An intervention study using a breastfeeding positioning and attachment tool

Abstract

Exclusive breastfeedirig provides both mother and infant with the optimum method of feeding for the first 4-6 months of life, however few women achieve this goal. Key reasons cited for cessation include sore nipples and breasts, insufficient milk and tiredness. The impact of these factors may be reduced and breastfeeding outcomes improved, if women left hospital able to correctly position and attach their infant to the breast. Breastfeeding is a learned skill and in the absence of a breastfeeding culture, success relies upon the support and skill of health care professionals. As advice is often inconsistent, a more
systematic method of teaching breastfeeding skills may prove beneficial. This study investigated whether an intervention in the form of a positioning and attachment checklist for use by health care staff in a maternity unit would increase duration of breastfeeding and decrease the incidence of sore nipples in breastfeeding mothers. The checklist was designed specifically for use in the study and reviewed by a number of experts in the field. A longitudinal, controlled pre-test-post-test design was adopted, and the study was conducted as a pilot to allow calculation of sample size required for further study. One hundred and twenty two women were recruited into the study from one ward in a large Maternity Hospital, 60 during the pre-test and 62 during the post-test stage of the inquiry. Data was collected by questionnaire at seven days and telephone interview at six weeks. Response rates were good to the questionnaire (88% pre-test and 82% post-test) and to the six week interview undertaken by the researcher, (97% and 85%). Key outcomes measures were exclusive breastfeeding at seven days, six weeks, and nipple pain. Breastfeeding at seven days increased from 60.4% to 70% and at six weeks from 30.8% to 36.2%,
although this change was not statistically significant. Nipple pain was reduced at seven days (n=74, u=586.6, p (one-tailed) =0.057). Analyses also considered maternal satisfaction, and whether the checklist was more effective within specific groups. Whilst the results did not prove to be statistically significant, the trends towards improved breastfeeding outcomes can be argued to be of clinical significance and further investigation is therefore warranted.