Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding

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Infant Feeding CareWomen and Family Experiences
of Establishing Breastfeeding

• Pat Hoddinott

• Research team
• University of Aberdeen Leone Craig
• University of Stirling Jane Britten, Rhona
  McInnes

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Aim

• To link the experiences and perspectives of women
  and families with research evidence and policy
• Different approaches

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INFORMATION ABOUT THE RESEARCH Talking about feeding babies A research study A chance to share your experiences of feeding babies and make a difference to the care families receive in future You can join this study by letter, by e mail, by telephone or through the website www.babyfeedingtalk.com

The Feeding Support Team Project A research
project
NHS Grampian
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Talking about feeding babies study

• Disadvantaged areas in Stirling and Aberdeen
• 36, women, 26 fathers, 8 grandmothers, 1 sister
  and 2 health visitors
• 220 interviews from pregnancy until 6 months
  after birth
• Hoddinott P. et al. NHS Health Scotland. 2010.
  http//www.healthscotland.com/documents/4720.aspx

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Health Inequalities
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(No Transcript)
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NHS resources balance
Sitting through a feed
Breastfeeding workshops
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Pregnancy
Ideal
Reality

• More AN education will change behaviour
• Separating women by feeding intention BF
  workshops
• Correct technique no problems
• Rosy pictures

• No evidence (Gagnon 2007)
• Segregation disliked -
• inflexible
• Emotions, confidence reassurance are crucial
• The word on the street

Theory v practice
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Theory and practice
They tell you that theres a way of doing it,
when in fact what you want to know is that
theres loads of different ways of doing it
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Parenting models
Ideal
Reality

• Intensive mothering (Lee 2008) breastfeeding
  on demand
• Fathers family do the household chores
• Persevere whatever
• Sacrifice me time

• Family well-being is the priority
• Father feeding - a unique bond
• Immediate gains of stopping BF pain, time,
  sleep, anxiety
• Other priorities for time

Meanings and values
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Communication respect for different values
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Goals
Ideal
Reality

• Aim maximum health gain - nutrition and
  bonding
• Exclusive breastfeeding

• Aim a happy mother, baby and family
• Well-being determined by a complex balance of
  values

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Goal setting - policy
Smart goal setting
Setting women up to fail
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Translation of policy

• The midwife was like....
• its for six months and basically
• you are attached to this baby for six months
  and she made it seem quite negative

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Smart goal setting
NICE Behaviour Change Guidance (2007)

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Pivotal points
I could feel myself welling up because I had my
heart set on getting out of hospital that day
thats why I said wed go on to the formula
(Stopped breastfeeding in hospital) 'We call
that a crisis bottle,' she (health visitor) went,
'and there's nothing wrong with that she says.
'If it works for you, that's fine, but one bottle
a day is not going to do any harm,' so if
anything she was a bit more encouraging (Still
breastfeeding at 6 months)
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Pivotal points - behaviour change
Story telling (woman centred)
Q and A (breastfeeding centred)
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Performing and craft skills
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Rules
Reality
Ideal

• Rules work assumes
• There is a right way to breastfeed
• Dos and donts
• Rights and wrongs
• Guidelines
• Checklists
• No conflicting information
• or practice

• Rules are resisted as feeding has multiple
  meanings
• All or nothing unpopular
• Experiential knowledge
• Family narratives
• Word on the street
• Conflicting information and practice

Compliance v deviance
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Breaking the rules

• Father We feel that we've done the right thing
  introducing solids, but there was not...  
• Mother It was a hard decision for us, wasn't it?
   
• Father Aye, it was a hard decision because we
  were going against...  
• Mother The rules, if you like  
• Father The rules, we were breaking the rules

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The Feeding Support Team Project A research
project
The FEST Study
NHS Grampian
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Evidence

• Global ideal

• UK
• reality

• Hoddinott et al. (2011)
• Since 2000 all 9 UK RCTs of additional lay or
  professional support no significant
  effects on breastfeeding duration

• Evidence synthesis - Chung et al. (2008)
  Britton et al. (2007)
• Additional lay or professional support is
  effective at improving breastfeeding duration

Context matters
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Health inequalities behaviour change
Ideal
Reality

• Targeting low SES women with more one-to-one
  health professional information, advice and
  support will change behaviour
• Assumes rational decision making

• Environmental and system interventions may be
  more effective
• Dual process decision making (Strack Deutsch,
  2004) - automatic decisions

Jury still out
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Universal health care provision
Reality
Ideal

• All staff fully support exclusive breastfeeding
  and are trained to provide evidence based
  consistent care
• Staff have sufficient time
• Seamless transition between hospital and
  community

• Commitment, personalities skills vary
• Staff shortages and competing demands
• Centralisation of services impedes continuity
  and communication

Evolution Adaptation
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Study design

• Intervention scenarios
• Dedicated feeding team on a postnatal ward
  before and after study
• RCT Proactive and reactive daily telephone
  support vs. reactive only for 2 weeks

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Results 23 increase in any breastfeeding
(n69)

OR 2.56 95 CI 0.88, 7.51 (p 0.085)
Number of women
OR 2.55 95 CI 0.86, 7.54 (p 0.091)
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Before and during the feeding team on the ward

any breastfeeding
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Telephone call activity

• Reactive calls 34 women

• Proactive calls 35 women
• Medians

• Only 1 call
• Call lasted 8 minutes

• 8 calls per woman
• 3 attempted calls per woman
• Successful calls lasted 5 minutes
• 3 women stopped calls before day 7
• 20 stopped calls before day 14

Surprise!
I thought the phone would never stop
ringing.....
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CONCLUDING THOUGHTS
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Why is the idealism-realism debate important?

• Overt or covert philosophies determine our spoken
  and unspoken language and our actions
• Mismatch in goals/values creates tension
• Critical reflection can help us to understand
  human behaviour and relationships
• Policy top down bottom up

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Why is proactive CARE in the early weeks
important?

• Anticipate pivotal points
• Addresses the inverse care law
• NHS actions speak louder than words

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What next?

• RCT proactive team telephone support
• Premature babies (Sweden Renee Flacking et al.)
• UK Neonatal Units
• BIBS Benefits of Incentives for Breastfeeding
  and Smoking cessation in pregnancy (Grampian,
  Lancashire, Glasgow)

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Evolution division of labour and specialisation