Charity calls for urgent review of breastfeeding support following closure of all Lothian-based drop-in clinics
An Edinburgh-based pregnancy and parenting charity is calling for an urgent review of the support offered to breastfeeding mothers across the Lothian region.
It comes a year after all specialist, drop-in breastfeeding clinics closed in the region. The accessible service, which saw up to 40 women per week in five specialist breastfeeding clinics, was replaced by a referral only system for up to 12 women per week. The decision was made without public consultation.
Scotland continues to have one of the lowest breastfeeding rates in Europe, coupled with higher than average child ill health rates.
Daisy Dinwoodie from the Pregnancy and Parents Centre explains: “Until December 2017, breastfeeding women with babies of any age could self-refer or be referred at any time to one of five breastfeeding clinics located across the region.
“The clinics were supporting more than 2,000 visits a year with 26% of babies seen presenting with large weight loss, slow weight gain or requiring supplements, demonstrating the urgency of the support being offered.
“The service has been replaced with two weekly, half day specialist breastfeeding clinics seeing around a third of the previous number on a referral and appointment system only.
“We speak to many women experiencing serious breastfeeding problems every week who have found it very difficult or even impossible to secure a referral to the specialist breastfeeding clinics.
“The new system is failing to support breastfeeding mothers in Lothian. The referral system has created barriers for women who need immediate access to help which is essential for a new mother under pressure to feed her child.”
To get a referral, a woman must first be seen by a community midwife or health visitor who decides whether their problem needs specialist support.
The health professional then contacts their local breastfeeding champion who, without seeing the women themselves, decides whether to progress the referral.
The infant feeding specialist at the clinic makes the final decision to accept the referral. Only then is an appointment scheduled.
It may take up to a week, or longer, for a mother to be seen in one of the new clinics.
Reducing services impacts on those most in need and is widening inequalities especially for those experiencing acute social exclusion and poverty.
For many families, the location of the two clinics – one at the Royal Infirmary at Little France and one at St John’s Hospital in Livingston – is prohibitive as they can’t afford public transport to attend.
Daisy continues: “Mothers have been reassured that their community midwife or health visitor will now provide some of the services previously offered by the drop-in clinics but the reality is that these staff are already stretched too far. They don’t have the time or resources to sit with a woman and her baby for an hour or more and resolve a feeding issue.
“We have spoken to a number of staff who have tried and failed to secure a referral for a woman they felt needed specialist support. They have also raised concerns about the extremely limited breastfeeding training they have received leaving them feeling unconfident when dealing with many feeding challenges.
“Many women have told us that the drop-in clinics saved their breastfeeding when it was at its most difficult. NHS Lothian justified the closure of the five drop-in clinics saying they were ‘untenable and unworkable, with mothers waiting 4-5 hours, 20% of clinics not running due to staff sickness, absence, frequent use of bank staff, and therefore unstandardised advice being given.’
“In reality, the costs for the entire drop-in specialist breastfeeding clinic service were approximately equivalent to the cost of employing one Band 6 midwife.
“The clinics usually ran for 4 hours (occasionally longer if attendance numbers were high) with mothers arriving at various times over the first two hours. They were seen as soon after arrival as possible and usually within 1- 2 hours.
“The 20 percent closure rate was not due to staff sickness or absence but was due to NHS Lothian’s decision to stop training new clinic staff to replace staff who retired or moved on. From 2015, the number of staff overall dropped from 12 to 5, making clinic closures inevitable.
“NHS Lothian recently conducted a user survey of the new service, however only those women who have successfully secured a referral to the new clinics are receiving a questionnaire about their experiences.
“The voices of mothers unable to access specialist breastfeeding services in the region are going unheard. If Scotland is serious about improving its breastfeeding rates, we urgently need to review the support offered to mothers in each NHS region to determine whether it is fit for purpose.”
Case Study: Charlotte
Charlotte Milliken, 28, had daughter Niamh in February 2018 and experienced considerable difficulties establishing breastfeeding. She secured a referral to one of the weekly clinics.
Charlotte said: “I found it depressingly difficult establishing breastfeeding. My daughter really struggled to latch from the get go and continued to do so.
“I mainly used Dr Google to tell me how to use the nipple shields I had bought and other online resources such as videos to try to work out better ways to latch and positions to hold her in because nothing seemed to work.
“If the drop-in clinics had been available, I would have attended in a heart-beat. Being able to pop on a quick bus or walk to one would have been amazing rather than having to pack my baby into the car and drive to another town.
“It feels like a false economy to have shut the drop-in clinics. It may save money in the short term but there are so many articles about how much money breastfeeding could save the NHS, so why make it harder for the Mums who want to breastfeed? Only two clinics for all the mums who are having problems is ridiculous.
“It took a long time for my daughter to regain and pass her birth weight and we ended up having to go to the Royal Hospital for Sick Children as her jaundice was considered to be prolonged and needed checking.
“The advice I was given by a paediatrician was to ‘get her feeding sorted’, which I found immensely unhelpful as there was no following advice about how I was supposed to do that.
“I did secure a referral to the new clinics from my Health Visitor and attended the one at St John’s which is only held on a Wednesday. When I was there, it was only staffed by one woman who was desperately trying to manage all the referrals herself. She was incredibly apologetic that she was running a minimum of an hour behind and offered us forms to complain.
“The appointment itself was really good. I was recommended different nipple shields and I was shown different ways to more easily hold my daughter for feeds. I felt listened to and supported. The staff desperately want to give the mothers attending the attention and care they deserve but they have not been allowed the time and resources to make this possible.”
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