Breastfeeding Women Admitted to Hospital Clinical Guideline - V3.1 June 2020
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Breastfeeding Women Admitted to
Hospital Clinical Guideline
V3.1
June 2020INTERIM GUIDANCE DURING COVID-19 PANDEMIC
During Covid-19 there is increased accessibility to the Infant
Feeding Team Leads to support your management of the
breastfeeding woman/person admitted to hospital, or feeding a
baby whilst unwell with Covid-19.
We have staff on site that you can co-ordinate with to arrange use
of Trust breast pumps and to ensure safe milk storage.
Please contact us via rcht.feedingsupport@nhs.net, and if you do
not have a response within in the hour, please call us directly on
07828 021754 (Janey Ashton) or (Helen Shanahan) 07795 390050
– Infant Feeding Co-Ordinators.
Thank you
Helen Shanahan and Janey Ashton
Infant Feeding Coordinators
19th April 2020
Breastfeeding Women Admitted to Hospital Clinical Guideline V3.1
Page 2 of 101. Aim/Purpose of this Guideline
1.1 Breastfeeding is known to be one of the most powerful health protective
influences and as such, deserves the efforts of all of us to protect and
promote it. This guideline applies to women who are admitted to the
general side of the Trust and who are breastfeeding at the time of
admission.
1.2 Benefits of breastfeeding for the baby – advantages include a reduction of:
Gastroenteritis, respiratory, ear and urinary infections
Incidence of obesity, diabetes and high blood pressure
Long term problems with dental malocclusion
Risk of childhood cancers
1.3. Benefits of breastfeeding for the mother – advantages include a reduction
of:
Breast, ovarian and endometrial cancers
Osteoporosis
Post-partum anaemia
Obesity and diabetes
Weight post-partum
1.4. This version supersedes any previous versions of this document.
1.5. Data Protection Act 2018 (General Data Protection Regulation – GDPR)
Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal
basis to process personal and sensitive data. The legal basis for processing
must be identified and documented before the processing begins. In many
cases we may need consent; this must be explicit, informed and
documented. We can’t rely on Opt out, it must be Opt in.
DPA18 is applicable to all staff; this includes those working as contractors
and providers of services.
For more information about your obligations under the DPA18 please see
the ‘information use framework policy’, or contact the Information
Governance Team rch-tr.infogov@nhs.net
1.6. This guideline makes recommendations for women and people who are
pregnant. For simplicity of language the guideline uses the term women
throughout, but this should be taken to also include people who do not
identify as women but who are pregnant, in labour and in the postnatal
period. When discussing with a person who does not identify as a woman
please ask them their preferred pronouns and then ensure this is clearly
documented in their notes to inform all health care professionals (NEW
2020).
2. The Guidance
2.1. When a breastfeeding woman is admitted to hospital, the support she needs
depends on the nature of her illness and the treatment needed.
Breastfeeding Women Admitted to Hospital Clinical Guideline V3.1
Page 3 of 102.2. All clinicians concerned with the woman need to know that she is
breastfeeding and need to plan her treatment with this in mind, hopefully
planning to prescribe treatment which is compatible with breastfeeding.
2.3. The options for care then need to be explained to the mother, and the aim
should be to protect the breastfeeding relationship if at all possible.
2.4. Facilitate the baby staying with the mother, breastfeeding on demand
(easiest in a single room with another adult available to help with baby care
if the mother is too unwell to manage independently).
2.5. Encourage another family member to bring the baby in for frequent short
visits to breastfeed. Provide facilities and support for the mother to express
her milk and maintain her supply and hopefully the milk can be taken home
regularly by relatives to feed to the baby when separated from the mother.
2.6. If the mother needs isolation care, continue to provide facilities and support for
her to express her milk and maintain her supply, and hopefully the milk can be
taken home regularly by relatives to feed to the baby.
2.7. If the mother needs isolation care and is on medications definitely known to
be incompatible with breastfeeding but only on a short term course, continue to
provide facilities and support for her to express her milk and maintain her supply.
This milk should be discarded, and she can resume breastfeeding once the
medication has stopped.
2.8. If the mother needs to start longer-term therapy with medications
incompatible with breastfeeding, such as chemotherapy, provide facilities and
support for her to express her milk and decrease her supply gradually, as
appropriate for her comfort (eg over a week or so) and discard the expressed
milk.
