Janet Dalzell: Breastfeeding Coordinator, NHS Tayside, Directorate of Public Health

1
Janet 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

3
Aim

• To examine the accounts of infant feeding
  experiences of low-income mothers and the
  professionals involved in their care.

4
Sample

• 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

5
Framework
(Ritchie and Spencer, 1994)
6
Themes
Sustainability
Support with breastfeeding
Choices Decisions
7
Choices and Decisions
8
Information

• 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.

9
High 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)

10
Desire 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)

11
Previous 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)

12
Seeing 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.

13
Support
14
Initiation

• 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

15
Initiation

• 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.

16
Initiation

• 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.

17
A 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

18
Practice

• 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.

19
Practice

• 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.

20
Developing 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.

21
Developing 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)

22
Support at home and community

• Feeding prior to discharge
• Strong family support
• Embarrassment
• Privacy

23
Feelings

• 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.

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Sustainability
25
Promoting

• 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

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Preparing

• Preparing women realistically
• Antenatal Education
• Practical skills
• Physiology
• The nuts bolts

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Being 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)

28
Policy 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)

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Conclusions
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Breastfeeding 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)

31
Self-efficacy

• Based on four sources of information
• Performance accomplishment
• Vicarious experience
• Verbal persuasion
• Physiological responses
• (Bandura 1977)

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Summary

• 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

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Janet 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