Encourage and support families to breastfeed. Explain the overwhelming evidence that proves breastfeeding gives mothers and babies significant health benefits well beyond the breastfeeding period itself. Signpost information and resources.
Ensure all women have access to ongoing, evidence based infant feeding support, including referrals to specialist support in their local community and in a variety of formats, that services are monitored, evaluated and adequately resourced to meet need local need.
Support women to respond to their babies’ needs for food and love and are offered ongoing, one to one, practical and skilled help to get breastfeeding off to a good start. Signpost to information and resources.
Educate women on how to breastfeed responsively and how to hand express their breastmilk. When babies are not breastfed, care is provided to ensure that parents are enabled to formula feed as safely as possible. Women's decisions are respected, and parents are supported to feed their baby responsively and to build close and loving relationships.
Support women continue to breastfeed for as long as they wish, and when required specialist support is available. Women are welcomed to breastfeed in their communities and are supported to continue to breastfeed when out and about.
Provide women who breastfeed with information and support to enable them to maximise the amount of breastmilk their baby receives. Parents are supported to introduce their baby to solid food in ways which support optimal health and development. Signpost to information and resources.
Access the SACN report, noting their recommendation for women to exclusively breastfeed for around the first 6 months and to continue breastfeeding for at least the first year of life once solid foods have been introduced.
Educate the workforce to ensure consistent and appropriate advice is given to all families. Support the development of medical students, GP Registrars / FY3s to include infant feeding and breastfeeding support.
Work closely with all relevant partners to commission high-quality, evidence-led services that support women to feed their infants and build a close and loving relationship with their babies. Use PHE and Unicef UK’s guidance to commission evidence-based interventions to improve breastfeeding rates across England.
Analyse local data, demographics and population data to understand how to implement a locally sensitive infant feeding strategy using strategic guidance.
Collaborate with NHS providers and Clinical Commissioning Groups to develop and implement a comprehensive local breastfeeding support and infant feeding strategy.
Understand that Sudden infant death (SIDS) claims the lives of 2000 children per year in the UK (lullaby trust 2020). SIDs is an unexplained death of a child and 88% of SIDS deaths occur when a baby is six months old or less. There many are things that parents and carers can do to reduce the risk of SIDS to their child. Midwives health visitors and other care professionals can advise and support in reducing SIDS.
Advise to not co-sleep if under the influence of drugs or alcohol this includes medication prescribed that may affect levels of alertness o if a parent or carer smokes. Advise to never fall asleep with baby on a sofa or armchair.
Advise that breastfeeding lowers of risk of SIDS and encourage breastfeeding (if possible). Breastfeeding for at least 2 months halves the risk of SIDS but the longer you can continue the more protection it will give your baby.
Provide continuity of carer, to ensure safe care based on a relationship of mutual trust and respect in line with the woman’s decisions.Continuity of carer, to ensure safe care based on a relationship of mutual trust to support open discussion about domestic violence, FGM and other safeguarding concerns. Provision of Domestic Violence Champions within Health Visiting Services.
Access to and investment in continuity of carer for women should be prioritised by maternity, Health Visiting and Family Nurse Partnership services, reflecting wider NHS recommendations.
Train all staff working with pregnant women and new are trained in the specific indicators, needs and risks associated with domestic violence including intimate partner violence and FGM.
Ensure all women are given the same opportunities and support to nurture and bond with their baby and be empowered about how to protect to protect them.
Women have access to information and materials related to FGM, domestic violence and other safeguarding concerns which meet language and literacy needs.
Access Ashiana support information to help prevent murder and serious harm to black, Asian, minority ethnic and refugee women in England, Wales and Scotland as a result of domestic abuse and forced marriage and 'honour'-based violence. Also supports children and young people.
Recognise that the postnatal period is an important time to promote mental health for both parents. Discuss emotional wellbeing and promote mental health through established models of self-care.
