Baby Friendly News 11, August 2002 - Unicef UK

Baby Friendly News
UNICEF UK BABY FRIENDLY INITIATIVE Issue No. 11, August 2002
After presenting the Baby Friendly award to Aintree Centre for Women's Health in
May, Coronation Street actress Jennifer James meets babies and the breastfeeding
coordinators at the unit
photo courtesy of Aintree Centre for Women's Health
Survey finds rise in breastfeeding while
Baby Friendly practices gain ground
The proportion of babies breastfed in
the UK has risen by 3% between 1995
and 2000 according to the latest
national survey. The largest increases
were seen in Northern Ireland (a 9%
rise) and Scotland (8%), while a 2%
improvement in England and Wales
was mainly attributed by the survey
authors to changes in the age and educational
profile of mothers. Scotland
was also the only part of the UK to
record an increase in breastfeeding
beyond birth, with higher prevalence at
all ages up to 9 months (see table on
page 2).
The survey, which is carried out every
five years, found that more poorer
mothers in 2000 chose to breastfeed,
with a 7% rise noted in social class five.
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As well as these modest improvement
in the breastfeeding rates, the survey
also records mothers' wider experiences.
Some figures show that practices
recommended by the Baby
Friendly Initiative are gaining ground:
• The number of women who had a
full discussion about infant feeding during
their antenatal check-ups rose from
58% in 1995 to 68% in 2000. Women
reporting that they were simply asked
their feeding intention fell from 29% to
17%.
• The proportion of mothers who
breastfed their baby within an hour of
birth rose by 4% (and these mothers are
significantly more likely to be still breastfeeding
at 2 weeks than mothers who
didn't breastfeed in the first hour)
• 79% of mothers now report continuous
rooming-in with their babies in hospital,
up by 5% on 1995
• While 28% of breastfed babies still
receive a bottle of formula in hospital,
this is down by 8% since 1995.
Mothers whose babies had a bottle
were much less likely to be still breastfeeding
at 2 weeks - 40% gave up during
this time compared with 13% of
mothers whose babies were exclusively
breastfed.
Reflecting the findings of 5 years
ago, nine out of every ten mothers who
gave up breastfeeding in the first 6
weeks of their baby's life said that they
had stopped before they wanted to. The
main reasons given for stopping are still
those which suggest that better breastfeeding
support may have made a difference
(reported milk insufficiency,
pain during feeding and baby refusing
to suck).
One in four babies had been fed
solid foods by the age of three months,
although this was down from more than
half in 1995. The proportion receiving
solids at 4 months fell from 91% to
85%. In each case, breastfeeding
mothers were slightly less likely to introduce
solids early.
Hamlyn B et al (2002). Infant Feeding 2000. The
Stationery Office, London. http://www.doh.gov.uk/
public/infantfeedingreport.htm
Inside...
• WHO issues Global
Strategy on Infant and
Young Child Feeding
• UK supports 6 months’
exclusive breastfeeding
• Four new Baby Friendly
Hospitals
• Scotland legislates to
protect breastfeeding
• New Baby Friendly
audit and advisory visits
• Hand expressing
teaching model launched
UNICEF UK Baby Friendly Initiative, Africa House, 64-78 Kingsway, London WC2B 6NB
Telephone 020 7312 7652 Fax 020 7405 2332 bfi@unicef.org.uk www.babyfriendly.org.uk
This newsletter may be photocopied and distributed but not in conjunction with any commercial purpose
The Baby Friendly Initiative is a programme of the UK Committee for UNICEF, Registered Charity 1072612

England Northern United
& Wales Scotland Ireland Kingdom
Age of baby 1995 2000 1995 2000 1995 2000 1995 2000
Birth 68 71 55 63 45 54 66 69
1 week 58 57 46 50 35 37 56 55
2 weeks 54 54 44 47 32 34 53 52
6 weeks 44 43 36 40 25 26 42 42
4 months 28 29 24 30 12 14 27 28
6 months 22 22 19 24 8 10 21 21
Percentage of babies breastfed at ages up to 6 months by country (1995 and 2000)
Hamlyn B et al (2002). Infant Feeding 2000. The Stationery Office, London.
