Breastfeeding initiation: An in-depth qualitative analysis of the perspectives of women and midwives using Social Cognitive Theory

OBJECTIVE

to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory.

DESIGN

a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT).

SETTING AND PARTICIPANTS

a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland.

FINDINGS

attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support.

KEY CONCLUSIONS

interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both.

IMPLICATIONS FOR PRACTICE

to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.

The Infant Feeding Genogram: a tool for exploring family infant feeding history and identifying support needs

Background

Family culture and beliefs are passed through the generations within families and influence what constitutes appropriate infant care. This includes infant feeding decisions where a family history and support network congruent with women’s infant feeding intentions has been shown to be important to women’s breastfeeding experience. This is reflected in breastfeeding rates where women who were not breastfed themselves are less likely to initiate and continue with breastfeeding. Given the importance of family infant feeding history in the initiation and duration of breastfeeding, and the limited ability of some families to provide support; it is unclear why infant feeding family history and support networks are not explored during pregnancy.

Methods

The Infant Feeding Genogram was adapted from a simple pictorial device that is widely used in psychotherapy and genetic counselling. This tool was developed as part of a study investigating the experience of women when they were the first to breastfeed in their family. Fourteen Scottish participants completed their Infant Feeding Genogram as part of a semi-structured interview. The tool was adapted alongside their narratives to give a visual representation of each participant’s family infant feeding history.

Results

The utility of the genogram is illustrated through two contrasting case examples with very different family feeding histories. The genogram showed family structures, patterns of infant feeding over time, and supportive or conflicting relationships. In the research setting it assisted women to explore their infant feeding history, identify challenges and sources of support and build rapport with the interviewer.

Conclusions

The infant feeding genogram is proposed as a time efficient tool that could assist health professionals and other breastfeeding workers to support women and their families and by stimulating discussion around breastfeeding, Bby identifying strengths or possible deficits in social support for each individual, the tool could inform tailored support and care interventions. The effectiveness and acceptability of the Infant Feeding Genogram requires testing in the clinical environment. However, its successful application in other clinical contexts, combined with the interest in genealogy in popular culture, mean this is likely to be an acceptable, family friendly way to develop more effective breastfeeding conversations.

Integrated constructed wetlands: water management as a land-use issue, implementing the 'Ecosystem Approach'

Awareness of the need for social, economic and environmental coherence in the management of water is becoming evermore apparent. Water supply as well as treatment is becoming more costly; a challenge that is not only limited to developing countries. The use of wetlands, natural and constructed, is now more widely accepted as a means of tackling a range of problems in water management to deliver this coherence. The use of 16 Integrated Constructed Wetlands that mimic shallow, emergent-vegetated, palustrine wetlands in a 2,500 ha catchment in County Waterford, Southeast Ireland, has shown a number of distinct advantages in implementing the all encompassing 'Ecosystem Approach', addressing the key elements for sustainable water management in an intensively used agricultural area. The significant increase in water quality, biodiversity, social amenities and acceptance by the local rural community provided by this 'real' field-scale demonstration show the benefits that such a joined-up approach can have on catchment management in the widest sense.

The process of implementing a community-based peer breast-feeding support programme: the Glasgow experience

AIM

to document the process of implementing and maintaining a community-based peer-support programme.

DESIGN AND SETTING

a community-based study located in a socio-economically disadvantaged housing estate on the outskirts of Glasgow.

PARTICIPANTS

pregnant women residing in a target postcode area.

INTERVENTION

a programme of peer counselling and support for breast feeding, comprising antenatal and postnatal home visits over a period of three years.

IMPLICATIONS FOR PRACTICE

peer support may provide an acceptable and appropriate role model for breast-feeding mothers. However, further research is required on other influential factors such as the social network and the impact of this programme on the peer supporter.

CONCLUSIONS

despite a low prevalence of breast feeding, initiating and maintaining peer breast-feeding support was possible. Peer support appeared to be acceptable to mothers and health professionals. Study mothers spoke enthusiastically of the intervention and mentioned increased confidence and self-esteem.

Evaluation of a community-based intervention to increase breastfeeding prevalence

BACKGROUND

The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow.

METHODS

The study was designed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme. The intervention comprised peer counselling of pregnant women, support of breastfeeding mothers and local awareness-raising activities. The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area. Data were collected by means of four self-completion questionnaires, two administered antenatally and two post-natally. The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time.

RESULTS

Of the 995 women enrolled in the study, data were available for analysis on 919 (92 per cent) to 6 weeks postnatally. At booking, 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed. At delivery, the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls, and by 6 weeks post-natally, the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group. Using multivariate analysis to adjust for factors (such as socio-economic status) known to influence breastfeeding, the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [odds ratio (OR) 2.0; 95 per cent confidence interval (CI) 1.2-3.1, p = 0.006]. By 6 weeks post-natally the difference between the two groups was not statistically significant (OR 1.8; 95 per cent CI 1.0-3.4, p=0.07).

CONCLUSIONS

As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally, it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities.