Red hat…orange hat….

Hospital Peer Supporters in Truro may have noticed a new system, for flagging up mums and babies who need a little more support and attention with feeding on Wheal Fortune recently.  It is possible too that community groups will start to see mums and babies who have been part of this system so we thought it could be good to explain a little more about how it works.

This Beanie project is a pilot running until the end of February.  The hat system applies to all mums and babies.  The red/amber/green hat idea for feeding support comes from sharing innovative practice amongst other maternity units in the UK who have also been grappling with the issue of high re-admission rates for newborns – particularly with feeding ‘problems’.

The Royal Cornwall Hospital Trust, Treliske have seen an increasing number of babies being admitted to the neonatal unit with low temperatures and low blood glucose and of babies being readmitted to hospital with feeding problems. These problems are typically related to the loss of more than 10% of their birth weight by the day 5 midwife appointment and the Trust is eager to reduce this number of re-admissions.

So, babies and mums are assessed and babies allocated a hat when they are born – either green (pretty much good to go), amber (support and attention needed) or red (significant support and attention needed).

The green hat babies of first time mums can go straight home from delivery but should have been breastfed or bottle fed on the unit (delivery or birthing centre) twice.  A second time or subsequent mum may go home after one feed on the unit if they are confident and she has breastfed for one month or more with a previous baby.  In any green hat baby case they will be encouraged to keep their baby in uninterrupted skin to skin contact, have one feed observed and be offered a feed chart to use in hospital and at home if so they could like to keep track of their baby’s feeds and wet and dirty nappies.

This does not necessarily mean that all will go smoothly with breastfeeding – we all know that once home things can go awry and we hope that, if this is the case, those mums will need to be sign posted to a breastfeeding group.

Amber and Red hat babies and their mums will normally have been admitted to Wheal Fortune postnatal ward for a period of time.  This could be due to a trickier birth (Ventouse, Forceps or Caesarian, Post partum haemorrhage), or low birth weight or slight prematurity (35 weeks + but otherwise well).  It might be that the baby is just not quite ready to start breastfeeding and mums and baby would benefit from some support to get it off to the best start possible.  It could be that mum needs some extra support due to the birth (C-section) or a condition such as Diabetes.

In the case of mums choosing to breastfeed the help could be supporting the mum to start expressing her colostrum to enable this to be fed to the baby via syringe or even finger whilst they settle into the normal feeding behaviours we see in healthy term babies.  It might be that the baby is being screened for infections that have suppressed their normal feeding behaviours or are being treated with antibiotics as a precaution.  If the baby is with mum the hat acts as a reminder to both parent and staff (and volunteer) that this mum and baby need more support and attention for some reason.

This pilot will be assessed to see if it is effective in bringing down the readmission rates and parents will be asked for their opinion on how the system worked for them.

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