Qualitative study of decisions about infant feeding among women in east end of London

What is the impact of the Internet on decision-making in pregnancy? A global study

BACKGROUND

  Women need access to evidence-based information to make informed choices in pregnancy. A search for health information is one of the major reasons that people worldwide access the Internet. Recent years have witnessed an increase in Internet usage by women seeking pregnancy-related information. The aim of this study was to build on previous quantitative studies to explore women's experiences and perceptions of using the Internet for retrieving pregnancy-related information, and its influence on their decision-making processes.

METHODS

  This global study drew on the interpretive qualitative traditions together with a theoretical model on information seeking, adapted to understand Internet use in pregnancy and its role in relation to decision-making. Thirteen asynchronous online focus groups across five countries were conducted with 92 women who had accessed the Internet for pregnancy-related information over a 3-month period. Data were readily transferred and analyzed deductively.

RESULTS

  The overall analysis indicates that the Internet is having a visible impact on women's decision making in regards to all aspects of their pregnancy. The key emergent theme was the great need for information. Four broad themes also emerged: "validate information,""empowerment,""share experiences," and "assisted decision-making." Women also reported how the Internet provided support, its negative and positive aspects, and as a source of accurate, timely information.

CONCLUSION

  Health professionals have a responsibility to acknowledge that women access the Internet for support and pregnancy-related information to assist in their decision-making. Health professionals must learn to work in partnership with women to guide them toward evidence-based websites and be prepared to discuss the ensuing information.

How are babies fed? A pilot study exploring primary school children's perceptions of infant feeding

BACKGROUND

  Breastfeeding is the optimal feeding method for human infants. In the United Kingdom some women do not initiate breastfeeding, and many commence formula milk feeding after a brief period of breastfeeding. Infant feeding perceptions may develop early in life, and this research aimed to explore infant feeding awareness among primary school children as a first step toward informing appropriate health education interventions.

METHOD

  Fifty-six children aged 5/6, 7/8, and 10/11 years were recruited from three schools in southern England. Children were shown a series of drawings, and were read a story about a hungry newborn baby. A creative method, "draw, write and tell," was developed for this research. Children were asked to finish the story, showing how they thought the baby might be fed. They were given the opportunity to verbally interpret their work. A constant comparison method was used to analyze the data.

RESULTS

  Children were aware of formula milk, breastfeeding, and solid foods. Formula milk feeding was referred to more frequently than breastfeeding. Some children combined feeding methods. Children appeared to have gained their awareness in various settings.

CONCLUSIONS

  Children have a range of perceptions around infant feeding. They appear receptive to new ideas on the subject while of primary school age. An opportunity for education in primary schools arises to present breastfeeding to children as a normal way to feed a baby, but it is vital that education is evidence based and any interventions are evaluated.

Increasing support for breastfeeding: what can Children's Centres do?

Britain has one of the lowest breastfeeding rates in Europe, with particularly low rates among White British families living in disadvantaged communities. As breastfeeding has important long-term health benefits for babies and their mothers, this represents a serious inequality in health. It is part of the remit of Sure Start Children's Centres which serve disadvantaged areas to offer child and family health services, including breastfeeding support. This study utilised an action research strategy to involve stakeholders in developing and extending breastfeeding promotion and support within three Children's Centres in Bristol. A total of 10 focus groups were conducted with Children's Centre staff and local parents between July 2008 and May 2009. Stakeholders' views were explored on current breastfeeding promotion and how Children's Centres could better support breastfeeding to meet local needs. Barriers to breastfeeding promotion were identified as latent hostility in the local community towards breastfeeding, and lack of knowledge about infant feeding among staff. Following implementation of the proposed changes, staff, parents and researchers shared their views on what had been achieved and on possible future initiatives. While there was variation in the extent to which Children's Centres engaged with the action research process, and in the extent to which change was made, all Centres did develop their breastfeeding promotion practice. Initiatives put into practice included strengthening links with health professionals, actively seeking to involve fathers, increasing the breastfeeding peer support offered locally and adopting a clear 'Breastfeeding Welcome' policy. This study has demonstrated that a collaborative action research approach can effectively stimulate the development of breastfeeding promotion and support within Children's Centres, leading to prompt and sustainable changes in practice.

Breastfeeding duration, age of starting solids and high BMI risk and adiposity in Indian children

This study utilized data from a prospective birth cohort study on 568 Indian children, to determine whether a longer duration of breastfeeding and later introduction of solid feeding were associated with a reduced higher body mass index (BMI) and less adiposity. Main outcomes were high BMI (>90th within-cohort sex-specific BMI percentile) and sum of skinfold thickness (triceps and subscapular) at age 5. Main exposures were breastfeeding (six categories from 1-4 to ≥21 months) and age of starting regular solid feeding (four categories from ≤3 to ≥6 months). Data on infant-feeding practices, socio-economic and maternal factors were collected by questionnaire. Birthweight, maternal and child anthropometry were measured. Multiple regression analysis that accounted for potential confounders demonstrated a small magnitude of effect for breastfeeding duration or introduction of solid feeds on the risk of high BMI but not for lower skinfold thickness. Breastfeeding duration was strongly negatively associated with weight gain (0-2 years) [adjusted β = -0.12 standard deviation, 95% confidence interval (CI): -0.19 to -0.05 per category change in breastfeeding duration, P = 0.001], and weight gain (0-2 years) was strongly associated with high BMI at 5 years (adjusted odds ratio = 3.8, 95% CI: 2.53-5.56, P < 0.001). In our sample, findings suggest that longer breastfeeding duration and later introduction of solids has a small reduction on later high BMI risk and a negligible effect on skinfold thickness. However, accounting for sampling variability, these findings cannot exclude the possibility of no effect at the population level.

Men and infant feeding: perceptions of embarrassment, sexuality, and social conduct in white low-income British men

BACKGROUND

The views of fathers have been shown to be important determinants of infant feeding decisions, but men's perceptions of breastfeeding and formula feeding are rarely explored. Our objectives were to address this gap and examine cultural associations and beliefs concerning infant feeding practices among men.

METHODS

Five focus groups were conducted with low-income men (n = 28) living in areas of social deprivation in Leeds, northeast of England, and low-income areas of Glasgow, west of Scotland. Participants were white British men, aged between 16 and 45 years, and included fathers, expectant fathers, and potential fathers.

RESULTS

Overarching themes concerning sexuality, embarrassment, and social conduct were identified across all groups. Participants perceived breastfeeding as "natural" but problematic, whereas formula feeding was mainly considered as convenient and safe. Participants without direct experience of breastfeeding assumed that it involved excessive public exposure and attracted unwanted male attention. Underpinning these fears were strong cultural associations between breasts and sexuality and anxieties concerning appropriate gender roles.

