Unmet Needs: Breastfeeding Pilot Project

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Unmet Needs Breastfeeding Pilot Project

• Kim Fraser
• Breastfeeding Project Leader

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Unmet Needs

• Pilot Project
• 3 NHS boards with highest deprivation
• Demonstrate a link with deprivation and health
  gain
• Evidence based
• Innovative, sustainable, partnership working

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Infants should be exclusively breastfed for
the first six months of life to achieve optimal
growth, development and health and continue up to
two years of age or beyond. (WHO 2003)
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Inequalities

• Disadvantaged areas-50 less likely B/F
• 1990- highest rates social class 1-3
• (Dundee Infant Feeding Study)
• 2000s
• most affluent 68.2
• Most disadvantaged 29.4
• (Health Inequalities Strategy)

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Breastfeeding by Postcode
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Evidence

• Systematic Review NICE 2005
• Successful interventions
• Include both antenatal and postnatal periods
• One to one interventions
• Need further evidence especially deprived areas

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Evidence
Mothers Who Would Have Liked to Breastfeed Longer
Source Hamlyn et al 2002
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Evidence Variables

• Health care factors
• Partner and family
• support
• Lactation knowledge
• and understanding
• Workplace
• environment

• Years of education
• Parity
• Age
• Income

Source Higginson 2001
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Evidence

• Use of Healthcare Assistants
• DOH report on evaluation breastfeeding between
  1999 and 2002
• 3 projects which explored the role of health care
  assistants providing extra support to
  breastfeeding mothers
• Qualitative evidence from these indicated that it
  was a successful way of working

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Summary Evidence

• Mothers wishing to breastfeed longer
• Mothers wish more support
• Initiatives that cover both the antenatal and
  postnatal periods are more effective
• Use of healthcare assistants has been successful
• Some factors are modifiable

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AIMS

• To provide women on low incomes in Dundee with
  additional information and support by
  breastfeeding support workers to improve
  breastfeeding initiation and duration rates

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Objectives

• Recruit and train BSWs
• Identify mothers living in deprived areas from
  postcode areas
• Provide additional support , information and
  practical skills in the antenatal and postnatal
  periods
• Evaluate effectiveness

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Design

• Non- randomised experimental design
• Intervention group Depcat 5,6 and 7 areas of
  Dundee
• 2 control groups
• Inclusion Criteria- All pregnant women living in
  the designated postcode areas
• Exclusion Criteria- none

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Recruitment

• System that allows information to be obtained
• Information when collect hand held notes
• Contacted by BSW
• Rate 1 in 4 initially increased to 40
• Not persuading

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Intervention

• Provided by Breastfeeding Support Workers
• Make contact in the antenatal period
• Continues postnatally in hospital and home
• Up to 6 weeks post discharge
• Additional support
• Not problem solving

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Results (July to December)
Source ISD 2006
Source ISD May 2006
Source ISD 2006
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Results (July to March)
Intervention 9 increase (CI 4.7-13.3) Control
increase 1.8(CI -8.8- 12.4) All points of
examination statistically significant difference
plt0.001
Source ISD September 2006
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Breastfeeding in Tayside at 6-8 weeks
Source ISD 2006
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Results first 6 months
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Results
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Results
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Qualitative Data

• Maternal Satisfaction Questionnaires
• 76 response rates
• High levels of satisfaction
• Emerging themes
• Enabled establishment and continuation of
  breastfeeding
• Knowledge and Information
• Supportive role
• Increased confidence

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Qualitative data

• Focus Groups
• Breastfeeding Support Workers
• Midwives
• Health Visitors
• In-depth Interviews
• Mothers-12

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Continuation

• In May NHS Tayside Executive Team extended
  project until end March 2007 further data
  collection
• September- Executive Team agreed to non-recurring
  funding for 3wte breastfeeding Support Workers
  for further 2 years

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Future

• Integrate model into mainstream practice
• Expand throughout Tayside
• Disseminate information to other health board
  areas

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Conclusion

• This is a project which has taken the limited
  evidence around breastfeeding and deprivation and
  through a research process has demonstrated an
  effective model of working that can improve
  breastfeeding rates for those living in deprived
  communities that can be used to inform future
  practice.