In her role as a community infant feeding nurse, Elizabeth Smith provides support to mothers across NHS Ayrshire & Arran while also promoting cultural changes within the community to encourage breastfeeding.
I knew I wanted to be a nurse from quite a young age. I went to the University of Glasgow where I graduated with my Bachelor of Nursing Degree, this was the early days of graduate nursing. While I was studying, I had gone on a placement with the health visiting teams in Glasgow and that was just a trigger for me – I knew community was where I wanted to be, and I had found my home in nursing. At that time, in order to be a health visitor, you needed to be a midwife first. So, after completing midwifery I went straight on to study for my health visitor diploma. I still have a love of learning, having recently completed my PhD.
I applied for the role of community infant feeding nurse in 2009, with the post initially developed to deliver UNICEF UK baby friendly accreditation – a benchmark of high-quality infant feeding care to families. Since accreditation, it has been about developing the clinical specialist aspect of the role.
This morning we had a meeting of breastfeeding mums in a local coffee shop for a support chat. I listen intently to what they are telling me to understand the issues that lie beneath what they may be saying. The core of my work as a specialist is promoting breastfeeding and that’s about changing attitudes. I also bring my expertise to educating, supervising and advising other staff, particularly health visitors, as well as working strategically, meeting senior managers and influencing policy.
I am available to support women who are having trouble feeding their babies, enabling them to feel confident in the choices they make, whether or not that is to breastfeed. I could be following up a referral from a member of a health visiting team who has come across a mum having problems feeding. The health visitor can contact me if they’ve tried supporting her but feel things aren’t moving on and they don’t know where to go next. I will go and visit the mum to do an assessment. This will be followed up with information and support. I’ll contact the health visiting team and let them know and I will continue to visit that woman until things have improved. We work between us to make sure that mums across the whole of Ayrshire & Arran feel supported.
The NHS is clearly supportive of breastfeeding due to the many health benefits but Ayrshire’s breastfeeding rates are really low, and breastfeeding is not seen too often in the community. I am working with partners in education and the third sector to challenge social norms about breastfeeding.
In my clinical role, I visit mothers who are struggling to feed their babies – this is the first role as a mother and is therefore emotionally charged. My role is to assess and plan, to encourage change using facilitating and empowering language and strength-based approach.
In my work, I mainly support breastfeeding mothers, but I also support mothers who have chosen to formula feed. I am clear that our role is to ensure informed decision making by parents – once the decision is made, we support all families. I am proud that this what we do in our service.
I’ve been a community nurse now for 28 years and I still love it – I’ve never thought about doing anything else, it is undoubtedly the place for me. Community nurses day in and day out walk up to a door, knock, the door is opened and we are invited into people’s homes. We must strike up a conversation, build instant rapport and confidence. These are the skills community nurses often take for granted but we should not. These are the skills we can use to assess, plan, adapt and improve not only for patients but for whole communities. The Queen’s Nurse award, for me, is a recognition of the skills community nurses have.
Currently one of the main aspects of my role, and the one I wanted to explore under my Queen’s Nurse issue for development, is around addressing some of the cultural issues affecting breastfeeding.
The work included increasing public awareness of our breastfeeding welcome scheme ‘Breastfeed Happily Here’ where venues across Ayrshire can sign up to show they support breastfeeding. Of course, by law, you have the right to breastfeed anywhere but having the right and feeling confident is two different things.
Some of the ways breastfeeding can be a difficult choice for women is if they live in an area where nobody breastfeeds. They have no experience, they don’t know anyone who has breastfed to ask for support. If everyone is formula feeding around you then it is the easy choice to make. Breastfeeding becomes a harder choice for women in those areas. We need to change that. I want to make it so that breastfeeding is for every mum and every baby, if they want to do it. It’s about equality of choice. Our service is about letting mothers know, we will be there, we will be beside them and we will support them.
Some of the work looking at addressing cultural change will build on previous work I’ve done as part of the Catalysts for Change programme run by QNIS. We started some breastfeeding promotion work in schools in North Ayrshire and I now aim to extend this offer of support to implement such a programme at other schools across the area.
I will not be delivering these actions alone and aim to work in partnership with health and local authority colleagues, third sector partners and importantly with families. Together, we can achieve so much more.