CONCLUSIONS

In some communities few opportunities may occur to witness breastfeeding, and thus existing fears concerning the activity as attracting predatory male attention remain unchallenged. Perceptions of breastfeeding as a sexual activity and the dominant mass media emphasis on breasts as a sexual site may present additional obstacles to breastfeeding. Antenatal or perinatal education with men should address not only practical issues but also provide advice on tackling problems generated by wider sociocultural issues of sexuality and masculinity.

The correlation between breastfeeding and maternal quality of life in southern Brazil

PURPOSE

This study examined the relationship between the breastfeeding efficacy and quality of life (QoL) in a sample of 89 mothers from southern Brazil. To the authors' knowledge, this is the first study to explore correlations between maternal QoL and breastfeeding efficacy in Brazil.

METHODS

Research participants completed the Portuguese version of the World Health Organization Quality of Life-BREF and Multicultural Quality of Life Index questionnaires. Breastfeeding efficacy was evaluated through the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Correlations between the scores of the QoL instruments and the BSES-SF were examined using Pearson product-moment correlation coefficients.

RESULTS

There were significant correlations among the scores of the two QoL questionnaires and the BSES-SF. Multiple regression analysis revealed that both QoL instruments significantly predicted BSES-SF scores. Neither socioeconomic status nor level of educational attainment was a significant predictor of breastfeeding efficacy.

CONCLUSIONS

The results from the present study indicate that breastfeeding efficacy is significantly related to QoL among mothers in southern Brazil. The association between QoL and breastfeeding efficacy appears to be independent from any effect of socioeconomic status or level of educational achievement.

Infant feeding choices: experience, self-identity and lifestyle

In England, 78% of mothers initiate breastfeeding and, in the UK, less than 1% exclusively breastfeed until 6 months, despite World Health Organization (WHO) recommendations to do so. This study investigated women's infant feeding choices using in-depth interviews with 12 mothers of infants aged 7-18 weeks. Using content analysis, four themes emerged: (1) information, knowledge and decision making, (2) physical capability, (3) family and social influences, (4) lifestyle, independence and self-identity. While women were aware of the 'Breast is Best' message, some expressed distrust in this information if they had not been breastfed themselves. Women felt their own infant feeding choice was influenced by the perceived norm among family and friends. Women described how breastfeeding hindered their ability to retain their self-identities beyond motherhood as it limited their independence. Several second-time mothers felt they lacked support from health professionals when breastfeeding their second baby, even if they had previously encountered breastfeeding difficulties. The study indicates that experience of breastfeeding and belief in the health benefits associated with it are important factors for initiation of breastfeeding, while decreased independence and self-identity may influence duration of breastfeeding. Intervention and support schemes should tackle all mothers, not just first-time mothers.

UK-born ethnic minority women and their experiences of feeding their newborn infant

OBJECTIVE

to explore the factors that impact on UK-born ethnic minority women's experiences of and decisions around feeding their infant.

DESIGN

in-depth semi-structured interviews.

PARTICIPANTS

34 UK-born women of Black African, Black Caribbean, Pakistani, Bangladeshi, Indian and Irish parentage and 30 health-care professionals.

SETTING

women and health-care professionals were recruited primarily from hospitals serving large numbers of ethnic minority women in London and Birmingham.

FINDINGS AND CONCLUSIONS

despite being aware of the benefits of exclusive breast feeding, many women chose to feed their infant with formula. The main barriers to breast feeding were the perceived difficulties of breast feeding, a family preference for formula feed, and embarrassment about breast feeding in front of others. Reports from women of South Asian parentage, particularly those who lived with an extended family, suggested that their intentions to breast feed were compromised by the context of their family life. The lack of privacy in these households and grandparental pressure appeared to be key issues. Unlike other participants, Irish women reported an intention to feed their infant with formula before giving birth. The key facilitators to breast feeding were the self-confidence and determination of women and the supportive role of health-care professionals.

IMPLICATIONS FOR PRACTICE

these findings point to common but also culturally specific mechanisms that may hinder both the initiation and maintenance of breast feeding in UK-born ethnic minority women. They signal potential benefits from the inclusion of family members in breast-feeding support programmes.

Caregiver- vs infant-oriented feeding: a model of infant-feeding strategies among special supplemental nutrition program for women, infants, and children participants in rural east Tennessee

The aim of this project was to collect data from focus-group participants to inform the future development of region-specific educational strategies to modify infant-feeding practices that may predispose children to obesity. Infant-feeding perceptions and practices were collected from participants of the Special Supplemental Nutrition Program for Women, Infants, and Children, through recorded focus groups, in two East Tennessee counties. Focus groups replaced the participants' required, prescheduled nutrition-education classes for participants with infants younger than 6 months of age. Twenty-nine focus groups were convened and recorded, reaching a total of 109 participants. Results of this series of focus groups indicate that the Special Supplemental Nutrition Program for Women, Infants, and Children population in rural East Tennessee was similar to populations elsewhere in terms of early solid-food introduction, frequent switching of formula, and sources of and valuation of infant-feeding advice. However, this population seemed to be different in the magnitude at which they introduce infant cereal early (primarily as an addition to the bottle). For this reason, interventions designed to reduce inappropriate infant-feeding behaviors in this population should focus on early introduction of solid food (especially infant cereal) first. In addition to these findings, a model of infant-feeding strategy development based on caregiver-orientation (framed within parenting styles) is presented and discussed.

'Breast is not always best': South Asian women's experiences of infant feeding in the UK within an acculturation framework

Acculturating to a host country has a negative impact on immigrant women's breastfeeding practices, particularly when coming from countries where breastfeeding rates are higher than Western countries. Whether this is true of those immigrating to the UK remains to be investigated. The study aimed to explore whether acculturating to the UK had detrimental effects on breastfeeding practices of South Asian women, and to provide explanations as to how acculturation may have exerted its influence. Twenty South Asian women completed semi-structured interviews exploring infant feeding experiences. Data were thematically analysed. A bidimensional measure assessed women's acculturation status. Women displaying low acculturation levels were aware of living in a formula-feeding culture but this had little influence on breastfeeding intentions/behaviours; drawing upon South Asian cultural teachings of the psychological benefits of breast milk. These women opted to formula-feed in response to their child's perceived demands or in a bid to resolve conflict; either when receiving information about the best feeding method or between their roles as a mother and daughter-in-law. Highly acculturated women also experienced such conflict; their awareness of the formula-feeding culture governed feeding choice. The findings provide a picture of how acculturation may affect South Asian women's breastfeeding intentions and behaviours; encouraging health service providers to meet the varying needs of an acculturating population. If breastfeeding is to be encouraged, it is necessary to understand factors influencing feeding choice; with particular attention to the acculturation pathways that may govern such decisions. This paper highlights ways to tailor information for South Asian women depending on levels of acculturation.