Complete a holistic needs assessment asking all women about any past or present severe mental illness, previous or current treatment, and any severe postpartum mental illness in a first degree relative. Recognise signs of emotional distress and mental health difficulties. Refer to a mental health professional, depending on the severity of the presenting problem.
Integrate stepped care involving maternity, health visiting and general practice as not all women will meet the threshold for specialist services but may require additional support with their emotional and mental health. Signpost to Tommy’s and relevant local emotional wellbeing support options.
Refer individuals with suspected or known severe mental illness to a secondary mental health service, preferably a specialist perinatal mental health service, for assessment and treatment.
Embed a collaborative care planning approach in your workforce to safeguard equitable access across operational mental health pathways that improves the wellbeing of people with a mental illness and reduces mental health inequalities.
Ensure Provider staff have the skills to be confident and competent in recognising signs of mental distress and the ability to appropriately support people to improve their mental health, including referral to mental health services.
Demonstrate mental health leadership through providing workforce development opportunities and supporting implementation of evidence-based services targeted to the local population, including collaborative care planning.
Work collaboratively with other agencies to provide universal person-centred and needs-led perinatal mental health pathway support according to guidance.
Recognise the signs of distress in the parents’ relationship, and discuss relationship issues comfortably, offering effective support and sensitively referring to specialist services where necessary. Signpost to Tommy’s and NHS websites.
Engage with families to support the home learning environment (e.g. Hungry Little Minds & Tiny Happy People) to promote parental bonding, reflective function and parental sensitivity during pregnancy, helping mothers and partners to identify with the baby and bond prenatally. Signpost to community-based resources (e.g. libraries, children’s centres, family hubs, local voluntary and community sector services, clinics etc.).
Help parents and carers to manage difficult and challenging issues that are affecting their transition to parenthood, such as parental and infant disability and chronic illness, perinatal depression, toxic stress, previous trauma, family conflict or social isolation.
Assess presence of individual risk and resilience factors in families during the perinatal period, and using these to determine the level of future health visiting support in line with the safeguarding procedures of their local area.
Access to and investment in continuity of carer for women facing multiple complex social factors should be prioritised by maternity services, reflecting wider NHS recommendations.
Implement initiatives to ensure women are given the same opportunities and support to nurture and bond with their baby including how to nurture brain development.
Provide women and their partners information on the importance of early relationships, how to meet their babies’ emotional needs (emotional regulation and attunement), and babies’ cues. This should accommodate language and literacy needs and be a core component of antenatal education. Signpost to Tiny Happy People and Baby Buddy.
Use the ‘Early Years High Impact Area: Transition to parenthood. Health visitors leading the Healthy Child Programme’ to guide your approach to commissioning positive adult relationships and parenting transition initiatives.
Ensure maternity teams receive mandatory training in infant mental health, how to support sensitive, responsive relationships, and how to identify and act on risk factors for the early relationships.
Embed the 1001 Days philosophy across services to increase the likelihood that all babies have secure, nurturing relationships that they need to thrive.
Provide training for staff to feel confident in routine enquiry of women and their partners about how they are feeling about their baby, with efforts made to identify risk factors for early relationships.
Provide women and their partners should be given information about the importance of early relationships, how to meet their babies’ emotional needs (emotional regulation and attunement), and babies’ cues. This should accommodate language and literacy needs and be a core component of ante natal education i.e. Tiny Happy Baby People and Baby Buddy.
Provide equal access to uniform and quality assured screening. The Healthy Child Programme should provide women and their families with high quality information so that they can make.
Conduct Newborn and Infant Physical Examination (NIPE) screening to all eligible newborn babies within 72 hours of birth, and then once again between 6 and 8 weeks for conditions. The NIPE will assess their heart (congenital heart disease), hips (developmental dysplasia of the hip), eyes (predominantly congenital cataracts) and testes cryptorchidism (undescended testes).
