1. Awareness of breast feeding in mothers Dr. D.Veerappan Dr. Ezzati

2. Under the kind guidance of G.Subramanian G.Subramanian J.Rawal J.Rawal

3. Background It was observed that a number of mothers were showing lack of awareness about issues in breast feeding in the postnatal wards. It was observed that a number of mothers were showing lack of awareness about issues in breast feeding in the postnatal wards.

4. Aim The aim of this audit was to explore the adequacy of education and support in breast feeding The aim of this audit was to explore the adequacy of education and support in breast feeding

5. Method Questionnaire Questionnaire PALS approval PALS approval Questionnaire was given by me and by my colleagues to 200 consecutive mothers (in the postnatal ward) who consented to fill questionnaire Questionnaire was given by me and by my colleagues to 200 consecutive mothers (in the postnatal ward) who consented to fill questionnaire

6. Standards

7. Questionnaire Auditing the awareness/knowledge of mothers in HWH about breast feeding Auditing the awareness/knowledge of mothers in HWH about breast feeding 1-Do you want to give breast milk to your baby?  Yes  No 1-Do you want to give breast milk to your baby?  Yes  No if yes, for how long are you considering breast feeding?  1 month  4-6 months if yes, for how long are you considering breast feeding?  1 month  4-6 months  6-12 months  > 1year  6-12 months  > 1year 2-Have you had breast feeding experience before?  Yes  No 2-Have you had breast feeding experience before?  Yes  No 3-Do you feel confident in breast feeding?  Yes  No 3-Do you feel confident in breast feeding?  Yes  No 4-Do you think that breast feeding has health benefits for the baby?  Yes  No 4-Do you think that breast feeding has health benefits for the baby?  Yes  No 5- Do you think that breast feeding has health benefits for the mother?  Yes  No 5- Do you think that breast feeding has health benefits for the mother?  Yes  No 6-Have you had antenatal breast examination regarding to the breast feeding?  Yes  No 6-Have you had antenatal breast examination regarding to the breast feeding?  Yes  No

8. 7-Did you like antenatal classes for breast feeding?  Yes  No  Not attended 7-Did you like antenatal classes for breast feeding?  Yes  No  Not attended If attended, do you think the teaching was adequate?  Yes  No If attended, do you think the teaching was adequate?  Yes  No 8-Have you been taught about the first feed? (The best time for it)  Yes  No 8-Have you been taught about the first feed? (The best time for it)  Yes  No 9- Have you been taught about the correct positioning and attachment?  Yes  No 9- Have you been taught about the correct positioning and attachment?  Yes  No If yes, do you feel that it was enough?  Yes  No If yes, do you feel that it was enough?  Yes  No 10-Do you know about the composition of the breast milk?  Yes  No 10-Do you know about the composition of the breast milk?  Yes  No 11- Do you know that the amount and composition of the breast milk changes during the day?  Yes  No 11- Do you know that the amount and composition of the breast milk changes during the day?  Yes  No 12- Do you know that the amount and composition of the breast milk changes as the baby is growing?  Yes  No 12- Do you know that the amount and composition of the breast milk changes as the baby is growing?  Yes  No 13- Do you know about the differences in breast milk in mothers of term and preterm babies? Yes  No 13- Do you know about the differences in breast milk in mothers of term and preterm babies? Yes  No 14- Do you know how often you need to feed the baby during the early days after birth?  Yes  No 14- Do you know how often you need to feed the baby during the early days after birth?  Yes  No 15- Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk)  Yes  No 15- Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk)  Yes  No

9. 16- Do you know that let down reflex is a sign of enough milk production in your breast?  Yes  No 16- Do you know that let down reflex is a sign of enough milk production in your breast?  Yes  No 17- Do you know that passing enough urine (making 6 nappies wet) per day is a sign of 17- Do you know that passing enough urine (making 6 nappies wet) per day is a sign of enough milk intake by your baby?  Yes  No enough milk intake by your baby?  Yes  No 18-Do you think that during breast feeding, you need to change your diet?  Yes  No 18-Do you think that during breast feeding, you need to change your diet?  Yes  No If yes, what changes do you believe? If yes, what changes do you believe? 19-What do you believe will increase the amount of your breast milk? 19-What do you believe will increase the amount of your breast milk?  Specific diet  rest & sleeping  medication  others  none  Specific diet  rest & sleeping  medication  others  none  Baby’s sucking  Baby’s sucking 20-What do you believe will decrease the amount of your breast milk? 20-What do you believe will decrease the amount of your breast milk?  Specific diet  stress  medication  others  None  Specific diet  stress  medication  others  None 21- Do you think that culture in health staff/community is supportive enough regarding the breast feeding?  Yes  No 21- Do you think that culture in health staff/community is supportive enough regarding the breast feeding?  Yes  No 22-Have you had any conflicting advice regarding breast feeding from any health staff? 22-Have you had any conflicting advice regarding breast feeding from any health staff?  Yes  No If yes, what was it?  Yes  No If yes, what was it? 23- Do you feel that there is enough support for Breast feeding in HWH? 23- Do you feel that there is enough support for Breast feeding in HWH?  Yes  No  Yes  No

