Breastfeeding support for mothers in NHS Ayrshire & Arran (G113)

Breastfeeding has a significant positive effect in the short, medium and long term on the health of both mother and baby. Sudden cessation of breastfeeding can result in serious consequences and acutely impact on the health of the mother resulting in complications including mastitis which may lead to sepsis and associated life threatening morbidities which can prolonged hospital stay. All NHS staff have a duty of care to promote and protect breastfeeding.

Risks of not breastfeeding for the baby:

Includes, but not limited to an increase of;

• Gastroenteritis, respiratory, ear and urinary infections.
• Incidence of obesity, diabetes and high blood pressure.
• Long term problems with dental malocclusion.
• Risk of childhood cancers.

Risks of not breastfeeding for the mother:

Includes, but not limited to an increase of;

• Breast, ovarian and endometrial cancers.
• Osteoporosis.
• Post-partum anaemia.
• Obesity and diabetes.
• Post-menopausal heart disease.

NHS Ayrshire & Arran holds Baby Friendly Accreditation for both maternity services and for health visiting and family nurse teams awarded by UNICEF Baby Friendly Initiative and is committed to:

• Providing the highest standard of care to support new mothers and their partners to feed their baby and build strong and loving parent-infant relationships. This is in recognition of the 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 centred, non-judgemental and that mothers decisions are supported and respected.
• Working together across disciplines and organisations to improve mothers/ parents experiences of care.

• All staff involved in the care of a patient who is breastfeeding should provide treatment and care which supports continuing breastfeeding.
• The bed manager should be informed when a breastfeeding patient is to be admitted and, whenever possible, they should arrange for single room accommodation in the most appropriate area.

• All babies, regardless of the feeding method, should be permitted to stay with the mother during the day as part of Patient Centred Care; however this will be guided by the mother’s condition.

• To enable breastfeeding to continue when a mother is admitted for general care it is important that the mother and baby dyad remain together and are supported to continue to responsively breastfeed with as little interruption as possible. The UNCRC recognises the rights of the child to remain with the mother and to access optimal nutrition. Continued breastfeeding is important for the physical and mental health of both the mother and child. Breastfeeding will significantly reduce stress in both the mother and baby and aid recovery. It can be perceived to be easier to send the baby home to enable the woman to “rest” but this can cause increased anxiety and distress in both mother and baby leading to early cessation of breastfeeding and the complications associated with this, there may be circumstances where the mother herself feels too unwell to breastfeed or wishes to express and an individualised plan of care to maintain lactation and prevent issues can be implemented with support from the local Infant Feeding lead.
  Sudden cessation of breastfeeding can result in serious consequences and acutely impact on the health of the mother resulting in complications including mastitis which may lead to sepsis and associated morbidities which can prolonged hospital stay so even if the mother no longer wishes to breastfeed effective management and gradual cessation is important to prevent complications. It does however remain important that the mother and baby remain together wherever possible.

• An identification band must be attached to the baby’s ankle with the mother’s name and CHI number on it.

• The baby is not a patient therefore if the baby becomes unwell, the family should access healthcare in the community i.e. GP or NHS 24.

• The baby will remain the responsibility of the mother at all times. The baby must not be left unattended at any time, which includes during any treatment or investigations the mother requires as part of her care. In such circumstances where she may not be able to look after her baby, arrangements should be made for a family member or designated friend to care for the baby. This person will be responsible for all care of the baby. If there is no-one who can stay with the mother to provide this care and there is no-one at home to take the baby, social services should be contacted.

• If it is not possible for the baby to stay with the mother overnight the reasons for this must be documented. A family member or designated friend should be encouraged to bring the baby in to breastfeed. There must be flexibility of visiting to facilitate breastfeeding and transportation of expressed breast milk (EBM).

• Facilities and support for the mother to express her milk and maintain her milk supply must also be provided. If the mother wishes to express her milk and has a breast pump she should be encouraged to bring it with her, along with the relevant sterilising equipment. Steam sterilisers will require to be PAT tested before use. The mother or family member will be responsible for cleaning and sterilising the equipment. If the mother does not own a breast pump, every effort will be made to lend her one from the Emergency Department at UHA and UHC. If there is any difficulty accessing these pumps please contact the Inpatient Ward for Maternity Services. A cold water steriliser can also be provided. In such cases the mother/family member will be responsible for changing the sterilising fluid daily.

• Expressed breastmilk should be taken home regularly. EBM should be stored in accordance with community guidance from NHS Health Scotland. Breastmilk can be stored for 6 hours at room temperature and up to 5 days in a fridge at 0-4°C. Ideally expressed breastmilk should be stored and transported in a cool bag with ice packs provided by the family and changed regularly. Ice can be provided on the wards if required.

