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Lactation Support Service Specialists Annual Update
DEBRA FENTON
Maternity Service Manager JENNY LESTER
Lactation Specialist LOUISE STONE
Lactation Specialist
ALLISON VODANOVICH
Lactation Specialist
Lactation support service
The lactation support service is based in Middlemore Hospital’s maternity wards and community midwifery service, and is delivered by a team of nine midwife and nurse specialists with lactation qualifications and three breastfeeding advocates.
The service offers mothers advice on infant feeding and provides intensive assistance to mothers and staff when babies have complications that impede effective breastfeeding. The lactation specialists are available Monday to Friday from 7am to 3:30pm. Further support is given by the breastfeeding advocate team who educate mothers about successful feeding and are available during the day, 7 days a week.
Over the past year, the team has worked on various projects and work streams. Some of the main ones are summarised below.
Newborn hypoglycaemia
LOUISE STONE, LACTATION SPECIALIST
During 2019, the lactation team provided input into the newly developed Women’s Health Guideline for Management of Newborns at Risk of Hypoglycaemia.
Newborn babies with hypoglycaemia are at risk of not effectively establishing breastfeeding, due to complications associated with poor fetal growth, diabetes and other complications during pregnancy. At CM Health, 12 per cent of our pregnant women have diabetes. We also have high numbers of women having late preterm deliveries, so this guideline applies to a considerable number of our babies.
Giving dextrose gel to newborn babies with low blood sugar can help protect exclusive breastfeeding. However, a considerable number of our babies still required supplementary feeding with an artificial breast milk substitute to avoid newborn hypoglycaemia.
The lactation specialists help staff become familiar with the hypoglycaemia guideline, supporting them with newborns who meet the criteria in the guideline, and emphasising the measures that protect and preserve breastfeeding.
Transitional care beds in maternity
ALISON VODANOVICH, LACTATION SPECIALIST
The introduction of transitional care beds in the maternity wards began in late 2019. This model of care is designed to support babies, mothers and whaanau progressing from the Neonatal Unit.
Transitional care babies tend to have been born prematurely or had a more complex medical course. Their mother or caregiver is re-admitted as a boarder on the maternity ward to gain experience in mother-craft and establish feeding before the baby goes home. Babies are often progressing to breastfeeding after having been on nasogastric feeding support.
Transitional care provides a collaborative approach to baby’s care between the whaanau and maternity staff, including the lactation support team and neonatal medical staff. Staff promote autonomy for families by helping mothers and whaanau evaluate their infant’s feeding and encouraging other aspects of safe infant care.
This model of care has been used for some time in maternity services, but this initiative created an opportunity to formalise the arrangement and dedicate beds for transitional babies. On average, four babies will be transitioning on the maternity wards at Middlemore at any one time. Others area cared for in the primary birthing units. The goal for Middlemore was to have up to eight dedicated transition beds by the end of 2020. However, progress of this model was complicated by visitor restrictions during COVID, compounded by high levels of postnatal acuity experienced on the ward, which required dedicated staff and bed space resources.
Posters developed for COVID-19
Two very useful posters about the benefits of breastfeeding during COVID-19 were developed with the initiative and
input of the Lactation Support Services team and the two maternity ward midwife managers. They amalgamated information sourced from the Lakes District Health Board, and were consistent with World Health Organisation and Ministry of Health advice on breastfeeding.
The first poster simply advised that breastfeeding, skin-toskin and rooming-in continue to be recommended during COVID-19, and were placed in all rooms that did not have an isolation function (see next page).
The second poster was provided to any breastfeeding (or unsure) mother who was in isolation with suspected or confirmed Covid-19. They were provided on the mother’s arrival to the room, to reassure her that she could continue or elect to breastfeed, and discarded when she left (see next page).
Thematically, the posters aligned with the design used for local general COVID -19 information, and their production fast-tracked, so they could be distributed as soon as possible.
The Baby Friendly Hospital Initiative (BFHI) is an international programme designed to ensure all maternity services become centres of breastfeeding support worldwide.
At CM Health, the lactation support service delivered the following BFHI workshops in 2020. Some courses were cancelled due to Covid-19.
• Patient safety training – six 1-hour practical sessions, attended by 149 staff (89 midwives, 58 registered nurses, two enrolled nurses).
• BFHI essentials (for new midwifery and nursing staff) – six 2-day courses, attended by 74 staff (24 midwives, 44 registered nurses, one lactation consultant, five dieticians). • BFHI update (for staff who have been with us for 2 years) – seven courses, attended by 52 staff (31 midwives, 18 registered nurses, one enrolled nurse, one lactation consultant, one speech language therapist. • BFHI applied – three courses, attended by 36 staff (25 midwives, nine registered nurses, two lactation consultants).
(64 midwives, 27 registered nurses, one enrolled nurse, six lactation consultants). • BFHI workshop – five courses, attended by 20 staff (14 midwives, five registered nurses, one lactation consultant).
• New staff orientation – 10 courses, attended by 67 staff (36 midwives, 29 registered nurses, two lactation consultants).
Overall, 496 midwifery and nursing staff received BFHI training throughout the year, including 283 midwives, 190 registered nurses, four enrolled nurses, 13 lactation consultants, one speech language therapist and five dieticians.
In addition, 97 allied health staff completed BFHI education in 2020: 28 health care assistants, nine cleaners, four social workers, 40 clerks, eight hearing screeners, two pharmacists, two dieticians, a community health worker and three breastfeeding advocates.
Exclusive breastfeeding at discharge statistics
Despite delivering a consistent BFHI education programme, the exclusive breastfeeding rate on discharge continues to decline at Middlemore Hospital, and has fallen below the BFHI target of 75 per cent of babies being exclusively breastfed at their first discharge from a maternity facility, as shown in Figure 49.
Rates at the three primary birthing units remain high.
We will begin a programme of work shortly to identify the factors contributing to the decline in exclusive breastfeeding rates at Middlemore Hospital. At first glance, these factors are likely to include rising intervention rates, an increase in detection of small-for-gestational-age babies and implementation of the newborn hypoglycaemia guideline, alongside with social and other population health determinants.
The lactation support team continues to provide an essential service in our secondary maternity care environment. We continue to implement quality improvement initiatives that uphold the standards required of our BFHI-accredited facilities. Next year, we hope to be able to report a turn around in our exclusive breastfeeding at discharge rates at Middlemore, ahead of our BFHI re-assessment in 2022.
