Popular pregnancy and parent guides updated

New advice on storing breast milk and the best medicines to take during pregnancy are some of the updates the Department of Health has made to its popular Pregnancy and Birth to Five books being relaunched today.

The books have been a vital source of information for mums-to-be and new parents for over ten years, offering the latest information on issues that matter to them. The books will be given free to all expectant women and new parents by their midwives and health visitors.

The Pregnancy and Birth to Five books have now been updated to reflect latest advice and evidence and include extra information parents have told us they need.  Some of the changes include:

- Increasing the amount of time it is recommended breast milk can be stored in a fridge from 24 hours to 5 days

- Reflecting latest Food Standards Agency advice that:
- it is safe for mothers to eat peanuts during pregnancy, but babies shouldn’t be given them for the first six months of life
- pregnant women should not drink more than 200mg of caffeine a day – that’s two mugs of instant coffee

- Introducing a step-by-step breast feeding guide and information on medicines for common ailments while pregnant or breast feeding

All of this information has been updated in online resources on NHS Choices as it has changed, but these books bring it all together in one handy reference tool for parents.

Commenting on the new books, Health Minister Ann Keen said:

“Parents have told us how useful they find these books and the advice they give, and we’ve listened to their feedback on what extra information they need.  That’s why we’ve updated the Pregnancy and Birth to Five books to include more advice on the topics parents find most difficult including post natal depression and breast feeding.  I would encourage all parents to use these books and their midwife and health visitor to ensure they have all the information and support they need through pregnancy and early years.”

Commenting on the new books, General Secretary of the Royal College of Midwives Cathy Warwick said:

“The RCM is pleased to have helped update these publications and feels that they will be a vital new resource for pregnant women and their families. We believe that they will help empower and educate pregnant women to make informed choices and decisions about their unborn baby and their newborn child’s health.”

As well as offering advice and guidance, the books let parents know what support and contact they can expect from the NHS at every stage of pregnancy and early years.

First time mum-to-be Hannah Plumridge said:

“The new Pregnancy book is really easy to dip in and out of. It’s good to read something that is written from the NHS point of view so you don’t just learn about what is happening physically, but what you can expect at each midwife appointment and what the NHS can offer at each stage of the pregnancy. I thought the section on the labour was the most informative I have read – I now know more about the process once labour begins and what happens afterwards, rather than just physically giving birth.”

NCT response to BMJ cot death research

A report out today in the British Medical Journal (BMJ) regarding cot death has found that there is a possible link between cot death and socio-economic deprivation.

A team of researchers at the Bristol and Warwick universities studied all unexpected infant deaths – aged from birth to two years old. Of the 80 cot deaths analysed, more than half (54%) occurred while co-sleeping compared to one-fifth (20%) co-sleeping rate among both control groups. Much of this risk may be explained by the combination of parental alcohol or drug use prior to co-sleeping (31% compared with 3% random controls), and the high proportion of co-sleeping deaths on a sofa (17% compared with 1% random controls).

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Rose Dodds, Senior Public Policy Officer says:

“While this study reaffirms the risks of falling asleep with a baby on a sofa, or if you have been drinking or taking drugs that affect arousal. The risks for babies whose parents had not drunk alcohol, taken drugs, fallen asleep on the sofa with their baby and did not smoke but who did sleep with their baby were not different from that for babies in a separate cot.

“However, it is not appropriate to tell all parents not to sleep with their babies. It is clear from many surveys that around half of parents sleep with their babies at some point in the first six months, and around a quarter do so routinely, so we need to help them to do this in the safest way possible. If we demonise the parents’ bed we may be in danger of the sofa being chosen. A better approach may be to warn parents of the specific circumstances that put babies at risk.

“Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa and that they should never co-sleep with an infant if they have consumed alcohol or drugs.

“Mothers who breastfeed and bed share with their baby, are more likely to continue breastfeeding and there is good evidence that breastfeeding helps to protect against cot death.”