Global Strategy calls for national action
Every government in the world should
now be developing a wide ranging
national policy and action plan on
infant and young child feeding following
the endorsement of a key World
Health Organisation proposal in May.
The UK, along with every other WHO
member state approved the Global
Strategy on Infant and Young Child
Feeding at the World Health Assembly.
The Global Strategy updates the
1990 Innocenti Declaration, which led
to significant developments in breastfeeding
support over the last decade.
Governments are now expected to
adopt policies and strategies covering
the whole area of infant and young
child feeding, including action to:
• promote and support exclusive
breastfeeding for six months and continued
breastfeeding (with good complementary
feeding practices) for up to
24 months or beyond
• ensure that all maternity services fully
implement all Ten Steps to Successful
Breastfeeding and to support the extension
of the Baby Friendly Initiative into
community and paediatric settings
• legislate to end all promotion of artificial
feeding and to protect the breastfeeding
rights of working women
- ensure that policies and practices take
into account vulnerable groups such as
refugees, mothers with HIV and those
with disabilities or who are drug users.
The Global Strategy also identifies
the obligations and responsibilities of
other organisations including local
authorities, the health service, health
professional and voluntary organisations,
employers, trade unions and education
bodies. The full document can
be seen at www.babyfriendly.org.uk/
pdfs/globalstrategy.pdf
Breastfeeding strategies are already
in place in Northern Ireland and Wales.
No national policy or strategy exists in
England or Scotland, although the
Scottish Executive has asked its 15
Health Boards to adopt local strategies.
WHO's Global Strategy should now act
as an impetus for further action, both in
developing new policies and in supporting
their implementation.
The Global Strategy was developed
in consultation with the WHO's member
states. The first consultation took
place at a seminar arranged by the
Baby Friendly Initiative in Scotland in
September 2000, which involved input
from the Scottish Executive, health service
managers and infant feeding coordinators,
health professional and voluntary
organisations, researchers and
individuals working with refugees, drug
users and HIV positive people.
Previous Resolutions from the World
Health Assembly have led to ground
breaking progress in infant and young
child feeding. These include the adoption
of the International Code of
Marketing of Breastmilk Substitutes in
1981 and the endorsement of the Baby
Friendly Initiative in 1992.
UK support for six
months' exclusive
breastfeeding
Speaking at the launch of National
Breastfeeding Awareness Week in May,
Imogen Sharp, Head of Cardiovascular
Disease and Cancer Prevention at the
Department of Health, acknowledged
that the WHO recommendation of
exclusive breastfeeding for six months
should be adopted in the UK.
Most health professionals are still
working to the 1994 advice that babies
need no food or drink than breastmilk
for the first 4 to 6 months, but the adoption
of a new recommendation by
WHO last year meant that there has
been confusion around when mothers
should be advised to start giving complementary
foods. It now appears that a
clear statement may soon be made.
The UK Government voted in favour
of the 6 month position at the World
Health Assembly in May 2001, where it
was agreed "to strengthen activities and
develop new approaches to protect,
promote and support exclusive breastfeeding
for six months as a public
health recommendation… and to provide
safe and appropriate complementary
foods, with continued breastfeeding
for up to two years of age or beyond".
This stance was re-iterated at the 2002
Assembly earlier this year.
The Government's Scientific Advisory
Committee on Nutrition agreed in
September 2001 that "there is sufficient
scientific evidence that exclusive breastfeeding
for 6 months is nutritionally
adequate". It noted that early weaning
is common in the UK and repeated a
warning against weaning before 4
months (17 weeks) The Committee also
noted that individual circumstances
should be taken into account when
advising mothers over when to introduce
foods other than breastmilk.
