeding and Weaning Peer Support Programme has trained mothers to help other mothers, funded by the NHS in Islington and Islington Council. It has adopted the infant feeding advice and targets of World Health Organisation and Department of Health, and aims to:
• Encourage Islington mums to initiate breastfeeding from birth and support them to continue breastfeeding.
• Encourage Islington mums to exclusively breastfeed for 6 months.
• Support Islington mums to start solid foods at 6 months and to develop healthy baby-feeding practices.
• Create a breastfeeding friendly environment in the whole borough.
• Eliminate health inequality by targeting young mums and mums from disadvantaged socio-economic backgrounds.

The programme is run by the charity The Breastfeeding Network (BfN), which carries out the training and supervision of peer supporters in Islington. In the first two years the 15-20 newly trained peer supporters worked as unpaid volunteers. Funding was increased in 2009 to employ paid peer supporters so that more mothers could be offered support during the all-important first week after birth.

Since 2010 the programme has employed three paid peer supporters (full-time equivalent) and 25 volunteers, who provide breastfeeding support in a range of locations: postnatal wards at two hospitals (UCLH and the Whittington); eight baby clinics; and seven children’s centres; as well as home visits to manymothers with new babies and telephone support via the National Breastfeeding Helpline.

Interim figures suggest that, in 2012, Islington’s peer support team helped 2,780 mothers on 5,560 occasions – i.e. many mothers were seen more than once. In the majority of cases (3,260), the baby was less than one week old. More than half of all contacts (2,500) were made in hospital; 690 were home visits made by peer supporters to mothers with new babies; 1,100 were visits from mothers to breastfeeding support groups (which meet in children’s centres); and 320 were seen when they attended a baby clinic (at a GP surgery/health centre).

An additional service started in 2012 to offer dedicated phone support to young mums (under 25 years). Anyone eligible can register to receive daily support over the phone to answer questions and provide practical help and encouragement during the first two weeks.

For 2013, extra funding has been made available so that every mother in Islington can be offered a home visit from a breastfeeding peer supporter soon after her baby’s birth.

The peer support programme is an intrinsic part of the wider Islington breastfeeding programme. This trains health professionals such as health visitors, midwives and children’s centre staff to provide effective breastfeeding support and uphold good infant feeding practices, and aims to create a breastfeeding welcome environment everywhere in Islington, working towards achieving UNICEF Baby Friendly Accreditation.

What does a peer supporter do?
Peer supporters are mothers who have experience of breastfeeding their own babies and who have been trained to give non-judgemental support to other mothers.

Breastfeeding is a skill that has to be learned by both mother and baby. The most important aspect of this skill is to position the baby so that it can latch on to the breast. As many mothers – including myself – have discovered, it can be surprisingly difficult and frustrating to achieve this. Like any other skill, it can take time and practice to learn, and is easier if you can call on the support of someone knowledgeable, able to answer questions.

The course tutor describes the fundamental role of a breastfeeding supporter as “to empower the mother”. The training emphasises a “hands-off” approach, so that when a mother needs help to position the baby, the supporter would aim to talk the mother through the process, guiding her to position the baby herself, rather than simply taking over and trying to do it for her.

Trainees are told always to ask permission before touching either the baby or the mother. It sounds incredibly basic, but while in hospital many mothers have the experience of somebody grabbing both the baby and the mother’s breast and trying to force them together. Sometimes the baby does indeed latch on as a result; but an overly hands-on approach risks being traumatic for baby, mother or both, and in severe cases the baby can develop an aversion to breastfeeding. The hands-off approach aims to respect the mother and allow her to stay in control.

Learning non-judgemental listening skills is a vital part of the course. A module is dedicated to helping the trainees look back on their own breastfeeding experiences and personal beliefs so that they can become more aware of their own “baggage” and can leave it behind when they start working with mothers. Many exercises explore how to really listen, observe, ask relevant questions, and reflect back.

There is plenty of time to experience and understand the difference between giving “advice”, i.e. telling somebody what to do instead of letting them make up their own mind; “hijacking”, i.e. talking about your own views and what worked and didn’t work for you personally instead of listening to the person in front of you; and the ideal, which is to ask open-ended questions, listen to the answers, help the mother to understand the options available to her, and leave her free to make her own choices.

