Health Times August 2019

August 2019

Midwifery special feature + Culturally appropriate birthspace crucial for Indigenous women's wellbeing + The benefits of hypnobirthing or ‘meditative labour’ + Continuity of midwifery care instrumental in identifying postnatal depression + Mums in prison or whose babies are in care need breastfeeding support too

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August 2019 We hope you enjoy perusing the range of opportunities included in this issue.

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HealthTimes - August 2019 | Page 11

Interventions to tackle undernutrition in aged care

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report by the NSW Nurses and Midwives’ Association (NSWNMA) highlights the risk of malnutrition in aged care residents due to nutritional deficiency and understaffing, making dietary intervention critical and challenging for nurses.

NSWNMA General Secretary, Brett Holmes, said the ability of nurses to implement nutritional interventions is dependent on adequate, skills-based staffing.

“Nurses working in aged care need the opportunity to sight a person, observe them during mealtimes and have the time to provide supervision over the assistance given by colleagues, such as care workers and assistants in nursing.”

Unfortunately, staffing and skills mix levels don’t support the required observation of a registered nurse working in aged care.

“The knowledge and expertise of a registered nurse are often undervalued in aged care,” said Mr. Holmes.

The National Aged Care Survey revealed that residential aged care facilities that employed one registered nurse to over 150 residents were 12 per cent more likely to lack time to assist people in eating and drinking compared to ratios of one to 50 residents or less.

“Any ratio higher than one to 50 residents yielded more chance of failure to adequately meet residents’ nutritional and hydration

Page 12 | HealthTimes.com.au

needs.”

Undernutrition in aged care residents Aged care residents face many challenges that negatively impact their ability to maintain adequate nutritional wellbeing, said Mr. Holmes.

“Changes in the physiology and immunity of elderly people can often result in a greater need for vitamin and mineral supplements.

“It’s well documented that over 50 per cent of residents in residential aged care facilities have dementia.

“Some of these people experience increased physical activity, which means they require higher nutritional intake to prevent them from losing weight.

“It’s alarming to note that the average daily spend on food per resident per day, can be as little as $6.

“It’s therefore not surprising that approximately half of the residents in these settings are also malnourished.

“Another important factor is practising good oral hygiene and dental care. Anyone with painful gums or ill-fitting dentures is more likely to experience both poor diet and hydration,” said Mr. Holmes.

Aged Care Clinical Nurse, Angela Donato Connolly, said many factors cause malnutrition in elderly patients.

“Chronic disease, taste bud deterioration, mechanical or motor issues and the onset of dementia, depression and social isolation are

just a few of the myriad of influences that can place an elderly person’s nutritional intake at risk.

“Whether combined or in isolation, an elderly person’s individual circumstances can place them at an increased risk of malnutrition which can then lead to the development of conditions that greatly compromise their health,” said Ms Donato Connolly.

Nutritional interventions in aged care Awareness of routines, preferences, social and cultural factors and education are essential nutritional interventions that minimise the risk of dietary deficiency, explained Ms Donato Connolly.

“Familiarity with a client’s usual routines and preferences is a nurses’ best ally in assessing any change in their usual nutritional intake.

“Small and subtle changes can often lead to a snowball effect that can lead to bigger, more difficult problems to manage.

“If we catch them early, interventions can be implemented at the early stages to avoid large gaps in nutritional deficits.”

Food also has significant social and cultural connections for many Australians, which don’t disappear with age.

“If we can keep older Australians engaged, whether by family, friends or the healthcare worker, in sharing food and the practices surrounding it, there is a good chance they will continue to meet their own nutritional needs without the need for intervention.

“These constructs will also be the ones to identify changes in nutritional intake that may require further intervention, which can then be dealt with respectfully and sensitively and tailored to each client.”

Nurses are a trusted source of health advice and education on nutrition, which can minimise the risk of nutritional deficiency.

“In knowing a client’s preferences and habits, nurses can provide specific practical

advice to increase protein intake for wound healing and hydration and fibre intake to avoid bowel issues.

“Small changes can often be the difference between quick fixes and deterioration in a client’s health.”