• In extenuating circumstances, for patients in UHC, EBM may temporarily be stored in the designated fridge in the neonatal unit in Ayrshire Maternity Unit. In UHA EBM may be temporarily stored in the fridge in the breastfeeding room situated in suite H. The key for this is held in reception and the room contains a locked fridge that can be used to store expressed milk if required. This is accessible by members of staff. The EBM must be clearly labelled with the mothers name and CHI number, the date and time it was expressed and the ward that she is in.

• If a woman is attending for planned procedures or surgery she should be routinely asked if she is breastfeeding. This should be recorded in the admission documentation or preoperative assessment. The responsible clinician/anaesthetist should be made aware of this so they are able to deliver suitable care/analgesia/anaesthesia to facilitate breastfeeding where applicable.

• The mother can be advised to contact her health visitor for any advice or support required to prepare for ensuring that breastmilk is available for baby whilst the mother is having surgery. Loan of a breast pump can be arranged when required to facilitate this process.

• The mother should be encouraged to breastfeed or express her breastmilk immediately prior to surgery. This will help to ensure her breasts do not become engorged during/after the procedure. Breastfeeding/expressing should resume as soon as possible following surgery. A general principle is that after anaesthesia a mother can resume breastfeeding once she is awake, stable and alert. Special consideration may be necessary depending on the type of pain relief that is required or any additional medication. Please refer to further guidance from the pharmacy department regarding drug safety and breastfeeding. Specialist infant feeding support should be access as required.

• Further information:
  • UNICEF Baby Friendly page regarding the support of breastfeeding women undergoing anaesthesia and sedation.
  • Association of Anaesthetists: Anaesthesia and sedation in breastfeeding women.

Women who are breastfeeding should not have emergency treatment delayed due to concerns about the safety of medication or medical treatments during breastfeeding. Where information is not available, treatment should be offered as appropriate and then further information on the safety of continued breastfeeding investigated. Breastmilk should be expressed and stored until the appropriate information regarding medication and impact on milk can be ascertained. For safety reasons this milk should be clearly marked and identifiable so that it can be discarded if this is deemed the safest option.

• Every effort should be made to prescribe medication that is conducive to the continuation of breastfeeding. However, where this is not possible, the mother should continue to express her milk in order to protect milk supply and discard until such time a more suitable drug can be used.

• UKDILAS page on General Principals for Medicines Use during Breast Feeding, provides some general guidance for prescribing for patients who are breast feeding
  https://www.sps.nhs.uk/articles/ukdilas-general-principles-for-medicine-use-during-breastfeeding/ (link provided by Medicines Information, Ayr Hospital)

• The Breastfeeding Network have fact sheets for many drugs on the following link and is a useful resource for patients and medical staff: https://www.breastfeedingnetwork.org.uk/drugs-factsheets/

• During normal working hours, complex cases (e.g. mother on multiple medications etc) should be discussed with the clinical pharmacist for the area in which the patient is in, who can refer this to Medicines Information if required. For complex cases out of hours, the out of hour’s clinical pharmacist can be contacted through switchboard for advice and support. In the rare occurrence clinical pharmacist advice is not available the safest option would be for the mother to express and store her milk, but not feed it to her baby until her case can be looked into during working hours. For safety reasons this milk should be clearly marked and identifiable so that it can be discarded if this is deemed the safest option.

• If the mother needs to start longer term therapy with medications incompatible with breastfeeding, such as chemotherapy, facilities and support should be provided for her to express her milk and decrease her supply gradually, as appropriate for her comfort, and discard the expressed milk.

EBM – Expressed breastmilk
PAT – Portable Appliance Testing
UNICEF – United Nations International Child’s Emergency Fund
UHC – University Hospital Crosshouse
UHA – University Hospital Ayr

Employees are reminded that they may have patients/carers who require communication in an alternative format e.g. other languages or signing. Additionally, some patients/carers may have difficulties with written material. At all times, communication and material should be in the patient’s/carer’s preferred format. This may also apply to patients with learning difficulties.

In some circumstances there may be religious and/or cultural issues which may impact on clinical guidelines e.g. choice of gender of health care professional. Consideration should be given to these issues when treating/examining patients.

Some patients may have a physical disability or impairment that makes it difficult for them to be treated/examined as set out for a particular procedure requiring adaptations to be made.

Patients’ sexual orientation may or may not be relevant to the implementation of this guideline, however, non-sexuality specific language should be used when asking patients about their sexual history. Where sexual orientation may be relevant, tailored advice and information may be given.

This guideline has been impact assessed using the NHS Ayrshire and Arran Equality Impact Assessment Tool Kit. No additional Equality & Diversity issues were identified.