The centre of this newsletter is a poster
on UNICEF’s worldwide drive to eliminate
maternal and neonatal tetanus,
which kills more than 200,000 newborns
and 30,000 mothers each year.
Baby Friendly News 2 No 11, August 2002

Baby Friendly rising in Wales and West Midlands,
while Scotland has most Baby Friendly births
Four hospitals in Wales and the West
Midlands have been accredited as
Baby Friendly. North Staffordshire
Hospital in Stoke became the West
Midlands' first Baby Friendly hospital in
May, closely followed by Wordsley in
Stourbridge. Meanwhile, the total
number of Baby Friendly hospitals in
Wales was doubled as the Royal
Glamorgan Hospital and Nevill Hall
Hospital in Abergavenny achieved their
accreditation.
Dame Lorna Muirhead, President of
the Royal College of Midwives, presented
the Baby
Friendly award to
North Staffordshire
Percentage of births
Hospital at a ceremony
on 22 July. Baby Friendly Hospitals
that take place in
The hospital which
August 2002
serves a population
with some significant areas of
deprivation, has seen a 4% increase in
its breastfeeding initiation rate since
1998. More than 300 maternity and
80 neonatal staff were trained in the
process of gaining the award.
Wordsley Maternity Unit has seen an
increase of 3% in its breastfeeding initiation
over the past year, which translates
into a 4% rise in the breastfeeding
rate at transfer to community. Staff at
the hospital report that more mothers
are volunteering to help with the local
breastfeeding support groups.
Royal Glamorgan Hospital in
Llantrisant became the third hospital in
Wales to achieve Baby Friendly accreditation
in May. The unit achieved the
unusual distinction of passing the
assessment in one go. The process is
normally a two stage process, with
Northern
England Wales Scotland Ireland Kingdom
8 19 34 20 13
problem areas being reinvestigated at a
second visit. However, the high standards
on the criteria for each of the Ten
Steps meant that a follow-up visit was
not necessary.
The proportion of babies breastfed
at Nevill Hall Hospital has leapt dramatically
since it began work towards
Baby Friendly accreditation last year.
68% of babies are now breastfed at
birth - a rise of 20% over the almost static
figures for the previous five years.
Staff at the hospital report that mothers
are very pleased with the introduction of
skin-to-skin contact and other Baby
Friendly practices. They are supported
in the community by a new peer support
group.
Following the accreditation of
Aintree Centre for Women's Health and
Calderdale Royal Hospital earlier in the
year, the new awards
United bring the total number
to 44. Scotland
continues to lead the
way, with a third of
all babies born in
Baby Friendly hospitals
(and a further third in units with a
Certificate of Commitment). Northern
Ireland and Wales follow with 1 in 5
births taking place in Baby Friendly hospitals.
A full list of Baby Friendly awards
can be seen on our web site at
www.babyfriendly.org.uk/list.asp
Scotland protects the right to breastfeed
Legislation protecting a mother's right to
breastfeed in public could soon be
adopted in Scotland. Elaine Smith MSP
has put forward a bill to the Scottish
Parliament which would make it a criminal
offence for anyone to prevent a
mother from breastfeeding in any public
place or licensed premises where
children are otherwise welcomed.
Scottish Health Minister Malcolm
Chisholm has indicated his support for
the principle of Ms Smith's bill, which
has received cross-party backing. An
advisory committee including representatives
from the UNICEF UK Baby
Friendly Initiative and other health
organisations has been established to
help guide the bill through parliament.
Campaigners for the bill are encouraging
Scottish residents to ask their
MSPs to support it. (MSPs can be contacted
c/o The Scottish Parliament,
Edinburgh EH99 1SP - to find out who
your MSPs are, call the Scottish
Parliament on 0131 348 5000 or visit
www.scottish.parliament.uk). A 6-week
consultation period on the bill is expected
to begin in September. The consultation
paper will be available via the
Scottish Parliament's web site or from
Elaine Smith's office at the Parliament.
