Breastfeeding and the NHS

Breastfeeding support within the NHS

Breastfeeding support has until recently been the domain of Midwives and Health Visitors (Pay band 5 and upwards), and breastfeeding rates clearly hightlighted the need to offer more to parents; both in terms of time and quality of support received.

Next "Infant Feeding Coordinators or Advisors" (IFC) were introduced in some areas (Pay band 6 and upwards). This can sometimes, (if you're very lucky) be an IBCLC (Lactation Consultant) but realistically is far more often a Midwife or Health Visitor who is pro-breastfeeding (note, often no specific qualifications are required beyond enthusiasm, thus making the quality of care variable - some are excellent, others not so!)
There is usually one IFC to cover and entire area, two if the area is particularly large (some areas for some reason don't get one at all!) and thus they obviously cannot hope to provide all that is required within a community.

And so, a new role has appeared; that of "Breastfeeding Supporter" and with it a lot of concerns!.

This new group of employees are providing the backbone of breastfeeding support both antenatally and postnatally.

Below is an example of a recent job advert for this post and the person specification,

The position is band 2 on the pay scale (£13,653 - £16,753) which is standard pay for Peer Supporters. However, note the job description and the lengthy list of duties and responsibilities - this is way beyond the remit of someone with 8-12 weeks training. To see exactly what training covers, click here You might expect that breastfeeding qualifications and experience supporting mothers to breastfeed would be an obvious requirement, and really pretty essential for the role? Not so!

After the job details, you will find the comments of someone who is currently employed within the NHS in this role. To protect her identity, name & area have been removed. My own comments also follow!

CLOSING DATE: 12 NOON ON 30^TH APRIL 2010

TERMS AND CONDITIONS OF SERVICE

Post: Breastfeeding Peer Support Worker

Reference Number: xxxxxxxxxxx

Pay Banding: Band 2 - £13,653 - £16,753 Pro Rata

JOB DESCRIPTION

JOB IDENTIFICATION

Job Title

Breastfeeding Support Worker

Job Holder Reference

Immediate Senior Officer

Peer Support Coordinator

Location

xxxxxxxxxxx

Grade

No of Job Holders

3 37.5 hours or part time

JOB PURPOSE

To support and facilitate the initiation and duration of breastfeeding in women in the community and hospital settings from areas across xxx where breastfeeding rates are below 30% at initiation. The role will require working with the women and their families both in the antenatal and postnatal periods.

DIMENSIONS

Based within health facility, you will be required to work flexibly in a variety of settings to meet identified need.

ORGANISATIONAL POSITION

ROLE OF DEPARTMENT

To provide a community breastfeeding support service to patients/clients in a variety of settings.

MAIN TASKS, DUTIES AND RESPONSIBILITIES

· In collaboration, deliver breastfeeding support for clients, within their own homes.

· To liaise with clients and refer to other agencies when required.

· Appropriately record and report on work undertaken and produce data for audit.

· Contribute to ongoing research associated to this model of practice.

· Participate in ongoing regular clinical supervision with the peer support coordinator to ensure delivery of a clinically effective service.

· Participate in ante-natal, parenthood education programmes.

· Participate within own professional competency, identifying and accessing training and support as necessary through monitoring of personal development planning.

· Sustain concentration.

· Provide additional support and empathy during potentially emotional circumstances in relation to feeding, to motivate and empower parents.

· Organise own workload effectively.

· Participate in appropriate breastfeeding initiatives including awareness events.

7a.

EQUIPMENT AND MACHINERY

Use of props; breast pumps, nipple shields, baby models, breast models

Health promotion equipment e.g. display boards, mobile phones.

7b.

SYSTEMS

· Recording personally generated observations and report, as appropriate, child protection concerns.

· Contribute as required to ongoing evidence base.

· Working with Baby Friendly Framework.

DECISIONS AND JUDGEMENTS

Interpreting observations of women’s breastfeeding behaviour.

Supporting decision making using a woman centred approach.

COMMUNICATIONS AND RELATIONSHIPS

To establish therapeutic relationship with clients and their families.

To establish professional relationships with the Primary Care Team and hospital based team.

Regularly communicate with various people both individually and in a group setting face to face on the telephone and in written correspondence.

Contacts will be mainly with:

· peer support coordinator

· public health nurses/health visitors

· midwifes

· infant feeding advisor

· local voluntary and statutory agencies

· breastfeeding women and their families

10.

ASSIGNMENT AND REVIEW OF WORK

Referrals will be accepted and discussed via the peer support coordinator.

Work will be reviewed by the peer support coordinator on an ongoing basis.

11.

