The public health issue which is being focused on this essay is breastfeeding and the community of practice that the essay will be based on is Newham, which is my placement area. Breastfeeding is an incomparable way of providing complete food for the healthy growth and development of infants (WHO, 2019). Breastfeeding is also an important part of the reproduction process which has very important effects on the health of mothers who breastfeed, which would benefit the mothers but could also lead to potential risks (WHO, 2019). Evidence has shown, that in terms of a population starting point, breastfeeding exclusively (when the infant does not need any additional food or fluid) for 6 months is the greatest way to feed infants (WHO, 2019).
The data shows that there is a high local count for mothers that have initiated breastfeeding which is 5,907. In the area of Newham, 96.7% of mothers were found to have initiated breastfeeding which compared to the national average (74.5%) is higher. One of the reasons for this high prevalence in Newham is that it is one of the most deprived areas in the London borough. According to Trust for London (2018), 35.6% of employees working in Newham are low-paid, which is the highest percentage in London. The poverty rate was found to be is 37%, which is ten percentage points higher than the London average. Another reason for the high prevalence rate for initiation of breastfeeding in Newham is that breastfeeding is a free alternative of feeding a baby compared to buying formula milk which can be costly, especially if mothers have more than one child to support. The sociodemographic population was also considered as a reason for the high prevalence of breastfeeding initiation. The table below is showing the comparison between the different population groups in Newham and England.
The data shows that the population of Newham is diverse and that 64% of people living in Newham are from the ethnic minority group. The percentage of the ethnic minority group could have an impact on the breastfeeding initiation rates as different cultures highlight the importance of breastfeeding compared to others. A factor in the high prevalence rate is that women are more likely to stay at home and not work due to the difference in culture. In some cultures, the men are financial providers or breadwinners whilst the women look after their children and home. This would, therefore, give the women more time to their children and therefore, breastfeeding can be initiated more regularly. One of the services available to help support mothers with breastfeeding in Newham, which in turn could lead to a high prevalence of breastfeeding is the National Childbirth Trust (NCT). This is a charity for parents that supports parents throughout your whole pregnancy, birth and beyond. If the women would prefer to meet in person, there are antenatal workshops, which is for pregnant women and their partners to see how breastfeeding works. They are usually held at Newham University Hospital and at Newham children centres, during different times of the year. Also, there is a milk bar which could be an opportunity for mothers to come together irrespective of which method of feeding they use. The women would ask questions and meet other people in the area that is going through the same problem, in terms of breastfeeding. There are also options for women who won’t be able to attend in person, such as a breastfeeding line (which is open every day of the year) and the women would be able to seek help from a qualified breastfeeding counsellor, a national breastfeeding helpline which is run by the association of breastfeeding mothers and the breastfeeding network and lastly there is a service called ‘’La Leche League’’ which make great efforts to help mothers to breastfeed through mother to mother support, encouragement, information, and education.
The assessment of the breastfeeding public health issue was done by coming together as a group of individuals whose community of practice was Newham. Everyone was given a small part of the task to do some research and to put every information and source together into a full presentation as a group. The group members also came together for workshops in order to start putting every idea and information together in a way that would be easy to understand and to explain to our peers. The strengths of this assessment are that there was enough data found concerning the breastfeeding rates in Newham, and how those rates were compared to those of the England value, which was found to be higher due to the several reasons stated above. The limitation of this assessment was finding the right research on how breastfeeding is measured. There were sources which proved to be non-reliable. However, once the right information was found, the prospective/intended methods of measuring breastfeeding were found to be more accurate but too expensive to use in most surveys which are large-scale. Therefore, methods which have already been established (retrospective) were found to be used due to the data already being analysed and published, as well as it being proven to be a less expensive way of measuring breastfeeding. This assessment was great as everyone in the group made an effort to put together and find valuable information concerning breastfeeding initiation rates in Newham, therefore there is nothing that needs improvement.
Risk and benefits of breastfeeding
Breastfeeding is the ideal form of milk for a baby as it is easy for the baby to absorb. It has the ideal components for an infant’s nutrition for the first 6months of their life and provides infants with immunological protection to prevent infections (British Nutrition Foundation, 2018). Breastfeeding has many benefits for the mother and infant, however, there are some risks involved as shown below.
[bookmark: _Hlk10756399]Some of the benefits of breastfeeding an infant are: breastfeeding protects the baby from having infections, which would mean fewer visits to the hospital. There is evidence which is increasing to prove that breastfeeding helps lower the risk of the baby developing cardiovascular risk factors and obesity, such as hypertension and resistance to insulin, in the child’s future life (Public Health England, 2018). Another benefit of breastfeeding is that it provides protection from cot death (sudden infant death syndrome), gives protection allergies, diarrhoea and prevents constipation (UNICEF, 2019). Breastfeeding provides the baby with excellent nourishment and helps with growth. Breastfeeding contains colostrum which contains transferring factor- antibodies (immunoglobin A) and white blood cells, which are transferred to babies and boosts the infant’s immunity (UNICEF, 2019). Colostrum recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth (WHO, 2019). Lastly, breastfeeding provides the baby with vitamins and minerals
Small amounts of medication could spread to breastmilk and can sometimes cause side effects, for example, codeine- can cause difficulty to breathe. Another risk of breastfeeding for a baby is that it can cause restricted tongue movement (tongue tie). This could result in sore nipples and the baby could lose weight (UNICEF, 2019).