Meanwhile, breastfeeding remains
prohibited in the chamber, committees
and public galleries of the Parliament
buildings in London following a decision
in March by the Speaker Michael
Martin not to overturn a ban imposed
by his predecessor.
New advisory visits to
tackle problem areas
If you are facing a particular difficulty
with a specific part of the Baby Friendly
best practice standards, you may find it
useful to have an advisory visit from a
member of the Baby Friendly team.
Advisory visits are tailored to your
needs and give specialised advice or
training on specific issues. For example,
if you are having difficulties in improving
staff’s positioning and attachment
skills, an advisory visit could teach key
workers how to conduct effective clinical
practice sessions. A hospital struggling
to adopt Step 6 could use a visit
for specific teaching on hypoglycaemia.
For more details or to discuss your
requirements, contact the Baby Friendly
Initiative office on 020 7312 7652.
Baby Friendly News 3 No 11, August 2002

Hand expressing teaching model launched
A model to support health professionals
learning how to teach hand expressing
is now available following a collaboration
between the UNICEF UK Baby
Friendly Initiative and Limbs & Things
Ltd.
The breast model, which was previewed
at the Baby Friendly Initiative's
2001 Conference, is designed so that
simulated 'milk' is expressed from the
nipple when a correct hand expressing
technique is used. Designed as a teaching
and learning tool for health professionals
(not mothers), it is realistic in
shape, texture and proportion, and is
warm to the touch.
The Baby Friendly Initiative recommends
that all breastfeeding mothers
be taught how to express their milk by
hand as this provides a 'first aid' measure
in the event of breastfeeding complications
and equips women with a
means of expressing milk in a situation
where their baby cannot breastfeed
directly. However, health care facilities
working towards assessment for Baby
Friendly accreditation commonly report
difficulties in teaching this skill to health
professionals.
The Hand Expression Breast Model
costs £450 plus VAT & carriage and
can be ordered from Limbs and Things
Ltd (Product no. 40103) - on 0117 311
0500. £50 from the sale of each model
will be donated to the UNICEF UK Baby
Friendly Initiative.
Bed sharing policy
and leaflet revised
The Baby Friendly Initiative's sample
policy on babies sharing their mother's
bed in hospital and the accompanying
leaflet for parents 'Sharing a
bed with your baby' have been
amended. The new versions address
the common differences in the
sleeping positions of breast- and
bottle feeding mothers and mothers
who are unable to respond fully to
their babies for reasons other than
sedation, tiredness or illness (e.g.
disability). The statement on maternal
tiredness is reworded to give
more explanation and guidance.
The documents can be seen at www.
babyfriendly.org.uk/bedshare.asp
Recent research…
Metabolic adaptation of
SGA babies
Term healthy babies respond to the normal
post-delivery decline in blood glucose
levels by producing ketone bodies,
which provide an alternative energy
source for their brains. This study investigated
the ability of small for gestational
age (SGA) babies to produce ketone
bodies, depending on whether they
were exclusively breastfed, breastfed
with formula supplements or exclusively
formula fed. There were no differences
in blood glucose levels between the
groups, but ketone concentrations were
highest in babies who were exclusively
breastfed. Peak ketone body concentration
was negatively associated with
the volume of formula received. The
authors conclude that neonatal ability
to generate ketone bodies depends
more on successful breastfeeding than
on size for gestational age or nutritional
status and that routine formula supplementation
of SGA infant should not
be recommended.