For the NCT position statement on co-sleeping, please visit http://www.nct.org.uk/press-office/position-statements/transitionparenthood

NCT response to Swansea University research relating to drugs in labour and breastfeeding

A study published in the British Journal of Obstetrics and Gynaecology suggests that there may be an association between drugs used during the third stage of labour and a reduction in breastfeeding at 48 hours after birth.*

This study suggests that injected synthetic oxytoxin alone or with ergometrine (e.g. Syntometrine), which is given to speed the delivery of the placenta and prevent haemorrhage after the birth, could also make breastfeeding more difficult. It is already known that pethidine and similar opioid drugs can have an impact on babies’ ability to start breastfeeding in the early days.

For more information about oxytocin, the third stage of labour or drugs that may be offered to women during labour, please visit the NCT info centre

Mother and Baby survey reveals mothers worries about breastfeeding in public

A new Mother and Baby survey, carried out in conjunction with NCT, reveals that most British women still feel uncomfortable breastfeeding in public.

The survey, of over 1,200 mums, discovered that 60 per cent feel that the UK isn’t breastfeeding friendly. It also found that 65 per cent felt so strongly about it that they don’t even intend to try breastfeeding because they feel too self-conscious about people staring at them.

65 per cent of those questioned felt that they would feel more encouraged to try breastfeeding if there was a more relaxed attitude towards it among the general public. 30 per cent also thought attitudes towards breastfeeding are more positive abroad.

Two thirds of mothers who did choose to breastfeed said feeding their baby in public had been a stressful experience[l1] . Over half (54 per cent) have been asked to move on from a restaurant, cafe or coffee shop and 30 per cent have been asked to move in a shopping centre.

London came out on top as the place where mums feel most comfortable breastfeeding in public with no-one reporting that they had been asked to move on from feeding in a public place.

The North West (64.8%) and West Midlands (63.3%) were considered the most stressful areas to be a breastfeeding mum.

Women in Scotland didn’t care who saw them and felt most confident about breast feeding in front of other people – with 60 per cent not worrying who saw them. Mums in Wales feel the most supported by specialist GP and health visitors with 73 per cent feeling that they received all the support they needed. Only half of breastfeeding mums in the North felt supported.

70 per cent of mums said celebrities should breastfeed in public to help encourage acceptance.

Notes:

The survey was conducted by Mother  & Baby magazine and online at www.askamum.com and NCT website www.nct.org.uk

1236 replies were received.

Mother & Baby magazine is published monthly by Bauer Media.

COW and GATE found guilty of misusing research to sell their brands of formula milks

Cow & Gate this week had a complaint against their advertising of follow on milk upheld by the Advertising Standards Authority (ASA). The ruling states that Cow & Gate’s claim that their follow-on milk “support[s] your baby’s natural immune system” is unsubstantiated. This complaint was brought by the NCT.  Baby Milk Action has also won a similar ASA ruling about Aptamil’s follow-on milk advertising.

NCT lodged a complaint with the ASA in July 2007 pointing out that Cow & Gate’s claim was unproven. The evidence that the company provided, purporting to support their claims, was based on a study which was not relevant for this product because:

• Follow-on milk is for babies who are aged 6 months or over. The study used as a basis by Cow & Gate for this claim recruited babies less than 4 months old who were fed on formula milk, not follow-on milk.
• The product in the study was different from the product being advertised with the claim. The formula milk provided to the babies in the study contained extensively hydrolysed cow’s milk*. Neither Cow & Gate’s formula milk, nor its follow-on milk contains cow’s milk that is extensively hydrolysed.
• The findings of the study are not necessarily relevant to babies who are not susceptible to allergies.  Because the babies selected to be part of the study, were all susceptible to having allergies (either a parent or a sibling had an allergy).

The ASA stated that Nutricia (manufacturer of Cow & Gate) needs to hold robust evidence to support their claims in any future advertising.

Parents are best served by talking to healthcare professionals and other bodies without a financial interest in formula, for their information.  By its nature, advertising is never impartial.

*Hydrolysing is where protein is broken down into amino acids and short chain peptides.

The Scientific Advisory Committee (SACN) which advises the government on nutrition, points out that the use of claims is ‘entirely unsupportable’. If an ingredient is beneficial it should be included in all formula milks. They said “We find the case for labeling infant formula or follow on formula with health or nutrition claims entirely unsupportable. If an ingredient is unequivocally beneficial as demonstrated by independent review of scientific data it would be unethical to withhold it for commercial reasons. Rather it should be made a required ingredient of infant formula in order to reduce existing risks associated with artificial feeding. To do otherwise is not in the best interests of children, and fails to recognise the crucial distinction between these products and other foods.”

www.sacn.gov.uk/pdfs/position_statement_2007_09_24.pdf

Report published on women’s satisfaction levels with maternity care in Wales

Most women are satisfied with maternity care in Wales with services generally meeting an appropriate standard, says a report published this week by the Auditor General. But the report also highlights some specific problems including the way that labour is managed in some trusts and dissatisfaction with support for infant feeding.