Other modules look at sources of information on breastfeeding and the role of research, emphasising the difference between unbiased, evidence-based information; received wisdom and anecdote; and biased claims made by those with a commercial interest (e.g. formula manufacturers).

Once trainees have completed the initial course, which takes place over 14 weeks for two hours per week, they can help mothers with the vital skill of positioning and attachment (getting the baby to latch on well) and identify common problems. They will be equipped to answer questions about the normal course of breastfeeding and weaning, based on up-to-date research evidence. They can then start volunteering under supervision, usually at a breastfeeding support group alongside a more experienced peer supporter.

Once they are volunteering regularly they can apply to take the next level of training, which will enable them to help mothers who are experiencing less common but more complex obstacles to breastfeeding (such as mastitis, baby’s slow weight gain, tongue tie and other issues).

Impact on mothers
Comments from mothers who have used the programme highlight the value of having dedicated breastfeeding help at the time they needed it:

“[The peer supporter] spent a large amount of time giving me practical advice and sympathetic reassurance.”

“They were so supportive, patient, [and] constructive.”

“[They] have been able to answer all of my queries, provide encouragement and support without making any judgment. They also offer suggestions and advice without being prescriptive or using the word ‘should’, which I have experienced a lot amongst health professionals as a new mother.”

“Honestly, without the kind attention from them I would have given up breastfeeding as it was just too painful. Discovering your team has been incredible and such a relief as I don’t feel so alone dealing with the problems.”

Health statistics from the year 2012-13 show 75% of mums in Islington were breastfeeding at the time of their baby’s 6-8 week check, with 50% still breastfeeding exclusively at that time. The rate of exclusive breastfeeding has risen around 1% each year over the last 3-4 years. Islington’s Infant Feeding Coordinator comments “this may not seem much, but we are glad that it is rising. We’re working to ensure that even more mums are empowered to continue exclusive breastfeeding with greater confidence”.

Interested in becoming a peer supporter?
Between the start of the programme in 2007 and the end of 2012, 95 mothers, from a wide range of social and ethnic backgrounds, completed the initial breastfeeding peer support training in Islington. To date, 36 have gone on to complete the more advanced training. The training is free, takes place during school hours, and a crèche is provided for children under five. Trainees are usually mothers who have breastfed a baby for at least three months. They must commit to volunteering for a set period after they complete the training (normally two hours per week for at least one year), and attending a certain number of supervision sessions per year to keep their skills up to date. Volunteers are reimbursed for reasonable expenses, including childcare.

Personally, I was helped by the breastfeeding support team in Islington when I was struggling to breastfeed my first baby in 2008, and in 2009 I took the initial peer supporter training. I can highly recommend it. I found the training, and volunteering afterwards, an eye-opening and rewarding experience. It taught me useful skills, I met interesting people who were committed to helping others, and it gave me the chance to be involved in a local service that really makes a difference. Courses run every spring for the initial “helper” training and autumn for the more advanced “supporter” training.

[box] Fundraiser on 15 June 2013
The Breastfeeding Peer Support Programme is holding a Family Fun Day on 15 June 2013 with a cake stall, information stall and activities. Hold the date and come along to find out more – venue details available from the coordinators nearer the time.

Getting help with breastfeeding
Phone the National Breastfeeding Helpline 0300 100 0212 or the Breastfeeding Network Supporterline on 0300 100 0210.
Attend a Breastfeeding Support Group. For an up-to-date list see:
Islington: http://www.whittington.nhs.uk/default.asp?c=11713
Camden: http://camden.gov.uk/ccm/content/contacts/categories/contacts-for-breast-feeding.en
Haringey: http://www.haringey.gov.uk/childrens_centre_breastfeeding_support.pdf
If you live in Islington and wish to request a home visit, contact 020 3316 8439.
Breastfeeding support is also available from other organisations such as La Leche League and NCT.

Training to be a breastfeeding peer supporter
To find out more about the course run by the Breastfeeding Network see: http://breastfeedingnetwork.org.uk/training-for-mothers.html
To register an interest in training in Islington contact the Breastfeeding Peer Support Coordinators Heidi Hembry or Anthea Tennant-Eyles on 020 3316 8439, heidi.hembry@nhs.net or anthea.tennant-eyles@nhs.net .