NICE guidelines recommend peer supporters meet with mums antenatally and within 48 hours after birth.

[RubyBuckleberry]

click on the link - commissioning guide

Is this happening anywhere? Should it happen? What do people think? Is it necessary for people to set up private peer supporting/counselling enterprises like this one although it was commissioned by sure start? because the PCTs seem to be being so slooowwww about this and women everywhere could do with a 'knowledgeable friend' to help them through the first weeks...

I have read/heard some BFing counsellors say that this is a 'scary' prospect because breastfeeding peer counsellors are not trained enough, being only trained for 12 weeks. Do people think this is true? 12 weeks is quite alot to learn all about breastfeeding I would have thought, and most HVs only do a 3 day UNICEF course in breastfeeding management.

Any thoughts?

tia

Ruby - I did the LLL BFPS course and it is 12 weeks - 2 hours a week for 12 weeks though. I think we get enough training to be 'knowledgeable friends' but not enough to be what the NHS really wants - which is free IBCLCs Also BFPS would need to be mentored when they first start. It's one thing to know the theory but another to be watching a mum struggle and feel that you are really in the deep end and you can't swim.

The real trouble with peer supporters is that they quite often come with (breastfeeding) small children which aren't terribly welcome on maternity wards - not being siblings of the newborn and all. I would love to do maternity ward visits but would need on-site creche facilities as standard.

I can do the 10 day check MW clinic/baby weigh HV clinic because they are at my local children's centre and if I need to go to a private room to give a mum some 1-2-1 attention/observe latch etc, my children can be minded by the centre's staff for 10 mins or so.

I really wish I had the answers

I think antenatally is an excellent idea, especially if the PS can feed then an d there.
However, I did a PS course and we were told not to give advice or given much training on how to help with 'problems', and I would imagine that's what mums want in the first 48 hours.

'but not enough to be what the NHS really wants - which is free IBCLCs' but do they really? even on that webchat i've just been reading they were saying that all it takes is someone to believe they can do it. i've been reading about peer support and it seems to be more about asuming breastfeeding can work and sharing information about a normal physiological function rather than something that can only be done by experts .

hmm creche facilities is a hard one
the peer counsellor at my local group helps with all sorts of problems. so are people being told different things?

I think the "believing in them" is a very good point, and what people need once they've overcome the initial hurdle of the first few feeds. For those though, I think they need a bf expert.

'Little Angels have recently started to facilitate volunteer peer support on the postnatal maternity wards at The Royal Bolton Princess Anne Maternity Unit. Peer Supporters provide additional support and community information to breastfeeding mothers and their families, helping to promote, support and protect breastfeeding in the Bolton area.'

I've just got this from the little angels website - it sounds allright!i think they should do this everywhere!

I find that women are coming to the drop-ins with more than just a self confidence crisis or unsure about how many times a day to feed a baby.

We talk things through with mums issues with engorgement, thrush, mastitis, expressing, going back to work, latch/positioning problems, identifying/referrals for tongue tie, weaning, introducing bottles, sore/cracked nipples, low supply, over supply, supplementing, relactation, night feeding, scheduling, teething, biting, bfing older babies, etc, etc. Obviously thrush/mastitis mums get given BfN leaflet and implored to go to Drs for prescription - they haven't given us prescription pads yet.

Yes, a lot of what we do is talking with mums about what life with a bfing (or not) baby is like and what is normal and what is not but if we didn't tackle some of the issues we do then who does? We have the support of a HV at the groups who is training towards IBCLC but for the most part we are it in the local area.

TruthSweet that sounds great! obviously there must be scary things that need full on lactation consultants but you sound like you know what's what. do the women you see carry on - are the problems they have solved with your support?

Mostly we never find out - we have a 'hardcore' of women who come to almost every single drop-in (I've been going for over 4 years now with 1 year as a BFPS) most of whom came with problems or needing support in one way or another.

It's not group practice though to phone a mum up unless she specifically asks for it (I had my first call request today in over a year of BFPSing) as we don't wish to be too pushy or harrassing.

Often I bump into mums I've talked to in the supermarket/library but I don't like to pry in case I upset them. I just usually stick to a generic 'How's baby/things?' and see what happens from there.

