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Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding

Pat Hoddinott. Research team: University of Aberdeen: Leone Craig University of Stirling: Jane Britten, Rhona McInnes. Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding. Aim.

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Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding

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  1. Pat Hoddinott Research team: University of Aberdeen: Leone Craig University of Stirling: Jane Britten, Rhona McInnes Infant Feeding Care:Women and Family Experiences of Establishing Breastfeeding

  2. Aim To link the experiences and perspectives of women and families with research evidence and policy Different approaches

  3. The Feeding Support Team Project A research project NHS Grampian

  4. 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

  5. Health Inequalities

  6. NHS resources: balance Sitting through a feed Breastfeeding workshops

  7. Pregnancy Ideal Reality No evidence (Gagnon 2007) Segregation disliked - inflexible Emotions, confidence & reassurance are crucial The word on the street • More AN education will change behaviour • Separating women by feeding intention – BF workshops • Correct technique = no problems • Rosy pictures Theory v practice

  8. They tell you that there’s “a way” of doing it, when in fact what you want to know is that there’s loads of different ways of doing it Theory and practice

  9. 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

  10. Communication: respect for different values

  11. 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

  12. Goal setting - policy Smart goal setting Setting women up to fail

  13. 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

  14. NICE Behaviour Change Guidance (2007) Smart goal setting

  15. I could feel myself welling up because I had my heart set on getting out [of hospital] that day …that’s why I said we’d go on to the formula (Stopped breastfeeding in hospital) 'We call that a crisis bottle,' she (health visitor) went, 'andthere'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) Pivotal points

  16. Pivotal points - behaviour change Story telling (woman centred) Q and A (breastfeeding centred)

  17. Performing and craft skills

  18. Rules Reality Ideal “Rules work” assumes: • There is a right way to breastfeed • Do’s and don’ts • 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

  19. 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 Breaking the rules

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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Results: 23% increase in any breastfeeding (n=69) • 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)

  26. Before and during the feeding team on the ward % any breastfeeding

  27. Telephone call activity Proactive calls: 35 women Medians Reactive calls: 34 women 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.....

  28. CONCLUDING THOUGHTS

  29. 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

  30. Why is proactive CARE in the early weeks important? Anticipate pivotal points Addresses the inverse care law NHS actions speak louder than words

  31. 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)

  32. Evolution: division of labour and specialisation

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