Despite potential for proven population health benefits and economic gain, BC has failed to make meaningful investments in skilled lactation care. Healthcare providers struggle to navigate systemic barriers to deliver quality breastfeeding support. A lack of funding and scope limitations are common challenges seen across professions. Creative solutions are being explored, but challenges remain. Rural, remote, northern and Indigenous communities are disproportionately impacted by these struggles. With such substantial gaps in services, how do we support health care providers to deliver consistent care? This paper explores the different professions/service models providing care in B.C., the barriers experienced, and recommendations for system improvement.
See our correspondence with the Ministry of Health in follow-up to the position statement below.
Access to high quality breastfeeding support across regions and within healthcare programming was inconsistent prior to the crisis. The current situation has exacerbated the pre-existing lack of support through re-deploying public health resources and social distancing, making it even more difficult for breastfeeding families to achieve their goals. Yet when breastfeeding is going well, it provides a vital safety net to families by ensuring a safe, secure, reliable food source, providing immunological support to the infant and down-regulating the stress response for the breastfeeding dyad. BCLCA has drafted a position statement outlining the impacts of the COVID-19 crisis on the families we serve and arguing that increasing support in key areas will minimize the potential for negative effects on the next generation.
At BCLCA, all members are committed to promotion, protection, and support of breastfeeding and our experience with families tells us that breastfeeding is intertwined with and influenced by nighttime parenting and sleep. Thus, the recent attention that baby boxes are getting has led to both parents and members to ask for more information on the issue. In response, we have prepared 2 documents:
1. Infographic - "Thinking Outside the Baby Box: What Parents May Want to Consider". This Infographic can be used as a guide for conversation in counseling families.
THINKING OUTSIDE THE BABY BOX (Dec 15).pdf (active links)
THINKING OUTSIDE THE BABY BOX (Dec 15).png (inactive links - if sharing on social media with others who might wish to see the links, either share the pdf format or direct them to this page for the pdf)
2. Information Brief - This document can be use as a guide for conversation with other health care providers and health care organizations.
Breastfeeding and Safe Sleep: Promoting a Collaborative, Informed Shared Decision Making Model (September, 2014)
In recent discussions regarding nighttime care of infants, a central question has been whether bedsharing is a reasonable option for breastfeeding families with no other risk factors. As some of the literature indicates there is an association between bedsharing and Sudden Infant Death Syndrome (SIDS), it may seem reasonable to simply advise parents against this practice.
Safe infant sleep is a controversial topic among researchers. There is no consistent definition for bedsharing, which complicates the appraisal of available research. For example, there is significant difference in risk between a non-smoking breastfeeding mother sleeping with her infant on a mattress on the floor and a father who occasionally sleeps with his infant on the sofa, yet both situations may be defined as bedsharing in the literature.
Additionally, the members of the BC Lactation Consultants Association (BCLCA) report that parents continue to bedshare as an understandable way to cope with the intense nighttime care needs of infants. Our experience is validated by the literature which puts the rate of bedsharing at 70%. So despite the well-intended predominantly anti-bedsharing message in public health, most families continue to bedshare, at least some of the time.
Most concerning is that BCLCA members are seeing an increase in sofa sharing amongst parents they counsel. BCLCA members find that desperate parents are so concerned about bedsharing that they have been sofa sharing instead. Unfortunately, the literature supports the finding that both sofa sharing and SIDS deaths due to sofa sharing are on the rise.
BCLCA members are ethically obligated to uphold the process of informed, shared decision making. They feel they don’t have the tools to clearly outline options and reduce risk when an infant will not settle in a solitary crib environment. The provincial handout “Every Sleep Counts!” simply states don’t bedshare. It could be argued that this “just don’t do it” approach is unintentionally putting infants at risk.
It is BCLCA’s position that the most recent literature in the areas of breastfeeding, sleep and SIDS be reviewed by relevant stakeholders, including parents, in an effort to more accurately translate our best knowledge regarding safe infant sleep to real-life practice. Further we maintain the priority action of this group is the development of a decision support tool that acknowledges the possible consequences of a variety of sleep arrangements and supports fully informed decision making on the part of parents.
British Columbia sustains significantly increased costs to its health care system and increased cases of avoidable illnesses as a result of failure to provide effective support for breastfeeding mothers. The duration of breastfeeding, especially exclusive breast milk feeding, remains low across the province, particularly in high risk populations, and shows no increasing trend despite decades of discussion and persistently high initiation rates. There is clear evidence that low cost interventions at the hospital and public health level would result in significant cost savings, improved health outcomes and increased health equity.
British Columbia has done an excellent job in encouraging the initiation of breastfeeding and it continues to have the highest rate of initiation in the country. These rates drop almost immediately with exclusive breastfeeding rates low at hospital discharge and a rapid drop continuing over the next 6 months. Several economically advanced jurisdictions have demonstrated that significant change in the maintenance of exclusive breastfeeding is possible for all populations and risk groups. Some of these jurisdictions are in Canada, specifically Nova Scotia, Newfoundland and Labrador, Quebec and Ontario. Implementation of policy change in these provinces has resulted in improvements to the duration of exclusive breastfeeding particularly in the first weeks of life. Similar policies have resulted in increases in exclusive breastfeeding rates in international jurisdictions with initiation rates equivalent to those in British Columbia.
British Columbia has policies regarding breastfeeding which include statements of support from the Ministry of Health and recommendations resulting from the several core reviews which have highlighted the value of breastfeeding. No requirements exist for evidence based action. There is limited or no requirement for reporting on recommended actions and no target dates have been established. Continuing the current policy path or withdrawing current policies without replacement will result in increasing and persistent costs to the health care system and unnecessary illness both in early childhood and from chronic disease. This burden of disease will rest predominantly on low income and at risk families.
This paper recommends that policy be established to provide clear and specific evidence-based goals with defined reporting standards and target dates for implementation specified within the Ministry of Health Service Plan. The policy should:
1. Align with the Baby Friendly Initiative Ten Steps,
2. Expand the role of the provincial lead for breastfeeding to provide support and to permit oversight of progress by health authorities,
3. Require a designated individual with a recognized specialty in breastfeeding to take a lead role in each health authority to oversee implementation and staff education,
4. Require substantive reporting on progress with an established date by which health authorities are to achieve implementation of Baby Friendly designation, or an agreed upon equivalent, for all hospitals and health centres which provide maternity care, and
5. Require provincially funded child and family health services to establish a policy which complies with the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly Resolutions.
For the complete discussion of this issue, please see Policy paper Increasing the rates of exclusive breastfeeding to six months-4.pdf