Nutritionist Dr Sandra Iuliano, a senior research fellow at Melbourne University, said available literature suggests the nutritional needs of those in aged care are not being met, citing insufficient protein, calcium, zinc and fibre intake.

Nurses play a critical role in identifying nutritional deficiency in aged care residents through routine screening on admission.

“It’s important that routine screening captures residents prior to being malnourished.

“And a thorough investigation into why a resident is losing weight with a food-based approach first.

“This requires co-operation with all the systems in aged care, including food service.

Staff need to work as a team.

“Better screening to identify those at risk prior to becoming malnourished is crucial as it’s more difficult to regain nutritional status than it is to maintain it.

“If nursing staff are alerted to the concerns about a resident, then appropriate investigations with interventions, such as offering foods residents like, can be monitored.

“Protein supplements are effective over the short term, but less effective long-term.

“The ideal is when the intervention is sustainable,” said Dr Iuliano.

HealthTimes - August 2019 | Page 13

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HealthTimes - August 2019 | Page 15

Culturally appropriate birthspace crucial for indigenous women’s wellbeing

F

or midwife Rebecca Clarke, pregnancy and birth was so second nature, that she rarely gave a second thought to encouraging women of all cultures to come to hospital to delivery their babies.

That was until she encountered an indigenous woman who felt she simply couldn’t give birth at the local hospital, instead choosing to travel much further.

“I couldn’t understand why,” says Ms Clarke, who was a midwife at Midwifery Group Practice, specifically catering to young Aboriginal and Torres Strait Islander or remotely residing women.

“History has engrained forceful assimilation, and this felt no different - telling women they should come to the hospital to birth was something so normal for me and I had not considered a different perspective “I later discovered that she had lost a loved one in the hospital and had been told she would catch an infection and die.

“There was nothing I could do in the time frame I had before she would birth. But it played on my mind.”

It was this experience that prompted Ms Clarke to investigate the development of a culturally appropriate space for aboriginal women to give birth.

“All women deserve a place that feels safe and comfortable to give birth to their child,” she says.

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“For many indigenous women a hospital is a place of death and dying, not a place to give birth.

“I was at an Aboriginal Cultural safety conference and through working with members of the local community I learnt a number of important factors.

“Firstly, I learnt that it was important to have the space blessed and smoked to cleanse of the passed spirits.

“And secondly, I began to consider how I could make this an inviting space that women would want to come to give birth.

“I knew I needed to consult the women, so I did past and present clients including elders of the community.

“I consulted my unit manager and put a plan together.”

Fortunately, Metro South Health Hospital District was also supportive of Ms Clarke’s findings and granted her the approval to develop a dedicated space at Redlands Hospital, in conjunction with Birthplace – however funds were needed to make it happen.

“I was very lucky to have a significant donations, which meant that the pipe dream was becoming a reality.

“I was so excited by the women’s response in the community, so I got to work finding the right people to involve in the project.

“Well respected Aboriginal Artist Shara

Delaney painted a beautiful mural on the wall in the room which she had previously birthed.

“I was delighted to find aboriginal fabrics from Alice Springs in which I consulted the community on suitable designs which included embracing the importance of the saltwater to the Quandamooka people and additionally suited aspects of the Torres Strait Islander women’s culture.

“Fabulous Janet Purcell from Birthplace brought the fabrics to life creating a bed cover, and bassinet sheet and cushions.

“I had also discovered the tradition of the coolamon (a shield) traditionally used to collect berries which we believed would be a nice touch for women to weigh their babies in on the scales rather than the cold plastic.”

Ms Clarke says the overall goal was to incorporate as much culturally significant aspects as they could to give women a strong connection with their culture.

The room also features: * Large wall mural by Shara Delaney * Culturally inspired photography by Miriam Ackroyd * Soft furnishing/cot linen and textile art using Aboriginal Fabrics by Birthplace * Coolamon * Soft lighting * Appropriate music including ability for women to Bluetooth their own music.

Ms Clarke says it’s crucial for all midwifes to be aware of cultural preferences when working with Aboriginal women.

“It is vital that midwives are aware of possible aspects but not to assume that because a woman is Aboriginal or Torres Strait Islander that these aspects are a given and care should always be led by the woman.

