Feasibility and acceptability of a motivational interviewing breastfeeding peer support intervention

An uncontrolled study with process evaluation was conducted in three U.K. community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer‐support intervention informed by motivational interviewing (MI; Mam‐Kind). Peer‐supporters were trained to deliver the Mam‐Kind intervention that provided intensive one‐to‐one peer‐support, including (a) antenatal contact, (b) face‐to‐face contact within 48 hr of birth, (c) proactive (peer‐supporter led) alternate day contact for 2 weeks after birth, and (d) mother‐led contact for a further 6 weeks. Peer‐supporters completed structured diaries and audio‐recorded face‐to‐face sessions with mothers. Semistructured interviews were conducted with a purposive sample of mothers, health professionals, and all peer‐supporters. Interview data were analysed thematically to assess intervention acceptability. Audio‐recorded peer‐support sessions were assessed for intervention fidelity and the use of MI techniques, using the MITI 4.2 tool. Eight peer‐supporters delivered the Mam‐Kind intervention to 70 mothers in three National Health Service maternity services. Qualitative interviews with mothers (n = 28), peer‐supporters (n = 8), and health professionals (n = 12) indicated that the intervention was acceptable, and health professionals felt it could be integrated with existing services. There was high fidelity to intervention content; 93% of intervention objectives were met during sessions. However, peer‐supporters reported difficulties in adapting from an expert‐by‐experience role to a collaborative role. We have established the feasibility and acceptability of providing breastfeeding peer‐support using a MI‐informed approach. Refinement of the intervention is needed to further develop peer‐supporters' skills in providing mother‐centred support. The refined intervention should be tested for effectiveness in a randomised controlled trial.     

A qualitative analysis of text message conversations in a breastfeeding peer counselling intervention

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) breastfeeding peer counselling (BFPC) program supports optimal early life nutrition by providing evidenced‐based breastfeeding protection, promotion, and support. The Lactation Advice Through Texting Can Help (LATCH) study was a randomized controlled trial that tested the effectiveness of a text messaging intervention designed to augment the BFPC program. The purpose of the present study was to understand the topics discussed during the text message exchanges between breastfeeding peer counsellors (PCs) and their clients in the intervention arm of the LATCH study, from the time of enrollment up to two‐weeks postpartum. Text messaging data were first coded and analysed for one‐ and two‐way text message exchanges. Text messages of participants with a high volume of two‐way exchanges were then analysed qualitatively. Four domains were identified in both the prenatal and postpartum periods: the mechanics of breastfeeding, social support, baby's nutrition, and PCs maintaining contact with participants. Additional themes and subthemes identified in the postpartum period included the discussion of breastfeeding problems such as latching trouble engorgement, plugged ducts, pumping, other breastfeeding complications, and resuming breastfeeding if stopped. Two‐way text messaging in the context of the WIC BFPC program provides an immediate and effective method of substantive communication between mothers and their PC.     

The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results

The UK has low breastfeeding rates, with socioeconomic disparities. The Assets‐based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets‐based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention – delivered through face‐to‐face, telephone and text message by trained Infant Feeding Helpers (IFHs) – ran from 30‐weeks' gestation until 5‐months postnatal. Outcomes included recruitment rates and follow‐up at 3‐days, 8‐weeks and 6‐months postnatal, with collection of future full trial outcomes via questionnaires. A mixed‐methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow‐up rates were 68.0%, 85.4% and 80.6% at 3‐days, 8‐weeks and 6‐months respectively. Breastfeeding at 8‐weeks was obtained for 95.1% using routine data for non‐responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention‐related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.     

Feasibility and acceptability of a mobile app in an ecological momentary assessment of early breastfeeding

Ecological momentary assessment (EMA) is a novel data collection method that samples subject experiences in real‐time – minimizing recall bias. Here, we describe the feasibility of EMA to track breastfeeding behaviour through a mobile phone app. During their birth hospitalization, we approached healthy, first‐time mothers intending to exclusively breastfeed for at least 2 months to participate in a study tracking breastfeeding through 8 weeks postpartum. Participants downloaded a commercially available smartphone app, entered information and thoughts about breastfeeding as they occurred, and emailed this data weekly. We called participants at 2 and 8 weeks to assess breastfeeding status. At the 8‐week call, we also assessed participants' experiences using the app. Of the 61 participants, 38% sent complete or nearly complete feeding data, 24% sent some data, and 38% sent no data; 58% completed at least one free‐text breastfeeding entry, and five women logged daily or near daily entries. Compared with women who sent no data, those who sent any were more likely to be married, highly educated, intend to breastfeed more than 6 months, have a more favourable baseline attitude towards breastfeeding, and less likely to have used formula during hospitalization. There was a high degree of agreement between participant‐reported proportion of breast milk feeds via app and interview data at 2 weeks (ICC 0.97). Experiences with the app ranged from helpful to too time‐consuming or anxiety‐provoking. Participants and researchers encountered technical issues related to app use and analysis, respectively. While our data do not support the feasibility of stand‐alone app‐based EMA to track breastfeeding behaviour, it may provide rich accounts of the breastfeeding experience for certain subgroups of women. © 2016 John Wiley & Sons Ltd     