Conduct a Newborn Hearing Screening Programme (NHSP) screen for all babies ideally within the first 4 to 5 weeks after they are born. Review NHSP provide separate care pathways for well babies and for those in SCBU/NICU.
Offer a Newborn Blood Spot Screening (NBS) blood test for all babies, ideally on day 5. The NBS tests for: cystic fibrosis, sickle cell disease, congenital hypothyroidism, phenylketonuria, medium-chain acyl-CoA dehydrogenase deficiency, maple syrup urine disease, isovaleric acidaemia, glutaric aciduria type 1 and homocystinuria. The test can be done on babies up to 12 months, though Cystic fibrosis is not tested for after 8 weeks of age.
Support health visitors to deliver a strengths-based continuity of carer approach to work in partnership with parents and carers to provide individualised care that promotes behaviour change and improves health outcomes. Access ‘Early Years High Impact Area: Transition to Parenthood. Health visitors leading the Healthy Child Programme’ for guidance.
Support parents to understand the importance of participating in the progress checks for their children so that any SLCN can be identified and timely support received.
Promote communication strategies to support language learning (e.g. infant-directed speech, joint-attention activities, book sharing, respond to infant communication - ‘watch, wait and listen’, interpret gestures, language in everyday routines etc.).
Use healthcare contacts in postnatal period both as an opportunity to discuss and provide future contraception if not already addressed and initiating conversations about longer term pregnancy plans and promotion of a healthy next pregnancy.
Remind parents of the need to protect baby with the routine childhood immunisation programme starting at 8 weeks of age. Uptake of routine vaccinations has fallen in recent years, so every effort should be made to ensure all babies can access the vaccinations and any parental concerns are addressed.
ASK and record smoking status, ADVISE that smoking can affect fertility and the best way to quit is with a combination of support and medication and ACT by referring or signposting to specialist support to stop.
Ask all women and their partners: ‘Are you drinking at the moment?’ Identify their response according to alcohol guidelines, provide brief advice and signpost to information and support if necessary.
Ask about illicit drug and medicine misuse, providing information, advice and help including advising women to abstain from drug use and referral into specialist treatment where indicated. If you remain in contact with a patient who has reported using drugs, review their drug use at each session.
Complete the misuse of illicit drugs and medicines e-learning session. This brief interactive e-learning has been developed to increase the confidence and skills of health and care professionals, to embed drug misuse prevention in their day-to-day practice.
Support referrals into and engagement with specialist alcohol and drug treatment services. You can find details of your patient’s nearest specialist alcohol or drug treatment service by going to the FRANK website and searching using their postcode.
If a woman has a problem with alcohol or drugs, they should be given the name and phone number of a midwife or doctor who has special experience in the care of pregnant women with alcohol or drug problems. They should be put in touch with an alcohol or drug treatment programme.
Use Alcohol CLeaR to assess how effective the local system and services are at preventing and reducing alcohol-related harm. Monitor the number of babies born with Foetal Alcohol Spectrum Disorders.
Use ‘PHE Alcohol Commissioning Support: Principles and Indicator’s guidance for the latest evidence on effective population-level actions to reduce alcohol-related harms. Monitor services for pregnant women through local key performance indicators.
Refer to ‘Promoting healthy weight in children, young people and families’ a resource to support embedding a systematic approach to creating local environments that promote healthy weight.
Access the ‘Obesity’ Health Education England e-learning programme for practitioners in the NHS and local authorities working in weight management to support workforce learning and development.
Access ‘All Our Health: Adult Obesity’ on Health Education England e-learning for key evidence, data and signposting to trusted resources to prevent illness, protect health and promote wellbeing.
Refer women with a BMI of 30 or more after childbirth to tier 2 adult weight management services. Use ‘A guide to commissioning and delivering tier 2 adult weight management services’ to guide your practice.
Reduce health inequalities by commissioning services which respond to local need set against clear outcome measures, empowering providers to make service improvements. Monitor pre-pregnancy BMI prevalence in your service area(s).