Breastfeeding support - the importance of self-efficacy for low-income women

Breastfeeding is a key determinant in promoting public health and reducing health inequality. Low-income women have a significantly lower level of breastfeeding. Midwives in the UK have been encouraged to implement the World Health Organization/United Nations Children's Fund's Ten Steps to Successful Breastfeeding, but to date, there has been no evaluation of the impact of the training initiative on the breastfeeding behaviours of low-income women. As part of a wider study, this qualitative component was designed to answer the question - what are the views and experiences of low-income women (defined by Jarman scores) in relation to their breastfeeding support received in the post-natal period? A sample of seven women was interviewed. The in-depth interviews were analysed using a qualitative, thematic approach based on the self-efficacy theory. The four themes that emerged from the data were the following: breastfeeding related to the woman's self-confidence, the social environment in which the woman lived, knowledge of breastfeeding and the influence of maternity services on breastfeeding outcomes. These themes were interpreted in relation to the self-efficacy theory. The findings suggest that the components that inform self-efficacy are consistent with the themes from the data, suggesting that midwives and other health professionals should take the psychosocial aspects of breastfeeding support into account. As this important feature of breastfeeding support is not explicitly part of the current Ten Steps to Successful Breastfeeding, we suggest that further research and debate could inform expansion of these minimum standards to include the psychosocial aspects.

A meta-ethnographic synthesis of women's experience of breastfeeding

Despite considerable evidence and effort, breastfeeding duration rates in resource-rich countries such as Australia remain below World Health Organization recommendations. The literature on the experience of breastfeeding indicates that women construct and experience breastfeeding differently depending upon their own personal circumstances and the culture within which they live. Breastfeeding has also been described as a deeply personal experience, which can be associated with 'moral' decision-making. The aim of this synthesis was to better understand the social phenomenon of breastfeeding by making the hidden obvious. Using a meta-ethnographic approach, we analysed the findings from 17 qualitative studies exploring women's experience of breastfeeding. Commonly used metaphors, ideas and phrases across the national and international qualitative studies were identified. Two overarching themes emerged. Breastfeeding was described in terms of 'expectation' and 'reality', while the emotional aspects of breastfeeding were expressed in 'connected' or 'disconnected' terms. The prevalence of health professionals and public health discourses in the language women use to describe their experience, and the subsequent impact of this on maternal confidence and self-assessment of breastfeeding are discussed. This synthesis provides insight into some of the subtle ways health professionals can build maternal confidence and improve the experience of early mothering.

Seeing other women breastfeed: how vicarious experience relates to breastfeeding intention and behaviour

Vicarious experience gained through seeing women breastfeed may influence infant feeding decisions and self-efficacy. Our aim was to measure the attributes of seeing breastfeeding and to investigate how these relate to feeding intention (primary outcome) and behaviour (secondary outcome). First, we developed a Seeing Breastfeeding Scale (SBS), which consisted of five attitudes (Cronbach's alpha of 0.86) to most recently observed breastfeeding: 'I felt embarrassed'; 'I felt uncomfortable'; 'I did not know where to look'; and 'It was lovely' and 'It didn't bother me'. Test-retest reliability showed agreement (with one exception, kappas ranged from 0.36 to 0.71). Second, we conducted a longitudinal survey of 418 consecutive pregnant women in rural Scotland. We selected the 259 women who had never breastfed before for further analysis. Following multiple adjustments, women who agreed that 'It was lovely to see her breastfeed' were more than six times more likely to intend to breastfeed compared with women who disagreed with the statement [odds ratio (OR) 6.72, 95% confidence interval (CI) 2.85-15.82]. Women who completed their full-time education aged 17 (OR 3.09, 95% CI 1.41-6.77) or aged 19 (OR 7.41 95% CI 2.51-21.94) were more likely to initiate breastfeeding. Women who reported seeing breastfeeding within the preceding 12 months were significantly more likely to agree with the statement 'It was lovely to see her breastfeed' (P = 0.02). Positive attitudes to recently seen breastfeeding are more important determinants of feeding intention than age of first seeing breastfeeding, the relationship to the person seen and seeing breastfeeding in the media.

Establishing individual peer counselling for exclusive breastfeeding in Uganda: implications for scaling-up

Exclusive breastfeeding remains critical for child survival, potentially reducing childhood morbidity and mortality. In Uganda, 98% of children are ever breastfed, but exclusive breastfeeding levels remain low. Supporting mothers in breastfeeding exclusively can improve breastfeeding practices. This paper describes experiences of establishing individual peer counselling for exclusive breastfeeding in the Uganda site of the Promoting Infant Health and Nutrition in Sub-Saharan Africa: Safety and Efficacy of Exclusive Breastfeeding Promotion in the Era of HIV trial, and highlights some implications for scaling-up. Twelve women were identified by their communities, one from each of 12 clusters. They were trained for 6 days and followed up for 1 year while they counselled mothers. Their knowledge and attitudes towards exclusive breastfeeding were assessed before and immediately after training, and also 10 months into peer counselling. Observations, field notes and records of interactions with peer counsellors were used to record experiences from this intervention. The communities were receptive to peer counselling and women participated willingly. After training and 10 months' follow-up, their knowledge and attitude to exclusive breastfeeding improved. All were retained in the study, and mothers accepted them in their homes. They checked for mothers several times if they missed them on the first attempt. Husbands and grandmothers played key roles in infant feeding decisions. Involving the communities in selection helped to identify reliable breastfeeding peer counsellors who were acceptable to mothers and were retained in the study. Other key issues to consider for scaling-up such interventions include training and follow up of peer counsellors, which led to improved knowledge and attitudes towards exclusive breastfeeding (ClinicalTrials.gov no: NCT00397150).

Racial/Ethnic Differences in Breastfeeding Initiation and Duration Among Low-income, Inner-city Mothers

OBJECTIVES: Despite the promotion of breastfeeding as the "ideal" infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status. METHODS: Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration. RESULTS: Both foreign-born black mothers and Hispanic mothers (most of whom were foreign-born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers' prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women. CONCLUSION: Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was also more common among low-income immigrant black women than white or native-born black mothers.

