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A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration.
Midwifery 2006; 22(3):262-73M

Abstract

OBJECTIVE

To determine whether postnatal 'hands off' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration.

DESIGN

Mothers were randomised at the first postnatal feed to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care.

SETTING

Eight wards in four English Midlands hospitals.

PARTICIPANTS

370 primiparous mothers with term babies who intended to breast feed, and could sit out of bed to do so.

INTERVENTIONS

Experimental protocol of verbal-only advice on positioning and attachment, delivered at the first postnatal ward feed compared with routine care by a qualified midwife.

MAIN OUTCOME MEASURES

Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife. The mothers' self-reported experience of care and support before, during and after delivery were assessed at 6 weeks, and feeding outcomes and employment status at 17 weeks.

FINDINGS

Experimental group mothers more often held the baby across their lap and received 'hands off advice', but fewer babies in the experimental than control groups attached and fed: 59% (106/180) vs. 67% (118/175), p=0.1. No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups (stopped exclusive breast feeding: 76% (130/172) vs. 77% (126/163) at 6 weeks; 96% (167/174) vs. 96% (161/168) at 17 weeks; odds ratio 1.02, 95% CI 0.77 to 1.22; p=0.8; stopped any breast feeding: 35% (61/172) vs. 32% (53/167) at 6 weeks; 63% (109/173) vs. 60% (101/167) at 17 weeks; odds ratio 1.10, 0.84 to 1.45; p=0.5). There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation (other than at the first postnatal ward feed), nor after discharge home.

CONCLUSIONS

No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment, perhaps because aspects of the intervention are already within routine UK practice. Other care practices at subsequent feeds may negate benefits of care at earlier feeds. 'Hands off' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward.

IMPLICATIONS FOR PRACTICE

Midwives can be trained in a 4-hr workshop to achieve improved knowledge of 'hands off' positioning and attachment care, and these can be translated into clinical practice. Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds, and apply this advice consistently at successive feeds.

Authors+Show Affiliations

Health Services Research Centre, GE404, School of Health, Coventry University, Priory Street, Coventry CV1 5FB, UK. l.wallace@coventry.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16380197

Citation

Wallace, Louise M., et al. "A Randomised-controlled Trial in England of a Postnatal Midwifery Intervention On Breast-feeding Duration." Midwifery, vol. 22, no. 3, 2006, pp. 262-73.
Wallace LM, Dunn OM, Alder EM, et al. A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration. Midwifery. 2006;22(3):262-73.
Wallace, L. M., Dunn, O. M., Alder, E. M., Inch, S., Hills, R. K., & Law, S. M. (2006). A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration. Midwifery, 22(3), pp. 262-73.
Wallace LM, et al. A Randomised-controlled Trial in England of a Postnatal Midwifery Intervention On Breast-feeding Duration. Midwifery. 2006;22(3):262-73. PubMed PMID: 16380197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration. AU - Wallace,Louise M, AU - Dunn,Orla M, AU - Alder,Elizabeth M, AU - Inch,Sally, AU - Hills,Robert K, AU - Law,Susan M, Y1 - 2005/12/27/ PY - 2004/10/21/received PY - 2005/06/01/revised PY - 2005/06/15/accepted PY - 2005/12/29/pubmed PY - 2006/12/27/medline PY - 2005/12/29/entrez SP - 262 EP - 73 JF - Midwifery JO - Midwifery VL - 22 IS - 3 N2 - OBJECTIVE: To determine whether postnatal 'hands off' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration. DESIGN: Mothers were randomised at the first postnatal feed to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care. SETTING: Eight wards in four English Midlands hospitals. PARTICIPANTS: 370 primiparous mothers with term babies who intended to breast feed, and could sit out of bed to do so. INTERVENTIONS: Experimental protocol of verbal-only advice on positioning and attachment, delivered at the first postnatal ward feed compared with routine care by a qualified midwife. MAIN OUTCOME MEASURES: Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife. The mothers' self-reported experience of care and support before, during and after delivery were assessed at 6 weeks, and feeding outcomes and employment status at 17 weeks. FINDINGS: Experimental group mothers more often held the baby across their lap and received 'hands off advice', but fewer babies in the experimental than control groups attached and fed: 59% (106/180) vs. 67% (118/175), p=0.1. No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups (stopped exclusive breast feeding: 76% (130/172) vs. 77% (126/163) at 6 weeks; 96% (167/174) vs. 96% (161/168) at 17 weeks; odds ratio 1.02, 95% CI 0.77 to 1.22; p=0.8; stopped any breast feeding: 35% (61/172) vs. 32% (53/167) at 6 weeks; 63% (109/173) vs. 60% (101/167) at 17 weeks; odds ratio 1.10, 0.84 to 1.45; p=0.5). There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation (other than at the first postnatal ward feed), nor after discharge home. CONCLUSIONS: No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment, perhaps because aspects of the intervention are already within routine UK practice. Other care practices at subsequent feeds may negate benefits of care at earlier feeds. 'Hands off' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward. IMPLICATIONS FOR PRACTICE: Midwives can be trained in a 4-hr workshop to achieve improved knowledge of 'hands off' positioning and attachment care, and these can be translated into clinical practice. Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds, and apply this advice consistently at successive feeds. SN - 0266-6138 UR - https://www.unboundmedicine.com/medline/citation/16380197/A_randomised_controlled_trial_in_England_of_a_postnatal_midwifery_intervention_on_breast_feeding_duration_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0266-6138(05)00064-1 DB - PRIME DP - Unbound Medicine ER -