The report includes a survey of new mothers and although many women questioned were satisfied with their experience, a significant minority felt they were not always treated with dignity and respect or kindness and understanding.

Antenatal care generally meets good practice guidelines, but some women do not receive enough check-ups and there is generally low attendance at antenatal classes. The report also shows that women in some trusts tend to receive too many scans whilst trusts are not yet offering the most up-to-date screening for Down’s syndrome.

The way labour is managed in some NHS trusts gives rise to concern. A significant minority of women felt they were left alone and worried during or shortly after labour and some trusts could do more to prevent unnecessary Caesarean sections. Women were least satisfied with the postnatal phase of care, with over a third of women being unhappy with the quality of support they received for infant feeding.

The report calls for the Assembly Government to develop an overall strategy for maternity services in Wales. This would help the planning of maternity services which is currently being undermined by the lack of a clear vision and poor information about the cost and quality of care.

The strategy would also provide a comprehensive source of guidance aimed at removing some of the specific problems with maternity services, such as the failure to meet recommended staffing levels in some trusts and the low level of staff training in many trusts.

The report called Maternity Services makes a number of recommendations for improvement, by calling on:

• the Assembly Government to develop a comprehensive strategy for maternity services, highlighting good practice and offering guidance on local service planning
• new local health boards to assess staffing requirements for delivering safe and high quality services
• local health boards to make sure that all maternity staff receive the necessary clinical training
• local health boards to review their training programmes to ensure that there is sufficient focus on the principles of respect, well being, choice and dignity
• the Assembly Government, in partnership with the NHS in Wales and other key stakeholders, to agree a standard set of data that is routinely collected, monitored and used to support service improvement.

Advice for toddlers and young children to avoid rice drinks due to risk of exposure to inorganic arsenic

Following research published by the Food Standards Agency (FSA) looking at levels of arsenic in rice drinks, the Department of Health (DH) has advised that all toddlers and young children should avoid the consumption of rice drinks in order to minimise their exposure to inorganic arsenic.

The research was from a survey of total and inorganic arsenic levels in 60 samples of rice drinks available in the UK. Rice drink (also known as rice milk) is a blend of filtered water and rice and is usually marketed as either a ‘dairy free-alternative to cows’ milk’ or a ’low-fat drink’ and are usually often consumed by those who wish to avoid dairy foods. Some toddlers and young children who are allergic to cows’ milk and soya drink are currently advised to use calcium fortified rice drinks.

A DH statement notes that arsenic occurs naturally at low levels as organic and inorganic forms in a wide range of foods. Most arsenic in the diet is present in the less harmful organic form but the inorganic form is known to cause cancer. Low levels of inorganic arsenic were detected in rice drinks (12 μg/kg of rice drink). None of the samples tested in the survey were above the legal limits. The Committee on Toxicity has not been able to set specific thresholds of exposure (tolerable intakes) for inorganic arsenic, and has advised that exposure to arsenic should be as low as reasonably practicable.

However, the DH say that toddlers and young children may be particularly vulnerable, because of their proportionally higher milk intake and are likely to have higher dietary exposure to inorganic arsenic per kilogram of body weight. In the statement it also says that a toddler or young child consuming about half a pint of rice drink a day, (instead of cows’ milk) is likely to double his total dietary exposure to inorganic arsenic. Therefore, as a precaution, the DH advises against the substitution of breast milk, infant formula, cows’ milk or soya drink with rice drinks for toddlers and young children aged 1-5 years.

The Department’s advice is that:

• All toddlers and young children (aged 1-5 years) should not be given rice drinks in order to minimise their exposure to inorganic arsenic.
• This is a precautionary measure to minimise children’s exposure to arsenic. Parents who have given their children rice drinks should be reassured that there is no immediate risk of harmful effects but in order to reduce further exposure to inorganic arsenic, they should stop giving rice drinks to toddlers and young children.
• Parents of toddlers and young children with diagnosed allergy to cows’ milk and soya drink who are currently consuming rice drinks should be advised of suitable alternatives such as fully hydrolysed infant formula or oat or almond drinks. Growth and development of these children should be monitored and parents should receive specific dietary advice to ensure that their nutritional needs particularly of calcium are met through a diversified diet.

Parents of toddlers and young children who are lactose-intolerant or who have galactosaemia should be advised to give their infant lactose-free formula.

Further details of the FSA survey of rice and rice products is available on www.food.gov.uk

UK adopts new growth charts based on breast-fed babies

New growth charts have been launched for National Breastfeeding Awareness Week.  As of early May, all newborn babies and children up to four years old will have their growth measurements plotted on new charts. The launch of the charts, which have been developed for the Department of Health (DH) by the Royal College of Paediatrics and Child Health (RCPCH), based on the World Health Organisation’s (WHO) work, coincides with National Breastfeeding Awareness Week (10 – 16 May) and replaces current measures which are based predominately on babies fed with formula milk.

Research shows that breast-fed babies tend to gain weight at a healthier pace and are less likely to become obese in later life. The new charts will play an important role in establishing breastfeeding as the norm and will be included in the Personal Child Health Records, which parents of every newborn are given. They will help parents and healthcare professionals identify children at early risk of obesity and provide important reassurance for parents of breast-fed babies, who are likely to gain weight more slowly.

The new charts include parent-friendly instructions and a chart specifically for premature babies. As babies can lose and gain weight at different rates between birth and two weeks, it is recommended that they are weighed at 3-4 days but the weight is not plotted on the chart. The charts also help make more reliable predictions of a child’s adult height.

The charts and supporting educational materials can be viewed on http://www.rcpch.ac.uk.

The charts replace the current UK90 charts. Other features of the revised Personal Child Health Record include information on the Healthy Child Programme and information on new one year and two to two and a half year reviews, as well as on breast-feeding support services.

The DH recommends exclusive breastfeeding for the first six months (26 weeks) of an infant’s life, as breast milk provides all the nutrients a baby needs at this time. Breastfeeding (and/or breastmilk substitutes, if used) should continue beyond the first six months along with appropriate types and amounts of solid foods

Research indicates breastmilk helps protect babies from infection and diseases such as gastro-intestinal infections, ear infections, urine infections, eczema and obesity in later childhood. Healthy Weight, Healthy Lives: A Cross-Government Strategy for England aims to reverse the rise in childhood obesity, and breastfeeding plays an integral role in this. Breastfeeding also provides health benefits for mothers. It can help them to return to pre-pregnancy weight and can reduce the risk of ovarian cancer and breast cancer later in life.

In England, 78% of mothers initiate breastfeeding and only 22% are still breastfeeding at 6 months. Initiation rates for many other European countries are much higher: Norway: 99%; Denmark: 98%; Sweden: 97.7%; Switzerland: 94%; Austria: 93%; Italy: 91%; Spain: 84.2%, whilst France, Ireland and Germany have lower rates than England Germany: 77.8%; France: 69%; Ireland: 53%.

In addition to the support offered by healthcare professionals, the DH provides the National Breastfeeding Helpline 0300 100 0212, which mums can call and speak to a trained breastfeeding volunteer in their local area. The DH also provides a free DVD ‘From bump to breastfeeding – following real mothers’ stories to find out how’, available to all pregnant women and distributed by midwives and health visitors. For more information visit http://www.breastfeeding.nhs.uk

The growth charts form part of the DH’s long term commitment to increasing breastfeeding rates in England. Last year the DH announced £4 million extra funding to help support hospitals in disadvantaged areas to achieve Unicef Baby-Friendly Status, a set of best practice standards for maternity units and community services on improving practice to promote, protect and support breastfeeding

Equality Bill laid down in Parliament

The Equality Bill was laid down in Parliament last week and will be discussed and debated over the coming months in both the House of Lords and the House of Commons.  The main elements of the Bill are:

