Upcoming changes for this guidance
This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this guidance. The following resources provide support:
Practice for working effectively with Māori
Our practice shift
Concept of ūkaipō
“Ūkaipō refers to the nurturing of a person, literally to the place where a person is suckled. The word ūkaipō is supported to be an abbreviated form of the extended phrase ‘kai waiū i te po’ or ‘suckling milk at mother’s breast’.”
“Our concept of ūkaipō, literally to feed, is not just the physical nurturing but also the spiritual and emotional nurturing that eventually makes the adult.”
A right to be breastfed
The United Nations states that “Children have the right to life, survival and development and to the highest attainable standard of health, of which breastfeeding must be considered an integral component”. Women have the right to “accurate, unbiased information in order to make an informed choice about breastfeeding … and they have the right to … appropriate conditions in public spaces for breastfeeding which are crucial to ensure successful breastfeeding.”
If a mother is unable to breastfeed or chooses not to, skin-to-skin contact, cuddling, nurture, feeling warmth and knowing the scent of each other is important.
When a mother is unable to feed her pēpi because she is physically unable to breastfeed, is on medication that means it is unsafe for the mother to breastfeed or the pēpi is unable to breastfeed, every effort should be made to enable skin-to-skin contact, bonding and attachment. Not breastfeeding should not mean a loss of contact and the mother may need extra support to manage the emotional impact of not being able to breastfeed her pēpi.
Social workers have a responsibility to protect and uphold the human rights of the tamariki and whānau or family we work with. The United Nations Convention on the Rights of the Child (UNCRoC) is an overarching framework that helps guide our practice. Article 24 of UNCRoC outlines the expectation that tamariki have the right to enjoy the highest attainable standard of health and references the importance of breast milk and breastfeeding as a key area of support and knowledge for parents.
In addition to this international framework, for Māori, breastfeeding is considered a taonga and is therefore protected under the principles of Te Tiriti o Waitangi. Wai ū (breast milk) and whāngai ū (breastfeeding) appear as metaphors in Māori literature and art in a range of ways, from mōteatea (traditional chants) to whare whakairo (structural carving).
The World Health Organization (WHO), UNICEF and the New Zealand Ministry of Health recommend that a pēpi is exclusively breastfed for the first 6 months of life, meaning no other foods or liquids are provided or needed, including water.
We have a responsibility to ensure that our interventions support and do not undermine pēpi being breastfed by their mothers.
Only in exceptional circumstances, where the immediate safety or health of pēpi will be compromised through breastfeeding, will breastfeeding not be supported and encouraged when a pēpi enters the care or custody of the Oranga Tamariki chief executive.
Why breastfeeding is important for pēpi and their mother
Te Ao Māori
The survival of whānau, hapū and iwi relies on effective child-rearing practices. All Māori babies in pre-European times were sustained on breast milk. Breastfeeding was imperative in maintaining and sustaining the development and wellbeing of te tamaiti. A well-fed pēpi reflected the health status of the whānau, hapū and iwi.
The proverb “The land provides the sustenance for the coming generations” compares the sustenance from the land to the milk from a woman’s breast. While wai ū literally means breast milk, it has a deeper, more significant spiritual meaning – Te Wai Ū o Tuwharetoa, life-giving waters of Tuwharetoa or “the living waters”. This relates to amniotic fluid, spring water and breast milk and recognises the life-giving and protective qualities of breastfeeding.
Breastfeeding not only provides for the physical nurturing a pēpi needs, but it is also an integral factor in meeting the spiritual and emotional needs of a pēpi. The ūkaipō links the pēpi back to protection given at a generational level, for example the protection of antibodies passed from generation to generation through wai ū, breast milk, is cumulative.
The love and the nurturing at the breast by a mother contributes to the emotional wellbeing and the potential of the pēpi. The act of breastfeeding the pēpi, with physical closeness, eye-to-eye contact, and the length of time a pēpi spends at the breast, maintains whakapapa through waiata and mōteatea or traditional chants.
The wellbeing of the mother and pēpi is the responsibility of the whānau and hapū. Breastfeeding is crucial in maintaining and sustaining health and wellbeing and the development of a pēpi.
