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TOWARDS A BETTER START Updated Summary Report Final
TOWARDS A BETTER START Updated Summary Report Final
A BETTER
START:
Summary report of breastfeeding
experiences in Aberdeen and Shire
Breastfeeding in Grampian
Breastfeeding rates in NHS Grampian are higher than in Scotland on average. For
example, 61% of Grampian mothers breastfed 10 days after birth compared to the
Scottish average of 51%. This trend is also reflected in in the 6-8-week data collected
by a health visitor with 51% of 2local women still breastfeeding compared with a
2
Scottish average of 41% . While this trend should be celebrated, we must also
consider that having a higher percentage of women breastfeeding in Grampian,
would logically suggest a higher need for breastfeeding support services.
Additionally, breastfeeding rates in Scotland are low compared to those achieved in
other countries. There is therefore considerable scope to further improve the rates of
breastfeeding in Grampian and particularly rates of exclusive sustained breastfeeding.
Furthermore, in the local context, increasing the percentage of babies exclusively
breastfed at 6-8 weeks to 41% by 2021 is one of the key improvement aims in the
Local Outcome Improvement Plan for Aberdeen City and a key indicator in efforts to
reduce health inequalities locally.3
Methodology
The 2018 breastfeeding survey ran online via Survey Monkey for almost 4 weeks from 18
June to the 13 July 2018 and generated 636 responses, which is a 62% increase compared to
4
2016 . The survey was open to women who had given birth in the last 12 months in the NHS
Grampian region.
The survey was a self-selecting, rather than random, sample and therefore it cannot be
assumed to be statistically representative of the experiences of all women who have given
birth in the NHS Grampian region in the 12-month period.
Survey Participants
Almost two-thirds (63%) of the 534 respondents that provided age information were in the
31-40 age group. There were 215 respondents who could be mapped to a specific Aberdeen
City area and 275 respondents could be mapped to a specific Aberdeenshire area. Just over a
third (222, 34%) had previously breastfed and 414 (66%) were breastfeeding for the first time.
BREASTFEEDING
CONFIDENCE
A mother’s confidence in her chosen feeding method soon after birth can be important to the
breastfeeding journey. In the 2018 breastfeeding survey, 39% of mothers who were not confident in
their feeding method leaving the hospital stopped giving breastmilk before their baby was 6 months old.
This is nearly double the percent of mothers (20%) who said they felt very confident in their chosen
feeding method when leaving the hospital.
25%
A larger percentage of
women felt not
confident (25%) in 2018
than in 2016 (21%)
Confidence levels are fairly similar between the two surveys,
though they are slightly lower in 2018
The majority of mothers who felt ‘Not Confident’ were new to
breastfeeding
Almost two-thirds of
women who felt ‘Very
Confident’ were women
who had previously
breastfed.
The majority of women who
felt ‘Not Confident’ were
new to breastfeeding (85%).
Latch quality and midwife support can make or break feeding confidence
Confidence boosters
Previously breastfed
Midwife and hospital staff support
Baby latched and fed well
Baby latched and fed well
Midwife and hospital staff support
Confidence breakers
The adage “It takes a village” is often referenced in relation to raising children. Frequently, it also takes a
wide circle of support for mothers to successfully breastfeed their children. Our survey found that mums
had a range of supporters in their life and reached out to different people and groups for help along the
breastfeeding journey.
4
infant feeding team than in the 2016 survey (21%) and fewer
women in the 2018 survey (13%) said they weren’t told out of 5 women had
about any options than on the 2016 survey (22%) breastfeeding concerns or
needed to access
A smaller percentage of women (8%) in the 2018 survey said breastfeeding support
they accessed help from the breastfeeding peer support
service than in 2016 (18%)
2018 2018
2018 2018
2018 2018
21% 38%
Reasons women didn’t pursue more Several key people and groups
breastfeeding support beyond stood out as top supporters for
midwife or health visitor breastfeeding mums
2018 2018
2018 2018
2018 2018
Rarely is breastfeeding a simple journey. A variety of problems can plague a mother. Overall, the
challenges facing breastfeeding women are similar in 2018 to 2016. Understanding what challenges
mothers face within the NHS Grampian health board area can help inform support efforts so that they
can be most efficient and effective. This section details some of the challenges breastfeeding mothers
faced as well as ways the challenges were overcome and supports respondents wished had been available
to them.