De Rooy L and Hawdon J. Nutritional factors that affect
the postnatal metabolic adaptation of full-term smalland
large-for-gestational age infants. Pediatrics 2002;
109 (3) (www.pediatrics.org/cgi/content/full/109/3/e42)
Breast cancer
A review of 47 breast cancer studies
that included information on breastfeeding
patterns found that the longer
women breastfeed, the more they are
protected against breast cancer. The
relative risk of breast cancer decreased
by 4·3% (95% CI 2·9-5·8; p

Derby Mayor launches
breastfeeding campaign
Managers of Derby's shops, restaurants
and other public premises are the target
of a campaign by the newly appointed
Mayor, who wants to extend Baby
Friendly principles across the city.
Councillor Robin Turner has issued a
leaflet in which he promises to support
premises which welcome breastfeeding,
while refusing to visit places which have
not signed up to the campaign.
A framed copy of the Baby Friendly
Initiative's 'Welcome to Breastfeed Here'
poster will be presented by the Mayor to
premises which welcome breastfeeding
mothers and provide suitable seating in
their public areas. Councillor Turner
said 'this campaign will be of long term
benefit for breastfeeding mothers and
babies and will commercially benefit the
managers of premises supporting it.'
Adverts placed in the city centre and the
local press will encourage people to
use premises which join the campaign.
Derby is home to the first GP surgery
to achieve Baby Friendly status, as well
as one of the UK's first Baby Friendly
hospitals and one of the first Sure Start
areas to have obtained a Certificate of
Commitment.
In brief
Audit visits will support
work on Baby Friendly
standards
Health care facilities nearing readiness
for a Baby Friendly assessment can now
get extra support from the Baby Friendly
Initiative as they seek to monitor their
progress towards accreditation.
The newly launched Audit Visits will
provide a snapshot of how well the Ten
Steps or Seven Points are being implemented
and will help health professionals
to decide whether or not they are
ready for a full Baby Friendly assessment.
Facilities may also use them to
help identify areas of weakness which
require further attention.
The visits last a single day and are
run by two Baby Friendly Initiative assessors.
They consist of interviews with
small samples of staff, pregnant women
and new mothers, using the same questionnaires
and principles as are used at
a full Baby Friendly assessment. The
findings and relevant advice are reported
at a feedback meeting at the end of
the visit as well as in a written report.
The audit visit costs £540. If you wish
to book or to discuss the visits further,
please call the Baby Friendly Initiative
office on 020 7312 7652.
'Breastfeeding Your Baby' is a video which provides information on the benefits
and management of breastfeeding. The video is available in Urdu & English,
Bengali & English or Gujarati & English from Mrs Quinn's Office, Women's
Health Services, Tower View Offices, Queens Park Hospital, Blackburn BB2
3HH, price £12.50 each including p&p (cheques to Blackburn, Hyndburn &
Ribble Valley Health Care NHS Trust).
The Breast Benefits education pack provides a tool for breastfeeding education
in secondary schools with 13-15 year olds. The pack, which has been positively
evaluated by young people, includes a fully comprehensive teacher's
guide, visual aids including a short video, a quiz and postcard handouts. Breast
Benefits was developed with a multi-disciplinary team including young people,
researchers, educators, community workers and midwives. The pack is available
for £40 (cheques payable to University of Brighton) from Rachael Lockey, Centre
for Nursing and Midwifery Research, University of Brighton, Westlain House,
Falmer, Brighton BN1 9PH.
Please send us brief details of your activities and we will try to include
them in future editions of Baby Friendly News. Inclusion does not necessarily
mean endorsement by UNICEF or the Baby Friendly Initiative.
Reply form
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as applicable) @ £15.00 per pack
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leaflet Breastfeeding Your Baby (for
new mothers) in Arabic / Bengali /
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/ Urdu (delete as applicable) @
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n.b. These leaflets can be viewed at
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require the translated leaflets in more
than one language, please supply full
details on a separate sheet. The English
language leaflets are sponsored by and
available from Baby Welcome - 01737
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London WC2B 6NB. Prices include VAT where
appropriate and UK postage and packing.
For overseas orders, please add 20%.