Are starting and continuing breastfeeding related to educational background? The generation R study

OBJECTIVE

To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association.

METHODS

We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously.

RESULTS

Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics.

CONCLUSIONS

Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women.

Confident commitment is a key factor for sustained breastfeeding

BACKGROUND

The characteristics that distinguish women who breastfeed successfully from those who do not are just beginning to be identified in breastfeeding literature. The objective of this study was to identify the processes contributing to breastfeeding decisions among Caucasian and African American women.

METHODS

Data were initially collected through 24 focus groups consisting of separate groups of African American and Caucasian pregnant women, and breastfeeding and formula-feeding mothers from three major United States cities. The focus group study was initiated by the U.S. Department of Health and Human Services to obtain data on salient messages that would inform a national campaign to promote breastfeeding. This study was a secondary analysis of those data using a modified grounded theory approach.

RESULTS

The process that emerged associated with successful breastfeeding was labeled "confident commitment." This process included several components: a) confidence in the process of breastfeeding, b) confidence in their ability to breastfeed, and c) commitment to making breastfeeding work despite obstacles.

CONCLUSIONS

Contrary to popular conceptions, breastfeeding appears to be a learned skill. If mothers achieved a level of "confident commitment" before the birth, they were able to withstand lack of support by significant others and common challenges that occurred as they initiated breastfeeding. Without the element of "confident commitment," a decision to breastfeed appeared to fall apart once challenged.

Sources and acceptance of infant-feeding advice among low-income women

The purpose of this study is to identify sources and acceptability of infant-feeding advice among participants in the US-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups are used to identify sources of infant-feeding advice and factors that contribute to acceptance of or resistance to that advice among 65 WICeligible mothers (34 English speaking and 31 Spanish speaking). The mothers primarily rely on experienced family and friends for advice and frequently use their own intuition to find solutions that work to solve real or perceived infant-feeding problems. Professional advice is perceived as credible when caregivers exhibit characteristics similar to those of experienced family and friends: confidence, empathy, respect, and calm. Using this information, it may be possible for WIC staff to make programmatic modifications to increase their ability to promote optimal infant-feeding behaviors in this population, thereby contributing to the reduction in the prevalence of childhood overweight.

A qualitative approach to social support and breast-feeding decisions

OBJECTIVE

to explore pregnant women's perceptions and personal experiences of the influence of formal and informal social support on breast-feeding decision-making, in relation to breast-feeding initiation and duration.

DESIGN

qualitative focus groups and interviews.

SETTING

four primary-care centres in Valencia, Spain.

PARTICIPANTS

19 primiparous women in their first trimester of pregnancy participated in focus groups and 12 primiparous and multiparous women in their third trimester of pregnancy participated in interviews. Women had different socio-demographic backgrounds and socio-economic status.

FINDINGS AND CONCLUSIONS

women's perceptions and personal experiences of formal and informal social support of breast feeding may be linked to age and socio-cultural status. Women from higher socio-cultural backgrounds took their partner's opinion and support more into account when choosing breast feeding. They also conceded great importance to formal health support, and employed mothers wished to have more institutional support. Among women from lower socio-cultural backgrounds, friends were the closest social network and had the greatest influence on feeding decisions. They perceived some contradictions in health-promotion messages on breast feeding, and most of them preferred to leave work after birth to exclusively care for their baby. Younger women, without previous experience of breast feeding or possibility of receiving tangible support from their mothers, wanted more practical health-care support (e.g. providing skills in breast-feeding technique).

IMPLICATIONS FOR PRACTICE

breast-feeding promotion strategies should take into account women's different characteristics. Health professionals should consider offering postnatal support as a follow-up to practical support (e.g. breast-feeding workshops).

Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial

OBJECTIVE

To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women.

DESIGN

Cluster randomised controlled trial with prospective mixed method embedded case studies to evaluate implementation processes.

SETTING

Primary care in Scotland.

PARTICIPANTS

Pregnant women, breastfeeding mothers, and babies registered with 14 of 66 eligible clusters of general practices (localities) in Scotland that routinely collect breastfeeding outcome data.

INTERVENTION

Localities set up new breastfeeding groups to provide population coverage; control localities did not change group activity.

MAIN OUTCOME MEASURES

PRIMARY OUTCOME

any breast feeding at 6-8 weeks from routinely collected data for two pre-trial years and two trial years.

SECONDARY OUTCOMES

any breast feeding at birth, 5-7 days, and 8-9 months; maternal satisfaction.

RESULTS

Between 1 February 2005 and 31 January 2007, 9747 birth records existed for intervention localities and 9111 for control localities. The number of breastfeeding groups increased from 10 to 27 in intervention localities, where 1310 women attended, and remained at 10 groups in control localities. No significant differences in breastfeeding outcomes were found. Any breast feeding at 6-8 weeks declined from 27% to 26% in intervention localities and increased from 29% to 30% in control localities (P=0.08, adjusted for pre-trial rate). Any breast feeding at 6-8 weeks increased from 38% to 39% in localities not participating in the trial. Women who attended breastfeeding groups were older (P<0.001) than women initiating breast feeding who did not attend and had higher income (P=0.02) than women in the control localities who attended postnatal groups. The locality cost was pound13 400 (euro14 410; $20 144) a year.

CONCLUSION

A policy for providing breastfeeding groups in relatively deprived areas of Scotland did not improve breastfeeding rates at 6-8 weeks. The costs of running groups would be similar to the costs of visiting women at home.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN44857041.

Grandmother breastfeeding support: what do mothers need and want?

BACKGROUND

Grandmothers are an important source of support for new mothers. Their infant feeding experience and knowledge can influence mothers' decisions to initiate and continue breastfeeding. The objective of this study was to explore mothers' perceptions of grandmothers' breastfeeding knowledge and support, as part of a larger study to design an intervention that facilitates the development of grandmothers' support of breastfeeding.

METHODS

Thirty mothers participated in one of four focus groups held in a North Texas metropolitan area. We analyzed the text of each focus group interview using the content analysis method and identified five themes within and across groups that described mothers' perceptions of grandmother breastfeeding support.

RESULTS

The essence of what mothers needed and wanted from grandmothers could be summarized as grandmother breastfeeding advocacy, which is defined by the two themes, "valuing breastfeeding" and "loving encouragement." Three other themes, "acknowledging barriers,""confronting myths," and "current breastfeeding knowledge," reflected mothers' perceptions of what grandmothers need to become their advocates, particularly if they did not breastfeed their own children.

