How to be NICE: Post Natal Care NICE Guideline recommendations for infant feeding support
In April 2021 NICE published - NICE Guideline NG 194 - on Postnatal Care. The guideline covers the organisation and delivery of routine postnatal care that women and their babies should receive in the first 8 weeks after birth. As an infant feeding charity, our focus is specifically on Section 1.5: Planning and supporting babies feeding, and we’ve summarised the key points for you here.
Feed’s favourite bits:
You have the right to be respected and actively supported in whatever feeding choices you make
You have the right to make informed infant feeding choices
Breastfeeding support should be delivered by a competent professional, and should be available face to face until you feel you can mange without the support
Formula feeding will only be discussed if you raise it but once raised you should expect full support
What are NICE Guidelines?
National Institute for Health and Care Excellence, aka NICE, is an independent organisation who draw on evidence and best practice to develop guidelines around particular health and care issues. They have independent groups set up to examine specific health issues; the groups have expertise in their particular field and they critically analyse the current research in that area to develop evidence based guidelines for patient care. NICE guidelines are generally regarded as current best practice, and for this reason health care professionals use them to aid their decision making for patients. There are some situations in which providers can work outside the guidelines if they can justify their reasons for this, usually where evidence for an intervention or care pathway is less strong or limited . NICE guidelines are not rules or laws, but they provide a good guide for ensuring optimum patient centred care. It’s like using a google maps to get to your destination; there’s an optimum route, but if you hit traffic you can still get to where you want to go via a different road on the map.
What does the NICE Postnatal Care guideline recommend for infant feeding support?
The key point made in the guideline is:
respect parent choice
We are 100% on board with this as it’s the fundamental foundation on which Feed is built!
So far, so NICE….
The guideline breaks down the recommendations for infant feeding by feeding method; breastfeeding or formula feeding. Unfortunately it doesn't include guidance for healthcare providers in supporting families whose babies require tube feeding.
Recommendations for supporting breastfeeding
The categories under which recommendations for providing optimum breastfeeding support are presented are: giving information about breastfeeding, the role of the healthcare professionals in supporting breastfeeding, supporting women to breastfeed and, assessing breastfeeding.
Giving information about breastfeeding
Discuss breastfeeding both before and after delivery, and provide information on supporting breastfeeding
Give information on how a partner can support breastfeeding
Inform breastfeeding mothers the need to take vitamin D supplements
Inform women that legally they have the right to breastfeed in any public space
Role of healthcare professionals supporting breastfeeding
Those working in supporting women to breastfeed need to be trained appropriately
Those working in supporting women to breastfeed need to be respectful of women’s privacy and gain consent before helping with feeding
Supporting women to breastfeed
This section is quite big in the full guidelines and covers many of the difficulties faced both physically and emotionally and how to recognise, prevent and treat these issues. But the key points are:
Give breastfeeding care that is tailored to the induvial needs of the woman. This should be in person and also written, over the phone to maximise support avenues. This should cover basics of breastfeeding and the pitfalls that some may face and how to overcome them.
·Discuss what support avenues exist outside healthcare professionals (partners and peer support groups)
Make face-to-face breastfeeding support integral to the standard postnatal contacts for women who breastfeed. Continue this until breastfeeding is established and any problems have been addressed
Ultimately, the guideline states that if you chose to breastfeed, then a professional should be there to support you until you feel you can go it alone. You have a right to ask for that help and support. As an infant feeding organisation we know breastfeeding support can be patchy due to stretched resources, but these guidelines affirm that this should be the minimum standard.
Assessing breastfeeding
A competent healthcare professional should assess breastfeeding in the first 24 hours of the baby’s life and then once more in the first week. Any issues should be addressed and reassessed as required.
Lactation suppression
The guideline recommends healthcare providers discuss with women who are ceasing breastfeeding:
healthy ways to supress lactation and to avoid complications
when to seek help
the possibility of being a milk donor
Recommendations for supporting formula feeding
Here we expected a similar breakdown of recommendations for providing optimum formula feeding support as had been given about breastfeeding; giving information about formula feeding, the role of the healthcare professionals in supporting formula feeding, supporting women to formula feed and, assessing formula feeding.
Sadly, NICE ain’t so nice to formula feeding folk and they have limited their information on supporting formula feeding families to a few short statements. We feel this is an error by the committee, especially given that in the rationale underpinning their guideline, they explain the evidence showed women who are formula feeding feel they aren’t given the information or support they need.
Giving information about formula feeding
No specific guidance on giving information about formula feeding was presented. However, in the few paragraphs dedicated to supporting formula feeding families, the following recommendations were made:
Discuss formula feeding before and after birth with those who are considering formula feeding (our emphasis)
Information about formula feeding should include; how to prepare formula safely, how to maintain breastmilk supply if supplementing, which formula to choose, and the difference between formula and breastmilk.
Parents should be given face to face feeding support and telephone, digital and written support.
Parents should be supported to make informed consent to formula feed
Role of healthcare professionals supporting formula feeding
No specific guidance was given on what healthcare practitioners should know about formula feeding in order to provide tailored support to formula feeding families.
Supporting women to formula feed
No specific guidance was given on how to provide tailored support to formula feeding women, or how to recognise or address the difficulties women encounter when formula feeding their babies.
Assessing formula feeding
No specific guidance was given on how to assess formula feeding or how to recognise or address formula feeding concerns.
Most women (80%) say they wish to breastfeed, but at Feed, we know that formula feeding is the prevailing feeding method by 3 months. Some healthcare professionals who are strictly following these NICE guidelines may be unlikely to discuss formula with you unless you specifically say you wish to discuss it. So the key point here is to remember to ask for formula support if you need it, because it might not be offered up.
Areas for research:
· Twin breastfeeding
Feed recommendations for NICE
If Feed were to write a report card for NICE it would read:
room for improvement.
The evidence presented for the recommendations is shoogly in places and completely absent in others. therefore, Feed recommends NICE go back to the drawing board on this one.
We can’t fault the recommendations to support women’s choice and that however you feed, this should be supported with face to face support and information from a healthcare professional. Another win is reinforcement of the fact that women have the right to informed choices – yes please! How this is rolled out in practice will be interesting to see.
The key take home message for anyone feeding an infant in the first eight weeks of life is this: You have the right to be respected and actively supported in whatever feeding choices you make.