10. 24-If you want to return to work, do you know how long at least you have to do breast 24-If you want to return to work, do you know how long at least you have to do breast feeding in order to establish Breast feeding?  Yes  No feeding in order to establish Breast feeding?  Yes  No 25- Do you know that you can keep your expressed milk in fridge for one day? 25- Do you know that you can keep your expressed milk in fridge for one day?  Yes  No  Yes  No 26- Do you know that you can keep your expressed milk in freezer for 3 months?  Yes  No 26- Do you know that you can keep your expressed milk in freezer for 3 months?  Yes  No 27-Which kind of training for breast feeding do you think is best and most helpful? 27-Which kind of training for breast feeding do you think is best and most helpful?  Self study (eg.journals, books, internet)  Observation of other breast feeding mothers  Self study (eg.journals, books, internet)  Observation of other breast feeding mothers  Training by health staff  Training by GP  Training by Paediatrician  Training by health staff  Training by GP  Training by Paediatrician 28- Do you know that exclusive breast feeding can be used as contraception? 28- Do you know that exclusive breast feeding can be used as contraception?  Yes  No  Yes  No 29- Do you know that some medication can be passed to the baby by breast feeding? Yes  No 29- Do you know that some medication can be passed to the baby by breast feeding? Yes  No 30-If breast feeding, what are your concerns? (You may give more than one answer) 30-If breast feeding, what are your concerns? (You may give more than one answer)  Job  Discomfort  Self figure  Any painful experience  Job  Discomfort  Self figure  Any painful experience  Lack of freedom/interfere with daily routines  Other  Lack of freedom/interfere with daily routines  Other

11. Results Maternal age group Maternal age group Marital status Marital status Age group 15-2021-2526-3031-3536-40>40 No15346061282 Marital status SingleMarried Not known No6311720

12. Maternal age group

13. Marital Status

14. Ethnicity Ethnicity Sex of the baby Sex of the baby Mode of delivery Mode of delivery EthnicityCaucAfrocaAsianOrientOtherNG No113362511015 SexMaleFemaleNGNo100964 TypeNVDFor/ven Em C/S El C/S NGNo1362128105

15. Ethnicity

16. Sex

17. Mode of Delivery NVDInstrumentalEm.LSCSEl.LSCSNG 1362128105

19. Questions Have you had breast feeding experience before? Have you had breast feeding experience before?  Yes 76  No 117 NG 7  Yes 76  No 117 NG 7 Do you feel confident in breast feeding? Do you feel confident in breast feeding?  Yes 99  No 84 NG 14  Yes 99  No 84 NG 14 Do you think that breast feeding has health benefits for the baby? Do you think that breast feeding has health benefits for the baby?  Yes 178  No 13 NG 9  Yes 178  No 13 NG 9 Do you think that breast feeding has health benefits for the mother? Do you think that breast feeding has health benefits for the mother?  Yes 162  No 24 NG 14  Yes 162  No 24 NG 14

21. Questions Have you had antenatal breast examination regarding to the breast feeding? Have you had antenatal breast examination regarding to the breast feeding?  Yes 12  No 178 NG 10  Yes 12  No 178 NG 10 Did you like antenatal classes for breast feeding?  Did you like antenatal classes for breast feeding?  Yes 23  No 161  Not attended 16 Yes 23  No 161  Not attended 16 If attended, do you think the teaching was adequate? If attended, do you think the teaching was adequate?  Yes 10  No 2 NG 11  Yes 10  No 2 NG 11 Have you been taught about the first feed? (The best time for it) Have you been taught about the first feed? (The best time for it)  Yes 68  No 123 NG 9  Yes 68  No 123 NG 9 Have you been taught about the correct positioning and attachment? Have you been taught about the correct positioning and attachment?  Yes 103  No 82 NG 15  Yes 103  No 82 NG 15 If yes, do you feel that it was enough? If yes, do you feel that it was enough?  Yes 52  No 9 NG 42  Yes 52  No 9 NG 42

22. Antenatal Care

23. Questions Do you know about the composition of the breast milk?  Do you know about the composition of the breast milk?  Yes 93  No 91 NG 16 Yes 93  No 91 NG 16 Do you know that the amount and composition of the breast milk changes during the day? Do you know that the amount and composition of the breast milk changes during the day?  Yes 60  No 128 NG 12  Yes 60  No 128 NG 12 Do you know that the amount and composition of the breast milk changes as the baby is growing? Do you know that the amount and composition of the breast milk changes as the baby is growing?  Yes 83  No 106 NG 11  Yes 83  No 106 NG 11 Do you know about the differences in breast milk in mothers of term and preterm babies? Do you know about the differences in breast milk in mothers of term and preterm babies? Yes 37  No 151 NG 12 Yes 37  No 151 NG 12 Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk) Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk)  Yes 93  No 95 NG 12  Yes 93  No 95 NG 12

