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Pregnancy, birth & the transition to parenthood
The First 1000 Days
Seána Talbot, Sure Start Coordinator
Pregnancy, birth & the transition to parenthoodNCTMaternity Services Liaison Committees
(MSLC)Strategy GroupsGAIN guidelinesCommissioning
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20112012P20,000
21,000
22,000
23,000
24,000
25,000
26,000
Northern Ireland Live births
Maternity Units8 consultant units – 90% of births
6 MLUs (3 alongside, 3 freestanding)
Fewer than 1% of babies born at home
RJMSMaterLagan Valley
Lagan Val-ley
Erne Hospital
Causeway Daisy Hill Hospital
Antrim Altnagelvin Ulster Craigavon Royal Maternity
0
1000
2000
3000
4000
5000
6000
Births 2010/11
Lead professionalGP /Consultant Obstetrician ‘shared care’MidwifeMedical v social model
Type of BirthNormal birthInstrumental birthCaesarean section
EmergencyElective
Trauma / perception
Caesarean birthWorld Health Organisation 10-15%
England R Ireland Scotland Wales N Ireland0
5
10
15
20
25
30
% Caesarean Section 2010/11
Elective Emergency Total0%
5%
10%
15%
20%
25%
30%
Caesarean Sections
England (2011)Northern Ireland (2011)Scotland (2010)Wales (2011)
N. Ireland Wales R. Ireland Scotland England 53
54
55
56
57
58
59
60
61
62
63
% Normal deliveries 2010/11
Place of BirthHospital 90%Midwife-led unit ‘Birth Centre’ 9%Home 1%Actual v perceived riskBirthplace Study NPEU60,000 birthsOutcomes good
Why more interventions?Medical model – surgicalMid-wife = with womanRitual and routineOxytocin v adrenalineFear & tensionCulture – varies between units
Lagan Val-ley
Ulster Causeway Craigavon Erne Hospital
Royal Maternity
Daisy Hill Hospital
Altnagelvin Antrim0
2
4
6
8
10
12
14
16
% Assisted deliveries
Erne
Hos
pita
l
Royal
Mat
erni
ty
Craig
avon
Daisy
Hill
Hos
pita
l
Antrim
Altnag
elvi
n
Ulste
r
Cause
way
Laga
n Val
ley
01020304050607080
% Normal deliveries 2010/11
Lagan Val-ley
Causeway Erne Hospital
Ulster Altnagelvin Antrim Daisy Hill Hospital
Craigavon Royal Maternity
0
5
10
15
20
25
30
35
% Caesarean Section
Achieving a positive birthMidwifeHome or midwife-led unitPreparation, informationAvoid induction/augmentationThe right birth partnerChoice of pain managementEating and drinkingPrivacy, dignity, respect
Transition to ParenthoodInfant mental healthMaternal mental healthBond with the bumpSkin-to-skinDelayed cord clampingExpectationsSupportBreastfeeding
Risks of formula feedingLarge, good quality, well controlled studies and good quality
systematic reviews demonstrate that in developed countries, not breastfeeding significantly increases the risk of gastro-intestinal disease (1, 2), lower respiratory tract infection (1,2), and sudden infant death syndrome for infants (1); necrotising enterocolitis for preterm infants (3); childhood cancers (4) and maternal breast cancer (4).
The epidemiological evidence supported by related physiological and immunological evidence suggests that not breastfeeding is likely to increase the risks of illnesses including Type 2 diabetes (5), coeliac disease (6), otitis media (1), obesity (7), and indicators of future cardiac disease (8) in the child, and ovarian cancer in the mother (1).
Increasingly strong evidence indicates a significant impact on cognitive and behavioural outcomes for the child (9).
Risks of formula feedingNo other health behaviour has such a broad
spectrum and long-lasting impact on population health, with the potential to improve life chances, a key policy priority (10), as well as survival and health.
InequalityNot breastfeeding is both an outcome and a cause of health and
social inequality. It is an outcome of inequality because (i) low income families
have the lowest rates of breastfeeding; (ii) there is a marked inter-generational effect that perpetuates these low rates (13) (iii); the long-term health and development of the child is affected by whether or not she/he is breastfed and (iv) the social patterning of infant feeding results in the greatest burden of ill health and adverse effects falling on the poorest families.
At the same time, breastfeeding provides a solution to this longstanding problem, and is in itself an intervention to tackle inequalities in health; a child from a low income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula fed (14).
• Breastfed baby (Social class 5)
is more healthy than • Bottle-fed baby (Social class 1)
Dundee Infant Feeding Study
Seven year follow-up, 1998
Breastfeeding and Health Inequalities
2006 2007 2008 2009 2010 20110
5
10
15
20
25
30
35
40
45
50
% Children breastfed on discharge from hospital
BelfastNIUpr SpringfieldWhiterock
Research on attitudes to breastfeeding undertaken in Northern Ireland in 1999 indicates that the reasons why respondents did not breastfeed include:
• never considered breastfeeding as an option;• bottle-feeding seen as more convenient;• felt too embarrassed to breastfeed;• mothers said they or their baby were too ill;• lack of confidence in their ability to breastfeed; and• lack of support and encouragement to breastfeed.
The First 1000 DaysFoundation for mental & physical healthLifelong impactsUpstream