CONCLUSIONS

Breastfeeding occurs within the context of an extended family in which grandmothers bring their own infant feeding practices and beliefs to their support of new mothers. Mothers need and want grandmothers' support, but their advice and concerns may reflect cultural beliefs that do not protect breastfeeding. Including grandmothers in conversations about breastfeeding practices can be one way for health caregivers to enhance grandmothers' knowledge and support of breastfeeding.

Breast or bottle? Eating disordered childbearing women and infant-feeding decisions

Debates about infant-feeding methods have intensified in recent years with increasing pressures on women living in industrialized nations to breastfeed their infants. This paper, based on a qualitative study of 16 childbearing women with a pre-existing eating disorder living in the north of England, examines participants' motivations for, and understandings of, infant-feeding decisions and practices. In this study, a small number of participants reported being 'desperate' to formula feed in order to resume practices underpinning their eating disorder and thereby to shed the weight accumulated during pregnancy. These participants anticipated an early return to restrictive eating, heavy exercise regimes and/or bingeing/purging behaviours. Most participants, however, reported being 'desperate' to breastfeed because this implied 'good' mothering and prolonged the time during which they could consume 'naughty' treats. Women who opted to breastfeed generally believed this would accelerate weight loss. This study contributes to research on the subjective experiences of a particular group of women living with chronic illnesses and problematic relationships with their bodies. Negotiating individual transitions to motherhood required participants to confront their own, often longstanding, disrupted eating patterns and to make important decisions about infant-feeding methods. Findings from this study raise questions about some of the assumptions underpinning infant-feeding activities and articulate some of the complexities surrounding these issues. By highlighting ways in which women may compromise their own well-being by prioritizing their baby's needs, for example by persisting with breastfeeding when they were 'desperate' to re-engage with their disordered eating practices, an individualized cost-benefit framing is outlined.

The Impact of a Self-Efficacy Intervention on Short-Term Breast-Feeding Outcomes

Maternal self-efficacy for breast-feeding may contribute to success in breast-feeding. This study aimed to increase breast-feeding self-efficacy and actual breast-feeding through an intervention based on Bandura's self-efficacy theory. A total of 90 pregnant women participated in the study. The women who were assigned to a breast-feeding self-efficacy intervention showed significantly greater increases in breast-feeding self-efficacy than did the women in the control group. Furthermore, at 4 weeks postpartum, women in the intervention group showed a trend toward breast-feeding their infants longer and more exclusively than did those in the control group. Greater increases in breast-feeding self-efficacy were associated with a significantly higher level of breast-feeding. Replicating previous research, breast-feeding self-efficacy was significantly related to concurrent breast-feeding behavior, and high antenatal breast-feeding self-efficacy predicted a higher level of later breast-feeding in control-group women. These findings have implications for breast-feeding support programs and for the potential general utility of self-efficacy-based interventions in health education.

Being a ‘good mother’: Managing breastfeeding and merging identities

Breastfeeding is not simply a technical or practical task but is part of the transition to motherhood, the relationship between mother and baby and the everyday experience of living with a new baby. Discussion of breastfeeding must therefore include the individual's personal and social context. This paper explores how women in England who have chosen to breastfeed their baby accomplish this task during the early stages of motherhood and the relative weight attached to different factors, which impinge on decision-making. Our findings, based on observing 158 interactions between breastfeeding women and midwives or health visitors from one Primary Care Trust in the north of England, UK, and in-depth interviews with a sample of 22 of these women, illustrate the dynamic between breastfeeding, becoming and being a 'good mother' and merging multiple identities as they embrace motherhood. In this context, the value attached to breastfeeding as synonymous with being a 'good mother' is questioned. In managing the balance between ensuring a healthy, contented baby and the reality of their daily lives, women negotiate the moral minefield that defines 'good mothering' and the diverse conceptions and influences that shape it--including health professionals, their social networks and the wider social and structural context of their lives. The implications for policy and practice are discussed.

Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial

OBJECTIVE

To investigate whether antenatal breast feeding education alone or postnatal lactation support alone improves rates of exclusive breast feeding compared with routine hospital care.

DESIGN

Randomised controlled trial.

SETTING

A tertiary hospital in Singapore.

PARTICIPANTS

450 women with uncomplicated pregnancies.

MAIN OUTCOME MEASURES

Primary outcomes were rates of exclusive breast feeding at discharge from hospital and two weeks, six weeks, three months, and six months after delivery. Secondary outcomes were rates of any breast feeding.

RESULTS

Compared with women who received routine care, women in the postnatal support group were more likely to breastfeed exclusively at two weeks (relative risk 1.82, 95% confidence interval 1.14 to 2.90), six weeks (1.85, 1.11 to 3.09), three months (1.87, 1.03 to 3.41), and six months (2.12, 1.03 to 4.37) postnatally. Women receiving antenatal education were more likely to breast feed exclusively at six weeks (1.73, 1.04 to 2.90), three months (1.92, 1.07 to 3.48), and six months (2.16, 1.05 to 4.43) postnatally. The numbers needed to treat to achieve one woman exclusively breast feeding at six months were 11 (6 to 80) for postnatal support and 10 (6 to 60) for antenatal education. Women who received postnatal support were more likely to exclusively or predominantly breast feed two weeks after delivery compared with women who received antenatal education (1.53, 1.01 to 2.31). The rate of any breastfeeding six weeks after delivery was also higher in the postnatal support group compared with women who received routine care (1.16, 1.02 to 1.31).

CONCLUSIONS

Antenatal breast feeding education and postnatal lactation support, as single interventions based in hospital both significantly improve rates of exclusive breast feeding up to six months after delivery. Postnatal support was marginally more effective than antenatal education.

TRIAL REGISTRATION

Clinical Trials NCT00270920 [ClinicalTrials.gov].

Do early infant feeding practices vary by maternal ethnic group?

Objective

To examine UK country and ethnic variations in infant feeding practices.

Design

Cohort study.

Setting

Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002.

Subjects

A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants.

Outcome measures

Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months.

Explanatory variables

Maternal ethnic group, education and social class.

Results

Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1–1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8–0.9); non-white mothers, 0.9 (0.8–1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0–1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women.

Conclusions

We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.