Whakawhanaungatanga interactions within whānau, hapū and iwi ensure pregnant and breastfeeding women are cared for by the collective. All her needs are taken care of and she is tapu to protect and support her ability to breastfeed. Breastfeeding is such a valued practice that its benefits are recognised in the social acceptance of ‘wet nursing’ or another woman breastfeeding a pēpi when there is a need.
For Pacific families, breastfeeding is an integral and traditional part of rearing children. In a traditional family setting, the baby is carried and held by other family members and returned to its mother for breastfeeding. This includes being held while asleep. Other women, especially older aunts and grandmothers, reinforce the natural connections and traditions and, along with aunts, siblings and cousins, are key supports for a breastfeeding mother.
Other cultural groups
Breastfeeding is highly valued by all cultures and we should understand the circumstances, values and beliefs of different cultures.
Social and emotional benefits
Breastfeeding encourages bonding and supports attachment. Breastfeeding releases hormones in a mother’s body that promote mothering behaviours. This emotional bond is as vital as the nutritional benefit a pēpi receives from their mother. Breastfeeding promotes a growing attachment between the mother and pēpi that will continue to play an important role in the development of the pēpi for years to come. Breastfeeding allows mothers to spend quality time with their pēpi.
Role of fathers and partners
Supporting breastfeeding is also important for fathers and partners. Fathers and partners can play an important role in supporting breastfeeding. This can be through their relationship with the mother, bringing pēpi to the mother, burping pēpi, changing pēpi and settling them after feeding. Expressing breast milk also enables for fathers and partners to feed pēpi.
Fathers and partners can also provide connection nourishment, such as skin on skin, cuddling and holding.
There is vast evidence that breastfeeding is an effective and important intervention for the health of both pēpi and mother.
The short-term benefits of breastfeeding for tamariki health are clear – breast milk is the normal, natural food for a pēpi. Breastfeeding is one of the most effective ways to ensure the health and survival of a pēpi. Breast milk is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breast milk provides all the energy and nutrients that the pēpi needs for the first months of life, and it continues to provide up to half or more of their nutritional needs during the second half of their first year, and up to one-third during their second year of life.
There are also several long-term health benefits of breastfeeding. Breastfed tamariki perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers, and breastfeeding has been shown to protect against post-partum depression.
Our commitment to supporting breastfeeding for pēpi in care
If the plan is for pēpi to come into care after birth, it is critical that the plan includes how breastfeeding is going to be supported if the mother wishes to do this. If breastfeeding cannot be supported, the plan should consider how the pēpi can have access to breast milk if at all possible.
It is not the role of Oranga Tamariki when working with a mother and pēpi to make the decision whether a mother should breastfeed. However, social workers need to work with the mother and her health providers, especially midwives, to ensure that, if a mother decides to breastfeed, this can be done safely and in the best interests of the pēpi. If the mother is using drugs or alcohol and in particular methamphetamine or opiates including methadone, the birth and breastfeeding planning should consider medical advice about the impact these have on pēpi when passed through breast milk.
It is the right of a newborn pēpi to be breastfed and the right of the mother to breastfeed her pēpi if she chooses, unless it is unsafe to do so. While supporting breastfeeding may be complex due to safety and care concerns, Oranga Tamariki has an obligation to support breastfeeding even when a pēpi is no longer in the care of their mother.
We need to ensure the right supports and information are made available to allow a mother and her whānau to make an informed choice about breastfeeding.
Breastfeeding will be most effectively supported if mother and pēpi can be placed safely together. A safety plan may be required for this to occur.
When mother and pēpi cannot be placed together and physical separation needs to occur, we need to do everything we can to encourage and support breastfeeding, including:
- ensuring support and information about breastfeeding is provided to the mother
- developing a safety plan that enables breastfeeding to occur
- ensuring frequent contact between the mother and her pēpi that enables breastfeeding
- providing appropriate resources (such as a double electric breast pump, containers for breast milk and accessories)
- ensuring transport for the breast milk to the pēpi
- educating the caregiver on the importance of supporting breastfeeding and breast milk, and ensuring they have the appropriate resources to enable it to occur.
