Breastfeeding and quality of care

The over all objectives of this thesis was to map factors of importance for breastfeeding such as maternal background factors, maternal perception of breastfeeding support, confidence, caring routines, breastfeeding attitudes of health care professionals, and to investigate whether a training intervention within the care team of the antenatal (ANC) and child health centres (CHC) would improve maternal perception of support and strengthen maternal feelings for the baby. Material and method: A questionnaire was sent to mothers when their babies were 9-12 months old (n=540). The questionnaire embraced questions regarding maternal background, caring routines, perception of support and duration of breastfeeding (I-II). Thereafter an attitudinal instrument was developed to measure breastfeeding attitudes in health care professionals (n=168). Four attitude dimensions were identified by factor analysis (III). Ten municipalities in a county of south west Sweden was paired and randomized to intervention or control (IV). Thus, all midwives and postnatal nurses working at the ANC or CHC in a randomised municipality were asked to participate in the study (n=81). Health professionals in the intervention group had a process-oriented training in breastfeeding counselling including planned continuity in family education and development of a common breastfeeding policy within the caring team. Changes in attitude were measured by the instrument developed in study III. For study V, mothers were recruited from the maternity and were allocated to interventionor control group according to the randomization of municipalities in study IV (n=565). Questionnaires were sent out at three days, 3 and 9 months post partum to investigate how the care and counselling skills acquired by the health care professionals would be reflected in maternal perception of breastfeeding support and maternal feelings for and relation to the baby. Results: Early initiation of suckling, late discharge from hospital (more than 72 hours) and perceived good support contributed positively to the duration of exclusive breastfeeding. Supplementation the first days after birth for other than medical reasons shortened the duration of breastfeeding. For primiparas, the partner’s presence after childbirth contributed positively to the duration of exclusive breastfeeding. Multiparas who were aware of their mothers breastfeeding history had a longer breastfeeding period than those who did not know of their mother’s breastfeeding history. Mothers were more satisfied with the breastfeeding information they had received at maternity than the breastfeeding information they got from the ANC and CHC (I-II). This induced the idea to develop an attitude instrument and start a training intervention for the care team at ANC and CHC. The attitudinal dimensions identified by the factor analysis were: The regulating factor comprising statements scheduling breastfeeding; the facilitating factor comprising statements showing confidence in the ability of the mother-infant dyad to breastfeed on their own; the disempowering factor comprising statements that objectified the woman and ascribed her no ability to breastfeed without guidance of the health care professional and the breastfeeding antipathy factor comprising statements that showed unwillingness and failing knowledge about breastfeeding (III). After training the health care professionals became less regulating and more facilitating (IV). Family classes provided the intervention mothers with better breastfeeding information, more knowledge about their social rights, the needs of the baby and a stronger social network than the control mothers (V). The postnatal nurse gave a better over all support, was a better listener, showed more understanding and provided the mother with better information about breastfeeding and the needs of the baby. Mothers in the intervention group reported that they interacted more with their baby. They had also more positive views on their baby and felt more confident and close with the baby than mothers in the control groups (V). Conclusion: This study showed that it is important to adopt caring routines, which will facilitate breastfeeding. The health care professional needs to find out the background of the mother to be able to provide her with adequate breastfeeding counselling. Caring routines should include early suckling. Supplementation of the baby the first week after birth should only be given on medical grounds. This study showed that a process-oriented training in breastfeeding counselling alters attitudes of health care professionals in a positive way. The trained health care professionals organized continuity of family classes and developed a common breastfeeding policy and were more supportive in their encounters with the mothers. These behaviors strengthen the mother’s feelings for her baby and brought about a richer interaction with her baby. A model to provide continuity of family classes, conducted by trained antenatal midwives and postnatal nurses should thus be practiced within the caring team around first time parents.