The 'Earlybird' gets the breastmilk: findings from an evaluation of combined professional and peer support groups to improve breastfeeding duration in the first eight weeks after birth

Australia has high initiation rates of breastfeeding, but the challenges of establishing and maintaining breastfeeding in the first few months of infant life result in many women changing to artificial formula feeding. This paper reports on the impact of a new strategy to improve breastfeeding duration rates in the first 8 weeks post-partum. The Earlybird Program (EBP) combines the professional expertise of child and family health (C&FH) nurses with the expertise of the participating mothers to support each other in establishing breastfeeding in the first 8 weeks. This retrospective study compared the breastfeeding patterns of first-time mothers who attended the EBP, with the breastfeeding patterns of mothers who accessed individual appointments with the nurses in a 12-month period, and examined the predictors of continued breastfeeding at 8 weeks. The total sample comprised 193 infant records. Women who selected the EBP were more likely to be employed and less likely to be categorized as non-English speaking background. These women also had more visits to the C&FH service. Logistic regression was used to determine the factors associated with breastfeeding cessation at 8 weeks post-natal. After adjusting for variables, only exclusive breastfeeding at first visit and attending the EBP were significant predictors of continuing to breastfeed at 8 weeks. Facilitation skills that recognize the expertise of participating women were considered an important aspect of the programme.

The opinions of employed mothers about their own nutrition during lactation: A questionnaire survey

OBJECTIVES

The main purpose of the study was to identify the changes employed mothers of infants aged 0-24 months made in their nutrition with the aim of increasing their milk production and extending their breastfeeding period.

METHODS

The 135 full-time employed mothers enrolled in this study came to the Well-Child Clinic at Akdeniz University Hospital. Dietary data were collected from the mothers via a questionnaire prepared by the researchers to elicit details about what kind of foods or nutrition supplements women added, avoided or were recommended to avoid or add to their diets and why.

RESULTS

All the mothers made changes in their diets while breastfeeding. The number one change that mothers made in their diet in order to increase milk production was to increase their fluid intake (38.6%) while the second was to increase their consumption of sweets (25.3%). The main type of food mothers were advised to avoid were dried legumes and grains (28.9%). The most important reason for this was the belief that they increased the chance of newborn colic (89.4%). There were statistically significant differences between foods avoided by breastfeeding mothers related to their age (chi(2)=6.88, p=.009), education level and those who mentioned increasing their consumption of fluid while breastfeeding (chi(2)=13.12, p=.000).

CONCLUSIONS

All of the mothers espoused specific practices, and had been given recommendations by others about their nutrition while breastfeeding. Mothers need to be informed about the factors that increase and decrease milk production and affect infant colic, and should be encouraged that they can successfully breastfeed without increasing their consumption of sweets or avoiding dried legumes and some vegetables.

Building a place for the father as an ally for breast feeding

OBJECTIVE

to analyse the opinions of men and women on the father's participation in breast feeding.

DESIGN

a qualitative and exploratory study, using the content analysis method, on its thematic modality. Data were collected at discussion groups that answered the following questions: which meanings and feelings are related to father's involvement in breast feeding? Which factors help or obstruct the act of breast feeding? How do fathers participate in breast feeding?

SETTING

three discussion groups took place during the event 'The man as an ally in breast feeding process: is that the question?', supported by the Federal University of Pernambuco, Brazil.

PARTICIPANTS

11 men and nine women attended the event. Of the men, two had more than one child and five had babies who were being breast fed. Among the women, all were mothers and three were breast feeding.

FINDINGS

four thematic nuclei emerged from the performed analysis, which was also based in the historical, social and cultural process of fatherhood: involvement in the pregnancy-puerperal cycle; feelings and meanings of breast feeding; meanings of breast feeding in public; and ways to include father in the breast-feeding process.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

fathers participating in breast feeding considered it to be a brief period in the process of fatherhood. Behaviours of ambivalence, conflict, exclusion, insecurity and concern towards breast feeding were revealed. There was a perception of the nursing mother as a sexless being. However, the participants also suggested ways of including fathers in the process of breast feeding. According to the participants, they could (1) provide a favourable environment for the mother and baby; (2) participate more during pregnancy and birth; (3) help with domestic chores; (4) develop parenthood; and (5) be present during breast feeding. These suggestions may function as foundations for health staff to develop programmes, in order to involve fathers in breast feeding. This could result in a contribution to improve the practice and duration of that process.

Breast-feeding in a UK urban context: who breast-feeds, for how long and does it matter?

Objective

To investigate what factors relate most strongly to breast-feeding duration in order to successfully support breast-feeding mothers.

Design

Prospective birth cohort study using questionnaires, routinely collected weights and health check at age 13 months.

Setting

Gateshead, UK.

Subjects

Parents of 923 term infants born in a defined geographical area and recruited shortly after birth, 50% of whom were breast-feeding initially.

Results

Only 225 (24%) infants were still breast-fed at 6 weeks, although 136 (15%) continued beyond 4 months. Infants in the most affluent quintile were three times more likely to be initially breast-fed (P < 0.001) and five times more likely to still be feeding at 4 months (P = 0.001) compared with infants in the most deprived quintile. A third of breast-fed infants were given supplementary feeds in the maternity unit and this was associated with a 10-fold increase in odds of giving up breast-feeding by discharge (P = 0.001). Frequent feeding was reported as a reason for giving up in 70% of mothers at 6 weeks and 55% at 4 months. Those infants who stopped breast-feeding earliest showed the most rapid weight gain and were tallest at age 13 months. Non-breast-fed infants had 50% more family doctor contacts up to age 4 months (P = 0.005).

Conclusions

Initiation of breast-feeding in urban Britain remains strongly determined by socio-economic background and early cessation seems to be related to frequent feeding and rapid growth as well as a continuing failure to eradicate health practices that undermine breast-feeding. Those infants not receiving breast milk suffered increased morbidity, but the apparent association between breast-feeding duration and growth probably reflects reverse causation.

Government funded breastfeeding peer support projects: implications for practice

In 1999, the Government, Department of Health in England, UK established the Infant Feeding Initiative. As part of this initiative, 79 1-year infant feeding projects were selected for funding. The funded projects specifically centred upon practice innovation and evaluation in relation to promoting breastfeeding and supporting breastfeeding women in socially excluded communities. The DH recently commissioned a comprehensive evaluation of the 79 projects (DH 2003). This paper focuses upon the evaluation of the 26 DH funded projects that specifically focused upon breastfeeding peer support schemes. The evaluation illuminated many of the challenges involved in implementing community based breastfeeding peer support schemes. Lessons learnt from the most effective projects in terms of: potential to increase breastfeeding initiation and continuation rates; uptake of the service; comprehensive evaluation; and sustainability are presented here, as a series of steps required for successful operationalization of breastfeeding peer support schemes. When these steps are followed, peer support schemes offer exciting prospects for supporting breastfeeding women and increasing breastfeeding initiation and continuation rates, while respecting diversity, ensuring inclusivity and stimulating community empowerment.

The peer-professional interface in a community-based, breast feeding peer-support project

OBJECTIVE

to explore key elements of the peer-professional interface within one breast feeding peer-support project.

