The First 1000 Days Seána Talbot, Sure Start Coordinator.

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