From Insight to Impact: Reflections on the development and spread of the Early Breast Milk Improvement Project toolkit

This blog explores how we are supporting mothers to safely and effectively express breastmilk through improving equity of access to properly fitted breast pump equipment.

Why the right fit matters

It sounds obvious that equipment needs to fit the patient, but have you ever wondered why we don't measure women for breast pumps? New evidence shows a well fitted breast pump flange will increase milk output, reduce pain, and reduce the risk of developing mastitis.

A mother's story that sparked change

After hearing a powerful patient story about a mother developing mastitis whilst expressing for her premature baby, Amber Clark, a local infant feeding specialist from University Hospital Southampton (UHS), was inspired to look into this issue further. It is hugely beneficial for premature babies to receive their mothers breast milk. Early breastmilk reduces the risk of sepsis, necrotising enterocolitis, and improves longer-term neurodevelopmental health, but it's hard work to express frequently and can be uncomfortable. This particular lady had to be admitted to hospital twice with mastitis and therefore separated from her new baby.

Amber’s experience and passion as an international board-certified lactation consultant combined with having recently completed the Health Innovation Wessex Maternity and Neonatal Coaching Programme meant she was well equipped to take this on as a quality improvement project.

What the research revealed

Her research highlighted that the flanges typically provided on wards were far too big for most women. In Ambers clinical experience the standard size flange fitted less than 1% of women she supported and could result in less milk being expressed, cause discomfort and potentially lead to mastitis. This led her to implement a small-scale pilot at University Hospital Southampton looking at flange sizing to support mothers to optimise breast milk yield and reduce discomfort. Encouraged by her and her teams' initial findings on the ward Amber was keen to see this grow.

Scaling up!

Health Innovation Wessex received a small pot of money from NHS England South West, and initiated a project to scale up this work to spread this best practice across the trusts in Wessex.

From April 2024 I worked with Amber and infant feeding leads across maternity and neonates and service users to develop practical resources for healthcare professionals and patients helping to scale this project.

We were committed to supporting the local healthcare system in addressing health inequalities. Central to this quality improvement project was our focus on ensuring equity of access for women of appropriately fitted expressing equipment, ensuring women from low incomes aren’t disadvantaged by having to purchase their own equipment.

Practical solutions for system-level change

The Early Breast Milk Improvement Project toolkit resources were developed through insight, and include;

• A patient information video on flange sizing and good expressing technique available to view via a QR code attached to all hospital breast pumps
• A staff training webinar designed to update all maternity staff on flange sizing and the benefits of this
• A physical handheld tool developed and distributed to support nipple measurement (also attached to hospital breast pumps).

Using our knowledge and evidence of this issue, we;

• Supported six other trusts in their purchasing of different flanges to keep as ward stock
• Negotiated with UK distributors to keep the cost of purchasing different sizes cost neutral for trusts
• Ensured that all trusts, regardless of the pump brands used, had the information needed to purchase smaller flange sizes
• Worked with infection control to provide a ward sizing kit to reduce plastic wastage.

I have worked across Wessex in various maternity roles and am aware of the challenges and complexities that come with making improvements at a system level. This is especially true with staff time and capacity, so I was blown away to see the level of interest this piece of work generated.

By February 2025, all resources were available in Wessex, and we compiled them into a free toolkit for other areas to access should they wish to implement in their local unit. We have received excellent feedback from women who have accessed the resources and the impact they are seeing for themselves, as well as from staff.

“I don’t dread pumping like I did previously, I am now pumping 40 ml of breastmilk on the left side alone, comfortably and quickly.”

Expressing mother

“I love the patient education video - the information is so clearly explained and visual. I am really excited to use this within our trust, and I think it will hugely improve the outcomes for our families who use breast pumps.”

Infant feeding lead

Delivering impact

University Hospitals Southampton saw an increase in the number of preterm babies receiving breastmilk within two days increase by 13% from April 2024 to April 2025.

The national interest in this project has been incredible, since we launched the toolkit in February 2025, it has been viewed 7,356 times from February 2025 - September 2025 with many other units having implemented or planning to implement including units in Australia and a charity working in Gaza.

Gaining recognition

I am so pleased that others have been able to use the resources we have developed in Wessex, we are aware of four other trusts that have implemented so far with interest from many others. We have been able to promote this project through national networks, Neonatal Operation Delivery Networks, British Dietetic Association, Neonatal Nurse Association, NHS Confederation and Health Innovation Network. The project impact and spread is currently being evaluated by Health Innovation Wessex.

I have loved supporting Amber with this, her passion, proactivity and initiative to get this off the ground has been inspiring and has been great to see her develop in her role from maternity support worker, breastfeeding specialist nurse to now leading the infant feeding team and I hope it inspires other clinicians to implement change in their area. This project has won both a local and South East region Excellence awards.

“I am thrilled to have been nominated and to win this award. It is a great opportunity to highlight the project within the system. Thanks to all those passionate clinicians currently working on this project and to Health Innovation Wessex for supporting the spread and adoption.”

Amber Clark, Infant Feeding Specialist

Power of collaborative innovation

For me this project highlights the role of the health innovation network, working with local clinicians on evidence-based quality improvement, using project management expertise to deliver this project and subsequent impact, then utilising existing networks to promote nationally. It has been a great feeling to see so many mothers and babies benefiting from the work we have done and the feedback we receive. I am delighted to see the sheer scale and reach of the project, which will result in even more families being supported across the country. I am incredibly proud of the work Amber, and I have achieved and continue to promote, I have thoroughly enjoyed working with such a passionate and innovative clinician. Bring on the next project!

Discover the toolkit resources here - Early Breast Milk Improvement Project Toolkit