TOWARDS

A BETTER
START:
Summary report of breastfeeding
experiences in Aberdeen and Shire

NCT Aberdeen City and

Shire Branch
publication
INTRODUCTION TO THE STUDY

About the NCT Aberdeen City and Shire Branch

NCT is a national charity whose aim is to support parents through the first 1,000
days of their parenting journey. NCT Aberdeen City and Shire Branch, which is
affiliated with the UK organisation but locally funded and managed by volunteers,
runs a variety of activities to support parents and their young children. It is also
fortunate to have a number of breastfeeding counsellors as well as peer supporters
who volunteer their time to support women locally.

A national focus on breastfeeding

The Scottish Government released the Maternal and Infant Nutrition Framework for
Action in 2011. The framework’s creation sprang from a desire to improve the health
and well-being of Scottish society through a focus on mothers and infants. 1
Prioritising the nutritional health of mothers and their babies during pregnancy and
beyond took national precedence. The framework provided guidance through to at
least 2021 with goals to see more children breastfed, and for longer, as part of its
purview.

Breastfeeding in Grampian
Breastfeeding rates in NHS Grampian are higher than in Scotland on average. For
example, 61% of Grampian mothers breastfed 10 days after birth compared to the
Scottish average of 51%. This trend is also reflected in in the 6-8-week data collected
by a health visitor with 51% of 2local women still breastfeeding compared with a
2
Scottish average of 41% . While this trend should be celebrated, we must also
consider that having a higher percentage of women breastfeeding in Grampian,
would logically suggest a higher need for breastfeeding support services.
Additionally, breastfeeding rates in Scotland are low compared to those achieved in
other countries. There is therefore considerable scope to further improve the rates of
breastfeeding in Grampian and particularly rates of exclusive sustained breastfeeding.
Furthermore, in the local context, increasing the percentage of babies exclusively
breastfed at 6-8 weeks to 41% by 2021 is one of the key improvement aims in the
Local Outcome Improvement Plan for Aberdeen City and a key indicator in efforts to
reduce health inequalities locally.3

Why commission a survey?

In 2016, NCT Aberdeen City and Shire conducted an online breastfeeding
survey. This was in response to what NCT Aberdeen City and Shire saw as a
high demand for breastfeeding support services within the community and from
NCT Breastfeeding counsellors.
The survey asked NHS Grampian-based mothers who had given
birth in the last 12 months about their experience of breastfeeding and
breastfeeding support. The survey was aimed at mothers who had given their
baby breastmilk, whether once or every day. These results were presented to
maternal healthcare professionals and supporters and helped to develop
breastfeeding support services in the Grampian region. To assess progress
and further understand experience, We repeated the survey in 2018.
The survey was modified to reflect changes in breastfeeding support over the
last two years and included a new section on tongue tie as this had been
highlighted by our breastfeeding supporters as an area of interest.
STUDY METHODS AND PARTICIPANTS

Methodology

The 2018 breastfeeding survey ran online via Survey Monkey for almost 4 weeks from 18
June to the 13 July 2018 and generated 636 responses, which is a 62% increase compared to
4
2016 . The survey was open to women who had given birth in the last 12 months in the NHS
Grampian region.

The survey was a self-selecting, rather than random, sample and therefore it cannot be
assumed to be statistically representative of the experiences of all women who have given
birth in the NHS Grampian region in the 12-month period.

The primary areas of questioning in the 2018 survey related to:

Breastfeeding confidence at time of hospital discharge or home equivalent
Breastfeeding support systems
Breastfeeding challenges
Breastfeeding cessation
Tongue tie

Survey Participants

Almost two-thirds (63%) of the 534 respondents that provided age information were in the
31-40 age group. There were 215 respondents who could be mapped to a specific Aberdeen
City area and 275 respondents could be mapped to a specific Aberdeenshire area. Just over a
third (222, 34%) had previously breastfed and 414 (66%) were breastfeeding for the first time.
 BREASTFEEDING
CONFIDENCE

A mother’s confidence in her chosen feeding method soon after birth can be important to the
breastfeeding journey. In the 2018 breastfeeding survey, 39% of mothers who were not confident in
their feeding method leaving the hospital stopped giving breastmilk before their baby was 6 months old.
This is nearly double the percent of mothers (20%) who said they felt very confident in their chosen
feeding method when leaving the hospital.

Changes since 2016:

Most respondents felt some level of
confidence in their chosen feeding method
27% when leaving the hospital
A smaller percentage of
women felt very
confident (27%) than in
2016 (31%)

25%
A larger percentage of
women felt not
confident (25%) in 2018
than in 2016 (21%)
Confidence levels are fairly similar between the two surveys,
though they are slightly lower in 2018
 The majority of mothers who felt ‘Not Confident’ were new to
breastfeeding

Almost two-thirds of
women who felt ‘Very
Confident’ were women
who had previously
breastfed.
The majority of women who
felt ‘Not Confident’ were
new to breastfeeding (85%).

