Why do it?
There is strong evidence for the benefits of improving maternal and infant health and care at admission in labour and promoting bonding, attachment and breastfeeding in neonatal units including:
- Improved patient experience for mothers and their families
- Reduced risks of chronic disease for clinically vulnerable babies
- Reduced risk of morbidity
Despite this:
- Caesarean section rates across Yorkshire and the Humber vary between 19% and 28% (source NHS Yorkshire and the Humber regional statistics, 2010).
- Breastfeeding rates at discharge from regional neonatal units are between <1% and 54% (Yorkshire Neonatal Survey 2008).
Improved outcomes from the admission in labour project are likely to include:
- Improved risk assessment, in particular for vulnerable women
- Reduction in unnecessary interventions, including caesarean section
- Increase in normal birth rates
- Improved quality of experience for parents with reductions in complaint, litigation and associated staff time
- More activity for the same money in each admission episode
Improved outcomes from the Neonatal project are likely to include:
- Skin-to-skin care and breastfeeding/providing breastmilk to facilitate other beneficial outcomes such as reduction in procedural pain and promotion of parent/infant attachment, and help to ease mothers’ shock, fear and grief in the high-tech environment of a neonatal unit.
- Parent experience and satisfaction with care and support.
- Inequalities in health will be addressed as parents from low socio-economic groups are over represented in neonatal units
- A recent economic analysis of breastfeeding in neonatal units considered two key outcomes:
- necrotising enterocolitis and sepsis. It found that provision of trained breastfeeding support in neonatal units resulted in an improvement per infant in QALYs that ranged from 0.009-0.251 and cost savings per infant in hospital that ranged from £66-£586, depending on the birth weight sub-population. With circa 6500 neonatal admissions a year in the region, short-term cost savings could be over £1 million, with considerably larger longer-term costs savings;
- these would result from decreased levels of illness (e.g. necrotising enterocolitis is increased fivefold if babies do not receive breastmilk), which in turn has an impact on health service outcomes such as length of stay and use of formula; savings would continue to accrue over the longer term as diseases such as diabetes, childhood cancers and cardiovascular disease are also reduced by breastfeeding. It is not possible to cost the impact of enhanced maternal-infant attachment, but the impact is likely to be profound and long-lasting for the child and family.