“I believe that this culturally appropriate birthing space and the continuity of care that is offered by the MGP program that works collaboratively with the Aboriginal and Torres Strait Islander Health workers at Redland Hospital is creating positive experiences for women beginning and building their families.

“Throughout the pregnancy, labour and birth and until 6weeks postnatal the Midwife and Health Worker works with the women to help ensure that both her and her babies health is optimal both socially and emotionally.

“Sometimes this involves complex problem solving and out of the box thinking to ensure the best care possible is delivered and outcomes achieved for mothers and babies.

“I honestly believe this period in a woman and family’s life has the capacity to either be transformative or possibly damaging.

“Ensuring that the model of care encompasses a women’s individual needs is paramount and I feel we as a team have achieved this.”

Ms Clarke says she would love to see more Aboriginal and Torres Strait Islander midwives.

“The goal must be creating stronger beginnings for Aboriginal mothers and babies ensuring that culture is valued and not dismissed.”

HealthTimes - August 2019 | Page 17

Residents of aged care facilities would benefit from mental health checks, more stimulation

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ccess to mental healthcare should be readily available and regular psychological assessment routine within aged care facilities, as increasing numbers of elderly residents present with depression and anxiety issues.

Along with increasing rates of mental health challenges among the elderly, diagnosis is often delayed or even missed, with shortstaffed teams failing to notice key signs.

“We often stereotype our aging population and many presenting symptoms go unnoticed,” says psychotherapist Dr Karen Phillip.

“Those in later life do not always discuss their emotional well-being as they tend to downplay symptoms.

“Some mental health issues can be mixed with declining health therefore become overlooked.”

The aging population can experience a range of physical, mental and psychological conditions including dementia, depression, anxiety, insomnia and degenerating body ability.

When confined to aged care facilities, they also can face isolation from community, friends and family.

“As we age, we usually become more proficient at regulating emotions, however, we do see the presentation of depression for many residents living in aged care facilities.

“This may also be connected to mental health issues experienced during earlier stages of life.

Page 18 | HealthTimes.com.au

“Many elderly are at a higher risk of suicide and depression if they lose their life partner.

“Most of these individuals have experienced this due to death or separation from their partner after admission into the facility.

“Therefore, support and counselling is essential to assist them to cope with these life adjustments and changes.”

While these risks are associated with the elderly generally, when it comes to those living in aged care facilities, the risks are even higher.

“Boredom, lack of physical ability and movement options, disconnection with friends and family members, feeling disparaged, and forgotten.

“Ongoing communication and assessment are essential for the ongoing care of all individuals in an aged care facility.

“We must recognise them as continued valued members of our community.

“Assessment with ongoing cognitive therapy would greatly benefit many residents.”

But as they say, prevention is better than cure and Dr Philip believes aged care facilities could be doing more to prevent depression and anxiety among residents.

“We know when we feel no purpose, we decline mentally and physically.

“While some facilities have basic entertainment for residents, it seems most are not hitting the mark for the type of activities

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where residents could thrive.

“Debates and discussions are a wonderful method to stimulate anyone’s mind and body, albeit politics, sport, current events or world views.

“Regular playing of uplifting music to move and even dance is enriching to both body and mind.

“Spending time speaking and sharing experiences with children, both young and older, as we all love to discuss our life events.

“Ongoing age appropriate communication is essential.”

These activities can also assist following the diagnosis of mental health issues.

“Stimulating both body and mind is known to alleviate many aging issues as we move outside of our self into a more stimulating area.

“Feel good hormones are released, communication is enhanced, relevance is felt, and a degree of purpose is experienced.

Movement and exercise are hugely beneficial.

“Our aging population are human beings that have lived active productive lives, been integral members of the community, worked hard, raised families and hold a wealth of information to share.

“Only when we start to recognise their continued value will they feel appreciated and recognised instead of elapsed.

“These feelings can help alleviate many mental and emotional health issues.”

HealthTimes - August 2019 | Page 19

The benefits of hypnobirthing or ‘meditative labour’

S

enior Midwife and Maternity Consultant, Kathy Fray, is an enthusiastic advocate for hypnobirthing or ‘meditative labour’ which can provide natural pain-relief via meditative practices.