I think I might suggest that we have a anonymous feed back form set up to see what we do right and what we could improve. Thanks for the idea

In my area peer supporters attend a course one day a week for 5 weeks. I understand it's mostly listening skills, not much detail on the technicalities.

I don't think it's working quite right yet in my area. I was supposed to get a phone call from a peer supporter on leaving hospital. I never did, and that in itself actually knocked my confidence because it felt like no one cared. I've started going to the local support group - 20 weeks in - but only because I'm quite interested in peer support myself. Nothing seems to really happen actually. Just a few successful breastfeeders chatting and playing with babies/toddlers, and the odd new mum. It's a bit weird if I'm honest, could be much better.

I would like to see actual b/f counsellors going into antenatal wards and providing proper help to new mums. I would love to train as a bfc in the future and I for one would be more than happy to spend time doing this. I'm not sure peer supporters are what are needed in those early stages. Women actually need teaching what to do by someone experienced - I think anyway. The ladies doing the webchat today seemed to suggest that MWs should be doing this teaching - not in my experience!

In our area, peer supporters are trained by the BfN. It's two hours/week, for 16 (?) weeks. They can then volunteer on the hospital wards. We also have paid breastfeeding support workers on the ward. It's often too busy for the supporters to see everyone, though.

that sounds good - whats your area NotQUiteCockney?

gaelicsheep, that does sound a bit pants, particularly not being contacted i just find it so frustrating that all the solutions are there, the people in power don't seem to be running with it though!?

i agree that experienced people should help initial latching on etc but someone who has been trained for 3/4 months in solely breastfeeding mechanics etc must be well qualified to support it to continue.

truthsweet no problem . i wonder if mums could tick a box somewhere to say whether they would be happy to have peer supporters phone them...

I think it's a fantastic idea. At the Royal Berks Hospital BFPS visit the pn wards, but it's a bit hit-and-miss because it's entirely up to the individual PS to come when she can. Certain ly I didn't see one, but then my dc was born on a Sunday.

I think bfing support should not come primarily through the medical HCP establishment. HCPs deal with ill-health, with the abnormal. Bfing is normal, and its support should be normal, should come through the community of mothers.

The 12w PS courses, plus mentoring/shadowing, plus ongoing refresher training, are certainly enough to make a huge difference, even if they havent done the full 2y course. A PS can really help a lot. It's not just listening skills so that the mother can talk freely, is also working out whether there is a problem, what it is, and how to support the mother as she resolves it. Helping the mother believe in herself. Helping her be proud of whatever bfing she does, and not feel bad if her bfing doesn't continue.

The short course HVs do is just about enough for them to recognise when to refer onwards. BFPSs have ongoing training to keep their knowledge and skills up-to-date, HVs don't - not in bfing anyway.

I'm in Tower Hamlets. First time mums get called by the breastfeeding folks (paid workers, not volunteers) and asked if they want a home visit, as well.

BF support needs to have HCP backup, though, as if they run into problems or areas of concern, they need to be able to easily flag their concerns to a HCP. Ditto HCPs need to be able to call in BF folk to help when BF seems to be the problem.

A lot of the BF peer support training, locally, focuses on newborn latch, because of the hospital work.

One of the issues with peer supporters is variability in their training and any ongoing supervision/learning. Some schemes are excellent and can demonstrate good results. Others look and sound great, but don't seem to make much difference. This could be something about the setup of the scheme, or the training, or the target population. Good schemes everywhere would be fabulous. I've heard rumours of some PCTs decommissioning these schemes if they don't increase bf rates.

The commissioning guidance linked to above does stress that a peer support programme should be part of a wider strategy and also stated the importance of implementing UNICEF Babyfriendly. It also says that peer supporters should attend a recognised, externally accredited training course in breastfeeding peer support. It seems like not all courses can claim this.

Of course HCP backup and support as well, but given that a good minimum level of training for a BFPS is a 12w course + ongoing monthly training (BfN), can we really expect that from an already over-stretched HCP?

Just as a GP needs to know when to refer to a specialist, so do all HCPs need to know when to refer to a bfing specialist. And to value them!

A well-trained peer supporter is experienced, both by virtue of the ongoing training and - in most cases - by having breastfed her own babies.

