Manchester: providing breastfeeding support

In north Manchester clinical commissioning group funding has supplemented investment by the council to create a network of breastfeeding support for new mothers.

The challenge

Breastfeeding has been shown to have many benefits. It protects babies from infections and illnesses and reduces the risk of obesity. There are also benefits for the mother, including a lower risk of breast and ovarian cancer.

Breastfeeding has also been shown to improve the emotional bond between mother and baby. It is why it is recommended babies are breastfed exclusively for the first six months.

But despite three-quarters of new mothers starting to breastfeed after birth, less than half are still managing it at the six to eightweek mark.

In north Manchester the health visiting service found there was such demand for help that it could not keep up.

The solution

In 2018 funding was provided by the clinical commissioning group to allow the councilcommissioned health visiting service to expand its infant feeding support.

Up to that point, there were only two specialist health visitor posts providing help for the entire city. The funding allowed a network of support to be established.

There are now seven infant feeding workers that health visitors can refer into. They work alongside the generic health visiting service in health centres, meaning women can receive prompt advice and support both oneto-one and in group settings when they need it for everything from poor latch to mastitis.

Those who have more complex problems are then referred on to the specialist infant feeding health visitors, of which there are  four. There is also a community paediatric dietician on hand.

Infant Feeding Lead Justine Baines said: “There can be a variety of reasons why there may be on going problems. The baby could be tongue-tied, there may be unidentified clefts or some kind of allergy. We carry out a full feeding assessment at home or at a clinic so we can start getting to the bottom of what the problem is.”

The impact

Since April 2018 there has been an additional 6,000 infant feeding support contacts – a figure that is increasing all the time as it took until October to get the service fully established.

For those that have been helped, the impact has been significant. Rachel (not her real name) describes the services as “amazing”. She said after struggling to breastfeed in the first two weeks she felt like a “complete failure”.

“I ended up at one of the groups and met the most amazing bunch of women. There were other mums, some who were struggling to get things going and others who were now able to feed their babies after a sticky start. We all had our own stories to tell and it was great to be able to share my feelings in such a supportive environment.

“The team talked me through my options and didn’t put any pressure on me which was my biggest worry. Within two weeks I had got rid of the shields and the formula. I’m not pretending it was easy, but the support made it possible.”

Lessons learned

The unique part of the service is the seamless referral pathways and integrated team delivery that benefits new mothers,  said Ms Baines.

Women are quickly referred to early interventions and help and then on to specialist support for more complex on-going problems if needed.

There is also rapid access to the paediatric dietician for babies who would normally have to wait months for referral. Reflux medications and specialist infant milks can be quickly prescribed by the service too.

How is the approach  being sustained?

To date, health visitors have just referred clients who they have identified as having difficulties. But that is now in the process  of changing.

Ms Baines said: “We want to offer feeding support universally. It is much better to identify issues as early as possible. At the moment we are just fire-fighting – providing support once problems have manifested themselves. By offering all women access to the infant feeding workers we hope to tackle that.”

In the longer term, the hope is similar support could eventually be provided across the city, added Ms Baines.

“The project aims to evidence what works well over the next two years so the service model can be replicated across the city – supporting Manchester’s aim of being a breastfeedingfriendly city.”


Justine Baines Infant Feeding Lead, Manchester Local  Care Organisation