“Hypnobirthing remains the most effective form of pain relief I have ever witnessed.

“It’s mind-blowing to witness first-hand.

“And I’ve assisted hundreds of women in giving birth beautifully using hypnobirthing techniques.

“The awe never wanes of watching a woman in meditative labour during strong contractions,” said Ms. Fray.

Although her caseload has a higher-risk factor than average, Ms. Fray said she is able to achieve an 85 per cent vaginal birth rate.

“It is all to do with the meditation reducing adrenaline so that oxytocin can dominate, which means the woman’s cervix dilatates quicker and she births faster.”

And though the literature on hypnobirthing can over-promote an anti-medicalisation stance, Ms. Fray said the majority of hypnobirthing teachers are reasonable and logical.

“It is always a fragile balance between necessary and unnecessary intervention.”

What is hypnobirthing?

Hypnobirthing uses the philosophies and techniques of hypnotherapy to reduce fears and condition a woman’s body to release endorphins during childbirth that act as natural pain relief.

Melissa Spilsted, Director of Hypnobirthing Australia, said hypnobirthing is simply a fancy word for a positive birth experience.

“Women have used their birthing knowledge for thousands of years, and what we teach … is simply tapping back into that wisdom and removing fear.”

Page 20 | HealthTimes.com.au

The difference between a regular birth and hypnobirthing is a sense of empowerment for the woman through the birth process and beyond, explained Ms Spilsted.

In a survey of pregnant women, over 99 per cent of respondents said they felt more prepared after hypnobirthing classes, said Ms Spilsted.

“Many caregivers describe hypnobirthing mothers as being calm and informed.

“Rather than arriving at the hospital unprepared and asking for caregivers to tell them what to do during birth, a mother who has attended a course has a toolkit of techniques to draw upon.

“This flows onto a more positive and satisfying birth experience, which then can lead to a more positive transition to parenthood.

“A metaphor I like to use is that our caregivers are the ‘lifeguards at the beach’, and we appreciate their presence, as they enable us to feel safe and supported. They will step in if we need help, but if all is well, we know that the birthing mother is the one who needs to do the swimming.”

Kate Vivian, a mother of three, has experienced both regular antenatal classes and hypnobirthing training.

“My last two births were positive, empowering experiences.

“In contrast, my first birth left me feeling overwhelmed and guilty about the whole experience.

“Hypnobirthing made such a difference to how I approached my birth, how I prepared, and how I felt about the experience.

It also had a positive impact on my partner and how he approached his role in births.

“I’m now a Hypnobirthing Australia practitioner.”

What does Hypnobirthing Australia training involve?

Hypnobirthing Australia courses help pregnant woman and caregivers to understand the role hormones play in labour, birth and beyond, teaching evidence-based techniques including breathing, upright positioning, deep relaxation (self-hypnosis), acupressure, touch and visualisation.

“Parents build their knowledge about the physiology of birth, options for care and possible interventions that may be offered or suggested leading up to or on their birthing day.

“When parents build some prior knowledge, they feel empowered and can make more informed decisions.

“The combination of knowledge, evidencebased tools and support that mothers receive in preparation for their birth have been shown to positively affect birthing outcomes, optimise health and wellbeing and have been shown to have a positive impact on women’s experience of childbirth,” said Ms Spilsted.

Is hypnobirthing suitable for every woman?

Elements of hypnobirthing can benefit all pregnant woman regardless of circumstances, medical interventions or pain medication.

“Our standard course prepares mothers for a natural birth and also incorporates special circumstances.

“We have a Positive Caesarean Birth Course, which is suitable for those mothers who know that they need a Caesarean section for the safe delivery of their baby.

(In a Caesarean birth) “the mother and birth partner learn techniques, such as breathing, visualisation, touch, deep relaxation and selfhypnosis, to stay calm and reduce anxiety leading up to and during the birth.

“They see videos of beautiful, positive caesarean births and learn more about possible birth preferences, such as advantages of skinto-skin, delaying the cord clamping and early

breastfeeding dependent on their medical circumstances.