PHYSICAL, MENTAL AND EMOTIONAL DEMANDS OF THE JOB

Physical Skills

Skills for assessment

Computer literate (desirable)

Physical Demands

Bending/kneeling whilst supporting breastfeeding

Lift and transport equipment

The ability to travel within the agreed geographical area

Mental Demands

Sustain concentration and focus throughout distressing and emotional circumstances, to motivate and empower women

Emotional Demands

Supporting women who are distressed/anxious/worried about their breastfeeding.

Working Conditions

Exposure to passive smoking

Delivering service in difficult domiciliary situations

Occasional exposure to animals of unknown temperament.

12.

MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

· Establishing cooperative supportive relationships with clients.

· Ensuring good communications with a range of health professionals.

13.

KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

Sound knowledge of breastfeeding/infant feeding (including weaning)

Good communication and interpersonal skills

An enthusiasm for supporting and promoting breastfeeding. Personal experience desirable.

Ability to work independently

Ability to be flexible and adaptable to balance conflicting priorities

14.

JOB DESCRIPTION AGREEMENT

Job Holder’s Signature

Date

Head of Department: Rhona Brown/Belinda Morgan

Signature

Date

Title

RECRUITMENT AND SELECTION STANDARDS

PERSON SPECIFICATION FORM

Post Title/Grade: Breastfeeding Support Worker

Department/Ward: xxx

Date:

	ESSENTIAL	DESIRABLE	MEASURE
Experience	Demonstrate good organisational skills. IT skills.	Previous work in caring role.	Interview
Qualifications/ Training	IT training. Demonstrate good verbal/communication skills.	SVQ caring modules.	Application form Interview
Knowledge	Awareness of how to deal with sensitive issues. Ability to inform Health Visitors of appropriate issues.		Interview
Skills	Good communications skills. Ability to travel independently. Organisational skills.		Interview
Aptitude	Keen to develop new skills. Able to work without constant supervision.		Interview
Other e.g. Team Player, Be able to travel	Team player		Application form Interview

Personal Experience: When I applied for the role of Breastfeding Supporter, we were asked to have some form of breastfeeding 'support' training, such as peer support training (which they offer in the area) or, in my case XXX supporter training & peer support training offered through the voluntary programme I was based with before I accepted the job.

Basic IT skills and relevant experience were a plus, but generally enthusiasm and basic breastfeeding knowledge was all that was required. Additional training is supposed to be provided within the role.

I'm employed as part of a team, but we are each based at different children's centres around the area and work independently with our own caseload. My role includes attending antenatal clinics and info sessions to promote awareness of the programme and breastfeeding in general; running these 'Parentcraft' classes and any other education sessions requested by individual groups (for example, we ran one this week for a young parents group). We are in the process of being cleared to attend the hospital postnatal wards to provide support immediately after delivery, and then postnatally within the community, We run support groups, as well as offering one-to-one support, including home visits. Once a mother signs up to the service, it is our 'job' to remain in contact with her until she finishes breastfeeding, or until baby is 6 months old, depending on which occurs first.

I agree wholeheartedly with what the programme is designed to do and it's great to see breastfeeding finally get some funding from the NHS, especially in an area where it is so desperately needed.

However whereas in my previous voluntary role as a peer supporter I would do just that- offer support - in this role the boundaries are 'less defined'. I asked my manager what I should do if I suspected the mother to have an underlying issue, anything from a blocked duct to mastitis or beyond- and was told I should offer 'advice and support, and refer to the GP if necessary'. I'll leave that statement to your imagination.

There is no-one above the team to whom we can refer more serious cases or even ask advice from- no breastfeeding counselor or IBCLC operates within the service. The majority of the 'Breastfeeding Support Workers' team also have more training and experience than the managers.

Am I qualified to handle this role? No, not at all, and I make no secret of that and had many reservations before accepting the position. I have made my concerns known to my employer and asked for more training where possible. What I miss most of all, though, is simply having someone more knowledgeable than myself to call on and check facts and ask advice from, or refer the mother on to if necessary (which was available in my voluntary position beforehand).

However I have the chance to earn a pittance doing something I truly love and feel passionate about; and limited as my knowledge and experience may be, if I can help just a handful of mums initiate/continue breastfeeding as part of my job, then to me, it has been worthwhile.

In the meantime I can only do the best I possibly can- I do aspire to do the counsellor training once I have completed my 6 months as a Peer Supporter and in the meantime I'm reading, researching and trying to get as much experience as I possibly can. But I do feel it's a shame that there aren't more qualified breastfeeding workers within the programme.

END

So - IT and organisational skills rank highly. The only mention of breastfeeding experience is within the general person description which lists requirements as: