Title: Janet Dalzell: Breastfeeding Coordinator, NHS Tayside, Directorate of Public Health
1Janet Dalzell Breastfeeding Coordinator, NHS
Tayside, Directorate of Public Health Sheila
Knight Health Visitor, Dundee CHP Alexandra-Charn
ock Greene, Social Anthropologist, St Andrews
University
Funded by The Queens Nursing Institute Scotland
and Dundee Public Health Nursing Network
2- Reduction of infant mortality rates
- Reduction of preventable infections
- Reduction of preventable paediatric
- admissions
- Improving childrens life outcomes and
- general wellbeing
- Breaking the cycle of deprivation
3Aim
- To examine the accounts of infant feeding
experiences of low-income mothers and the
professionals involved in their care.
4Sample
- 20 mothers
- Total 18
- Age 19-38 Mean age 27
- Primigravida8
- Parous10
- Depcat 4-7 (43,66,77)
- 10 health professionals
- 5 midwives
- 5 health visitors
5Framework
(Ritchie and Spencer, 1994)
6Themes
Sustainability
Support with breastfeeding
Choices Decisions
7Choices and Decisions
8Information
- breast is best, thats all you hear.
- Gestapo
- its finding a way to talk to people so that
theyll be receptive too and having that
information there for them without shoving it
down their throats.
9High Risk Clinic
- Because this is a high risk clinic and these
women have got problem pregnancies, I think
probably the focus goes on problems they have in
the pregnancy and to be honest I dont think we
revisit the breastfeeding issues in this clinic.
(MW1)
10Desire to breastfeed
- From day one I wanted to breastfeed (M10)
- Always wanted to breastfeed (M1, M16)
- I always thought would try breastfeeding (M5)
- From the age of 16 I always wanted to
breastfeed. (M2) - From when I was pregnant I wanted to breastfeed
(M7)
11Previous experience
- I didnt try as hard with Conner because I
didnt want to go through all this upset again so
if he didnt go for it straight away I never
really gave it much of a chance I must admit.
(M9) - Well again I tried and stopped with Sarah I
thought I will give it another go because it
might be easier this time and I kind of know what
I am getting into but I tried again but I only
tried for a couple of days and decided that it
wasnt working out. I was probably more ready to
decide that than I was with Sarah. (M7)
12Seeing and knowing
- Interviewer You decided to bottle feed, so do
you remember how you thought through that and
why? - Mother (M11) A lot of people think its better
breastfeeding, but Id rather bottle feed. - Interviewer Youd rather bottle feed?
- Mother (M11) If I got pregnant with the next
one, Im going to try breastfeeding. - Interviewer So what has changed your mind?
- Mother (M11) My friend and my cousin, they are
all breastfeeding, and shes a lot better. My
friend has breastfed her little boy for a month
and he feeds much better.
13Support
14Initiation
- Two thirds of the women said that the assistance
given to them was either unhelpful or that they
were not offered any help with feeding. - Six women highlighted that for them, not being
shown how to breastfeed made them feel that they
were left to get on with it. (M1,M5,M11,M13,M14,
M16) - These women felt that some of the staff were not
interested in what they were doing. - Five women never successfully fed their baby
before leaving the hospital
15Initiation
- it was humiliating actually because they would
just come and manhandle you like shoving your
nipple in his mouth and I think at one point I
had two midwives like basically trying to get
Jamie to feed and I was just lying there going, I
feel like a complete weed.
16Initiation
- I felt quite as if I was being invaded.. they
just grabbed it, opened the babys mouth, shoving
it in and it was like head on and everything just
seemed to be getting pushed and pulled and then
it was like thats it the baby is on so I am
away.
17A different approach
- She talked to me
- She actually listened to me
- Acknowledged the problems that I was having
- Didnt sort of just brush them aside
- Just spent time,
- I think she was better at it,
- She was the expert
- Even the midwives that were there said oh when
this person comes, it will be fine, shes the
expert, shes the one that we all turn to, - She was obviously good,
- And with a newborn, youre feeding every couple
of hours and you need someone there all the time - If its a busy ward, you might need more than one
person at a time, I mean, when I was there it was
really quiet as well, that was the thing, it
wasnt busy, I think the first couple of nights
it was busy but then after that there was two of
us in my bay and the other girl was bottle
feeding so
18Practice
- Supplementation
- they wanted to give him formula but I was
scared it would put him off breastfeeding. - I gave her formula as they said it would be a
treat for her and so she could sleep.