“This ensures they feel calm and empowered throughout the birth and are able to bond with their baby.

“This positive attitude to birth and the relaxation techniques learnt can assist them in breastfeeding, recovery and parenting.

How do you train to be a hypnobirthing midwife?

Hypnobirthing Australia™ Supportive Caregivers Course is available face-to-face in locations throughout Australia, and online. It is recognised for CPD points through the Australian College of Midwives. Further details can be found here. https://hypnobirthingaustralia.com. au/supportive-caregivers-training/ Hypnobirthing Australia™ Practitioner Childbirth Educator training is available for those who want to teach the program. It is taught in private clinics, hospitals and independently in locations all over Australia. Click here for further information about the Practitioner Training: https://practitioners.hypnobirthingaustralia. com.au/ “It is very gratifying to teach this program and watch the transformation take place in the parents.

“Often, they arrive at classes full of fear, and I see them evolve to feeling empowered and excited about their upcoming birth.

“The course is also bonding for the parents and baby.

“But the best part, for me, is knowing that by teaching this program, I am making a positive impact on the world by promoting a positive, gentle and empowering birth.

“I may be biased, but I think I have the best job in the world,” said Ms Spilsted.

HealthTimes - August 2019 | Page 21

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HealthTimes - August 2019 | Page 23

Inadequate nutrition in aged care food for thought

N

utritional standards in aged care have come under scrutiny with the release of the ‘Food for Thought: Nutrition & Hydration in Resident Aged Care’ by the NSW Nurses and Midwives’ Association (NSWNMA), which highlights the risk of malnutrition among residents due to nutritional deficiency and staff shortages.

In light of the report, aged care nurses have called for increased nutritional care standards and safe staffing to be implemented to achieve better health outcomes in residential aged care facilities (RACF).

NSWNMA Acting General Secretary, Judith Kiejda, said 35% of aged care members reported they didn’t have enough time to help a resident eat or drink as a result of competing workloads.

“This report paints a very stark picture of daily life for aged care residents,” Ms Kiejda said.

“Mealtime, which should provide social engagement and enjoyment for residents, is often hampered by understaffing.

“Aged care residents are more prone to becoming malnourished, dehydrated and deprived of an opportunity to connect with others because the majority of nursing staff are being run off their feet.

“It is worrying that 29% of our members surveyed had transferred a resident to a hospital due to dehydration or malnutrition within the past year.

“We also know skills mix is also a contributing factor, particularly in residential aged care facilities with only one registered nurse employed for over 150 residents.

“Staff in these facilities were 12% more likely to lack time to help residents eat and drink,

Page 24 | HealthTimes.com.au

compared to facilities with a ratio of one registered nurse to less than 50 residents.

“Nutrition is not a luxury item; it is an essential element of basic care and a human right.

“Without adequate nurse staffing, guidance and regulation our elderly are not receiving the care and compassion they should be afforded in residential aged care settings,” said Ms Kiejda.

The report highlights that despite the increased nutritional requirements, evidence suggests the daily average spend on food per resident, per day is as little as $6, much less than other healthcare settings.

An Assistant in Nursing, identified as a staff member for a rural for-profit RACF, stated in the report that cut-backs on staffing and food impacted negatively on staff and residents.

“I have had to feed residents mash and gravy only, due to the fact the kitchen didn’t make enough food.

“Our large fridge broke down, and we had no milk for tea and coffee and no salads.

“Aged care needs big changes and stop putting fees up when the quality and quantity is not there.

“Our facility was great when I first started, we had everything, and the staff morale was high, and residents were happy - now we all want out.”

The NSWNMA is part of an ongoing national campaign for minimum staff to resident ratios to be introduced across the aged care sector. For details, visit www.ratiosforagedcare.com.au.

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HealthTimes - August 2019 | Page 25

Continuity of midwifery care instrumental in identifying postnatal depression

C

ontinuity of midwifery care plays an instrumental part in the successful identification and management of postnatal depression, says Professor of Perinatal Mental Health Debra Creedy.

“The midwife plays a central role in detecting depression and supporting women along their journey,” says Professor Creedy.

“Continuity of midwifery care is essential to develop a trusting relationship.”

Continuity of midwifery care occurs when a woman is seen by a known midwife during pregnancy, during birth and up to 6 weeks postpartum.

“This enables a trusting relationship to develop and for a midwife to ensure that the woman stays safe.

“If the depression develops into a severe condition, then the woman may be admitted for care.”

Identifying post-natal depression is a critical part of a midwife’s role, with many maternity services around Australian incorporating routine screening for depression.

The Edinburgh Postnatal Depression Scale (EPDS) is the recommended tool for use both antenatally and postnatally to identify whether a woman is likely to be experiencing depression and/or anxiety in pregnancy or the

Page 26 | HealthTimes.com.au

postnatal period.

“In the public system screening using the EPDS is formalised and documented,” Professor Creedy says.

“I’m aware of some private practice midwives who also routinely screen and document.”In undergraduate Bachelor of Midwifery programs students are introduced to EPDS and psychosocial risk assessment – this includes identification of risk factors, signs and symptoms, treatment, role of the midwife in screening and providing care.

There are also a number of professional workshops and seminars available to maternity health professionals to further enhance their understanding of pre and postnatal depression, such as those offered at beyondblue and COPE. When assessing women who are about to, or have just given birth, midwives should be aware of the following signs: Mood: anger, anxiety, guilt, hopelessness, loss of interest or pleasure in activities, mood swings, or panic attack Behavioural: crying, irritability, or restlessness Whole body: fatigue or loss of appetite Weight: weight gain or weight loss Cognitive: lack of concentration or unwanted thoughts

Psychological: depression or fear Also common: insomnia or repeatedly going over thoughts “Many studies estimate that between eight and 15% of pregnant women in Australia, and seven to 21% of mothers of infants up to four months of age will experience postnatal depression.

“The estimated prevalence of anxiety disorders among childbearing women attending has been proposed to be as high as 20%. In addition, depression and anxiety disorders frequently coexist.”

Professor Creedy says if a midwife suspects postnatal depression, they should first ensure the woman and her baby are not at immediate risk.

“Midwives can provide a clinical pathway, a resource and referral list, and written patient education.”

Due to the frequency of Baby Blues, which many women experience soon after birth, it’s important for midwives to be able to differentiate between this and postnatal depression.

“After a woman gives birth, her hormone levels drop, which impacts on mood. Her newborn is probably waking up at all hours, too, so she isn’t getting enough sleep. That alone can make the woman irritable.

“A woman might simply be worried about caring for her baby, and it makes her feel a kind of stress she hasn’t dealt with before.

“These feelings often begin when her newborn is just 2 or 3 days old, but a woman is likely to feel better by the time her baby is 1 or 2 weeks old.

“If her feelings of sadness last longer than that, or become worse instead of better, a woman may have postpartum depression.

“It’s more severe and lasts longer than the baby blues, and about 10% of women get it.

A woman is more likely to have postpartum depression if she has already had bouts of depression or if it runs in her family.”

When It’s the Baby Blues • Her mood swings quickly from happy to sad. One minute, a woman feels proud of the job she’s doing as a new mom. The next, she could be crying because she thinks she is not up to the task.

• A woman doesn’t feel like eating or taking care of herself because she is exhausted.

• A woman feels irritable, overwhelmed, and anxious.

When It’s Postpartum Depression the woman • Feels hopeless, sad, worthless, or alone all the time, and will cry often.

• Doesn’t feel like she is doing a good job as a new mom.

• Is not bonding with her baby.

• Can’t eat, sleep, or take care of her baby because of her overwhelming despair.

• Could have anxiety and panic attacks.

With many women in hospital for just a few days or less, continuity of care post-birth would make the identification and successful treatment, that much easier.

HealthTimes - August 2019 | Page 27

Mums in prison or whose babies are in care need breastfeeding support too

A

ustralian women want to breastfeed but many struggle. And the most disadvantaged face the biggest challenges.

Among them are mothers who are involved with the child protection and criminal justice systems, who need extra support. But such support has been lacking.

However, Australia’s new National Breastfeeding Strategy, released on Saturday, is the first of its kind in the world to directly call for health, justice, and child protection systems to support women to breastfeed.

