This site is intended for health professionals only

The experience of running a breastfeeding clinic

Change is often perceived as being a "difficult problem" or a "challenge to overcome" rather than a "window of opportunity". However, my years of nursing, midwifery and health visiting have made me appreciate that adopting the "window of opportunity" approach, especially for health promotion, can result in a far more positive outcome.
My experience as a midwife and as a mother who had successfully breastfed two boys had generated an avid interest in learning more about breastfeeding. While employed by my primary care trust, I trained and qualified as a lactation consultant. I realised that I would need to relay the very valuable information I had learned about breastfeeding not only to my colleagues who I would be training, but also to parents and potential parents. This meant that I would need to utilise all resources available.

The Baby Café®
I was aware that other breastfeeding drop-in centres had been successfully established around the country. The Baby Café in Mid-Sussex had even developed their own professional application pack,(1) as a guide to setting up a similar clinic. I was eager to know the secret of their success so that I could successfully establish a similar initiative back in Scarborough, Whitby and Ryedale.
While on maternity leave with my third son, I went along to a thriving and successful baby café in Halifax, which had been set up by a midwife and experienced lactation consultant, Marilyn Rogers. The visit was a revelation. I cannot recall ever having been in a room with so many happy breastfeeding women. The success seemed to stem from two important elements working hand in hand: the availability of a highly qualified lactation expert and the very positive peer support. For those experiencing any problems, Marilyn was available to call on her professional knowledge and skills to identify the core of the problem and offer the appropriate help and advice. Alongside this, there was strong peer support from the other breastfeeding mothers.
I had entered the group as a mother rather than a healthcare professional, and chatting to the other mothers just underlined my initial impressions. They recognised that this was the place to get accurate information and advice away from conflicting viewpoints or negative experiences. It seemed a very open and flexible means to promote breastfeeding.
Some of those present were grandmothers or aunts, some were pregnant friends and relatives, and some had never breastfed. However, everyone was immensely positive about the attributes and benefits of breastfeeding. The general message that I picked up was that the mothers now felt fully informed as to why breastfeeding their baby was the best choice to make to ensure a positive health outcome for them and their child. They also displayed confidence that they could achieve this successfully due to the support from their baby café group. I returned to North Yorkshire determined to establish a similar group.

Getting the news out
We were offered a venue in the maternity unit at our local community hospital. This seemed an ideal location as it was close to town and had separate rooms for private discussion and consultation as well as beds for mothers to practise alternative positions to feed (eg, lying on their side or holding the baby under their arm rather than across their tummy). It was also felt that this venue might promote collaboration between the midwifery and health visiting services.
Initially word of mouth brought mums to our group. This was closely followed by a referral system from health visitors, GPs and midwives. Slowly I saw the same two-tier stream of self-referral and health professional referral emerging as I had witnessed working so well in Halifax.
Each new mother referred is given the privacy and time to discuss their problems with myself as a lactation consultant. This gives me the opportunity to observe a feed, so that I can determine the true nature of the problem and what the root cause might be. This increases the chance of thoroughly resolving the problem, not just providing a stopgap. Our aim is to "find the cause and treat the cause" rather than just dealing with the symptoms.

Primary tuition needed
In the vast majority of cases, poor attachment is the base cause. Mothers need time to relearn or even have primary tuition in the basic principles of positioning and attachment. All such consultations are fully documented, and the information is relayed to other professionals involved in the care of the mother and baby. This promotes continuity of care and information and reduces the risk of conflicting advice.
A healthcare assistant (who has also been a successful breastfeeding mother) works alongside me. Her role is to provide support in my absence (while I am seeing mothers in private) and feed back to me any problems that mothers may have expressed, or any hint of confusion regarding any health promotion issue. This arrangement seems to be very satisfactory.
At present, the system is working well. The mothers have expressed their delight at how both they and their partners are managing to continue feeding for as long as they want. They now have access to manageable methods of achieving this with the inclusion of fathers, such as expressing and feeding via a beaker. We encourage the view that the preservation of breastfeeding should be seen as a priority for fathers too.
The group varies in size but we usually have at least 10 mothers. When possible I am able to utilise the time as an open forum to focus on health promotion issues. Issues that we have discussed include baby massage and the introduction of solid food. Our discussions on baby nutrition also reinforce the "five-a-day" practice for families, thus encompassing health and wellbeing for the whole family unit.

Benefits of breastfeeding
This coming together of so many also enables us to provide mothers with further information about the benefits of breastfeeding, such as reducing their child's risk of obesity, diabetes, gastroenteritis and high blood pressure. We try to ensure that all mothers are made fully aware of the potential proven hazards of artificial milk. This has resulted in an unexpected response from other colleagues who have questioned the appropriateness of relaying this information, especially to mothers who choose from the start to artificially feed. However, we would argue that as professionals we are as
responsible for our omissions as well as our actions. Parents need as much accurate information as possible if they are to make a fully informed choice regarding how they feed their child.
Dr Helen Ball from the Postgraduate Centre at Bradford Royal Infirmary recently commented on how the first year of life should be viewed as the completion of gestational growth. As highly complex primates with large brains, the gestational life is interrupted to allow the passage of the baby's skull through the mother's pelvis. The following year sees all systems within the body grow at an amazing rate. Breastmilk provides the perfect nutritional substance to support this growth, allowing an individual to truly reach their full potential.
This type of information is important for mothers when they are deciding how to feed their child. It goes beyond the philosophical mantra of "breast is best" to fully explain why breastfeeding is so important. Perhaps this is why we have witnessed an outspoken support of breastfeeding from the mothers at our baby café. Some of the mothers were willing to forego breastfeeding when they first attended the baby café, due to one problem or another. Their response has made me even more aware that changing the longstanding culture of artificial feeding is not an easy task, but one that is
achievable with regular ongoing support.
The negative influence of friends and family, who may not have breastfed, often strongly contributes to mothers ceasing to breastfeed. It is very clear that the support, encouragement and evidence-based information that mothers receive while attending this group encourages them to continue breastfeeding.
The positive support from mothers who have experienced the ease and benefits of breastfeeding themselves is a huge benefit. I believe that the increasing use of peer support will evolve from groups such as this.

Segregation must stop
The Baby Café® manual states that: "Breastfeeding mothers are often already isolated, segregated and discriminated against, wither subtly or obviously at home or in public."(1) Through groups such as these this segregation stops.
Although our drop-in clinic is not at present signed up to the Baby Café requirements (due to lack of funding), I consider their professional pack to be an excellent resource. However, our drop-in does have a strong sense of identity, which is reinforced by us devising our mantra - "purely natural". 
The opening mission statement of the Baby Café pack is that such groups are "an imaginative and accessible way of delivering healthcare in the 21st century". We agree and believe that the main aim of groups such as ours is to allow the promotion of breastfeeding to grow and grow without limitation.

Conclusion
Breastfeeding is a fantastic gift for a mother to pass down to her child. I have witnessed how each new mother is welcomed into the group. I have watched mothers using newfound confidence to encourage and support these new members. This creates a feeling of cohesion from the very beginning and develops a whole new culture of united breastfeeding women. This is very positive - a window of opportunity that lays robust foundations to improving the health of our children.

Reference

  1. Williams J, Pardoe C. The Baby Café professional pack. Haywards Heath: The Baby Cafe; 2003.