Breastfeeding is much more than nutrition. Breast milk is full of essential nutrients to help babies to grow, it also protects them from infection and encourages development of a close and loving relationship between mother and baby. Due to the positive impact on the health of both mothers and babies, breastfeeding is viewed as an important public health intervention that impacts on health inequalities through building on the potential of every child by optimising physical, mental and social health. This has resulted in a global effort towards promoting, supporting and protecting breastfeeding.
The Scottish Government has invested in a national Breastfeeding Improvement Programme led by a Breastfeeding Leadership Team (BFLT) who are experienced infant feeding clinicians. The BFLT work collaboratively with colleagues from NHS and peer support organisations to develop agreed plans for national implementation. The Breastfeeding Improvement Programme started in 2019 using a Quality Improvement approach and with a stretch aim to 'reduce the drop off in breastfeeding rates at 6-8 weeks by 10% by 2025'. There are many strands of work within this programme. These include changing culture and enhancing promotion, support and protection for breastfeeding. To ensure that women can breastfeed they need to live within a supportive community and have access to the right support at the right time, allowing them to breastfeed for as long as they wish to.
The Becoming Breastfeeding Friendly Scotland report published in 2019 produced eight themes and their accompanying recommendations and actions which are incorporated in the BFLT Improvement programme. Theme seven is 'Ensuring families have equitable access to evidence-based infant feeding support when and how they need it through multi-component, structured models of care'.
All maternity units, health visiting and family nursing services are Unicef UK Baby Friendly Accredited. To hold this prestigious award means meeting requirements for delivery of evidence-based high quality care to support families with feeding and in developing close, loving relationships, ensuring that all babies get the best possible start in life.
Part of the Baby Friendly assessment process is to ensure that there is support across three levels of care; universal service provision, additional and specialist support. Universal provision in Scotland is delivered by maternity services, health visiting and family nurse partnership. Specialist support is provided through infant feeding specialists within these teams and this service supports mothers who have complex or intractable challenges.
It is within the additional support layer that peer support has a pivotal role; providing social, emotional and practical infant feeding and other support to families. Peer support is complimentary to health professional support and mothers should be able to access both types of support. There are many models of peer support provided across Scotland; we have paid and unpaid peer supporters, some services are delivered and managed within the NHS and some are wholly delivered through Third Sector including, but not exclusively, breastfeeding organisations.
This document provides core principles for delivery of all peer support services delivered in Scotland. Peer supporters or those thinking of taking on this role should be able to read this document and be clear of both their rights and responsibilities. Health professionals should be able gain insight into the role and be clear about the expectations and, importantly, the boundaries of the role. Peer support works best when provided within a framework of joint working with health professionals which is clearly in the best interest of families.
The BFLT intend working with partners to support the implementation of the core principles set out in this document which will provide a quality standard framework by September 2023. This will enable Third Sector organisations and NHS Boards to provide equitable, evidence-based care and support to families based on best practice. The aim is to improve health outcomes for families within Scotland and ensure a skilled workforce of volunteers who feel supported and valued.
Important note; individualised care
This document uses the words mother or mum to describe the parent who is breastfeeding. We acknowledge that there are parents who are breastfeeding who may have a gender identity other than female, and may use terms other than 'mother' to describe themselves. We also know that some parents may prefer 'chest feeding' to 'breastfeeding'. We are clear that all parents should be treated with dignity and respect when accessing support. When we are asked to use pronouns, terms, and descriptors other than those in this document we will use the preferred words as part of individualised care.
In the peer support advisory group there were several issues identified for development; these were the result of the number and types of services delivered and the lack of agreed parameters as shown below: