Infant Feeding - Green Maternity Challenge

Project completed as part of the National 2024-25 Green Maternity Challenge by the Great Western Hospitals NHS Foundation Trust team.

Team members:

· Zoe Daggatt-Powrie, Clinical Sustainability Fellow

· Angie Willis, Hazel Ward Manager

· Charlie Peters, Specialist Infant Feeding Nurse

· Rosalind Freestone, Specialist Infant Feeding Nurse

· Kath Townsend, Specialist Infant Feeding Midwife

Setting / patient group: Maternity (obstetrics) post natal

Issue:

Breastfeeding is important because it improves the long-term health of both mothers and babies. Infant feeding is also a carbon hotspot in maternity services. The impact can be reduced by increasing rates of breastfeeding, reducing formula and related equipment. Great Western Hospital supports 4200 births a year. Between 74-86% of birthing people start breastfeeding in the first 48 hours. Around 8% stop breastfeeding by the time they go home from hospital and a further 20% stop during the first two weeks at home. There are several reasons for this, but a lack of infant feeding support is a major contributor. Lack of support also contributes to 5-20 mothers and babies a month requiring readmission for jaundice, weight loss and tongue tie. From a carbon perspective, this increases emissions as it requires patient travel, clinician time, bed days, formula supplementation, equipment, tests and potentially phototherapy treatment. This has a financial cost to the hospital and can also negatively affect parents’ mental health.

Intervention:

Our intervention aimed to improve breastfeeding rates at time of discharge from hospital and two weeks after discharge through the introduction of daily feeding support groups on the maternity ward. We evaluated our existing service provision for breastfeeding support. Information was given antenatally, with advice and support given following birth and when requested on the ward. However, due to various factors including staffing pressure, support was inconsistent. We met as a team to discuss how to tackle this, deciding to implement a daily feeding support group on the maternity ward. Initially the group ran for one hour, five days a week, increasing to seven days a week. We supported staff to gain confidence in running the groups.

Outcomes:

- Environmental

A longer time period of data monitoring is required to assess whether the support groups lead to an increase in breastfeeding rates. We have modelled what the impact of a 5% increase in breastfeeding rates at hospital discharge and two weeks after birth would be.

The carbon footprint of formula feeding over breastfeeding in the year before the project was 9,729 kgCO2e. With a 5% improvement in rates, the carbon footprint would reduce to 8,340 kgCO2e, saving 1,389 kgCO2e.

As the impact of the project on readmission and outpatient attendances has not yet been recorded it was assumed that a 1% change in these indicators might be achieved when improving breastfeeding rates by 5%. The emissions related to inpatient stay, outpatient attendance and patient return journeys have been predicted to reduce from 19,673 kgCO2e to 19,476 kgCO2e, saving 197 kgCO2e.

Factoring in a small carbon footprint to print posters advertising the service, this results in total annual savings of 1585 kgCO2e.

- Social

By offering a support group, we hope to empower birthing people to get the support they need and be welcomed into a group setting, with the hope that they would feel more comfortable attending support groups in the community if they desired. The group also aims to offer evidence-based information, filling gaps that families may have had, for example, if they were unable to attend antenatal classes. Staff feel more confident in offering support in a group setting, developing their skills and providing job satisfaction, whilst using their time effectively.

- Clinical

Outcomes we hope to see are improved breastfeeding rates, reduced supplementation, and fewer readmissions for weight loss, feeding support and jaundice. We have had great feedback from families so far. We heard from several birthing people that they went home with the plan to exclusively breastfeed, following the support and information they received. We collect data on breastfeeding rates and supplementation rates at time of discharge and two weeks post discharge. We also monitor rates and length of readmissions for weight loss, feeding support and jaundice. These are metrics that will be monitored over the coming year.

- Financial

There is no direct cost to run the service, although it uses staff time. The hope is that by centralising feeding support, maternity staff will be making better use of their time overall. In the longer term, if the project is successful at reducing feeding issues, there would be a reduced number of infants readmitted due to jaundice and weight loss, and for feeding support. The average time to be readmitted for weight loss, or for jaundice, is two nights, which costs approximately £966. An outpatient appointment costs around £50, not including blood tests. Therefore, with better feeding support, we would anticipate a financial saving from these areas. A 1% reduction in both would bring annual savings of £4,641.

Key learning point:

Regular meetings with the project team were essential to ironing out issues that arose. If we were starting again, we would spend more time planning the process, perhaps looking at funds to improve the space so it was a more welcoming environment for families. In addition, providing additional breastfeeding training to staff prior to the roll out of the project would have been optimal.