Hands off technique has many benefits for breastfeeding mothers

Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan

AIMS

The objectives of this study were to design a structured prenatal education programme on breastfeeding and to evaluate the effectiveness of the programme. Indicators of effectiveness were selected based on Kirkpatrick's Training Evaluation Model, including satisfaction with the programme, breastfeeding knowledge, breastfeeding attitude, breastfeeding satisfaction, breastfeeding problems and rate of exclusive breastfeeding.

METHODS

This study applied a quasi-experimental design. The experimental group included 46 women who received a 90-minute group educational programme on breastfeeding during their 20th-36th week of pregnancy. Each experimental subject was matched by a control subject according to age, educational level, work status and pregnancy gestational age. Control subjects did not receive any intervention. Data were collected through self-administered questionnaires at preintervention, postintervention, three days postpartum and one month postpartum.

RESULTS

Satisfaction with the programme was high. The experimental group had higher scores in breastfeeding knowledge and breastfeeding attitude at three days postpartum. The experimental group showed higher breastfeeding satisfaction at three days and one month postpartum. There were no significant differences in experiencing breastfeeding problems. The rate of exclusive breastfeeding was higher for the experimental group at three days and one month postpartum, but the differences were not statistically significant.

CONCLUSION

This study demonstrated the effectiveness of a prenatal education programme on maternal knowledge, attitude and satisfaction toward breastfeeding.

RELEVANCE TO CLINICAL PRACTICE

Other hospitals could apply this model to plan and evaluate their prenatal education programme on breastfeeding.

A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration

OBJECTIVE

To determine whether postnatal 'hands off' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration.

DESIGN

Mothers were randomised at the first postnatal feed to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care.

SETTING

Eight wards in four English Midlands hospitals.

PARTICIPANTS

370 primiparous mothers with term babies who intended to breast feed, and could sit out of bed to do so.

INTERVENTIONS

Experimental protocol of verbal-only advice on positioning and attachment, delivered at the first postnatal ward feed compared with routine care by a qualified midwife.

MAIN OUTCOME MEASURES

Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife. The mothers' self-reported experience of care and support before, during and after delivery were assessed at 6 weeks, and feeding outcomes and employment status at 17 weeks.

FINDINGS

Experimental group mothers more often held the baby across their lap and received 'hands off advice', but fewer babies in the experimental than control groups attached and fed: 59% (106/180) vs. 67% (118/175), p=0.1. No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups (stopped exclusive breast feeding: 76% (130/172) vs. 77% (126/163) at 6 weeks; 96% (167/174) vs. 96% (161/168) at 17 weeks; odds ratio 1.02, 95% CI 0.77 to 1.22; p=0.8; stopped any breast feeding: 35% (61/172) vs. 32% (53/167) at 6 weeks; 63% (109/173) vs. 60% (101/167) at 17 weeks; odds ratio 1.10, 0.84 to 1.45; p=0.5). There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation (other than at the first postnatal ward feed), nor after discharge home.

CONCLUSIONS

No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment, perhaps because aspects of the intervention are already within routine UK practice. Other care practices at subsequent feeds may negate benefits of care at earlier feeds. 'Hands off' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward.

IMPLICATIONS FOR PRACTICE

Midwives can be trained in a 4-hr workshop to achieve improved knowledge of 'hands off' positioning and attachment care, and these can be translated into clinical practice. Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds, and apply this advice consistently at successive feeds.