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Analysis

A fight for funding

11 March, 2011

A fight for funding

When a client asked Helen Howard for advice about using donor breastmilk, they could not have anticipated the battle they would face. Their story has contributed to Helen being shortlisted for the RCM annual midwifery award for supporting breastfeeding.

When a client asked Helen Howard for advice about using donor breastmilk, they could not have anticipated the battle they would face. Their story has contributed to Helen being shortlisted for the RCM annual midwifery award for supporting breastfeeding.


Midwives magazine: Issue 2 :: 2011


As midwives, it is crucial that we support women in their choices. Both The code (NMC, 2008) and Modern supervision in action: a practical guide for midwives (NMC, 2009) state clearly that advocacy and support of choices are crucial elements of our role. But in the current climate of cost-cutting, we may encounter challenges – I speak from experience.

I was contacted by Jane* during her second pregnancy. I had already cared for her in my role as a community midwife and she was breastfeeding her first child, who was ten months old, when she discovered she was pregnant again.

At just six weeks’ gestation, she found a lump in her breast and was subsequently diagnosed with breast cancer requiring surgery, chemotherapy and radiotherapy treatment. Jane was advised to terminate her pregnancy, but explored her options and found that there had been cases where women had continued with their pregnancies. She underwent a full mastectomy of the affected breast with auxiliary lymph clearance at 15 weeks.

Following her recovery from the breast surgery, Jane contacted me to discuss her feeding options. Having breastfed her first child until she was forced to stop because of her diagnosis, Jane was keen to breastfeed her new baby. She was to start chemotherapy treatment while still pregnant, and her baby was due not long after the completion of her treatment. There would be an interim period of about four weeks where she would be unable to breastfeed.

I hadn’t encountered a situation like this before, but I am a keen advocate of donor breastmilk so I decided to examine the options. 

As a trust, we use donor breastmilk on our neonatal unit and the paediatricians are supportive of its use. I discussed our options with the local milk banks and found that the Countess of Chester Milk Bank might be able to help us supply donor breastmilk in the period between Jane finishing her chemotherapy treatment and being able to breastfeed herself. The main issue was the funding of the donor milk and agreement had not been reached when Jane gave birth to George* prematurely at 35 weeks’ gestation.

Naively, I thought using donor milk would not be a problem because George was born prematurely. However, he was not born at my trust, where we are familiar with its use, and donor breastmilk was not fully supported primarily due to cost restraints. NICE acknowledges that the cost implications for supporting breastfeeding can actually become cost savings, and breastfeeding should be promoted (NICE, 2006). Jane was keen for her baby to have breastmilk, and began to express, using a breast pump eight to ten times every 24 hours to establish her own lactation.

The World Health Organization and the Department of Health recommend all babies should receive exclusive human milk feeding for the first six months of life (WHO/UNICEF, 1980). In circumstances where the mother’s own milk is unavailable, pasteurised donor breastmilk should be considered. However, due to the cost implications, an application for exceptional funding was required to fully support Jane’s case.

Letters of support from the consultant oncologist, milk bank specialists, myself as a lactation consultant and supervisors of midwives were compiled and submitted to the panel to decide whether funding for the milk would be agreed. Unfortunately, cost overruled the clinical picture and funding was denied.

Undeterred, Jane transferred her baby’s care to the trust I work in and we appealed against the decision. Jane went to the press, which embraced her story. Further supporting letters from consultant paediatricians made the difference on appeal and, thankfully, Jane was able to receive the funding for George to receive donor breastmilk.

In my opinion, Jane should never have had to go through the rollercoaster of emotions over what in the first instance seemed a reasonable request. She is truly inspirational. George received donor breastmilk for longer than we had originally anticipated as Jane’s lactation was compromised, possibly from the anxiety caused by the appeal. However, Jane did also manage to breastfeed George.

Acting as a true advocate for women is difficult. However, I feel women’s choices should be respected, with consideration given to the long-term benefits, both to women and their babies, when making funding decisions.

As a result of the work I have done with Jane, the awareness of breast cancer and breastfeeding has been increased dramatically by jointly organising local events, raising funds for the Countess of Chester Milk Bank and Breast Cancer Care. We are also in the process of developing a bra-fitting service, linking with the breast care team.

I am proud to have met Jane and her family and am pleased to report that she is recovering well and George is thriving. 

*Name changed for anonymity.



RCM Communities
Does your trust support the use of donor breastmilk? Join the discussion at: http://communities.rcm.org.uk




References:

NICE. (2006) Routine postnatal care of women and their babies. Costing report. NICE clinical guideline 37. NICE: London.


NMC. (2007) The code: standards of conduct, performance and ethics for nurses and midwives. NMC: London.


NMC. (2009) Modern supervision in action: a practical guide for midwives. NMC: London.


WHO/UNICEF. (1980) Joint statement: meeting on infant and young child feedings. J Nur Midwife 25: 31.


NMC. (2008) The code: standards of conduct, performance and ethics for nurses and midwives. See: www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full (accessed 25 February 2011).


NMC. (2009) Modern supervision in action: a practical guide for midwives. See: www.nmc-uk.org/Publications/Midwifery-Supervision (accessed 25 February 2011).

 




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