2.9. The information and support listed below is needed by the breastfeeding
woman to enable her to make a fully informed choice about breastfeeding
and her treatment options.
2.9.1 She needs praise and encouragement to continue to breastfeed, in
the circumstances in which she now finds herself in hospital, unwell or
injured, frightened and perhaps separated from her baby.
2.9.2 She needs information about her planned treatment, and accurate,
evidence-based, up-to-date information about any drug treatments and
effects they may have on her and her baby.
2.9.3 Ward staff and family need to support her with expressing, whether
by pump or by hand, to maintain her supply for the baby and to prevent
complications (mastitis and/or breast abscess). Ideally, milk should be
expressed at each time the baby would be due to feed if the baby is not
available to breastfeed directly, but any expressing is valuable, as often
as is possible and manageable.
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 4 of 102.9.4 She needs information about milk storage. If the milk is to be fed to a
baby under 6 months old, the pump or containers need to be sterilised,
and the milk can be stored for up to 6 hours at room temperature, up to
5 days in a fridge at 5 degrees C or less, and up to 6 months in a
freezer. Many women in these circumstances choose to store their milk
in their room in a cool bag with freezer packs to keep them cold, which
can be changed regularly by family or staff. If the baby is over 6 months
old, the pump or containers need to be clean but not sterile.
2.9.5 She needs to be positively supported and encouraged to resume
breastfeeding if possible, after any reduction or break in feeding
necessitated by treatment, and may benefit from ongoing support in the
community once she is back home. Locations and times of local
breastfeeding support groups can be found in ‘The Essential Guide to
feeding and caring for your baby’, or look on the local website
www.realbabymilk.org
2.10. For more help, information and support, please contact NHS Cornwall Infant
Feeding coordinator’s, Helen Shanahan on helenshanahan@nhs.net and
07795 390050 or Stephanie Heard on stephanie.heard@nhs.net and 07990
656402.
2.11. Other sources of information and guidance include:
2.11.1. Paediatric Pharmacist, who will have access to other references.
2.11.2. www.breastfeedingnetwork.org.uk for excellent information on many
categories of drugs and breastfeeding.
2.11.3. Access Medications and Mothers’ Milk online, a very
comprehensive service, but you do need to be a subscriber.
2.11.4. If you have specific questions about medications or treatments,
please message the Drugs in Breastmilk information service
Facebook page or email
druginformation@breastfeedingnetwork.org.uk Please give brief
details of the background, age of baby, proposed treatment etc.
2.11.5. BNF is usually less helpful, as it goes largely by manufacturers’
guidance and for many drugs, there is no license and little direct
guidance or information.
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 5 of 103. Monitoring compliance and effectiveness
Element to be No system in place to identify breast feeding women admitted
monitored to hospital so unable to compliance monitor
Lead Breast feeding coordinator’s
Tool To investigate any datix submitted or verbal feedback to
feeding coordinators
Frequency As incidents arise
Reporting Datix
arrangements
Acting on Infant feeding coordinators
recommendations
and Lead(s)
Change in Feedback via ward managers
practice and
lessons to be
shared
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 6 of 10Appendix 1. Governance Information
Breast Feeding Woman Admitted To
Document Title
Hospital Clinical Guideline V3.1
Date Issued/Approved: May 2020
Date Valid From: June 2020
Date Valid To: 4th April 2022
Directorate / Department responsible Helen Shanahan, Infant Feeding
(author/owner): Co-ordinator
Contact details: 01872 252150/07795 390050
Guidance designed to promote and protect
the breastfeeding relationship when a
Brief summary of contents
breastfeeding woman is admitted to hospital
for injury or illness in herself
Breastfeeding, risk, assessment,
Suggested Keywords:
medications, contraindicated
RCHT CFT KCCG
Target Audience
Executive Director responsible for
Medical Director
Policy:
Date revised: May 2020
This document replaces (exact title of Care of Breastfeeding Women Admitted to
previous version): Hospital Clinical Guideline V3.0
Maternity Guidelines Group
Approval route (names of
Care Group Board
committees)/consultation:
PRG
Care Group General Manager
Debra Shields, Care Group Manager
confirming approval processes
Name and Post Title of additional
Not Required
signatories
Name and Signature of Care {Original Copy Signed}