24. Composition of Milk

25. Questions Do you know how often you need to feed the baby during the early days after birth? Do you know how often you need to feed the baby during the early days after birth? Yes 115 No 74 NG 11 Yes 115 No 74 NG 11 Do you know that let down reflex is a sign of enough milk production in your breast? Do you know that let down reflex is a sign of enough milk production in your breast? Yes 56 No 95 NG 14 Yes 56 No 95 NG 14 Do you know that passing enough urine (making 6 nappies wet) per day is a sign of enough milk intake by your baby? Do you know that passing enough urine (making 6 nappies wet) per day is a sign of enough milk intake by your baby? Yes 94 No 130 NG 8 Yes 94 No 130 NG 8 If you want to return to work, do you know how long at least you have to do breast If you want to return to work, do you know how long at least you have to do breast feeding in order to establish Breast feeding? feeding in order to establish Breast feeding? Yes 37 No 125 NG 38 Yes 37 No 125 NG 38

26. Adequacy

27. Questions Do you think that culture in health staff/community is supportive enough regarding the breast feeding? Do you think that culture in health staff/community is supportive enough regarding the breast feeding?  Yes 134  No 39 NG 27  Yes 134  No 39 NG 27 Have you had any conflicting advice regarding breast feeding from any health staff? Have you had any conflicting advice regarding breast feeding from any health staff?  Yes 12  No 177 NG 11  Yes 12  No 177 NG 11 Do you feel that there is enough support for Breast feeding in HWH? Do you feel that there is enough support for Breast feeding in HWH?  Yes 133  No 39 NG 28  Yes 133  No 39 NG 28

28. Support

29. Questions Do you think that during breast feeding, you need to change your diet?  Do you think that during breast feeding, you need to change your diet?  Yes 106  No 74 NG 20 Yes 106  No 74 NG 20 What do you believe will increase the amount of your breast milk? What do you believe will increase the amount of your breast milk? Specific diet 61  rest & sleeping 73  medication 4  others 6 none 14  Baby’s sucking 94 NG 34 Specific diet 61  rest & sleeping 73  medication 4  others 6 none 14  Baby’s sucking 94 NG 34 What do you believe will decrease the amount of your breast milk? What do you believe will decrease the amount of your breast milk?  Specific diet 29  stress 124  medication 31  others 8  None 14  Specific diet 29  stress 124  medication 31  others 8  None 14 NG21 NG21

30. 53% agrees diet change needed Factors Improving Factors Improving  47% Suckling  36% Rest& Sleep  30% Specific diet  4% Medication  3%Others  4% None Factors affecting  62% Stress  15% Medication  14% Diet  4%Others  7% None

31. Questions Do you know that you can keep your expressed milk in fridge for one day? Do you know that you can keep your expressed milk in fridge for one day?  Yes 144  No 40 NG 15  Yes 144  No 40 NG 15 Do you know that you can keep your expressed milk in freezer for 3 months?  Yes 125  No 61 NG 14 Do you know that you can keep your expressed milk in freezer for 3 months?  Yes 125  No 61 NG 14

32. Storage

33. Questions Which kind of training for breast feeding do you think is best and most helpful? Which kind of training for breast feeding do you think is best and most helpful?  Self study (eg.journals, books, internet) 38  Self study (eg.journals, books, internet) 38  Observation of other breast feeding mothers 47  Observation of other breast feeding mothers 47 Training by health staff 113 Training by health staff 113  Training by GP 17  Training by GP 17  Training by Paediatrician 30  Training by Paediatrician 30 NG 31 NG 31

34. Training 57% By Health staff 57% By Health staff 24% Observing others 24% Observing others 19% Self study 19% Self study 15% by Paediatrician 15% by Paediatrician 8.5% By GP 8.5% By GP

35. Questions Do you know that exclusive breast feeding can be used as contraception? Do you know that exclusive breast feeding can be used as contraception?  Yes 49  No 135 NG 16  Yes 49  No 135 NG 16 Do you know that some medication can be passed to the baby by breast feeding? Do you know that some medication can be passed to the baby by breast feeding? Yes 151  No 36 NG 13 Yes 151  No 36 NG 13

36. Others Medication * 75% think will be passed to the baby * Remaining assume they are not passed to the baby

37. Questions 30-If breast feeding, what are your concerns? (You may give more than one answer) 30-If breast feeding, what are your concerns? (You may give more than one answer)  Job 17  Job 17  Discomfort 52  Discomfort 52  Self figure 10  Self figure 10  Any painful experience 23  Any painful experience 23  Lack of freedom/interfere with daily routines 29  Lack of freedom/interfere with daily routines 29 Other 23 Other 23 NG 46 NG 46

38. Maternal concerns

39. Conclusions

40. Recommendations