Examining the breastfeeding support resources of the public health nursing services in Ireland

Women's perspectives on the role and impact of breastfeeding support groups in Ireland

BACKGROUND

Breastfeeding Support Groups are deemed effective in promoting breastfeeding initiation and duration, but few studies have addressed the mothers' perspectives.

RESEARCH AIM

To investigate the role and impact of Breastfeeding Support Groups on breastfeeding mothers in Ireland from the women's perspective. Specific objectives included the assessment over time of breastfeeding self-efficacy knowledge, use, and limitations of BSGs and whether they contributed towards women achieving their breastfeeding goals.

METHODS

An online survey using an established, validated Breastfeeding Self-Efficacy tool and custom-designed questions was administered at two time points as part of a larger sequential explanatory mixed methods' design. Cultural Historical Activity Theory was used as the theoretical framework.

RESULTS

Majority of respondents at Phase 1 (N = 978) were multiparous, urban dwellers, and breastfeeding more than twelve months. Mothers first attend Breastfeeding Support Groups primarily to meet other breastfeeding mothers with many attending multiple types of group formats weekly. Qualities considered extremely important in breastfeeding supporters were: personal breastfeeding experience breastfeeding knowledge empathy understanding and listening skills There was no statistical difference in breastfeeding self-efficacy over time (z = -1.296, p = .195, r = -0.06).

CONCLUSIONS

Participants attend Breastfeeding Support Groups to 'meet other mothers' in a convenient and local location, and not necessarily for a problem. Breastfeeding Support Groups normalise breastfeeding through social support, with breastfeeding supporters providing knowledge, empathy, understanding listening, and personal breastfeeding experience. Breastfeeding self-efficacy was high and did not increase over time, suggesting mothers need to be highly efficacious in this cohort to breastfeed.

Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland

BACKGROUND

Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland.

METHOD

A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021.

RESULTS

Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF.

CONCLUSION

Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

The Support Needs and Current Practices of Public Health Nurses in the Republic of Ireland Who Provide Support to Breastfeeding Mothers: A Cross-Sectional Survey

BACKGROUND

Breastfeeding continuation rates are low in Ireland. The Breastfeeding Observation and Assessment Tool (BOAT) was developed to assist public health nurses in assessing breastfeeding challenges; however, little is known of its actual usage, the level of training experienced or desired by public health nurses, or their level of confidence in the support they provide to breastfeeding mothers.

RESEARCH AIM

To identify the current practices and support needs of public health nurses who provide breastfeeding support in Ireland.

METHOD

An online questionnaire was devised to collect respondents' confidence with breastfeeding issues, caseload, and practices. It was distributed to public health nurses with a current child health caseload in one Community Healthcare Organization. Mann Whitney U tests were used to ascertain the relationship between public health nurses' confidence level and those with qualifications in midwifery or as an International Board Certified Lactation Consultant (IBCLC).

RESULTS

The survey was completed by 66 public health nurses. Only 14 respondents (21.2%) indicated that they always used the BOAT. The most common reason for not doing so was a lack of education on its use (n = 17, 25.8%). Postholders also certified as IBCLCs were considered by participants to be the most appropriate professionals to resolve certain breastfeeding issues. Confidence levels to manage breastfeeding issues were highest among public health nurses with IBCLC credentialing (U = 12.5, p = .001) while no difference was seen when comparing those with a midwifery degree to those without (U = 184.0, p = .92). Face-to-face workshops and blended-learning approaches were ranked as the preferred formats for breastfeeding education (Median rank = 2).

CONCLUSIONS

Breastfeeding education incorporating a face-to-face component is needed to support public health nurses who work with breastfeeding mothers, as is prioritization of recruitment in the community of public health nurses with IBCLC credentials.

The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review

OBJECTIVE

The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. Studies suggest that the decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage. Therefore, this review aims to determine the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum.

METHOD

A systematic review of the studies identified by electronic database search (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Psych INFO, and Sociological Abstracts and Applied Social Sciences Index and Abstracts (ASSIA) published between 2014 - 2021.

RESULTS

A total of 14 studies met the inclusion criteria. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care.

CONCLUSION

Prenatal breastfeeding education increases women's knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education.

A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement

Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.

Fostering Resilience Among Mothers Early (FRAME): using growth mixture modeling to identify resources that mitigate perinatal depression

