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Pat Hoddinott. Research team: University of Aberdeen: Leone Craig University of Stirling: Jane Britten, Rhona McInnes. Infant Feeding Care: Women and Family Experiences of Establishing Breastfeeding. Aim.

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pat hoddinott
Pat Hoddinott

Research team:

University of Aberdeen: Leone Craig

University of Stirling: Jane Britten, Rhona McInnes

Infant Feeding Care:Women and Family Experiences of Establishing Breastfeeding

slide2
Aim

To link the experiences and perspectives of women and families with research evidence and policy

Different approaches

slide3

The Feeding Support Team Project

A research project

NHS Grampian

talking about feeding babies study
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. http://www.healthscotland.com/documents/4720.aspx

slide7

NHS resources: balance

Sitting

through

a feed

Breastfeeding

workshops

pregnancy
Pregnancy

Ideal

Reality

No evidence (Gagnon 2007)

Segregation disliked -

inflexible

Emotions, confidence & reassurance are crucial

The word on the street

  • More AN education will change behaviour
  • Separating women by feeding intention – BF workshops
  • Correct technique = no problems
  • Rosy pictures

Theory v practice

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

Theory and practice
parenting models
Parenting models

Ideal

Reality

  • 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

slide11

Communication:

respect for different values

goals
Goals

Ideal

Reality

  • 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
slide13

Goal setting - policy

Smart

goal

setting

Setting

women up

to fail

slide14

Translation of policy

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

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, 'andthere'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)

Pivotal points
slide17

Pivotal points - behaviour change

Story telling

(woman centred)

Q and A

(breastfeeding

centred)

rules
Rules

Reality

Ideal

“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

breaking the rules
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
slide21

The Feeding Support Team Project

A research project

The FEST Study

NHS Grampian

evidence
Evidence

Global ideal

UK

reality

Hoddinott et al. (2011):

Since 2000 – all 9 UK RCTs of additional lay or professional support no significant effects on breastfeeding duration

Evidence synthesis - Chung et al. (2008); Britton et al. (2007):

  • Additional lay or professional support is effective at improving breastfeeding duration

Context matters

health inequalities behaviour change
Health inequalities & behaviour change

Ideal

Reality

  • 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

universal health care provision
Universal health care provision

Reality

Ideal

  • 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

study design
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

results 23 increase in any breastfeeding n 69
Results: 23% increase in any breastfeeding (n=69)
  • OR 2.56; 95% CI 0.88, 7.51 (p 0.085)

Number of women

  • OR 2.55; 95% CI 0.86, 7.54 (p 0.091)
telephone call activity
Telephone call activity

Proactive calls: 35 women

Medians

Reactive calls: 34 women

Only 1 call

Call lasted 8 minutes

  • 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

Surprise!

I thought the

phone would

never stop

ringing.....

why is the idealism realism debate important
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

why is proactive care in the early weeks important
Why is proactive CARE in the early weeks important?

Anticipate pivotal points

Addresses the inverse care law

NHS actions speak louder than words

what next
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)