Promote physical activity using the UK Chief Medical Officers’ guidelines on the amount and type of physical activity people should be doing to improve their health.
Access the ‘Physical Activity and Health’ Health Education England e-learning module on physical activity for pregnant and post-partum women course for GPs, nurses and other healthcare professionals to support workforce learning and development.
Monitor CO for all pregnant women. If CO level 4ppm or above - opt out referral into specialist stop smoking support. If trained, deliver stop smoking intervention (see NSCST Standard Treatment Programme). Receive feedback and follow up referral.
Commission stop smoking support that is appropriate for women during and after pregnancy and their families according to recommendations. Monitor and evaluate antenatal smoking rates.
Provide general advice: Brush teeth at least twice daily with fluoride toothpaste (1350 -1500ppm fluoride). After brushing spit out paste but do not rinse out. Healthier eating advice should be routinely given to reduce both the amount and frequency of consuming foods and drinks that contain free sugars.
Identify mothers who may need further support or specialist referral regarding their oral health and refer them to oral health specialists. Hormonal changes new mothers link to periodontal problems, smoking is also risk factor for periodontal disease.
Offer referral for dental care and preventive advice for mothers and their babies who have not attended the dentist. A child considered by the healthcare professional to be at high caries risk should be referred to the appropriate health service provider. Use ‘SIGN 138 Dental interventions to prevent caries in children’ to undertake a dental caries risk assessment.
Be aware that poor oral health may be indicative of other problems in the care of the child such as infant feeding and toothbrushing practices and indicative of dental neglect and wider safeguarding issues.
Ensure your relationship with women from inclusion health groups is culturally and contextually appropriate to allow you to provide the necessary support.
Ensure staff working with new mothers in prison are trained in the specific needs and risks associated with pregnancy, birth and motherhood in prison. Implement processes to make sure women in prison receive the appropriate post-partum health checks at the correct time from midwives, health visitors and doctors, including a GP check at six weeks post birth.
Collaborate and work across boundaries to address complex needs, including flexible commissioning and supporting the third sector. Ensure to include agencies that provide housing and other community services to enhance care for women living in complex circumstances. Involve local community leaders, third sector organisations and lay groups, including the Maternity Voices Partnership, to actively co-produce the design of universal and speciality services will ensure they are accessible, acceptable, appropriate and not stigmatising.
Provide training to enhance sensitive and personalised care, both general (cultural sensitivity, unconscious bias and trauma-informed care) and relevant specialist training (FGM, HIV, entitlement to care, sickle cell and thalassaemia screening etc.). Recommend completion of Cultural Competency e-Learning as initial step.
Promote the needs of inclusion health groups in your area by raising the profile of inclusion health and social exclusion, and advocating for the prioritisation of inclusion health groups and the consideration of their needs in service design and commissioning.
Ensure prisons should seek to progress Mother Baby Unit (MBU) applications as quickly as possible and, where the process is held up by factors outside of the control of prison staff, prisons should consider a temporary admission to the MBU to prevent the unnecessary separation of mothers and babies.
Ensure new mothers who may be sentenced (to custody) are provided with information on the support and services available for women in prisons, including information about MBUs, and answers to frequently asked questions. Language and literacy needs are supported.
Ensure that protocols and equipment are in place in prisons to deal with birth-related emergencies in the prison such as postpartum haemorrhage and the resuscitation of infants. Staff trained in these procedures are on duty at all times.
Commission health services that respond to the local characteristics and needs of inclusion health groups in your area, raise the profile of inclusion health and social exclusion, and advocate for the prioritisation of inclusion health groups and the consideration of their needs in service design and commissioning.
Reduce health inequalities by commissioning services which respond to local need set against clear outcome measures, empowering providers to make service improvements and monitoring progress regularly. Collaborate with relevant services to support the roll-out of continuity of carer models, those aimed at BAME and other vulnerable groups.