The primary objective of this study was to delineate classes of individuals based on depression trajectories from the antenatal period through 54-month postpartum and internal and external resources that are associated with low depression risk. Participants came from the Growing Up in New Zealand (GUiNZ) study (n = 5664), which is a pregnancy cohort study and is nationally representative of the ethnic and socioeconomic diversity of contemporary New Zealand births. Growth curve mixture modeling was used to identify distinct subgroups based on depression scores from the antenatal period through 54-month postpartum. Logistic regression models were run to investigate socioeconomic factors and internal and external resources that were associated with depression class membership. A two-class model, "low risk" and "high risk," resulted in the best model fit. Most of the sample (n = 5110, 90%) fell into the "low-risk" class defined by no-to-mild depression symptoms during pregnancy and decreasing depressive symptoms over time (b_intercept =  - .05, b_slope =  - .05). Approximately 10% of the sample fell into the "high-risk" class (n = 554, 10%) defined by mild-to-moderate depressive symptoms during pregnancy and increasing depressive symptomology over time (b_intercept = .39, b_slope = .57). More positive parenting-related attitudes, better pre-pregnancy self-reported health, informal social supports, and community belonging were significantly associated with greater odds of being in the "low-risk" class, after controlling for socioeconomic factors. These findings suggest that targeting internal and external resources for individuals across the perinatal and early childhood periods is important to mitigating maternal depression.

A qualitative exploration of breastfeeding support groups in Ireland from the women's perspectives

OBJECTIVE

Volunteer breastfeeding support groups are deemed effective in promoting breastfeeding initiation and duration, but women's views are not well reported. The aim of this study was to explore women's experiences of Breastfeeding Support Groups in Ireland from their perspective.

DESIGN AND PARTICIPANTS

Semi-structured interviews with 15 breastfeeding mothers were conducted with participants recruited as part of a larger mixed-methods study.

METHODS

Interviews were conducted online. Interviews were audiorecorded, transcribed, and analysed using Thematic Analysis. Cultural Historical Activity Theory was used as the theoretical framework.

FINDINGS

Six key themes were identified: 'complexity of breastfeeding support', 'community and connection', 'impact of culture on breastfeeding needs', 'the journey', 'passing on', and 'what mothers want'. Mothers primarily attend in order to meet other mothers, and not necessarily with a problem, getting practical suggestions to meet their individual and changing needs. The social aspect of support groups fosters a sense of community and inclusion, long-standing friendships, a social outlet, and ongoing support.

CONCLUSIONS

Mothers attend breastfeeding support groups in order to meet other mothers and continue to attend for this reason to get mothering and breastfeeding support, as well as passing on their knowledge and experiences to other mothers, while meeting their social needs.

IMPLICATIONS FOR PRACTICE

More resources, acknowledgement and funding are needed to provide breastfeeding support groups in local communities. Breastfeeding support groups and health professionals need to emphasise the social aspects of the interactions at these group rather than attending for a breastfeeding problem.

Educational videos for practitioners attending Baby Friendly Hospital Initiative workshops supporting breastfeeding positioning, attachment and hand expression skills: Effects on knowledge and confidence

UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills.

Infant Feeding Attitudes and Practices of Spanish Low-Risk Expectant Women Using the IIFAS (Iowa Infant Feeding Attitude Scale)

The Iowa Infant Feeding Attitude Scale (IIFAS) has been shown to have good psychometric properties for English-speaking populations, but it has not been validated among low-risk pregnant women in Spain. The aim of this study was to assess the reliability and validity of the translated version of the IIFAS in order to examine infant feeding attitudes in Spanish women with an uncomplicated pregnancy. Low-risk expectant women (n = 297) were recruited from eight primary public health care centres in Galicia (Spain). Questionnaires including both socio-demographic and breastfeeding characteristics and items about infant feeding were administered during the third trimester. Participants were contacted by telephone during the postpartum period to obtain information regarding their infant feeding status. Prediction validity and internal consistency were assessed. The translated IIFAS (69.76 ± 7.75), which had good psychometric properties (Cronbach's alpha = 0.785; area under the curve (AUC) of the receiver operating characteristic (ROC) curve = 0.841, CI95% = 0.735⁻0.948), showed more positive attitudes towards breastfeeding than towards formula feeding, especially among mothers who intended to exclusively breastfeed. This scale was also useful for inferring the intent to breastfeed and duration of breastfeeding. This study provides evidence that the IIFAS is a reliable and valid tool for assessing infant feeding attitudes in Spanish women with an uncomplicated pregnancy.

Breastfeeding the late preterm infant: experiences of mothers and perceptions of public health nurses

BACKGROUND

The promotion and maintenance of breastfeeding with late preterm infants (LPIs) remain under examined topics of study. This dearth of research knowledge, especially for this population at-risk for various health complications, requires scientific investigation. In this study, we explore the experiences of mothers and the perceptions of public health nurses (PHNs) about breastfeeding late preterm infants in Calgary, Alberta, Canada.

METHODS

We used an exploratory mixed methods design with a convenience sample of 122 mothers to gather quantitative data about breastfeeding. We collected qualitative data by means of individual face-to-face interviews with 11 mothers and 10 public health nurses. Data were collected from April 2013 to June 2014. We then employed an interpretive thematic analysis to identify central themes and relationships across narratives.

