Women’s Perceptions and Experiences of Breastfeeding Support: A Metasynthesis

Abstract: Background: Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women’s perceptions and experiences of breastfeeding support, either professional or peer, to illuminate the components of support that they deemed “supportive.” Methods: The metasynthesis included studies of both formal or “created” peer and professional support for breastfeeding women but excluded studies of family or informal support. Qualitative studies were included as well as large‐scale surveys if they reported the analysis of qualitative data gathered through open‐ended responses. Primiparas and multiparas who initiated breastfeeding were included. Studies published in English, in peer‐reviewed journals, and undertaken between January 1990 and December 2007 were included. After assessment for relevance and quality, 31 studies were included. Meta‐ethnographic methods were used to identify categories and themes. Results: The metasynthesis resulted in four categories comprising 20 themes. The synthesis indicated that support for breastfeeding occurred along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counterproductive. A facilitative approach versus a reductionist approach was identified as contrasting styles of support that women experienced as helpful or unhelpful. Conclusions: The findings emphasize the importance of person‐centered communication skills and of relationships in supporting a woman to breastfeed. Organizational systems and services that facilitate continuity of caregiver, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence, involving supportive care and a trusting relationship with professionals. (BIRTH 38:1 March 2011)     

Impact of Baby‐Friendly Hospital Practices on Breastfeeding in Hong Kong

Abstract: Background: The World Health Organization (WHO) developed the Baby‐Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby‐Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby‐Friendly hospital practices on breastfeeding duration. Methods: A sample of 1,242 breastfeeding mother‐infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby‐Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming‐in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge. Results: Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby‐Friendly practices. After controlling for all other Baby‐Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42–0.88). Compared with mothers who experienced all six Baby‐Friendly practices, those who experienced one or fewer Baby‐Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41–6.95). Conclusions: Greater exposure to Baby‐Friendly practices would substantially increase new mothers’ chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines. (BIRTH 38:3 September 2011)     

A framework for recognition of prior learning within a Postgraduate Diploma of Nursing Management in South Africa

jooste k. & jasper m. (2010) Journal of Nursing Management  18, 704–714
A framework for recognition of prior learning within a Postgraduate Diploma of Nursing Management in South Africa Aims The present study focuses on the development of an initial framework to guide educators in nursing management in designing a portfolio for the recognition of prior learning for accreditation of competencies within a postgraduate diploma in South Africa. Background In South Africa, there is a unique educational need, arising from the legacy of apartheid and previous political regimes, to facilitate educational development in groups previously unable to access higher education. Awareness of the need for continuous professional development in nursing management practice and recognition of prior learning in the educational environment has presented the possibility of using one means to accomplish both aims. Evaluation Although the content of the present study is pertinent to staff development of nurse managers, it is primarily written for nurse educators in the field of nursing management. Key issues The findings identify focus areas to be addressed in a recognition of prior learning portfolio to comply with the programme specific outcomes of Nursing Service Management. Further work to refine these focus areas to criteria that specify the level of performance required to demonstrate achievement is needed. Conclusion and implications for nurse managers Managers need to facilitate continuous professional development through portfolio compilation which acknowledges the learning opportunities within the workplace and can be used as recognition of prior learning.     

Giving Birth in Two Maternity Hospitals in Lithuania

Abstract: Background: In many hospitals in former Soviet countries, traditional Soviet perinatal policies remain in place, although in others reforms have been introduced. This study explores women’s experiences during labor and birth in two Lithuanian maternity hospitals. The hospitals differed in that one (S) followed traditional Soviet era maternity practices whereas the other (P) had been exposed to World Health Organization‐Euro practices and policies with respect to more up‐to‐date evidence‐based and family‐centered care. Methods: Consecutive women giving birth in the two maternity hospitals were asked to participate in a survey. Completed responses were obtained from 416 women in one hospital (P) and 304 in the other hospital (S) representing 92.4 and 67.5 percent response rates, respectively. Results: Rates of interventions in both hospitals were similarly high with, however, P hospital being more likely to be sensitive to women’s psychosocial needs, such as being allowed to eat and drink more often during labor, and to have their husband or partner with them for labor and birth. Conclusion: It appears that in Lithuania, as in many parts of the world, introducing changes to the clinical care of birth takes time, and psychosocial changes may be easier to introduce than alterations in clinical practice. (BIRTH 37:2 June 2010)     

Cigarette smoking decreases the prolactin response to serotonergic stimulation in subgroups of alcoholics and controls

BACKGROUND: The prolactin response to serotonergic stimulation has been used as an index of central nervous system serotonin function. We evaluated the prolactin response to d,l-fenfluramine to determine whether subtypes of alcoholics differed in prolactin responsivity compared with nonalcoholics and whether cigarette smoking affected prolactin response. METHODS: One hundred ten healthy, abstinent men across four groups (controls [23% smokers]; alcoholics [72% smokers]; alcoholics with antisocial personality disorder [94% smokers]; nonalcoholic antisocials [88% smokers]) received d,l-fenfluramine (100 mg orally) in a randomized, double-blind, placebo-controlled study. Plasma prolactin levels were obtained at baseline and at half-hour intervals for 5 hr after fenfluramine/placebo administration. Plasma fenfluramine and norfenfluramine levels were obtained hourly. RESULTS: Smokers had a blunted prolactin response to fenfluramine compared with nonsmokers without any alcoholism or antisocial personality effects. Using a cutoff point of delta peak prolactin < 10 ng/ml, more smokers (41/76, 54%) had a dampened response to fenfluramine than did nonsmokers (7/34, 21%) [chi2(1) = 10.6, p < 0.003]. The percentage of low responders was greatest among smokers regardless of whether they were healthy controls, alcoholics, or antisocial. Multiple regression revealed that three variables--(1) number of pack-years of smoking, (2) actual dosage of fenfluramine received, and (3) plasma norfenfluramine level obtained--explained 43% of the variance (R2 = 0.43) in delta prolactin area under the curve. Variables that included alcoholism diagnostic status, antisocial personality diagnostic status, and impulsive aggressive personality, depressive, and suicidal traits failed to explain any additional unique variance. CONCLUSIONS: Cigarette smoking blunted the prolactin response to a pharmacological challenge with d,l-fenfluramine. Pharmacodynamic and pharmacokinetic factors related to smoking both appear to influence fenfluramine-induced prolactin secretion. Phenotypes of alcoholics did not differ in their prolactin response to this serotonergic probe.     

The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

Background  

Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients.