Sheila Knight: Health Visitor

Janet Dalzell: Breast-feeding Coordinator26/04/06

Breastfeeding RatesTarget - 50% at 6 weeks in Scotland by 2005

Location Breast-feeding at birth

At hospital discharge

At 6-8 weeks

Dundee 48.8% 40.4% 22%

Mill 31.7% 21.1% 7%

Erskine 46.3% 31.8% 13%

Arbroath 48.3% 36.6% 23%

Source: CHSP-PS 2002

Why telephone peer support?

• Previously focus was on medical, physical, and demographic reasons

• More recently researcher have been looking at social and confidence reasons

• Telephone peer support in middle class Canada

• Dennis(1999) developed Breast Feeding Self-efficacy Scale to measure maternal confidence

• It use so far has shown a correlation between low antenatal scores and formula feeding at 6 weeks

Breast-feeding self-efficacy

Breast-feeding self-efficacy refers to a mother’s

confidence in her ability to breast-feed her baby and is

a significant factor as it predicts;

• Whether a mother chooses to breast-feed 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 breast-

feeding difficulties (Dennis1999)

Breast-feeding self-efficacy

Gaining confidence in breast-feeding isinfluenced by four sources of information:1. performance accomplishment e.g.

previously breast-feed baby2. vicarious experience e.g. watching other

women successfully breast-feeding3. verbal persuasion e.g. factual information,

encouragement from influential others such as family, friends and professionals

4. physiological responses e.g. fatigue, stress, anxiety, pain

 

Bosom Buddy Project

• To investigate the feasibility, acceptability and satisfaction with telephone peer support to lower income women in two Dundee practices and one in Arbroath

• Funding from Queen’s Nursing Institute of Scotland

• Approval from Tayside Committee for Medical Ethics

• NHS Tayside Policy for Volunteers

Plan

• Volunteers, experienced breast feeding mothers from caseloads of practices involved

• Telephone contact initiated by supporter before birth

• Up to eight weeks support• Training provided• Evaluation by interviews and

questionnaires (provided by Dennis 2002 study)

ResultsRecruiting volunteers

•In Dundee, 27 asked, 13 said yes, 7 completed training and became volunteers

•Age Yes No•20-29 6 8 •30-39 5 6 •Over 39 2 0•And in Arbroath

Depcat Yes No

1 0 0

2 0 2

3 0 0

4 2 2

5 1 0

6 5 6

7 4 3

Recruiting Mothers

• Midwives to provide information during pregnancy, this did not happen• Opportunistic recruitment

–Planned antenatal by HV visit to recruit in Dundee

–Planned postnatal visit to recruit in Arbroath

–Bosom buddies invited to attend antenatal breastfeeding workshops in Arbroath to recruit women.

Recruiting mothers

• 16 mothers were recruited• 10 were prims and • 6 had previous children• 13 were had not previously

breast feed at all• 3 had breast fed for a short time

before

Being a volunteer

• Very enthusiastic about breast feeding

• Clearly understood the support role• Clear understanding of the difference

of professional problem solving role• Enjoyed contacts once established• Replacement buddy needed• Overall positive experience for the

buddy, would do it again• Keen to support other women

Training and Information Pack

• All said that training was adequate

• Bit about being non-judgmental was good

• Pack used for checking information

Telephone contacts:

• Diary sheets showed evidence of the buddies giving positive feedback to mothers

• Good rapport being established

• Bosom buddies checking usefulness of contact with the mothers

• Mobile phones in Dundee were useful

No contact established

• Two mothers decided to formula feed their babies, both before hospital discharge

• One mother changed her phone number and the service was unaware of this

• One bosom buddy telephoned the mother around thirty times over a two to three week period and got no replies but when contact was made the mother had started formula feeding

• One mother was reluctant to talk and it was clear to the bosom buddy that she had changed her mind about taking part.

Contacts

• Diary entries showed that there was a wide range of contacts and length of calls;

• the number of contacts per mother ranged from 2 to 11

• length of individual calls in minutes ranged from 3 to 90 minutes

• total contact time per mother ranged from 15 to 195minutes

• no replies to calls ranged from 2 to 30• mother initiated calls were four from

three mothers in Arbroath, none in Dundee

Satisfaction with Infant Feeding

• Scores ranged from 12 to 59, • Mean 50.3

• 13 intend to breastfeed next baby• 13 found experience enjoyable• 14 recommend to friends• 4 unhappy with feeding method at 8

weeks (formula feeding)

Maternal satisfaction with Peer Support

Comments from 14 mothers who completed the evaluation and questionnaires

Questionnaire Scores ranged from 33 to 50, and the mean was 46.5

7 said it extended the length of breast feeding

11 said helped to reach goals, kept me focused12 said they would like a bosom buddy the

next time7 said she helped me continue breastfeeding11 said all new mothers should have one12 said they had enough contact

Breastfeeding Self-efficacy

Feeding at 8 weeks

Mean scoresBefore project

(range)

Mean scoresAfter project(range)

% increase

Breastfeeding

110 (77-136)

144.5 (128-157)

31.3

Bottle Feeding

113.4(91-135)

118.6(77-137)

4.5

Breastfeeding Questionnaire

• at 8 weeks 8 of the14 babies still receiving breast milk

• From data interpretation 5 of the 6 not breastfeeding at 8 weeks did not fully establish breastfeeding.

Reasons given by mothers for giving formula feed

• Never attached successfully (2)• Painful cracked nipples mastitis

(1)• Did not like breastfeeding (1) • Baby feeding too long, too

hungry(3)• And did not have enough milk(2)

Conclusion

Feasibility• Recruiting volunteers successful• Volunteers positive and highly enthusiastic• Mobile phones useful and added versatility• Experience of breast feeding and 5 hours

training gave volunteers enough confidence

• Women keen to support other breast feeding mothers

Conclusion

Acceptability

• Over half the mothers who were asked, accepted the offer of a buddy

• May have been more if not a research project

• Mothers found telephone contact acceptable

• Buddies viewed it as a worthwhile thing to do

Conclusion

Satisfaction

• Volunteers rated highly by mothers• Mothers satisfied by experience of

the project• Mothers thought everyone should

have one• Would have buddy again with next

baby• Buddies happy with training and

support

Conclusion

• Telephone peer support cannot provide the intensive pre and post natal education guidance and support needed by mothers to establish breast feeding

• But when breast feeding is established it may be effective in increasing duration and exclusivity rates

• Volunteers need support, up-dating and deputy

Recommendations

• An RCT is needed to evaluate the effectiveness of telephone peer support in extending duration of breastfeeding.

• Comparison of areas of high and low deprivation, and urban and rural areas would be useful in the evaluation of the effectiveness of this intervention