RESULTS

We collected 74 complete data sets about breastfeeding. During the first 6-8 weeks postpartum, 61 mothers breastfed their infants. Of these, 51 partially breastfed and 10 exclusively breastfed. For qualitative purposes, the researchers interviewed 11 mothers with late preterm babies and three themes emerged: significant difficulty with breastfeeding, failing to recognize the infant's feeding distress and disorganized behavior, and the parental stress caused by the multiple feeding issues. The public health nurses' comments reinforced and expanded on what the mothers reported. The themes for the nurses included: challenges with initiating breastfeeding, challenges during breastfeeding, and the need for stimulation during breastfeeding.

CONCLUSION

Mothers face challenges when breastfeeding their late preterm infants and public health nurses can guide them through this experience. Families with a late preterm infant need to be informed about the challenges associated with breastfeeding a late preterm infant. It is necessary for all health care professionals to receive proper training on safe and effective breastfeeding of late preterm infants. It is essential for public health nurses to communicate effectively with families of late preterm infants to provide anticipatory guidance about potential challenges and strategies to resolve any breastfeeding problems.

Breastfeeding-Friendly Environmental Factors and Continuing Breastfeeding Until 6 Months Postpartum: 2008-2011 National Surveys in Taiwan

BACKGROUND

Although policies have been implemented to improve a breastfeeding-friendly environment, few studies have examined the effectiveness of these policies in Taiwan. We examined progress in breastfeeding environmental factors from 2008 through 2011 in Taiwan and their association with continuing exclusive and any breastfeeding until 6 months postpartum.

METHODS

This study was a secondary data analysis, using four cross-sectional and national surveys of 1,453-12,410 postpartum women in the years 2008 through 2011. Data were collected by telephone interviews, using structured questionnaires with randomly selected postpartum women who gave birth in the indicated years. Results were weighted to enhance representativeness. Logistic regression was used to compute adjusted odds ratios for the use of breastfeeding-friendly services on breastfeeding continuation.

RESULTS

The rates of breastfeeding at 6 months postpartum generally increased from 2008 to 2011, despite a drop in 2010. The use of breastfeeding-friendly environmental factors, including breastfeeding rooms in public places or workplaces, breastfeeding consultation phone lines/websites, breastfeeding volunteers, and delivery in baby-friendly hospitals, increased from 2008 to 2011. However, the percentage of women participating in breastfeeding support groups decreased during that period. After controlling for maternal characteristics, use of each of the breastfeeding-friendly environmental factors was significantly and positively associated with continuing breastfeeding until 6 months postpartum. The adjusted odds ratios for breastfeeding-friendly environmental factors ranged from 1.15 to 5.04.

CONCLUSIONS

The breastfeeding-friendly environment and long-term breastfeeding rates in Taiwan improved from 2008 to 2011, supporting the effectiveness of policy and public health efforts.

Supporting the use of evidence in community nursing: a national strategic approach

While there is an acceptance across all stakeholders that nursing practice should be informed by evidence, there is a substantial literature on the challenges this creates for nurses in the delivery of services. These challenges are accentuated for nurses in community settings, where accessible, up-to-date research evidence is more problematic because of the decentralised organisation and delivery of these services. Recognising this gap, and the consequent needs of its members, the Institute of Community Health Nursing (ICHN) in Ireland has commenced a national strategic development in this area. The purpose of the strategy is to actively support and facilitate public health and community nurses to provide services to individuals, families and communities that are based on the best available research evidence. This article provides a brief overview of the development and key components of the ICHN strategy.

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study

BACKGROUND

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

METHODS

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

RESULTS

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

CONCLUSIONS

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.

Factors influencing initiation and duration of breast feeding in Ireland

The aim of this research was to identify factors associated with mothers breast feeding and to identify, for those who breast fed, factors associated with breast feeding for as long as planned.

BACKGROUND

breast feeding rates in Ireland are amongst the lowest in Europe. Research evidence indicates that in order for mothers to be successful at breast feeding, multiplicities of supports are necessary for both initiation and duration. The nature of these supports in tandem with other influencing factors requires analysis from an Irish perspective.

DESIGN

cross-sectional study involving public health nurses and mothers in Ireland. This paper presents the results of the mothers' evaluation.

METHOD

mothers (n=1715) with children less than three years were offered a choice of completing the self-report questionnaires online or by mail. Data were analysed and reported using descriptive and inferential statistics.

FINDINGS

four in every five participants breast fed their infant and two thirds of them breast fed as long as planned. The multivariate logistic regression analysis identified that third level education, being a first time mother or previously having breast fed, participating online, having more than two public health nurse visits, and having a positive infant feeding attitude were independently and statistically significantly associated with breast feeding. Among mothers who breast fed, being aged at least 35 years, participating online, having a positive infant feeding attitude and high breast feeding self-efficacy were independently and statistically significantly associated with breast feeding for as long as planned.

CONCLUSIONS

findings from this study reinforce health inequalities therefore there needs to be a renewed commitment to reducing health inequalities in relation to breast feeding.

RELEVANCE TO CLINICAL PRACTICE

this study has identified factors associated with initiation and duration of breast feeding that are potentially modifiable through public health interventions.