Supporting breastfeeding despite safety or care concerns
Safety concerns during breastfeeding between the mother and her pēpi are often created by other adults through, for example, violence. However, drug and alcohol use by the mother is a safety concern. Safety concerns need to be carefully considered when plans to support breastfeeding are made.
A key area of concern in respect to breastfeeding is if the mother is using drugs such as methamphetamine or alcohol. This is because these can be present in breast milk and have an impact on the pēpi. There is specialised advice available regarding how risk in these situations can be reduced or managed – for example, while breastfeeding should not occur if the mother is using methamphetamine regularly, if methamphetamine use happened as a one-off occurrence, breastfeeding could still be safely continued after a period of 24 to 48 hours. The mother would need to use a breast pump during this time to maintain her milk supply, but her breast milk would not be given to pēpi. Discuss with the midwife, lead maternity carer or Wellchild/Tamariki Ora nurse the best suitable feeding alternatives for pēpi during this time.
Many medications are compatible with breastfeeding, but some are not. Certain prescription drugs can cause harm to the baby, and other medications can cause a decrease in the milk supply.
Some of the medications that are not compatible with breastfeeding are chemotherapy drugs, antiretroviral medications, radioactive iodine, some sedatives, seizure medication, and medicines that may cause drowsiness and suppress breathing.
Some infections can also be passed on through breast milk. These include HIV, HTLV (a virus linked to leukaemia and lymphoma) and tuberculosis.
Seek advice from health professionals, including the lead maternity carer, around the risks, issues and how to address any drug or health related safety concerns.
National Care Standards and assessment of needs
Assess the needs associated with breastfeeding under the health domain. Decisions regarding breastfeeding and how these will be supported need to be recorded in the All About Me plan for pēpi and reflected in the caregiver’s plan.
- Engage early with the mother, whānau or family and lead maternity carer to understand the wishes of the mother and whānau or family in terms of breastfeeding and breast milk. Does the mother plan to breastfeed her pēpi and want to continue to breastfeed despite the pēpi being cared for by other whānau or family or caregiver? If so, work with the mother, whānau or family and the lead maternity carer to build a plan to support this and ensure there is a wraparound support service for the mother and her pēpi.
- The lead maternity carer has the lead/key role in supporting the mother’s choices and care of pēpi. Engage and work with the lead maternity carer to ensure the mother has access to information and support to enable her choices.
- Consider how to engage with the parents, whānau or family, midwife and health support to ensure everyone has the correct information and understands the impacts of the choices they are making.
- Consider how to engage and communicate with the father of pēpi and his whānau or family and support their engagement in decision-making, and support of breastfeeding and access to breast milk.
- Whānau or family are the best support and resource to assist and enable breastfeeding to happen. Partners, mothers, sisters and cousins play an important role in supporting decisions to breastfeed and overcoming barriers to breastfeeding. Consider what support whānau or family need to play this critical role in supporting the mother and pēpi.
- Whānau or family and other cultural communities have different values and beliefs that underpin their views on motherhood and breastfeeding. Seek to understand the cultural practices of the mother’s whānau or family and seek advice from cultural experts if needed.
Arrangements for breastfeeding or the transporting of breast milk should be determined based on the needs and best interests of the pēpi, and not influenced by a lack of resources and cost. When a mother needs to express her milk for whatever reason, this can be frozen without losing its quality.
Placement and caregiver preparation
Breastfeeding will be most effectively supported if mother and pēpi can be placed safely together, so consider options that will allow this to occur. A safety plan to ensure the safety of the pēpi during breastfeeding may be required.
Caregivers, whether whānau or non-whānau, need to understand and be committed to what is being asked of them. Caregivers may need some practical things such as access to refrigeration or freezer space for expressed milk. Caregivers also need to understand the increased requirement for direct contact with the mother and their role in supporting breastfeeding.
Work with the caregiver and caregiver social worker to ensure the caregiver’s needs for information and practical supports are addressed and ensure these are included in the Caregiver Support Plan.