DESIGN

a descriptive, qualitative study design. Data were generated through focus-group discussions with volunteer peer supporters and health professionals.

SETTING

the Breastfriends scheme was a community-based, peer-support project located in Doncaster, a town in the North of England.

PARTICIPANTS

all of the volunteer peer supporters who were involved in the scheme at the time of data collection (n=7). In addition, a convenience sample of health professionals (community midwives and health visitors [n=9]) was also generated.

ANALYSIS

thematic analysis of the data was undertaken. Two key themes that have relevance to understanding the peer-professional interface were derived: benefits of working together, and constraints on enabling working relationships.

FINDINGS

benefits associated with participating in the breast feeding peer-support scheme were highlighted by volunteers and health professionals. Volunteers experienced enhanced social support and increased self-esteem and personal development. Health professionals benefited from being able to 'spread the load' of breast feeding support. Some health professionals were also able to learn from volunteers' specialist experiential and cultural knowledge. Health professionals were concerned about volunteers transgressing (poorly defined) boundaries. Both volunteers and health professionals described gate-keeping activities and surveillance behaviours practised by health professionals in an effort to control aspects of volunteers' access to, and work with, breast feeding women.

DISCUSSION

as a cohort of peer supporters develops, members may derive benefits from their participation that extend beyond those predicted and planned for in the project. They may also exert a proactive influence upon the evolution of the peer-support project and upon the relationships between volunteers and health professionals. However, midwives and health professionals may also seek to exert influence over the work of peer supporters, preferring the volunteers to work for, rather than with, them as health professionals. It is at the peer-professional interface that any disjuncture between the project ideal and the reality of the group may be most evident and most problematic.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

in order to reduce tension at the peer-professional interface, and optimise relationships between volunteers and health professionals, an ongoing process of development involving volunteers and health professionals is essential. Such a process would need to proactively identify and diffuse professionals' concerns while addressing both volunteers' vulnerabilities and their potential for semi-autonomous development within and beyond the context of the peer-support scheme.

The education of health practitioners supporting breastfeeding women: time for critical reflection

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

Breastfeeding peer supporters and a community support group: evaluating their effectiveness

Peer support for breastfeeding mothers has often been promoted as a way of increasing rates in communities with low breastfeeding prevalence, where there are few breastfeeding role models and a bottle-feeding culture predominates. This study evaluated the effectiveness of a peer support initiative, which trained peer supporters who then set up a support group, in an area of social and economic deprivation in South Bristol, UK. The effects of training on 6 local women were explored; the combined effect of peer support and the group on breastfeeding prevalence assessed; and mothers' views on what they had gained from the breastfeeding support group reported. Focus groups were held with the peer supporters, who also completed questionnaires before and after their training. Questionnaires were sent to all mothers (35) who attended the support group over the first 5 months to ascertain their views. Breastfeeding rates were extracted from routinely collected sources for both the local area and the wider Bristol population (excluding the peer support area). The initial training increased the peer supporters' knowledge about breastfeeding and their confidence in talking to and supporting mothers. The number of mothers attending the breastfeeding support group increased from 3 per week in May to 10 per week by September 2001. Mothers who attended the group particularly appreciated being able to talk about breastfeeding and getting consistent breastfeeding advice. Breastfeeding rates in the area for 12-months before and after the start of the peer support initiative showed a significant increase at 8 weeks (7%), which was higher than the overall increase in the wider Bristol area (3%). This evaluation suggests that peer supporters combined with a breastfeeding support group are an effective way of increasing breastfeeding prevalence in areas of low continuation.

Exploring women's views of breastfeeding: a focus group study within an area with high levels of socio-economic deprivation

There is ample evidence of the short- and long-term health benefits of breastfeeding for mothers and infants, yet breastfeeding rates remain low in the UK, particularly in areas of high social deprivation. It is imperative that appropriate strategies are utilized to support more women to initiate and continue breastfeeding. This study used focus group methodology to explore women's views in relation to breastfeeding. The study was conducted within an area with high levels of socio-economic deprivation in the north-east of England and aimed to identify local barriers to breastfeeding, influences on choice of infant-feeding method and strategies which might improve breastfeeding rates. Focus group discussions were conducted with low-income women, adolescent women and women from a minority ethnic group. The five key themes that emerged from the data were: society's negative attitudes towards breastfeeding; the influence of family and friends and the experience on choice of method of infant feeding; lack of knowledge of some aspects of infant feeding; perceptions of professional support; and women's positive and negative experiences of breastfeeding. Recommendations for promoting and supporting breastfeeding include improving facilities to breastfeed in public, enhancing the provision of information, addressing conflicting advice and poor professional practice and implementing support mechanisms. The findings and recommendations have been used to develop a breastfeeding strategy to meet local needs. This project was funded by the English Department of Health Infant Feeding Initiative.

One-to-one or group-based peer support for breastfeeding? Women's perceptions of a breastfeeding peer coaching intervention

BACKGROUND

Studies reporting one-to-one peer support interventions have been successful in some countries with high breastfeeding initiation rates, but less so in Great Britain, where low uptake of peer support has occurred. We conducted a peer coaching intervention study in rural Scotland that improved breastfeeding initiation and duration. This study reports qualitative data about participants' perceptions of the coaching intervention. The aim was to investigate why group-based peer support was more popular than one-to-one peer support.

METHODS

Qualitative data were collected and analyzed from an initial focus group; 21 semi-structured interviews; and 31 coaching group observations and respondents (n = 105/192) in response to an open question about reasons for not choosing a personal coach in a survey of breastfeeding experiences. We developed a coding frame, identified themes, and constructed charts for analysis and interpretation of data.

RESULTS

Analysis revealed that groups were more popular because they normalized breastfeeding in a social environment with refreshments, which improved participants' sense of well-being. Groups provided flexibility, a sense of control, and a diversity of visual images and experiences, which assisted women to make feeding-related decisions for themselves, and they offered a safe place to rehearse and perform breastfeeding in front of others, in a culture where breastfeeding is seldom seen in public. Women often felt initial anxiety when attending a group for the first time, and they expressed doubt that one set of "breastfeeding rules" would suit everyone.

CONCLUSIONS

Pregnant women and breastfeeding mothers will voluntarily engage in an activity to support breastfeeding if there is a net interactional (verbal, visual, emotional and gustatory) gain and a minimum risk of a negative experience. One-to-one peer coaching was perceived as a greater risk to confidence and empowerment than group- based peer coaching.