2018 feeding confidence levels by breastfeeding experience

Latch quality and midwife support can make or break feeding confidence
Confidence boosters

First time breastfeeding Previously breastfed

Previously breastfed
Midwife and hospital staff support
Baby latched and fed well
Baby latched and fed well
Midwife and hospital staff support

Confidence breakers

First time breastfeeding Previously breastfed

Baby not latching

Baby not latching
Concerns from negative experiences
Pain breastfeeding
breastfeeding previous child(ren)
Limited support from hospital staff
Limited support from hospital staff

“About 20 minutes after having

my little boy the midwife showed “Confidence Latch Pains
me how to give him his first feed. elsewhere Aberdeen not
He latched on instantly. It was the supportive~ left me for 3
most amazing thing I’ve ever seen, days and no-one helped.
“As I have had 2 Also when I did express a
he just knew exactly what to do. It “My milk didn't come in until
previous children who couple of hours later was
gave me so much confidence to day 4 so wasn't quite sure I
I breastfed and I learnt told 'is that it, is that all you
continue breastfeeding, which I was doing it right as baby
all the tricks and tips could manage'” – mother
did.” – first time mother wasn't settling.” – first time
then” with breastfeeding
breastfeeding mother
-mother with experience
breastfeeding
experience
 SUPPORT SYSTEMS

The adage “It takes a village” is often referenced in relation to raising children. Frequently, it also takes a
wide circle of support for mothers to successfully breastfeed their children. Our survey found that mums
had a range of supporters in their life and reached out to different people and groups for help along the
breastfeeding journey.

Changes since 2016:

Hospital midwives seem to be sharing more information to

help with breastfeeding problems as a higher percentage of
women in the 2018 survey (33%) said they knew about the

4
infant feeding team than in the 2016 survey (21%) and fewer
women in the 2018 survey (13%) said they weren’t told out of 5 women had
about any options than on the 2016 survey (22%) breastfeeding concerns or
needed to access
A smaller percentage of women (8%) in the 2018 survey said breastfeeding support
they accessed help from the breastfeeding peer support
service than in 2016 (18%)

A smaller percentage of mothers said that other mums (29%)

and online support (19%) were their top breastfeeding
supports as compared to 2016 (37% and 31% respectively)
 Top resources mothers said their Mums mainly sought breastfeeding
midwives told them about to support from a few sources
address breastfeeding concerns

2018 2018

Breastfeeding support groups 56% 47%

Other breastfeeding mums
in the area
2016
56%2016
61% 52%

2018 2018

Breastfeeding telephone 39% 41%

Online support
helplines 5
2016
56%2016
39% 66%

2018 2018

The Infant Feeding Team at 33% 36% Breastfeeding support groups

Aberdeen Maternity Hospital 2016 2016

21% 38%

Reasons women didn’t pursue more Several key people and groups
breastfeeding support beyond stood out as top supporters for
midwife or health visitor breastfeeding mums

2018 2018

Didn't need additional

44% 57%
Partner or husband
2016
56%2016
support 47% 49%

2018 2018

Didn't feel issues were 19% 29% Other mums

2016 2016
significant/Other
22% 37%

2018 2018

Too nervous to attend 18% 38% Your midwife or health visitor

a group 2016
56%2016
18% 37%
 BREASTFEEDING
CHALLENGES

Rarely is breastfeeding a simple journey. A variety of problems can plague a mother. Overall, the
challenges facing breastfeeding women are similar in 2018 to 2016. Understanding what challenges
mothers face within the NHS Grampian health board area can help inform support efforts so that they
can be most efficient and effective. This section details some of the challenges breastfeeding mothers
faced as well as ways the challenges were overcome and supports respondents wished had been available
to them.

Over four out of five 2018 survey respondents reported facing challenges whilst breastfeeding

Changes since 2016:

The same problems still seem to challenge
mothers in similar levels to what was found in A higher percentage of
2016 women reported tongue tie
issues (18%) in 2018 than in
2016 (11%)

There was a drop in women

reporting that a health
professional advised them to
reduce daytime feeds (7%),
replace night feeds with water
(7%), or wean before 6
months (11%)

A smaller percentage of 2018

respondents (21%) say they
wanted to be informed of
services available compared
to 2016 (28%)
 Ways women resolved their breastfeeding difficulties

Health visitors (5%), midwives (4%), and the infant

Nearly half of women (45%) feeding team (4%) were mentioned as valuable
who said they resolved a sources of support
breastfeeding issue did so 45%
through perseverance, self-care, “midwives on post-natal ward
“when baby had low and at home gave advice and
and online research
weight gain, she [Health support to improve latching
Visitor] told me to keep and manage oversupply. Home
going” midwife in particular was
Almost one in five women (19%) excellent.”
19% said they needed treatment from
the GP for mastitis or thrush to
resolve breastfeeding challenges
“without the encouragement and
support from [this individual] in the
“I had to ask infant bf team I may have went to
several times for combi feeding or formula as it was
help/medication going to be another 3 weeks for a
for breast thrush. referral [for tongue tie] when my
health visitor sent the referral again.”

At least three out of ten mothers in the 2018 survey wanted the following
supports to ease their breastfeeding journey:
Many respondents wanted to access peer
supporters in the hospital (37%) or at home
(31%)

Respondents also felt improving antenatal

education about breastfeeding (37%) and
reducing conflicting advice from health
professionals (32%) would be helpful

“Midwife didn’t cover bf in classes just told to attend

monthly session at hospital, however unable to make it
due to work and infrequency it was held.”

“I had fantastic postnatal community care from midwives

and HV and GP and support groups. For me the issues
were in hospital- I constantly received conflicting advice
from midwives on different shifts.”

“I really would have benefited from someone coming to

visit me at home to help. It was a real struggle and I didn’t
feel advice over the phone was sufficient.”

Supports that would have made the breastfeeding journey easier for
respondents, 2018 and 2016 surveys
 CESSATION OF
BREASTFEEDING

WHO guidelines recommend that infants are exclusively breastfed for the first 6 months of life. Yet for
many mothers, this goal was unattainable. Greater insight into why mothers in Aberdeen city and shire
stop exclusively breastfeeding before a baby is 6 months old can inform efforts to help future women like
them persevere.

Nearly three-quarters of mothers breastfed their

Changes since 2016:
babies for at least 6 months

A smaller percentage of
mothers said they stopped
breastfeeding due to demands
of other children (5%) in 2018
than in 2016 (22%)

A smaller percentage of mums

said difficulty to feed in public
stopped them from
breastfeeding (8% vs 20%)
in 2018 versus 2016
Nearly three-quarters of respondents breastfed their baby for 6
months or longer
Two-thirds of mothers who had not breastfed their baby for at
least 6 months wished they could have done so
There was a variety of reasons why mums stopped breastfeeding
6
before 6 months

As in 2016, concern over milk supply (15%) and weight gain (10%) as well as pain while breastfeeding
(12%) were some of the top reasons mothers stopped breastfeeding in a baby’s first 6 months of life.

‘Other’ category

Some respondents said that having to exclusively

Health issues
express was difficult to sustain.

Poor latch

“Baby could not latch to inverted

nipples. Expressed milk for 6 weeks
but couldn’t keep this up once we
Reflux started leaving the house as it took
too much time”

Exhaustion

Concerns
about under supply

“Exhaustion of trying to exclusively

pump for multiples”
 TONGUE TIE

One of the new issues that seems to be emerging as a concern for women since the 2016 survey is
tongue tie. The 2018 survey found that 20% of respondents reported concerns with tongue tie, and
there were variable experiences of being referred for treatment promptly. In some cases, women
reported that it seriously affected their ability to breastfeed.

1 in 5
respondents
Approximately thought or knew
their baby had
tongue tie

7
Health care professionals and mothers themselves identified tongue tie

Midwives (36%), health

visitors (29%), and the infant
feeding team (10%) were all
credited with identifying a
tongue tie and almost 20% of
mums themselves (as captured
in 'Other' responses) said they
identified the problem
 “It took months of me asking to get
a referral. Dr said ask Midwife.
Midwife said ask health visitor. My
Most respondents received referrals health visitor was away and other
hv wouldn’t do it. GP did a referral
to the tongue tie clinic which was rejected. As baby was
gaining weight nobody cared.”

Six out of ten respondents received a referral to the

tongue tie clinic, though it was noted that the referral
process was difficult and the wait to be seen long

Tongue tie was usually diagnosed in a baby’s first week of life

Just under half (41%) of tongue tie cases were identified in a baby’s first week of life
while almost a third (29%) were spotted once a baby was older than a month

“With formula top ups once a day

and using nipple shields. I also
borrowed a pump from the
hospital during this time to help
with keeping supply up.”
Most women kept breastfeeding during the referral
period despite not receiving additional support
While nearly nine out of ten mothers (89%) persevered in
breastfeeding their baby throughout the referral period, just under a
quarter (24%) were offered additional support to keep breastfeeding
during this time period

Several issues related to tongue tie stopped women from breastfeeding

Those who stopped breastfeeding in relation to a baby’s tongue tie did so due to long wait times
for the tongue tie clinic, latch problems, weight gain concerns, and decreasing milk supply
 RECOMMENDATIONS

Comparing 2018 results with those from 2016 reveal several positive and encouraging
signs as well as points for continued improvement. Based on survey results and
supplementary documents like the Scottish Maternal and Infant Nutrition Survey (MINS),
we have made 6 recommendations for improving breastfeeding supports in NHS
Grampian. The recommendations are summarised as follows

1. Appoint a Strategic Breastfeeding Champion: Designate a Breastfeeding Champion

role on the NHS Board so that breastfeeding is given a strategic priority and maintained
even during times of staffing pressure or change.

2. Improve breastfeeding support offered in labour ward, midwife unit and postnatal
wards: NHS Grampian should look at successful models of post-natal breastfeeding
support in other health boards and should take a strategic and innovative approach to
providing breastfeeding support to every woman who requires it acknowledging that
staffing is an issue – but not an excuse not to find a solution.

3. Review the Peer Support System: The health board should review peer support in
Grampian by identifying issues in the current system, studying successful models that
could be emulated, and determining how peer supporters can play a role in post-natal
wards.

4. Improved education:
For Partners: NHS Grampian should undertake work with mothers’ partners to explore
what kind of information or advice they would like to see provided.
a. For women, the health board should develop better or more targeted ante and
postnatal education and information on breastfeeding.
b. For GPs: NHS Grampian should develop and promote training materials for GPs on
breastfeeding conditions, particularly on identification and treatment of mastitis and
thrush and also increase knowledge of safe prescribing while breastfeeding.

5. Online support and information: Online breastfeeding information for NHS

Grampian should be improved, including the NHS Grampian website and social media
pages https://www.facebook.com/Breastfeed.Grampian/. All healthcare professionals
should be informing women about online sources of breastfeeding advice, like
feedgood.scot, along with paper-based sources like ‘Off to a Good Start’.

6. Tongue Tie: Tongue tie issues need to be better addressed. NHS Grampian should
review its policy of referral, support and treatment for suspected tongue tie and ensure
it is clear, well publicised and available for all families and healthcare professionals to
access, including online.

As a local Branch, we are aware that NHS Grampian’s resources are under significant
strain, perhaps best highlighted for Aberdeen Maternity Hospital by the regularity of open
midwife positions. We hope that the findings and suggestions in the report can form the
basis of open, ongoing dialogue with us and other parties in the voluntary and third sector
so that together, we can provide breastfeeding mothers with the support required.
 NOTES AND REFERENCES

1. The Scottish Government (2011). Improving Maternal and Infant Nutrition: A

Framework for Action. Edinburgh: The Scottish Government. Available from
https://www2.gov.scot/resource/doc/337658/0110855.pdf

2. Information Services Division (2017). Infant Feeding Statistics Scotland, Financial year
of birth 2016/17. Available from https://www.isdscotland.org/Health-Topics/Child-
Health/Publications/2017-10-31/2017-10-31-Infant-Feeding-Report.pdf

3. Community Planning Aberdeen (2019). Local Outcome Improvement Plan, 2016-26. P.

20. Available from https://communityplanningaberdeen.org.uk/wp-
content/uploads/2019/02/Final-Draft-LOIP-2016-26-web-version.pdf

4. The 2016 survey received 392 responses over the 2 weeks it was open. The 2018
survey received over 400 responses in the first 2 weeks it was open.

5. There were slight differences in the wording of options between the 2018 and 2016
surveys. Breastfeeding telephone lines was listed as breastfeeding helplines and Aberdeen
Maternity Hospital was abbreviated as AMH.

6. The analysis of the question about reasons women stopped breastfeeding excludes the
63% of respondents who said they breastfed for more than 6 months as the item isn’t
applicable to them.

7. Respondents could select multiple options as tongue tie can be picked up at different
times by different people.
 NCT Aberdeen City & Shire
Website: https://www.nct.org.uk/local-activities-meets-ups/region-scotland/aberdeen-city-and-shire
Facebook: https://www.facebook.com/nctaberdeencityandshire/
Phone: 01224 453298
Email: aberdeen@nct.org.uk

Report written and prepared by:

Donna Winston,
Philippa Mason,
Ruth Christie,
Kathryn Masterson,
Wendy Hunter,
Katherine Andrew, and
Tracy Kavanagh
Report design and layout prepared by:
Maria Paula Bonnet

The surveys and subsequent reports were possible through the tireless efforts of the Action on
Breastfeeding working group as well as the hundreds of mothers who shared their experiences with
us. We thank them for all that they have done.