The impact of peer support training on mothers' attitudes towards and knowledge of breastfeeding

While the benefits of breastfeeding are well established, few Scottish women exclusively breastfeed, as recommended nationally and internationally. Breastfeeding peer support can help mothers to breastfeed for longer, but the training peer supporters receive is variable and few studies have measured the effectiveness of peer supporter training. This study aimed to compare mothers' attitudes towards and knowledge of breastfeeding before and after undertaking Breastfeeding Network (BfN) peer supporter training. This study used a quasi‐experimental design to investigate levels of breastfeeding knowledge and attitudes in 28 women, immediately before and after the BfN peer supporter (Helper) training programme. Data were collected using the Infant Feeding Questionnaire. Mothers had high baseline scores for attitude (88.8%) and knowledge (76.4%). After training 78% of mothers improved their attitude scores. The mean difference in attitude scores was 4.9%, which was statistically significant (t = 4.44, P < 0.001). Ninety‐six per cent of mothers had increased their knowledge scores. The mean difference in knowledge scores was 10.4%, which was statistically significant (t = 6.25, P < 0.001). This study provides evidence that the BfN's accredited peer support training can improve both breastfeeding knowledge and attitudes of breastfeeding mothers. Peer supporters who have undertaken this training are therefore suitably qualified to provide mothers with the support and information required to make informed choices in breastfeeding and to contribute to effective support and promotion of breastfeeding as suggested in the National Institute for Health and Clinical Excellence guideline on maternal and infant nutrition (PH11) and Scottish Government's Maternal and Infant Nutrition: A Framework for Action (2011).     

Infant malnutrition treatment in Kenya: Health worker and breastfeeding peer supporter experiences

Acute malnutrition in infants under 6 months (u6m) is increasingly recognised as a global public health problem. The World Health Organisation (WHO) guidelines for inpatient nutritional rehabilitation of infants u6m is re‐lactation: the re‐establishment of exclusive breastfeeding. Evidence suggests these guidelines are rarely followed in many low‐income settings. Two studies of infant nutritional rehabilitation undertaken in three public hospitals in coastal Kenya employed breastfeeding peer supporters (BFPSs) to facilitate WHO guideline implementation. To explore the acceptability of the strategy to health workers (HWs) and the BFPSs, in‐depth interviews were conducted with 20 HWs and five BFPSs in the three study hospitals. The HWs reported that the presence of the BFPSs changed the way infant nutritional rehabilitation was managed, increasing efforts at relactation and decreasing reliance on supplemental milk. BFPSs were said to help address staff shortages and had dedicated time to support and assist the mothers. Key to the success of the BFPSs was the social relationships they were able to establish with the mothers due to the similarity in their experiences and backgrounds. Despite the success of the BFPSs, human resource management and infrastructure challenges remained. BFPSs can successfully be employed to facilitate the implementation of the WHO guidelines for the nutritional rehabilitation of acutely malnourished infants u6m in hospitals in Kenya, establishing supportive social relationships and trust with the mothers of the acutely malnourished infants and helping to address the issue of human resource shortages.     

The impact of a package of behaviour change interventions on breastfeeding practices in East Java Province,Indonesia

Suboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster‐randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0–23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age‐appropriate breastfeeding and bottle‐feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35–2.53) and age‐appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07–1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41–0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention.     

Availability of breastfeeding peer support in the United Kingdom: A cross‐sectional study

Peer support is recommended by the World Health Organization for the initiation and continuation of breastfeeding, and this recommendation is included in United Kingdom (U.K.) guidance. There is a lack of information about how, when, and where breastfeeding peer support was provided in the U.K. We aimed to generate an overview of how peer support is delivered in the U.K. and to gain an understanding of challenges for implementation. We surveyed all U.K. infant feeding coordinators (n = 696) who were part of U.K.‐based National Infant Feeding Networks, covering 177 National Health Service (NHS) organisations. We received 136 responses (individual response rate 19.5%), covering 102 U.K. NHS organisations (organisational response rate 58%). We also searched NHS organisation websites to obtain data on the presence of breastfeeding peer support. Breastfeeding peer support was available in 56% of areas. However, coverage within areas was variable. The provision of training and ongoing supervision, and peer‐supporter roles, varied significantly between services. Around one third of respondents felt that breastfeeding peer‐support services were not well integrated with NHS health services. Financial issues were commonly reported to have a negative impact on service provision. One quarter of respondents stated that breastfeeding peer support was not accessed by mothers from poorer social backgrounds. Overall, there was marked variation in the provision of peer‐support services for breastfeeding in the U.K. A more robust evidence base is urgently needed to inform guidance on the structure and provision of breastfeeding peer‐support services.     

