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HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The author accepts full responsibility for this talk. Health.

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Presentation on theme: "HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The author accepts full responsibility for this talk. Health."— Presentation transcript:

1 HSRU is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The author accepts full responsibility for this talk. Health Services Research Unit University of Aberdeen Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding Pat Hoddinott Research team: University of Aberdeen: Leone Craig University of Stirling: Jane Britten, Rhona McInnes

2 Health Services Research Unit Aim To link the experiences and perspectives of women and families with research evidence and policy Different approaches

3 Health Services Research Unit INFORMATION ABOUT THE RESEARCH Talking about feeding babies A research study A chance to share your experiences of feeding babies and make a difference to the care families receive in future You can join this study by letter, by e mail, by telephone or through the website The Feeding Support Team Project A research project NHS Grampian

4 Health Services Research Unit Talking about feeding babies study Disadvantaged areas in Stirling and Aberdeen 36, women, 26 fathers, 8 grandmothers, 1 sister and 2 health visitors 220 interviews from pregnancy until 6 months after birth Hoddinott P. et al. NHS Health Scotland. 2010.

5 Health Services Research Unit Health Inequalities

6 Health Services Research Unit Realism Idealism

7 Health Services Research Unit Increase care and help in the first 2 weeks Antenatal preparation and promotion NHS resources: balance Breastfeeding workshops Sitting through a feed

8 Health Services Research Unit Pregnancy More AN education will change behaviour Separating women by feeding intention – BF workshops Correct technique = no problems Rosy pictures No evidence (Gagnon 2007) Segregation disliked - inflexible Emotions, confidence & reassurance are crucial The word on the street Theory v practice IdealReality

9 Health Services Research Unit Theory and practice They tell you that there’s “a way” of doing it, when in fact what you want to know is that there’s loads of different ways of doing it

10 Health Services Research Unit Parenting models Intensive mothering (Lee 2008) – breastfeeding on demand Fathers & family do the household chores Persevere whatever Sacrifice “me time” Family well-being is the priority Father feeding - a unique bond Immediate gains of stopping BF: pain, time, sleep, anxiety Other priorities for time Meanings and values IdealReality

11 Health Services Research Unit Woman and family centred “help” “care” Breastfeeding centred “support” “breast is best” Communication: respect for different values

12 Health Services Research Unit Goals Aim: maximum health gain - nutrition and bonding Exclusive breastfeeding Aim: a happy mother, baby and family Well-being determined by a complex balance of values Ideal Reality

13 Health Services Research Unit Breastfeed for as long as you can and you want to Breastfeed exclusively for 6 months (WHO) Goal setting - policy Smart goal setting Setting women up to fail

14 Health Services Research Unit The midwife was like.... ‘its for six months and basically you are attached to this baby for six months’ and she made it seem quite negative Translation of policy

15 Health Services Research Unit Smart goal setting Success breast feeding Set achievable goal Attain goal Increase confidence Reset goal NICE Behaviour Change Guidance (2007)

16 Health Services Research Unit Pivotal points I could feel myself welling up because I had my heart set on getting out [of hospital] that day …that’s why I said we’d go on to the formula (Stopped breastfeeding in hospital) 'We call that a crisis bottle,' she (health visitor) went, 'and there's nothing wrong with that’ she says. 'If it works for you, that's fine, but one bottle a day is not going to do any harm,' so if anything she was a bit more encouraging (Still breastfeeding at 6 months)

17 Health Services Research Unit Family narrative Anticipate PPs Target care and help Checklists One size fits all Target low SES Pivotal points - behaviour change Story telling (woman centred) Q and A (breastfeeding centred)

18 Health Services Research Unit Emotions Experiential learning Self-efficacy Feeling well, Happy, Relaxed, Confident Oxytocin Technical Theoretical Cognitive Complicated School like Anxiety Oxytocin Performing and craft skills

19 Health Services Research Unit Rules “Rules work” assumes: There is a right way to breastfeed Do’s and don’ts Rights and wrongs Guidelines Checklists No conflicting information or practice Rules are resisted as feeding has multiple meanings All or nothing unpopular Experiential knowledge Family narratives Word on the street Conflicting information and practice Compliance v deviance Ideal Reality

20 Health Services Research Unit Father: We feel that we've done the right thing [introducing solids], but there was not... Mother: It was a hard decision for us, wasn't it? Father: Aye, it was a hard decision because we were going against... Mother: The rules, if you like Father: The rules, we were breaking the rules Breaking the rules

21 Health Services Research Unit The Feeding Support Team Project A research project NHS Grampian The FEST Study

22 Health Services Research Unit Evidence Global ideal Evidence synthesis - Chung et al. (2008); Britton et al. (2007): Additional lay or professional support is effective at improving breastfeeding duration UKreality Hoddinott et al. (2011): Since 2000 – all 9 UK RCTs of additional lay or professional support no significant effects on breastfeeding duration Context matters

23 Health Services Research Unit Health inequalities & behaviour change Targeting low SES women with more one-to-one health professional information, advice and support will change behaviour Assumes rational decision making Environmental and system interventions may be more effective Dual process decision making (Strack & Deutsch, 2004) - automatic decisions Jury still out IdealReality

24 Health Services Research Unit Universal health care provision All staff fully support exclusive breastfeeding and are trained to provide evidence based consistent care Staff have sufficient time Seamless transition between hospital and community Commitment, personalities & skills vary Staff shortages and competing demands Centralisation of services impedes continuity and communication Evolution Adaptation Ideal Reality

25 Health Services Research Unit Study design Intervention scenarios Dedicated feeding team on a postnatal ward – before and after study RCT: Proactive and reactive daily telephone support vs. reactive only for 2 weeks

26 Health Services Research Unit Results: 23% increase in any breastfeeding (n=69) OR 2.56; 95% CI 0.88, 7.51 (p 0.085) OR 2.55; 95% CI 0.86, 7.54 (p 0.091) Number of women

27 Health Services Research Unit Before and during the feeding team on the ward % any breastfeeding

28 Health Services Research Unit Telephone call activity Proactive calls: 35 women Medians 8 calls per woman 3 attempted calls per woman Successful calls lasted 5 minutes 3 women stopped calls before day 7 20 stopped calls before day 14 Reactive calls: 34 women Only 1 call Call lasted 8 minutes Surprise! I thought the phone would never stop ringing.....

29 Health Services Research Unit CONCLUDING THOUGHTS

30 Health Services Research Unit Why is the idealism-realism debate important? Overt or covert philosophies determine our spoken and unspoken language and our actions Mismatch in goals/values creates tension Critical reflection can help us to understand human behaviour and relationships Policy: top down bottom up

31 Health Services Research Unit Why is proactive CARE in the early weeks important? Anticipate pivotal points Addresses the inverse care law NHS actions speak louder than words

32 Health Services Research Unit What next? RCT: proactive team telephone support –Premature babies (Sweden – Renee Flacking et al.) –UK Neonatal Units BIBS – Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (Grampian, Lancashire, Glasgow)

33 Health Services Research Unit Evolution: division of labour and specialisation

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