Group/Directorate Governance Lead
confirming approval by specialty and
care group management meetings Name: Caroline Amukusana
Signature of Executive Director giving
{Original Copy Signed}
approval
Publication Location (refer to Policy
on Policies – Approvals and Internet & Intranet Intranet Only
Ratification):
Document Library Folder/Sub Folder Clinical/Midwifery and Obstetrics
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 7 of 10Links to key external standards Not applicable
Related Documents: Not applicable
Training Need Identified? No
Version Control Table
Version Changes Made by
Date Summary of Changes
No (Name and Job Title)
Helen Shanahan,
1 Aug
V1.0 Initial Issue Infant Feeding Co-
2009
ordinator
Revised to comply with Trust format, addition Helen Shanahan,
May 2013 V2.0 of Monitoring Compliance table, EIA, Infant Feeding Co-
Governance information. ordinator
Helen Shanahan,
2nd June
V2.1 Minor revision to update Infant Feeding Co-
2016
ordinator
Helen Shanahan,
4th April Full Review - minor revision to update other
v3.0 Infant Feeding Co-
2019 sources of information and guidance
ordinator
7th May To add in COVID-19 addition at beginning of Janey Ashton,
V3.1
2020 guideline and 1.6. equality statement Infant Feeding Team
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 8 of 10Appendix 2. Initial Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Directorate and service area: New or existing document:
Obs and Gynae Directorate Existing
Name of individual completing assessment: Telephone:
Janey Ashton 01872 252150 or 07795 390050
Infant Feeding Team
1. Policy Aim* This guideline gives guidance to staff in the care, information and
support needed by breastfeeding women when they are admitted to
Who is the strategy / hospital with injury or illness
policy / proposal /
service function aimed
at?
Safe, evidence-based care of breastfeeding women in hospital,
2. Policy Objectives*
protection of breastfeeding to promote short- and long-term health of
mothers and children
Promotion and protection of breastfeeding, and reduction in numbers
3. Policy – intended
Outcomes*
of women who stop breastfeeding as a result of their own admission to
hospital for care and treatment
To watch for a downward trend in the number of women who stop
4. *How will you breast feeding as a result of their admission to hospital for care and
measure the outcome? treatment.
5. Who is intended to Breastfeeding women and their families
benefit from the policy?
6a Who did you consult Local External
Workforce Patients Other
with groups organisations
X
b). Please identify the Please record specific names of groups
groups who have been Guidelines Group
consulted about this Obs and Gynae Directorate.
procedure. Policy Review Group
What was the outcome Guideline agreed.
of the consultation?
7. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative impact you
need to repeat the consultation step.
Are there concerns that the policy could have differential impact on:
Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence
Age X Applies to all breastfeeding women and families
Sex (male, Applies to all breastfeeding women and families
female, trans-gender
X
/ gender
reassignment)
Breast feeding woman admitted to hospital Clinical Guideline V3.1
Page 9 of 10Race / Ethnic Applies to all breastfeeding women and families
communities X
/groups
Disability - Applies to all breastfeeding women and families
Learning disability,
physical
impairment, sensory
X
impairment, mental
health conditions and
some long term
health conditions.
Religion / Applies to all breastfeeding women and families
X
other beliefs
Marriage and Applies to all breastfeeding women and families
X
Civil partnership
Pregnancy and Applies to all breastfeeding women and families
X
maternity
Sexual Applies to all breastfeeding women and families
Orientation,
Bisexual, Gay, X
heterosexual,
Lesbian
You will need to continue to a full Equality Impact Assessment if the following have been
highlighted:
You have ticked “Yes” in any column above and
No consultation or evidence of there being consultation- this excludes any policies which have
been identified as not requiring consultation. or
Major this relates to service redesign or development
8. Please indicate if a full equality analysis is recommended. Yes No X
9. If you are not recommending a Full Impact assessment please explain why.
Not required
Members approving
Date of completion and
May 2020 screening assessment PRG Approved
submission
This EIA will not be uploaded to the Trust website without the approval of the Policy
Review Group.
A summary of the results will be published on the Trust’s web site.
Breast feeding woman admitted to hospital Clinical Guideline V3.1
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