The plan is to keep mothers and babies together as much as possible, and provide them with skilled breastfeeding support.

How many infants does this affect?

In Australia, 14,000 infants are involved with child protection services, and about 2,000 are in foster care.

Breastfeeding is often abandoned despite the best interests of the child and the mother’s wish to breastfeed. Milk that mothers express isn’t always transported to infants in foster care, and women can be actively discouraged from breastfeeding during contact visits.

We don’t know how many Australian infants are affected by their mother’s incarceration; police, court and prison systems do not routinely collect information

Page 28 | HealthTimes.com.au

on whether these women even have children.

However, extrapolation from Western Australian research suggests perhaps as many as 600 children aged 0-2 years have mothers in prison nationally.

These children are hidden victims of crime, punished by judicially enforced separation.

While their mother’s imprisonment may be as little as a few weeks, this separation can severely disrupt the mother-child relationship, and can end breastfeeding.

Why supporting breastfeeding is important Breastfeeding provides vital protection against infectious and chronic diseases, obesity and sudden infant death syndrome (or SIDS). All of these are more common in disadvantaged families.

Breastfeeding is also important as it affects a mother’s ability to provide care. Women who interact with the child protection and justice systems often have experienced poverty, domestic violence, and childhood abuse.

These traumas can make it hard for them to look after their babies.

Breastfeeding helps by reducing stress responses, enhancing mothers’ desire to be with their babies, and promoting maternal behaviours.

These behaviours include affectionate touch, eye contact, speaking gently, and

responding to the baby, the types of behaviours that build healthy attachments between mother and child. In vulnerable mothers, breastfeeding can greatly reduce rates of maltreatment, particularly neglect.

A 2015 expert report for the South Australian Royal Commission on child protection highlighted breastfeeding’s important role in a “good childhood”, not only for nutrition, infection risk, and healthier development, but also for encouraging secure attachment and infant mental health.

What can we do to support breastfeeding?

We need child protection policies that recognise the importance of breastfeeding and the role it plays in protecting child health and strengthening maternal care giving. Skilled breastfeeding support should form part of early intervention services for vulnerable mothers.

In child protection investigations, every effort should be made to keep mother and child together including in supervised motherbaby residences. Where physical separation is necessary, mothers should be given support to express milk to be delivered to their infants.

Contact visits where direct breastfeeding can occur should be frequent. Foremost in mind should be that if child protection interventions result in a mother stopping breastfeeding and the child is returned to her care, the intervention has increased the child’s risk of abuse and neglect.

In the justice system, incarceration of mothers should be avoided whenever possible.

If mothers are imprisoned, mother-baby units, where women keep their babies with them, should be routinely available, including to those on remand.

Crucially, programs in mother-baby units should involve intensive parenting support, including for breastfeeding. This helps infants thrive despite their mother’s history of trauma.

Mother-baby units also provide broader

social as well as economic benefits; they reduce the likelihood of women re-offending saving A$90,000 per prisoner per year (the average cost of having a person in prison).

Yes, there are challenges There are challenges to implementing support for breastfeeding in the child protection and criminal justice systems.

Integrating services in health, child protection and the justice system can be difficult. The logistical problems of supporting breastfeeding when mother and child are physically separated are significant.

Maternal drug use (whether that’s illicit, prescribed or alcohol) can also be a concern.

Although this does not necessarily mean mums who use drugs are prohibited from breastfeeding.

There may be a place for milk banks to fill gaps; even at A$200-300 a litre, donor milk for newborns may still provide ample return in social, economic and health benefits to the wider community.

These can range from reduced health care costs to better child development and educational achievement, and improved child health.

Breaking the cycle Supporting breastfeeding for mothers in child protection and the justice system is not easy, but worth it. It would improve maternal health and reduce health and development disadvantage for the most vulnerable children.

Evidence tells us it will also reduce reoffending, the cost of prisons, and foster care. Everyone wins.

Breaking the cycle of disadvantage, child abuse and crime starts with helping vulnerable mothers provide “good enough” care to their babies. Supporting breastfeeding is part of helping mothers to do this.

HealthTimes - August 2019 | Page 29

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