Over four out of five 2018 survey respondents reported facing challenges whilst breastfeeding
At least three out of ten mothers in the 2018 survey wanted the following
supports to ease their breastfeeding journey:
Many respondents wanted to access peer
supporters in the hospital (37%) or at home
(31%)
Supports that would have made the breastfeeding journey easier for
respondents, 2018 and 2016 surveys
CESSATION OF
BREASTFEEDING
WHO guidelines recommend that infants are exclusively breastfed for the first 6 months of life. Yet for
many mothers, this goal was unattainable. Greater insight into why mothers in Aberdeen city and shire
stop exclusively breastfeeding before a baby is 6 months old can inform efforts to help future women like
them persevere.
A smaller percentage of
mothers said they stopped
breastfeeding due to demands
of other children (5%) in 2018
than in 2016 (22%)
As in 2016, concern over milk supply (15%) and weight gain (10%) as well as pain while breastfeeding
(12%) were some of the top reasons mothers stopped breastfeeding in a baby’s first 6 months of life.
‘Other’ category
Poor latch
Exhaustion
Concerns
about under supply
One of the new issues that seems to be emerging as a concern for women since the 2016 survey is
tongue tie. The 2018 survey found that 20% of respondents reported concerns with tongue tie, and
there were variable experiences of being referred for treatment promptly. In some cases, women
reported that it seriously affected their ability to breastfeed.
1 in 5
respondents
Approximately thought or knew
their baby had
tongue tie
7
Health care professionals and mothers themselves identified tongue tie
Just under half (41%) of tongue tie cases were identified in a baby’s first week of life
while almost a third (29%) were spotted once a baby was older than a month
Comparing 2018 results with those from 2016 reveal several positive and encouraging
signs as well as points for continued improvement. Based on survey results and
supplementary documents like the Scottish Maternal and Infant Nutrition Survey (MINS),
we have made 6 recommendations for improving breastfeeding supports in NHS
Grampian. The recommendations are summarised as follows
2. Improve breastfeeding support offered in labour ward, midwife unit and postnatal
wards: NHS Grampian should look at successful models of post-natal breastfeeding
support in other health boards and should take a strategic and innovative approach to
providing breastfeeding support to every woman who requires it acknowledging that
staffing is an issue – but not an excuse not to find a solution.
3. Review the Peer Support System: The health board should review peer support in
Grampian by identifying issues in the current system, studying successful models that
could be emulated, and determining how peer supporters can play a role in post-natal
wards.
4. Improved education:
For Partners: NHS Grampian should undertake work with mothers’ partners to explore
what kind of information or advice they would like to see provided.
a. For women, the health board should develop better or more targeted ante and
postnatal education and information on breastfeeding.
b. For GPs: NHS Grampian should develop and promote training materials for GPs on
breastfeeding conditions, particularly on identification and treatment of mastitis and
thrush and also increase knowledge of safe prescribing while breastfeeding.
6. Tongue Tie: Tongue tie issues need to be better addressed. NHS Grampian should
review its policy of referral, support and treatment for suspected tongue tie and ensure
it is clear, well publicised and available for all families and healthcare professionals to
access, including online.
As a local Branch, we are aware that NHS Grampian’s resources are under significant
strain, perhaps best highlighted for Aberdeen Maternity Hospital by the regularity of open
midwife positions. We hope that the findings and suggestions in the report can form the
basis of open, ongoing dialogue with us and other parties in the voluntary and third sector
so that together, we can provide breastfeeding mothers with the support required.
NOTES AND REFERENCES
2. Information Services Division (2017). Infant Feeding Statistics Scotland, Financial year
of birth 2016/17. Available from https://www.isdscotland.org/Health-Topics/Child-
Health/Publications/2017-10-31/2017-10-31-Infant-Feeding-Report.pdf
4. The 2016 survey received 392 responses over the 2 weeks it was open. The 2018
survey received over 400 responses in the first 2 weeks it was open.
5. There were slight differences in the wording of options between the 2018 and 2016
surveys. Breastfeeding telephone lines was listed as breastfeeding helplines and Aberdeen
Maternity Hospital was abbreviated as AMH.
6. The analysis of the question about reasons women stopped breastfeeding excludes the
63% of respondents who said they breastfed for more than 6 months as the item isn’t
applicable to them.
7. Respondents could select multiple options as tongue tie can be picked up at different
times by different people.
NCT Aberdeen City & Shire
Website: https://www.nct.org.uk/local-activities-meets-ups/region-scotland/aberdeen-city-and-shire
Facebook: https://www.facebook.com/nctaberdeencityandshire/
Phone: 01224 453298
Email: aberdeen@nct.org.uk
The surveys and subsequent reports were possible through the tireless efforts of the Action on
Breastfeeding working group as well as the hundreds of mothers who shared their experiences with
us. We thank them for all that they have done.