A realist review of one‐to‐one breastfeeding peer support experiments conducted in developed country settings

The World Health Organisation guidance recommends breastfeeding peer support (BFPS) as part of a strategy to improve breastfeeding rates. In the UK, BFPS is supported by National Institute for Health and Care Excellence guidance and a variety of models are in use. The experimental evidence for BFPS in developed countries is mixed and traditional methods of systematic review are ill‐equipped to explore heterogeneity, complexity, and context influences on effectiveness. This review aimed to enhance learning from the experimental evidence base for one‐to‐one BFPS intervention. Principles of realist review were applied to intervention case studies associated with published experimental studies. The review aimed (a) to explore heterogeneity in theoretical underpinnings and intervention design for one‐to‐one BFPS intervention; (b) inform design decisions by identifying transferable lessons developed from cross‐case comparison of context‐mechanism‐outcome relationships; and (c) inform evaluation design by identifying context‐mechanism‐outcome relationships associated with experimental conditions. Findings highlighted poor attention to intervention theory and considerable heterogeneity in BFPS intervention design. Transferable mid‐range theories to inform design emerged, which could be grouped into seven categories: (a) congruence with local infant feeding norms, (b) integration with the existing system of health care, (c) overcoming practical and emotional barriers to access, (d) ensuring friendly, competent, and proactive peers, (e) facilitating authentic peer–mother interactions, (f) motivating peers to ensure positive within‐intervention amplification, and (g) ensuring positive legacy and maintenance of gains. There is a need to integrate realist principles into evaluation design to improve our understanding of what forms of BFPS work, for whom and under what circumstances.     

The impact of breastfeeding peer support for mothers aged under 25: a time series analysis

Breastfeeding has known positive health benefits for babies and mothers, yet the UK has one of the lowest breastfeeding initiation rates in Europe. Despite national guidance that recommends provision of breastfeeding peer support, there is conflicting evidence regarding its effectiveness, especially in high‐income countries, and a lack of evidence among young mothers. This study evaluates the effectiveness of a breastfeeding peer support service (BPSS) in one UK city in increasing breastfeeding initiation and duration in young mothers. Routinely collected data were obtained on feeding method at birth, 2 and 6 weeks for all 5790 women aged <25 registered with a local general practitioner and who gave birth from April 2009 to September 2013. Segmented regression was used to quantify the impact of the introduction of the BPSS in September 2012 on the prevalence of breastfeeding at birth, 2 and 6 weeks, accounting for underlying trends. Results showed that breastfeeding prevalence at birth and 2 weeks began to increase month‐on‐month after the introduction of the BPSS, where previous figures had been static; prevalence at birth increased by 0.55 percentage points per month (95% CI 0.10–1.00, P = 0.018) and at 2 weeks by 0.50 percentage points (95% CI 0.15–0.86, P = 0.007). There was no change from an underlying marginally increasing trend in prevalence at 6 weeks. In conclusion, our findings suggest that a one‐to‐one BPSS provided by paid peer supporters and targeted at young mothers in the antenatal and post‐natal periods may be beneficial in increasing breastfeeding initiation and prevalence at 2 weeks.     

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations,attributes and effects

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers'' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers'' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face‐to‐face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.     

Experiences of online breastfeeding support: Support and reassurance versus judgement and misinformation

Breastfeeding support is integral to many women's successful breastfeeding experiences. However, cuts to professional and peer support services, distance from family, and a predominant formula‐feeding culture mean that many women in the United Kingdom do not receive the support they need. Turning to online support is an increasingly popular means of gaining both informational and emotional support, but research into online breastfeeding support groups is sparse in the United Kingdom. Data from Australia and the United States tend to focus on the positives: Women value such groups, finding information, reassurance, and a feeling of belonging. This study explored 14 women's experiences of using online support for breastfeeding in the United Kingdom, using semistructured interviews to understand their motivations and positive and negative experiences. Mothers were drawn to online support due to a lack of professional, familial, and partner support. Online support was reassuring, empathetic, and available around the clock and less daunting than attending a face‐to‐face group. Many attributed their continued breastfeeding to the support they received. However, women also experienced negativities: judgement for using formula, polarised debate, and a lack of regulation, meaning that unhelpful information was sometimes posted. The findings have important implications for those working to support mothers. These groups provide a safe space for breastfeeding mothers, but moderation is needed of such groups to ensure information is accurate and debate respectful. Online support groups are currently plugging a gap in funded support; they should be in addition not in replacement to professional and trained peer support services.     

Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research

Research on women's experiences of infant feeding and related moral discourse suggests that self-conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re-examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self-conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self-conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self-conscious emotions, the template also identified thoughts about self-evaluation, perceptions of judgement and sense of exposure. Self-conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well-being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self-conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self-conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.     

Mother's perceptions and experiences of infant feeding within a community-based peer counselling intervention in South Africa

Exclusive breastfeeding (EBF) has the potential to significantly reduce infant mortality, but is frequently not practiced in low-income settings where infants are vulnerable to malnutrition and infections including human immunodeficiency virus (HIV). This study explores mothers' experiences of infant feeding after receiving peer counselling promoting exclusive breast or formula feeding. This qualitative study was embedded in a cluster randomized peer counselling intervention trial in South Africa that aimed to evaluate the effect of peer counselling on EBF. Participants were selected from the three districts that were part of the trial reflecting different socio-economic conditions, rural-urban locations and HIV prevalence rates. Seventeen HIV-positive and -negative mothers allocated to intervention clusters were recruited. Despite perceived health and economic benefits of breastfeeding, several barriers to EBF remained, which contributed to a preference for mixed feeding. The understanding of the promotional message of 'exclusive' feeding was limited to 'not mixing two milks': breast or formula and did not address early introduction of foods and other liquids. Further, a crying infant or an infant who did not sleep at night were given as strong reasons for introducing semi-solid foods as early as 1 month. In addition, the need to adhere to the cultural practice of 'cleansing' and the knowledge that this practice is not compatible with EBF appeared to promote the decision to formula feed in HIV-positive mothers. Efforts to reduce barriers to EBF need to be intensified and further take into account the strong cultural beliefs that promote mixed feeding.     

Determinants of breastfeeding practices: an analysis of the Sri Lanka Demographic and Health Survey 2006-2007

Identification of factors that predict a woman's infant feeding choice is important for breastfeeding promotion programmes. We analysed a subsample of children under 2 years of age from the most recent Sri Lanka Demographic and Health Survey (SLDHS) to assess breastfeeding practices and factors associated with suboptimal practices. SLDHS 2006-2007 used a stratified two-stage cluster sample of ever-married women aged 15-49 years. Breastfeeding indicators were estimated for the last-born children (n = 2735). Selected indicators were examined against independent variables through cross-tabulations and multivariate analyses. Of the sample, 83.3% initiated breastfeeding within 1 h of birth. Continuation rates declined from 92.6% in first year to 83.5% in second year. Exclusive breastfeeding (EBF) rate under 6 months of age was 75.8%, with median duration being 4.8 months. Delayed initiation of breastfeeding was associated with low birthweight [odds ratio (OR) = 2.24] and caesarean delivery (OR = 3.30), but less likely among female infants (OR = 0.75), mothers from 'estate' sector (OR = 0.61) or richer wealth quintile (OR = 0.60). Non-EBF was associated with children from urban areas (OR = 1.72) and estate sector (OR = 4.48) and absence of post-natal visits by a public health midwife (OR = 1.89). A child was at risk for not currently breastfeeding if born in a private hospital (OR = 3.73), delivered by caesarean section (OR = 1.46) or lived in urban areas (OR = 2.80) or estate sector (OR = 3.23). Those living in estates (OR = 11.4) and not receiving post-natal home visits (OR = 2.62) were more likely to discontinue breastfeeding by 1 year. Breastfeeding indicators in Sri Lanka were higher compared with many countries and determined by socio-economic and health care system factors.     

