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Breastfeeding in Bristol: teaching good positioning, and support from fathers and families.

Abstract

OBJECTIVES

to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis.

DESIGN

a non-randomised prospective cohort phased intervention study.

SETTING

subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998.

PARTICIPANTS

1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique.

INTERVENTION

a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care.

MEASUREMENTS

frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems.

FINDINGS

significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) and in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02). Logistic regression analysis produced a model which showed that mothers with high scores for the 'hands-off' technique were significantly more likely to be breastfeeding at six weeks compared with those who did not use all the elements of the technique (OR 2.4; CI 1.3, 4.3). Factors associated with continuing to breastfeed at two and six weeks postpartum were also investigated using logistic regression. At two weeks, the significant factors associated with breastfeeding included mothers feeling that they had a 'plentiful milk supply' (OR 3.3; CI 2.1, 5.3), not using a dummy (OR 2.6; CI 1.6, 4.0), not giving the baby any other fluid in hospital (OR 2.4; CI 1.5, 3.8) and receiving enough support for breastfeeding from hospital staff (OR 2.1; CI 1.3, 3.5). By six weeks, in addition to these factors, the encouragement from a supportive partner, other family members and health professionals in enabling women to continue to breastfeed was found to show the largest associations with the maintenance of breastfeeding [(OR 37.2; CI 17.3, 80.2) for all three encouraging (327/817; 40% of breastfeeders) compared with no encouragement (67/817; 8% of breastfeeders)].

CONCLUSIONS

in the immediate postnatal period, if mothers are taught good breastfeeding technique by midwives in a 'hands-off' style, which enables mothers to position and attach their babies for themselves, and which is based on a physiological approach, breastfeeding rates are increased and the incidence of perceived milk insufficiency decreases. Successful breastfeeding in the early weeks was associated both with practices and support in hospital and with factors at home including not using dummies and having a supportive partner, family and health professionals who are encouraging breastfeeding.

IMPLICATIONS FOR PRACTICE

teaching mothers how to breastfeed in a 'hands-off' way is important in empowering mothers to 'do it for themselves' and in improving breastfeeding rates. Widespread adoption of consistent good practice is achievable following a brief workshop teaching session. Using the 'breastfeeding score checklist' may help midwives to assess a breastfeed more accurately and determine which aspects need improving. Health professionals should aim to educate all key family members, whenever an opportunity arises both during pregnancy and postnatally, in the benefits of breast milk for babies in the first few months of life and how to encourage and support a mother in the early weeks of breastfeeding.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Institute of Child Health, University of Bristol, Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK. jenny.ingram@bristol.ac.uk

    ,

    Source

    Midwifery 18:2 2002 Jun pg 87-101

    MeSH

    Adolescent
    Adult
    Breast Feeding
    Cohort Studies
    England
    Fathers
    Female
    Health Knowledge, Attitudes, Practice
    Humans
    Logistic Models
    Male
    Midwifery
    Mother-Child Relations
    Mothers
    Nurse's Role
    Patient Education as Topic
    Prospective Studies
    Surveys and Questionnaires
    Time Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    12139907

    Citation

    Ingram, Jenny, et al. "Breastfeeding in Bristol: Teaching Good Positioning, and Support From Fathers and Families." Midwifery, vol. 18, no. 2, 2002, pp. 87-101.
    Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery. 2002;18(2):87-101.
    Ingram, J., Johnson, D., & Greenwood, R. (2002). Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery, 18(2), pp. 87-101.
    Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: Teaching Good Positioning, and Support From Fathers and Families. Midwifery. 2002;18(2):87-101. PubMed PMID: 12139907.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. AU - Ingram,Jenny, AU - Johnson,Debbie, AU - Greenwood,Rosemary, PY - 2002/7/26/pubmed PY - 2002/11/26/medline PY - 2002/7/26/entrez SP - 87 EP - 101 JF - Midwifery JO - Midwifery VL - 18 IS - 2 N2 - OBJECTIVES: to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis. DESIGN: a non-randomised prospective cohort phased intervention study. SETTING: subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998. PARTICIPANTS: 1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique. INTERVENTION: a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care. MEASUREMENTS: frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems. FINDINGS: significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) and in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02). Logistic regression analysis produced a model which showed that mothers with high scores for the 'hands-off' technique were significantly more likely to be breastfeeding at six weeks compared with those who did not use all the elements of the technique (OR 2.4; CI 1.3, 4.3). Factors associated with continuing to breastfeed at two and six weeks postpartum were also investigated using logistic regression. At two weeks, the significant factors associated with breastfeeding included mothers feeling that they had a 'plentiful milk supply' (OR 3.3; CI 2.1, 5.3), not using a dummy (OR 2.6; CI 1.6, 4.0), not giving the baby any other fluid in hospital (OR 2.4; CI 1.5, 3.8) and receiving enough support for breastfeeding from hospital staff (OR 2.1; CI 1.3, 3.5). By six weeks, in addition to these factors, the encouragement from a supportive partner, other family members and health professionals in enabling women to continue to breastfeed was found to show the largest associations with the maintenance of breastfeeding [(OR 37.2; CI 17.3, 80.2) for all three encouraging (327/817; 40% of breastfeeders) compared with no encouragement (67/817; 8% of breastfeeders)]. CONCLUSIONS: in the immediate postnatal period, if mothers are taught good breastfeeding technique by midwives in a 'hands-off' style, which enables mothers to position and attach their babies for themselves, and which is based on a physiological approach, breastfeeding rates are increased and the incidence of perceived milk insufficiency decreases. Successful breastfeeding in the early weeks was associated both with practices and support in hospital and with factors at home including not using dummies and having a supportive partner, family and health professionals who are encouraging breastfeeding. IMPLICATIONS FOR PRACTICE: teaching mothers how to breastfeed in a 'hands-off' way is important in empowering mothers to 'do it for themselves' and in improving breastfeeding rates. Widespread adoption of consistent good practice is achievable following a brief workshop teaching session. Using the 'breastfeeding score checklist' may help midwives to assess a breastfeed more accurately and determine which aspects need improving. Health professionals should aim to educate all key family members, whenever an opportunity arises both during pregnancy and postnatally, in the benefits of breast milk for babies in the first few months of life and how to encourage and support a mother in the early weeks of breastfeeding. SN - 0266-6138 UR - https://www.unboundmedicine.com/medline/citation/12139907/Breastfeeding_in_Bristol:_teaching_good_positioning_and_support_from_fathers_and_families_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0266613802903086 DB - PRIME DP - Unbound Medicine ER -