• Banning age discrimination in the provision of goods, facilities or services and public functions. Things that benefit older people, such as free bus passes, will still be allowed.
• Increasing transparency in the workplace. If inequality remains hidden, we can’t measure it and make progress;
• Making Britain fairer through a single equality duty, which will require public bodies to consider the diverse needs and requirements of their workforce, and the communities they serve, when developing employment policies and when planning services;
• Extending positive action measures to allow employers to make their organisation or business more representative;
• Allowing political parties to use all-women shortlists beyond 2015;
• Reducing nine major pieces of legislation, and around 100 statutory instruments into a single Act, making the law more accessible and easier to understand, so that everyone can be clear on their rights and responsibilities

The Bill aims to lay provisions down for those making strategic decisions about the exercise of their functions to have regard to the desirability of reducing socio-economic inequalities; to reform and harmonise equality law and restate the greater part of the enactments relating to discrimination and harassment related to certain personal characteristics; to enable certain employers to be required to publish information about the differences in pay between male and female employees; to prohibit victimisation in certain circumstances; to require the exercise of certain functions to be with regard to the need to eliminate discrimination and other prohibited conduct; to enable duties to be imposed in relation to the exercise of public procurement functions; to increase equality of opportunity; and for connected purposes.

Should the Bill be passed into law as it stands it will make it clear that it is unlawful to force breastfeeding mothers and their babies out of places like coffee shops, shops, public galleries, public transport and restaurants. This will give women confidence that the law is on their side when they are breastfeeding their babies.
 
The Bill also lays down an ‘Equality Duty’ on public bodies which aims to ensure they support the needs of diverse groups, specifically referring to pregnant women and new mothers, when designing and delivering public services.   There is an emphasis on equality in procurement, including a requirement to advertise jobs on a part-time basis or with flexible working unless there is a business reason not to, which is likely to have a positive impact on family life in the long run and makes for a more family-friendly society.  

The Bill will now progress through Parliament and can take a year or more to get through the entire parliamentary process and be passed.

Department of Health supports Baby Friendly Initiative

Dawn Primarolo, Minister at the Department of Health (DH) this week noted their support for the National Institute for Health and Clinical Excellence (NICE) guidance on Maternal and Child Nutrition.  The guidance states that all maternity care providers should implement an externally evaluated, structured programme that encourages breastfeeding, using the Baby Friendly Initiative as a minimum standard. She also said that the DH encourages all NHS trusts to implement these recommendations.

The Minister said that the prevalence of breastfeeding at six to eight weeks is a key indicator in the Child Health and Well-being Public Service Agreement. “The Department supports the implementation of the UNICEF UK Baby Friendly Initiative and have funded 40 primary care trusts with low breastfeeding rates to implement Baby Friendly Initiative, which includes UNICEF UK’s 10 steps to successful breastfeeding.”

The Minister was also questioned this week about what the Department is doing to inform parents generally about the practice and benefits of breastfeeding, She responded that the DH have undertaken a range of initiatives to educate parents.  She noted that these include: advice through the National Breastfeeding Helpline; the DVD “From bump to breastfeeding” made available to all new mothers and a range of leaflets including “Birth to Five, Weaning leaflets”, providing advice on nutrition and the breastfeeding leaflet “Off to the best start”, which is available through the national health service.

Primarolo also noted that educational materials are also available at national and local activities held during the annual National Breastfeeding Awareness Week. The Department is also planning to introduce a Change4Life under 2’s marketing strategy later in 2009.

In response to another question on research to evaluate variations in complementary feeding in infancy the Minister turned to the Infant Feeding survey, which, she noted, is conducted every five years.  She said that the survey collects information on infant feeding practices adopted by mothers from the birth of their baby until the age of 10-months. “It provides national estimates of breastfeeding incidence and prevalence as well as capturing data on other aspects of infant feeding, such as the use of breast milk substitutes and information about weaning practices and age of introduction of complementary foods. Analysis includes a breakdown by age, socio-economic group and ethnicity.” The Minister affirmed that the next survey will be undertaken in 2010.

She also said that the DH and the Food Standards Agency (FSA) are also jointly planning to carry out a UK wide diet and nutrition survey of infants and young children aged four months to eighteen months. Ms Primarolo said: “the new survey will aim to gather detailed information about the diets of a representative sample of infants and young children in the UK, and will serve to bridge the gap in data between the age groups covered by the Infant Feeding Survey and the National Diet and Nutrition Survey.”