Dairy intensification,mothers and children: an exploration of infant and young child feeding practices among rural dairy farmers in Kenya

Agricultural strategies such as dairy intensification have potential to improve human nutrition through increased household food security. Increasing dairy productivity could also adversely affect infant and young child feeding (IYCF) practices because of increased maternal stress, demands on maternal time, and beliefs about the timing and appropriate types of complementary foods. Yet, few studies have looked rigorously at how interventions can affect young children (0–60 months). The study explores, within the context of rural dairy farming in Kenya, the relationship between level of household dairy production and selected IYCF practices using a mixed‐methods approach. Six focus group discussions with women involved in dairy farming investigated their attitudes towards breastfeeding, introduction of complementary foods and child diets. Ninety‐two households involved in three levels of dairy production with at least one child 0–60 months participated in a household survey. Quantitative results indicated that women from higher dairy producing households were more likely to introduce cow's milk to infants before they reached 6 months than women from households not producing any dairy. Themes from the focus group discussions demonstrated that women were familiar with exclusive breastfeeding recommendations, but indicated a preference for mixed feeding of infants. Evidence from this study can inform nutrition education programmes targeted to farmers participating in dairy interventions in rural, low‐income settings to minimise potential harm to the nutritional status of children.     

Pressure and judgement within a dichotomous landscape of infant feeding: a grounded theory study to explore why breastfeeding women do not access peer support provision

Lack of support is reported as a key reason for early breastfeeding cessation. While breastfeeding peer support (BPS) is a recommended intervention to increase breastfeeding rates, a number of studies identify that engagement with BPS is problematic. Due to paucity of research in this area, this study explores why breastfeeding women do not access BPS in South‐West England. Utilising a constructionist grounded theory approach, 33 participants (women (n = 13), health professionals (n = 6) and peer supporters (n = 14)) participated in a semi‐structured interview (n = 22) or focus group (n = 11). Analysis involved open coding, constant comparisons and focussed coding. One core category and three main themes explicating non‐access were identified. The core category concerns women's experiences of pressure and judgement around their feeding decisions within a dichotomous landscape of infant feeding language and support. Theme one, ‘place and space of support’, describes the contrast between perceived pressure to breastfeed and a lack of adequate and appropriate support. Theme two, ‘one way or no way’, outlines the rules‐based approach to breastfeeding adopted by some health professionals and how women avoided BPS due to anticipating a similar approach. Theme three, ‘it must be me’, concerns how lack of embodied insights could lead to ‘breastfeeding failure’ identities. A background of dichotomised language, pressure and moral judgement, combined with the organisation of post‐natal care and the model of breastfeeding adopted by health professionals, may inhibit women's access to BPS. A socio‐cultural model of breastfeeding support providing clear messages regarding the value and purpose of BPS should be adopted.     

The impact of intrapartum and immediate post‐partum complications and newborn care practices on breastfeeding initiation in Ethiopia: A prospective cohort study

This study aimed to investigate the impact of intrapartum and post‐partum complications and newborn care practices on early initiation of breastfeeding (EIBF). Data for the study came from a prospective cohort study in Ethiopia that recruited and followed pregnant and post‐partum women from 2019 to 2021. Resident enumerators conducted interviews at enrolment in 2019 and follow‐ups at 6 weeks, 6 months and 1 year post‐partum. The present analysis is based on data from the baseline survey and 6 weeks follow‐up. Multivariable logistic regression was used to estimate the effects of newborn care practices and intrapartum and post‐ partum complications on EIBF (the proportion of newborns who initiated breastfeeding within the first hour of birth). Overall, 2660 mother–infant pairs were included in this analysis. After adjustment, EIBF was less likely among women who experienced intrapartum haemorrhage (adjusted odds ratio [AOR]: 0.76, 95% confidence interval [CI]: 0.59–0.97), malpresentation (AOR: 0.46, 95% CI: 0.30–0.72) and convulsions (AOR: 0.48, 95% CI: 0.34–0.66) during childbirth. Mother–newborn skin‐to‐skin contact increased the likelihood of EIBF (AOR: 1.47, 95% CI: 1.11–1.94). Women who experienced post‐partum haemorrhage (AOR: 0.63, 95% CI: 0.47–0.84), retained placenta for more than 30 min (AOR: 0.36, 95% CI: 0.24–0.52) and convulsions after delivery (AOR: 0.57, 95% CI: 0.41–0.79) were less likely to initiate breastfeeding early. Also, women who had a caesarean birth (AOR: 0.28, 95% CI: 0.18–0.41), delivered outside of a healthcare facility (AOR: 0.70, 95% CI: 0.50–0.99) or had twin birth (AOR: 0.43, 95% CI: 0.22–0.85) were less likely to initiate breastfeeding early. Skin‐to‐skin contact should be encouraged whenever possible, and women with obstetric complications should be encouraged and supported to initiate breastfeeding early.     

Making use of expertise: a qualitative analysis of the experience of breastfeeding support for first‐time mothers

There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first‐time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio‐diaries at two time points during the first 5 weeks post‐partum. We discuss a key theme within the data of ‘Making use of expertise’ and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and ‘normalising gaze’ of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person‐centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way.     

Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability

Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around £40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.