Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of ScienceTeaching packs for Paediatricians and GPs are available from the UNICEF UK Baby Friendly Initiativewww.babyfriendly.org.ukNICE Guidance on BreastfeedingRecent guidance from the NICE gives evidence-based recommendations relating to the promotionof breastfeeding initiation and duration. 177 The guidance was formulated through the integration ofpublished scientific literature with practitioner expertise and experience obtained during a nationalconsultation exercise with professionals working in areas that could have an impact on maternaland child nutrition. These included hospitals, primary care trusts and social services. Theconsultation exercise focused on areas of deprivation. The guidance recommends that theWHO/UNICEF UK Baby Friendly Initiative should be implemented as routine practice. Anappropriate range of educational and support programmes should be routinely delivered by healthprofessionals and peer supporters. These include antenatal breastfeeding education combined withpeer support programmes to increase breastfeeding initiation and duration among women fromdisadvantaged backgrounds. Other recommendations include avoidance of routine hospitalpractices that might lead to separation of mother and infant since these have been shown to beharmful to breastfeeding rates. The guidance also states the importance of encouraging mothersto breastfeed on demand in order to encourage breast milk production and prevent breastengorgement and mastitis. Early skin-to-skin contact has also been shown to be effective inincreasing the initiation and duration of breastfeeding. A Cochrane review updated in 2007,considered the findings of 30 studies of 1,925 mother-infant pairs. 273 Early skin-to-skin contact hadpositive effects on breastfeeding initiation (odds ratio of initiation was 1.82, 95% CI 1.08 to 3.07)and breastfeeding duration (weighted mean difference in duration was 42.55 days,95% CI 1.69 to 86.79).Support for breastfeeding mothers returning to workIn the UK the proportion of women in employment has increased considerably in recent years andabout 50 per cent of women with pre-school children are in paid work outside the home. Workingmothers often return to work early after having a baby and can have difficulty maintainingbreastfeeding if not supported by their employers. This may discourage working mothers frombreastfeeding at all. Recent findings from the Millennium cohort study demonstrated that womenwho were employed full-time were less likely to initiate breastfeeding than mothers who were notemployed – rate ratio was 0.92 (95% CI 0.89 to 0.96) after adjustment for confounding factors. 274Strategies to support working mothers to continue with breastfeeding are needed. A recentCochrane review to identify workplace interventions to promote breastfeeding, found no publishedRCTs of relevance. 275 This represents an important gap in the evidence given the rapid increase inmaternal employment in recent years.Key messageStrategies are needed to support working mothers to continue with breastfeeding.Interventions that educate women about the benefits and practice of breastfeeding and thatpromote baby friendly policy and practice are effective at promoting the initiation and prolongingthe duration of breastfeeding. There are still some important gaps in the evidence, however, andstudies are needed to look for effective ways of supporting breastfeeding in the workplace.60Early life nutrition and lifelong health