19Practice
- Separation
- I think one night when my baby was unsettled
they took him away I felt so sad lying in bed -
not knowing if he was crying for me if it was
me he wantedbut the whole time I was thinking
about him crying and it made me quite upset
actually.
20Developing a Milk supply
- Every Wednesday I go out for a couple of
hours to do the shopping and what have you but it
seems to be as soon as I am out the door the
bottles are made up and he is given a bottle so
when I have came back from the doctors she had
given him a bottle for some apparent reason, so
all the time I was away was about half an hour
but in that time he had a 5 ounce bottle so he
started being sick.
21Developing a Milk Supply
- I find it difficult come the Thursday and the
Friday because it takes me a few days to then re
build my milk back up to what he needs because on
the Wednesday I have not fed him as much as I
should have fed him so I do find it a lot more
difficult like this because he is on the bottle
rather than just being solely breast fed I think
it would have been easier had he been solely
breast fed. (M13)
22Support at home and community
- Feeding prior to discharge
- Strong family support
- Embarrassment
- Privacy
23Feelings
- Unsuccessful
- I felt sad
- I felt like I had lost a lot when I stopped
- felt guilty for not giving it more of a go
- I cant believe I am such a failure
- disappointed
- I felt let down as it was not working
- I should have read more so its my
responsibility - sad and disappointed
- I should have tried harder
- I should have suffered more.
- Successful
- proud of breast feeding
- comments about babys development,
- fantastic first night at home sitting in the
rocking chair feeding him, - the bond was just unreal,
- enjoyed feeding,
- my Dad is chuffed,
- Ive created a family bed,
- never thought of giving him a bottle even when
up eight times per night, - very determined,
- felt supported by staff,
- the amount of love flowing through your body is
incredible.
24Sustainability
25Promoting
- Balance of information giving
- Promote motherhood and breastfeeding
- Clear guidance on giving information
- Social awareness
- Education in schools (MW5, MW4, M16)
- Education for other family members
26Preparing
- Preparing women realistically
- Antenatal Education
- Practical skills
- Physiology
- The nuts bolts
27Being Shown
- If I was given help it would have been different
(M1) - More contact so you know you are doing it right
(M9) - I think they should show you more, ask how you
are - feeling in the early days (M16)
- Should be shown how to do it, share
understanding of milk - supply. (M13)
- Staff to observe feeding, being shown sooner may
have - helped (M18)
28Policy Guidelines
- Midwives trained so there is more than
- one expert (M17)
- All using the same song sheet (M8)
- Make sure baby fed before leaving
- hospital (M12)
- Health care worker or support worker dedicated
to help with breastfeeding (M2)
29Conclusions
30Breastfeeding self-efficacy
- Breastfeeding self-efficacy refers to a mothers
- confidence in her ability to breastfeed her baby
- and is a significant factor as it predicts
- Whether a mother chooses to breastfeed or not
- How much effort she will expend
- Whether she will have self-enhancing or
- self-defeating thought patterns
- How she will respond emotionally to
- breastfeeding difficulties
- (Dennis1999)
31Self-efficacy
- Based on four sources of information
- Performance accomplishment
- Vicarious experience
- Verbal persuasion
- Physiological responses
- (Bandura 1977)
32Summary
- Stop persuading more mothers to try breastfeeding
but establish systems to identify women who are
high risk of breastfeeding cessation but who want
to breastfeed. - Provide information to all mothers who want to
breastfeed in different formats and methods of
delivery - Have more realistic preparation for breastfeeding
- Promote the positive emotional benefits of
breastfeeding - Ensure staff are trained with the necessary
skills to communicate and support. - Explore the use of skill mix e.g. health care
assistants, volunteers - Implement the UK Baby Friendly standards in
hospital and community
33Janet Dalzell Breastfeeding Coordinator, NHS
Tayside, Directorate of Public Health Sheila
Knight Health Visitor, Dundee CHP Alexandra-Charn
ock Greene, Social Anthropologist, St Andrews
University
Funded by The Queens Nursing Institute Scotland
and Dundee Public Health Nursing Network