The development and delivery of a practice-based breastfeeding education package for general practitioners in the UK

Growing acceptance that measurable improvements in public health, particularly in lower-income groups, could be achieved by increasing the incidence of breastfeeding has focused attention on the current lack of educational provision in breastfeeding issues for many health professionals. An audit of general practitioners in one area of northern England revealed an interest in receiving breastfeeding training. Department of Health funding was obtained by the breastfeeding subgroup of the local Maternity Services Liaison Committee to develop, deliver and evaluate a practice-based educational session supplemented by a resource pack. Over a 12-month period, 22 practices received the session and the project was evaluated using an illuminative evaluation model. Response rates to two evaluation questionnaires of 81% (133/164) and 62.5% (65/104) were achieved and findings indicated high levels of satisfaction with the session and its accompanying resource pack. Qualitative data related to perceived influence on future practice were subjected to thematic network analysis and revealed four main (organizing) themes: the acquisition of greater knowledge, improved access to resources, a proactive approach to breastfeeding support and the creation of a breastfeeding-friendly environment. The illuminative evaluation also identified recurring issues that could impact on any attempt to replicate or adapt this project; these were the influence of personal breastfeeding experiences, the desire for greater interaction during the training session and the wider implications for practice education of multidisciplinary attendance.

Effectiveness of a breastfeeding peer coaching intervention in rural Scotland

BACKGROUND

Breastfeeding initiation in Scotland in 2000 was 63 percent, compared with over 90 percent in Norway and Sweden. Although peer support is effective in improving exclusivity of breastfeeding in countries where over 80 percent of women initiate breastfeeding, the evidence for effectiveness in countries with lower initiation is uncertain. Our primary aim was to assess whether group-based and one-to-one peer breastfeeding coaching improves breastfeeding initiation and duration.

METHODS

Action research methodology was used to conduct an intervention study in 4 geographical postcode areas in rural northeast Scotland. Infant feeding outcomes at birth and hospital discharge; at 1, 2, and 6 weeks; and at 4 and 8 months were collected for 598 of 626 women with live births during a 9-month baseline period and for 557 of 592 women with live births during a 9-month intervention period. Groups met in 5 locations, with 266 groups meeting in the period when intervention women were eligible to attend. Data on place of birth and length of postnatal hospital stay were also collected. Control data from 10 other Health Board areas in Scotland were compared. An intention-to participate survey about coaching participation was completed by 206 of 345 women initiating breastfeeding. Group attendance data were collected by means of 266 group diaries.

RESULTS

There was a significant increase in any breastfeeding of 6.8 percent from 34.3 to 41.1 percent (95% CI 1.2, 12.4) in the study population at 2 weeks after birth compared with a decline in any breastfeeding in the rest of Scotland of 0.4 percent from 44 to 43.6 percent (95% CI -1.2, 0.4). Breastfeeding rates increased compared with baseline rates at all time points until 8 months. However, the effect was not uniform across the 4 postcode areas and was not related to level of deprivation. Little difference was seen in receipt of information and knowledge about the availability of coaching among areas. All breastfeeding groups were well attended, popular, and considered helpful by participants. A minority of women (n = 14/206) participated in formal one-to-one coaching. Women who received antenatal, birth, and postnatal care from community midwife-led units were more likely to be breastfeeding at 2 weeks (p = 0.007) than women who received some or all care in district maternity units.

CONCLUSIONS

Group-based and one-to-one peer coaching for pregnant women and breastfeeding mothers increased breastfeeding initiation and duration in an area with below average breastfeeding rates.

Breast-feeding initiation and exclusive duration at 6 months by social class--results from the Millennium Cohort Study

OBJECTIVES

To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates.

DESIGN

First sweep of a longitudinal population-based survey, the Millennium Cohort Study.

SETTING

Four countries of the UK.

SUBJECTS

Subjects were 18 125 singletons born over a 12-month period spanning 2000-01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth.

RESULTS

Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18-0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36-0.50) and 4 months (OR 0.5, 95% CI 0.31-0.77) compared with women in higher managerial and professional occupations.

CONCLUSIONS

Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.

Views of breastfeeding difficulties among drop-in-clinic attendees

Breast-milk is the optimum form of nutrition for the first 6 months of life. However, breastfeeding rates in the UK are low and static compared to other European countries and those in the North-west of England in the UK are even lower. Of the women who initiate breastfeeding, many cease in the first month following the birth for reasons that might be avoided. To try and prevent this, UNICEF Baby Friendly Hospital Initiative (BFHI) 'Ten Steps to Successful Breastfeeding' state that maternity facilities should foster the development of support groups for breastfeeding women. The aim of the present study was to describe breastfeeding difficulties reported by women who attended the infant feeding clinic at a Women's Hospital in the North-west of England. During the study period, the clinic was attended mainly by primiparous mothers who were educated beyond 18 years of age and of higher socio-economic status. They presented with a variety of problems including baby not latching on, concerns about baby's weight gain/loss, sore nipples and advice about expressing milk in preparation for return to work. The women highlighted the importance of meeting other mothers and having someone to talk to who understood what they were going through. Inconsistent information/lack of detailed knowledge from health professionals was cited as contributing to breastfeeding difficulties. A number of women reported that expert hands-on, one-to-one support, was invaluable and many felt they were able to continue breastfeeding but without the support, they may have given up.

What information, advice, and support do women want with breastfeeding?

BACKGROUND

Breastfeeding conveys many benefits, but women often encounter difficulties in the first few weeks. The objective of this study was to examine women's perspectives on the information, advice, and support they receive with breastfeeding.

METHODS

A qualitative analysis was conducted of women's responses to open questions about their experiences of breastfeeding support. Participants were recruited as part of a randomized controlled trial of additional support from volunteer breastfeeding counselors, and they completed questionnaires when their babies were 6 weeks old.

RESULTS

Of the 720 women recruited to the trial, 654 began breastfeeding and completed postnatal questionnaires; 492 (75%) participants were first-time mothers and 200 (31%) were of minority ethnic origin. At 6 weeks, 249 (38%) women were exclusively breastfeeding, 183 (28%) were both breastfeeding and bottle-feeding, whereas 222 (34%) were exclusively bottle-feeding. Although many women commented positively on their experiences, others thought they did not receive the information and support they needed. Thematic analysis of women's responses to open questions identified five components of the support that women wanted: information about breastfeeding and what to expect, practical help with positioning the baby to breastfeed, effective advice and suggestions, acknowledgment of mothers' experiences and feelings, and reassurance and encouragement.

CONCLUSIONS

Maternity services should address the components identified by the study findings as constituting good breastfeeding support. Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women's views on what support they want, together with when and how they want it provided.