Quality statement 4: Face-to-face feeding support | Postnatal care | Quality standards

Quality statement

Parents receive face-to-face feeding support at each routine postnatal contact. [new 2022]

Rationale

Regardless of their feeding choices, parents value face-to-face feeding support. This support should be an integral part of routine postnatal contacts. Individualised support, including assessment and observation of feeding, can give parents the knowledge and understanding they need. This helps them establish good feeding practice and make informed decisions about feeding their baby. If there are ongoing concerns, healthcare professionals can arrange additional contacts to observe feeds until feeding is established and any problems have been addressed.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence that healthcare professionals have the knowledge and skills they need to provide face-to-face feeding support.

Data source: Data can be collected from information recorded locally by provider organisations, for example, from training records.

Process

a) Proportion of women who had a live birth who had an observation of a feed within 24 hours of the birth.

Numerator – the number in the denominator who had an observation of a feed within 24 hours of the birth.

Denominator – the number of women who had a live birth.

Data source: Data can be collected from information recorded locally by provider organisations, for example, from patient records.

b) Proportion of women who breastfeed who had an observation of a feed between 2 and 7 days after the birth.

Numerator – the number in the denominator who had an observation of a feed between 2 and 7 days after the birth.

Denominator – the number of women who breastfeed (exclusively or partially).

Data source: Data can be collected from information recorded locally by provider organisations, for example, from patient records.

c) Proportion of routine postnatal contacts that include face-to-face feeding support.

Numerator – the number in the denominator that include face-to-face feeding support.

Denominator – the number of routine postnatal contacts.

Data source: Data can be collected from information recorded locally by provider organisations, for example, from patient records.

Outcome

a) Rates of exclusive or partial breastfeeding at 6 to 8 weeks after the birth.

Data source: Included within the NHS Digital Maternity Services Data Set, Office for Health Improvement and Disparities' breastfeeding statistics, and the NHS Digital Community Services Data Set.

b) Proportion of parents who are satisfied with postnatal support with feeding.

Numerator – the number in the denominator who are satisfied with postnatal support with feeding.

Denominator – the number of parents of babies.

Data source: Data could be collected from a local survey of parents of babies. The Care Quality Commission maternity survey collects information about women's experiences of maternity care including satisfaction with support with infant feeding.

What the quality statement means for different audiences

Service providers (such as NHS hospital trusts and community providers) ensure that processes are in place, and healthcare professionals have the knowledge and skills they need, to provide face-to-face feeding support to parents at each routine postnatal contact. Service providers ensure there is capacity to observe a feed within 24 hours of the birth and to provide a breastfeeding assessment, with another observation of a feed within the first week.

Healthcare professionals (such as midwives and health visitors) provide face-to-face feeding support to parents at each routine postnatal contact. Healthcare professionals observe a feed within 24 hours of the birth and assess breastfeeding, with another observation of a feed within the first week. They help to resolve any ongoing concerns.

Commissioners (such as integrated care systems and local authorities) commission services that provide face-to-face feeding support to parents at each routine postnatal contact. This includes observation of a feed within 24 hours of the birth, and breastfeeding assessment, with another observation of a feed within the first week.

Parents of babies receive face-to-face support with feeding their baby at each routine postnatal appointment so that they can get any help and advice they may need.

Source guidance

Postnatal care. NICE guideline NG194 (2021), recommendations 1.1.10, 1.5.10, 1.5.14, 1.5.18, and 1.5.19

Definitions of terms used in this quality statement

Face-to-face feeding support

This should include assessment of breastfeeding to identify and address any concerns. Healthcare professionals should:

ask about:
- any concerns the parents have about their baby's feeding
- how often and how long the feeds are
- rhythmic sucking and audible swallowing
- if the baby is content after the feed
- if the baby is waking up for feeds
- the baby's weight gain or weight loss
- the number of wet and dirty nappies
- the condition of the breasts and nipples
observe a feed within the first 24 hours after the birth, and at least 1 other feed within the first week.

If there are ongoing concerns with breastfeeding, healthcare professionals should consider:

observing additional feeds
other actions, such as:
- adjusting positioning and attachment to the breast
- giving expressed milk
- referring to additional support such as a lactation consultation or peer support
- assessing for tongue-tie.

Face-to-face formula feeding support should include:

advice about responsive bottle feeding and help to recognise feeding cues
offering to observe a feed
positions for holding a baby for bottle feeding and the dangers of 'prop' feeding
advice about how to pace bottle feeding and how to recognise signs that a baby has had enough milk (because it is possible to overfeed a formula-fed baby)
advice about ways other than feeding that can comfort and soothe the baby
how to bond with the baby when bottle feeding, through skin-to-skin contact, eye contact and the potential benefit of minimising the number of people regularly feeding the baby.

[NICE's guideline on postnatal care, recommendations 1.5.13 to 1.5.15 and 1.5.19]

Routine postnatal contact

Contact from a healthcare professional that is part of the standard pathway of postnatal care. This includes the first contact on the postnatal ward by a midwife, the first home visit by a midwife, and the first home visit by a health visitor. [NICE's guideline on postnatal care, recommendations 1.1.10, 1.1.14 and 1.1.15]

Equality and diversity considerations

Providing continuity of carer is particularly important to support younger women and those from a low income or disadvantaged background to continue breastfeeding.

Parents should be given information they can easily access and understand themselves, or with support, so they can communicate effectively with healthcare services. Clear language should be used, and the content and delivery of information should be tailored to individual needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. People should have access to an interpreter or advocate if needed. The interpreter or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language. For parents with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.