Breastfeeding support services I Ratonga tautoko whāngote

The importance of evidence-based breastfeeding support provided in a sensitive, culturally appropriate and individualised manner is well-established in research (Blixt et al 2019). Breastfeeding support services should be multidimensional, introduced at different points during the childbirth and postpartum journey, and offered by a range of providers, in different settings and using different modalities including online support innovations and culturally diverse services (Alberdi et al. 2017; Manhire et al. 2018; Bridges 2016)

In Aotearoa New Zealand, whānau can access breastfeeding support through community groups, private providers and DHBs, such as:

• postnatal care in maternity facilities
• Lead Maternity Carers
• IBCLCs (lactation consultants)
• peer support/kaiāwhina services.

The Ministry of Health currently funds a 48-hour postnatal stay following labour and birth. Longer stays are possible for women experiencing breastfeeding problems. During the postnatal stay the skilled support of midwives and other health professionals is offered to initiate and support breastfeeding.

In Aotearoa New Zealand, Lead Maternity Carers are required to provide a minimum of seven postnatal visits, at least five of which need to be in the home in the six weeks following birth (Ministry of Health 2019). This postnatal care is the final stage of the continuity of care relationship that begins during pregnancy, continues throughout the labour and birth, and concludes six weeks following birth.

International Board Certified Lactation Consultants (IBCLCs) have undertaken an education programme and gained a qualification in lactation consultancy. They may be employed in maternity facilities or community settings, or may be self-employed. They are often also nurses, midwives, GPs or other health professionals. IBCLCs work with more complex breastfeeding and lactation issues such as preterm babies; babies with cardiac or other medical conditions; and mothers with mastitis, breast abscess, breast cancers, delayed lactation and more. They often work in conjunction with midwives, Well Child Tamariki Ora Providers, doctors, breastfeeding advocates, kaiāwhina and breastfeeding peer supporters.

Peer support programmes such as those offered by La Leche League are available countrywide, working to increase breastfeeding knowledge, confidence and enjoyment (Ministry of Health 2015). Mother-to-mother, parent-to-parent and peer-to-peer groups have demonstrated significant success in sharing information, providing avenues for questions and discussions, empowering decisions, establishing support groups and enduring friendships, and teaching health professionals (La Leche League International; WABA 2016; Rossman 2011; Brown 2018; McFadden 2019).

Kaiāwhina are an essential part of the Aotearoa New Zealand health and disability sector workforce. Kaiāwhina are qualified Māori community health workers and use Māori models of health to work collaboratively with whānau. Many kaiāwhina can understand and speak te reo Māori and have a strong knowledge of local iwi and Māori health groups. This can help whānau to stay or become connected to local Māori support.

Kaiāwhina offer support services for mothers and their pēpe/tamariki that is designed to generate a warm, therapeutic, non-judgemental and culturally safe environment for the whānau and their pēpe. Kaiāwhina who have received breastfeeding education can help by supporting breastfeeding, encouraging parenting skills, and building self-esteem and confidence in a supportive environment for responsible and positive care of the tamariki.

Other sources of support range from those who provide wai rakau rongoa, complementary therapies, herbalists, and other registered therapists and health professionals, including physiotherapists, cranio-sacral therapists and more.

Services that raise awareness of breastfeeding are important support systems for breastfeeding as they both provide individual support and normalise breastfeeding (World Health Organization and United Nations Children’s Fund 2003).

In 2018/19 Bay of Plenty DHB Planning and Funding led a procurement process to seek providers for Kaupapa Māori Breastfeeding Support services for the region. The two selected providers have been delivering services since March 2019. Ngā Kakano works in the Western Bay of Plenty, and the Eastern Bay iwi alliance (service lead iwi – Ngati Awa Iwi Social and Health service) with Plunket covers the Eastern Bay of Plenty. The models are similar in that they provide open referral pathways into the service and operate a multi-tiered service, with kaiāwhina providing the parent-to-parent support and lactation consultants for clinical support. These services provide a kaupapa Māori service underpinning, with a big focus on manaakitanga, whānau ora and supportive traditional practices.

Alberdi G, O'Sullivan E, Scully H, et al. 2017. A feasibility study of a multidimensional breastfeeding-support intervention in Ireland. Midwifery. 92: 58–86.

Blixt I, Johansson M, Hildingsson I, et al. 2019. Women’s advice to healthcare professionals regarding breastfeeding: “offer sensitive individualized breastfeeding support”. An interview study. International Breastfeeding. 14(51).

Bridges N. 2016. The faces of breastfeeding support: Experiences of mothers seeking breastfeeding support online. Breastfeeding Review. 24(1): 11–20.

Brown A. 2018. Sociological and Cultural Influences upon Breastfeeding. Stuttgart: Georg Thieme Verlag.

La Leche League International. URL: https://www.llli.org/ (accessed 19 September 2020).

Manhire K, Williams S, Tipene-Leach D, et al. 2018. Predictors of breastfeeding duration in a predominantly Māori population in New Zealand. BMC Pediatrics. 18(1): 299–313.

McFadden A, Siebelt L, Marshall J, et al. 2019. Counselling interventions to enable women to initiate and continue breastfeeding: A systematic review and meta-analysis. International Breastfeeding Journal. 14(42).

Ministry of Health. 2015. Mother-to-mother peer support. Ministry of Health. URL: https://www.health.govt.nz/our-work/life-stages/breastfeeding/mother-mother-peer-support (accessed 19 September 2020).

Ministry of Health. 2019. Maternity care. Ministry of Health. URL: https://www.health.govt.nz/your-health/pregnancy-and-kids/services-and-support-during-pregnancy/maternity-care (accessed 19 September 2020).

Rossman B, Engstrom J, Meier P, et al. 2011. “They’ve walked in my shoes”: Mothers of very low birth weight infants and their experiences with breastfeeding peer counselors in the Neonatal Intensive Care Unit. Journal of Human Lactation. 27(1): 14–24.

World Alliance for Breastfeeding Action. 2016. Breastfeeding: A Key to Sustainable Development. World Alliance for Breastfeeding Action. URL: http://waba.org.my/archive/breastfeeding-a-key-to-sustainable-development-unicef-world-breastfeeding-week-2016-message/ (accessed 19 September 2020).

World Health Organization, United Nations Children's Fund. 2003. Global strategy for infant and young child feeding. Geneva: World Health Organization.