Besides, bfing is normal, ordinary. Mothers need to be supported by people like them, normal, ordinary people. Not scary authority figures.

The bf supporter here visits mat ward every week day

But Pretty, that isn't necessarily the minimum. It may be the minimum for that organisation, but others train peer supporters differently and some offer no ongoing training.

I really could have done with something like this. I was in hospital for 2 full days after my c-section and no-one came to talk to me specifically about feeding. I think they assumed that if you weren't complaining, you were ok, and asked me about feeding as a fleeting part of a long checklist of eating, toilet habits etc. I didn't realise until I was leaving that some mothers had signs on their door asking for assistance with feeding at particular times. It seems help was not offered unless you requested it.

I was saved by a maternity assistant who, on my second evening, showed me how to feed lying down (that morning a midwife had stopped me from raising my bed so I could sit up better to feed, but never suggested I try a different position), and a student midwife who came in every feed overnight that night to help me get his latch right. Apart from that we kind of muddled through. I could have done with someone to spend 5-10 minutes having a chat, offering tips and generally telling me I was doing ok. There are odd things you don't think of, like I didn't want to interrupt his feed and was carrying on feeding when he slipped off his latch, which led to nipple trauma until I called an NCT counsellor who put me back on track after about a week.

I don't see how a supporter could do a good job, or feel confident in her role as a supporter, on much less than that.

I'm not entirely sure... Seems a big ask of somebody who is 'just' a peer supporter (I am one but don't have much experience yet)

Where I am there are breast feeding support workers trained and employed by the PCTs. They go to antenatal classes, they are on teh postnatal ward and visit women postnatally in community as well as running postnatal b/f workshops.

I mean I'd talk antenatally and they do that at our local hospital, but after the birth... I dont know it's such a vulnerable time.

Having said that, even in the same shift you get so much conflicting advice from all the midwives, would it really matter if it were coming from a peer supporter?

Come to think of it peer supporters probably know more about BFing than midwives, my friend was looking into a midwifery degree and BFing barely entered the training, WTF?! But that's a whooooole other thread.

Hi FreudianSlimmery - loving the new name! I agree that some MWs seem to have very little knowledge (or don't want to impart it) about breastfeeding.

I hate that there is not one big check list that everyone can use to point them in the right direction (all of the time):-

Blanched nipples = x, y, z
Engorgement = a, b, c
Expressing = 1, 2, 3

And EVERYONE sticks to it. We all sing from the same song sheet. If the answer isn't on the sheet we refer on up the chain not cobble together some bullhockey to make the mum think we know we are talking about.

None of this 'if you feed more frequently than 6 times a day then obviously you don't have enough milk' or 'When I had my babies it was 20 mins on left then 10 on right. In 4 hours 20 mins on right then 10 on left. that works for all mums', 'I think mastitis means you have poor quality milk, best to stop' (None of that is real advice BTW so please no one think that's what I would tell a mum!).

At the moment a mum asks a MW/HV/BFPS about something and they run the gauntlet of whether or not the HCP is giving them clinical, evidence based advice and guidance or old wives tale advice. I want that to change and mums to be confident they are getting good support from their care givers.

If your hospital is going for baby-friendly accreditation, then they do end up a bit more 'one song sheet'.

Unfortunately, peer supporters can feel confident giving advice on much less than the BfN course - think of all the untrained people who feel confident sticking their noses in and telling BF mums what they're doing wrong!

And some people see the Unicef two-day course as equivalent to peer supporter training. From what I know, though, it doesn't include counselling skills, and it doesn't help supporters recognise the limits of their knowledge, both of which are essential skills for a peer supporter.

NQC- the 'breastfeeding folk' that you mentioned in your earlier post-are they employed by the hospital or someone else?

I really feel that women should get bf support in the early days - at home. If you can problems ironed out easily early on then you are less likely to stop.

I think bf groups are great for ongoing support - but you've got to be pretty motivated to visit one in the first week of giving birth (feeling knackered, sore and teary possibly).

Another poster mentioned the high drop out rate at 6 weeks too- wouldn't it be handy to have a quick catch up with someone at the 6 week check just to alert you - maybe mentioning growth spurts etc?

'spose it all comes down to money really.