According to NHS (2017), Breastfeeding reduces the risk of breast and ovarian cancer in mothers. It lowers the risk of having postnatal depression, reduces the risk of the mothers having weak bones/ osteoporosis (NHS, 2017).
[bookmark: _Hlk10757535]In terms of neurological/ emotional well-being, breastfeeding helps release oxytocin which leads to affection and builds the mothers emotional attachment to the baby and breastfeeding also increases brain development (NHS, 2017).
[bookmark: _Hlk10837049]The risks involved with breastfeeding mothers are that the breast can become full of milk (breast engorgement) and become painful. Breastfeeding can cause mastitis which is an infection of the breast and there can also be a poor attachment (NHS, 2017). When the infant is not latched on to the nipple properly, they would not receive sufficient milk, which would reduce milk production, cracked nipples and could even lead to weight loss (NHS, 2017).
Implications for practice
The prevalence of breastfeeding in Newham shows that women are supported by healthcare professionals antenatally and postnatally regarding breastfeeding. Newham University Hospital is currently accredited by the Baby Friendly Initiative as Level 2. This means that all staff working closely with the women are educated on how to support them (Baby Friendly Initiative, 2019). Newham University Hospital would need to work in order to become a Level 3 Baby Friendly Initiative accredited. In order to get to this level, the parent’s experiences of being supported with their infant feeding choices would need to be good as well as being encouraged by health care professionals to develop a loving and close relationship with their infant. The health care professionals would also need to be updated on knowledge concerning the benefits of breastfeeding, different breastfeeding positions and using the acronym CHIN. In terms of the six C’s, midwives can help women breastfeed by having a positive attitude, being aware of the women’s thoughts and feelings and keeping hands off when helping with positioning the baby at the breast- meaning to help women to breastfeed their baby, instead of ‘taking over’ and ‘doing it to them’ (McInnes Rhona; Chambers Julie, 2008).
According to NICE (2015), healthcare professionals should have sufficient time, as a priority, to give support to the mother and baby during initiation and the continuation of breastfeeding. In practice at Newham hospital, every day in the afternoon, on the postnatal ward there is one to one breastfeeding for those who require it. In order to provide woman-centred care, the midwife would need to explore the women’s hopes and expectations around her chosen method of feeding. The midwife would also explore what support the women has in order to give the best care, give factual evidenced-based information as well as practical guidance on how to feed a baby.
Although the hospital environment could be a bit fast paced, midwives have a duty of care to the women that they support, giving time and support to the women and baby in order to help with breastfeeding. This research allowed me to delve further into fully understanding the factors that could affect breastfeeding initiation and how important it is to the mother and baby to have support from trained health care professionals, in order to make sure that the mother feels confident when breastfeeding.
- WHO. (2019). Breastfeeding. Available: https://www.who.int/nutrition/topics/exclusive_breastfeeding/en/. Last accessed 10th May 2019.
- Trust for London. (2018). Poverty and inequality data for Newham. Available: https://www.trustforlondon.org.uk/data/boroughs/newham-poverty-and-inequality-indicators/. Last accessed 1st June 2019.
- Public Health England. (2018). Newham. Available: http://www.newhamambition.com/media/3800/3-newham-health-profile-2018.pdf. Last accessed 1st June 2019.
- British Nutrition Foundation. (2018). Infant nutrition. Available: https://www.nutrition.org.uk/nutritionscience/life/infant-nutrition.html?start=1. Last accessed 1st June 2019.
- Unicef. (2019). Benefits of breastfeeding. Available: https://www.unicef.org.uk/babyfriendly/about/benefits-of-breastfeeding/. Last accessed 1st June 2019.
- NHS (2017). your pregnancy and baby guide. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/ ( Accessed 1st June 2019)
- Baby Friendly Initiative. (2019). Going Baby Friendly Stage 2 – Baby Friendly Initiative. [online] Available at: https://www.unicef.org.uk/babyfriendly/accreditation/maternity-neonatal-health-visiting-childrens-centres/stage-2-an-educated-workforce/ [Accessed 9 May 2019].
- McInnes, Rhona; Chambers, Julie. (2008). Supporting breastfeeding mothers: qualitative synthesis. Journal of Advanced Learning. 62 (4), 407-427.
- NICE (2015). Quality statement 5: Breastfeeding | Postnatal care | Quality standards | NICE.[online] Available at: https://www.nice.org.uk/guidance/qs37/chapter/Quality-statement-5-Breastfeeding [Accessed 11 May 2019].