For a complete resource list and order
form, see www.babyfriendly.org.uk
Baby Friendly News 7 No 11, August 2002

Booking form
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Telephone: ....................................
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Please add any additional names
on a separate sheet of paper.
Please book ....... place(s) at
the UNICEF UK Baby Friendly
Initiative Annual Conference
(Harrogate, 13-14 November) on:
Both days / day 1 / day 2 *
Price: Both days - £115; Single day - £65.
(Discount - £105 both days / £60 one day if
if you book 5 or more places)
*Please delete as applicable
Please book ....... place(s) at
the following Course in Breastfeeding
Management:
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2002 Price: 1 to 4 places - £245 each; 5 or
more places - £200 each. 2003 Price: 1 to 4
places - £255 each; 5 or more places -
£210 each (all prices include VAT).
Please call me to discuss our
holding the Course in Breastfeeding
Management for our own staff
Total for the above order: £..........
(Please see overleaf for ordering
information.)
UNICEF UK Baby Friendly Initiative
Annual Conference 2002
Day 1, Wednesday 13 November, 9.30 am to 5.00 pm
Community and laboratory studies of night time interactions between mothers and
babies and the risk of illness and infant death (Prof Peter Fleming, Professor of
Infant Health and Developmental Physiology, University of Bristol)
The relationship between breastfeeding and health in adolescence and adulthood
(Dr Stewart Forsyth, Consultant Paediatrician, Ninewells Hospital, Dundee)
Supporting drug users to breastfeed (Dr Mary Hepburn, Senior Lecturer, University
of Glasgow)
Working in Partnership with the UNICEF UK Baby Friendly Initiative - The Scottish
experience (Jenny Warren, National Breastfeeding Advisor)
UNICEF UK's Child Exploitation Campaign (Anita Tiessen, Deputy Executive
Director, UNICEF UK)
Avoiding unnecessary supplements (Sue Ashmore, UNICEF UK Baby Friendly
Initiative)
The Baby Friendly Initiative - recent developments (Andrew Radford, UNICEF UK
Baby Friendly Initiative)
Day 2, Thursday 14 November, 9.30 am to 5.00 pm
Tongue tie and breastfeeding (Dr Mervyn Griffiths, Consultant Paediatric and
Neonatal Surgeon, Southampton General Hospital)
Safety issues related to bottle feeding (Prof Mary Renfrew, Director, Mother and
Infant Research Unit, University of Leeds)
Breast feeding and infant consultation patterns in general practice, with some
reflections on implementing Baby Friendly policies (Phil Wilson GP, Battlefield Road
Surgery, Glasgow)
Breastfeeding and the weaning process (Gill Rapley, UNICEF UK Baby Friendly
Initiative)
Stepping out with the community (Mary Whitmore, The Breastfeeding Network)
Maternal diet during breastfeeding (Andrew Radford, UNICEF UK Baby Friendly
Initiative)
Case studies on milk banking, hand expressing, and using Baby Friendly standards
and peer support in a Sure Start programme (Ann McCrea, Sperrin
Lakeland Milk Bank; Rachel McLean, Derby City Hospital; Marie Timms, Sure
Start Derby).
Diary dates
The UNICEF UK Baby
Friendly Initiative Annual
Conference 2002
Royal Hall, Harrogate International
Centre, 13-14 November
(To book or for details of any of these events,
call 020 7312 7652, visit our web site or use
the form opposite)
The Baby Friendly Initiative
Course in Breastfeeding
Management
Glasgow: 5, 6 & 26 September
London: 27, 28 Nov & 13 December
Derby: 16, 17 & 30 January 2003
London: 22, 23 Jan & 6 Feb 2003
London: 13, 14 & 28 February 2003
(The Course in Breastfeeding Management is
limited to a maximum of 22 participants)
For full details of all events, see www.babyfriendly.org.uk/training
Baby Friendly News 8 No 11, August 2002