Fiona Dykes

Adolescent Mothers and Breastfeeding: Experiences and Support Needs—An Exploratory Study

The experiences and support needs of adolescent mothers who commenced breastfeeding were elicited using focus groups and in-depth semistructured interviews. The study took place in the North West of England, UK. The qualitative data were analyzed using thematic networks analysis. Five themes related to experiences emerged: feeling watched and judged, lacking confidence, tiredness, discomfort, and sharing accountability. A further 5 themes were developed to describe the adolescents support needs: emotional support, esteem support, instrumental support, informational support, and network support. These forms of support were most effective when provided together in a synergistic way and within a trusting relationship. Key supporters identified were the mothers mother, the partner, and the midwife employed in a teenage pregnancy coordinator role. Health professionals need to further exsplore the ways in which relationships may be developed and sustained that provide the range of support required by adolescent mothers to enable them to continue breastfeeding. J Hum Lact. 19(4):391-401.

Breastfeeding in Hospital : Mothers, Midwives and the Production Line

Introduction 1. The Birthing of the Production Line 2. Formulating Infant Feeding 3. Participating in Production 4. It is so demanding - Breastfeeding as Labour 5. Time to Care - Midwifery Work at the End of the Medical Production Line 6. Breastfeeding and Midwifery Work: Reconceptualising Bodies, Time and Relationships

Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

BackgroundThe Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia.MethodsThe study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis.ResultsThree main themes were identified: Belief and Commitment; Interpreting BFHI and Climbing a Mountain. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings.ConclusionDespite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation.

The Relationship between Zinc Intake and Serum/Plasma Zinc Concentration in Children: A Systematic Review and Dose-Response Meta-Analysis

Recommendations for zinc intake during childhood vary widely across Europe. The EURRECA project attempts to consolidate the basis for the definition of micronutrient requirements, taking into account relationships among intake, status and health outcomes, in order to harmonise these recommendations. Data on zinc intake and biomarkers of zinc status reported in randomised controlled trials (RCTs) can provide estimates of dose-response relationships which may be used for underpinning zinc reference values. This systematic review included all RCTs of apparently healthy children aged 1–17 years published by February 2010 which provided data on zinc intake and biomarkers of zinc status. An intake-status regression coefficient () was calculated for each individual study and calculated the overall pooled and SE () using random effects meta-analysis on a double log scale. The pooled dose-response relationship between zinc intake and zinc status indicated that a doubling of the zinc intake increased the serum/plasma zinc status by 9%. This evidence can be utilised, together with currently used balance studies and repletion/depletion studies, when setting zinc recommendations as a basis for nutrition policies.

Staff Perceptions and Experiences of Implementing the Baby Friendly Initiative in Neonatal Intensive Care Units in Australia

OBJECTIVEnTo explore the perceptions, understandings, and experiences of maternity service staff toward the World Health Organization/United Nations Childrens Fund (WHO/UNICEF) Baby Friendly Hospital Initiative (BFHI) and its implementation in the Neonatal Intensive Care Unit (NICU).nnnDESIGNnAn exploratory study using naturalistic methods of inquiry.nnnSETTINGnParticipants were recruited from a total of four Australian metropolitan maternity hospitals of which two included a NICU. Focus groups and individual interviews were undertaken in the participants choice of location, usually hospital.nnnPARTICIPANTSnForty-seven participants included nursing and midwifery staff and one pediatrician.nnnMETHODSnData from focus groups and interviews were transcribed and thematic analysis used to identify themes related to implementation and perceptions of staff regarding BFHI.nnnRESULTSnMajor themes identified focused on the differences in NICUs relative to maternity units, separate worlds of mother and infant, the hard work involved in implementing the BFHI, and the positive attitude that BFHI can be achieved. There were misconceptions by participants on the nature of the BFHI as it applied to NICUs. Factors hindering and supporting BFHI implementation were also identified.nnnCONCLUSIONnMotivated staff, educational support, and clear guidelines are essential to support implementation of the BFHI in NICUs.

Giving me hope: women's reflections on a breastfeeding peer support service

Breastfeeding peer support has been identified as a key intervention to help improve breastfeeding and exclusive breastfeeding rates. The World Health Organization, and, in the UK, the National Institute for Health and Clinical Excellence, recommend the implementation of sustainable peer support programmes. As part of an evaluation into a comprehensive breastfeeding peer support service in north-west England, in-depth interviews were conducted with 47 women who had received a breastfeeding peer support service. In this paper, we have drawn upon the work of Morse and colleagues to interpret the data in relation to behavioural manifestations of hope, together with insights into the strategies used by the peer supporters to augment hopefulness for womens breastfeeding goals. These theoretical and practice-based findings offer insights into how the breastfeeding peer supporters provided realistic assessments across varying situational contexts, formed strategies and plans to help women overcome any obstacles, made women aware of any negative outcomes, mobilised external and personal resources to facilitate goal attainment, provided evaluations and feedback on womens (and infants) progress, and through praise, reassurance and instilling calm, the peer supporters helped women to focus their energy to achieve their breastfeeding goals. Practice-based implications are considered.

Implementing the WHO/UNICEF Baby Friendly Initiative in the community: a ‘hearts and minds’ approach

OBJECTIVESnto describe a hearts and minds approach to community Baby Friendly Initiative implementation developed from the views of multidisciplinary professionals.nnnDESIGNna qualitative descriptive study utilising focus groups and interviews, with thematic networks analysis conducted.nnnSETTINGnforty-seven professionals were consulted from two primary health-care facilities located in the North-West of England.nnnFINDINGSnthematic networks analysis generated a global theme of a hearts and minds approach to BFI implementation, which embodies emotional and rational engagement. The three underpinning organising themes (and their associated basic themes): credible leadership, engagement of key partners and changing attitudes and practice reflect the context, processes and outcomes of a hearts and minds approach.nnnCONCLUSIONS AND IMPLICATIONS FOR PRACTICEna hearts and minds approach transcends the prescriptive aspects of a macro-level intervention with its emphasis upon audits, training, statistics and hard evidence through valuing other professionals and engaging staff at all levels. It offers insights into how organisational change may move beyond traditional top-down mechanisms for driving change to incorporate ways that value others and promote cooperation and reflection.

The relationship between zinc intake and serum/plasma zinc concentration in pregnant and lactating women: A systematic review with dose-response meta-analyses

Recommendations for zinc intake during pregnancy and lactation vary widely across Europe. Using data on zinc intake and biomarkers of zinc status reported in randomized controlled trials (RCTs) and observational studies can provide estimates of dose-response relationships that may be used for underpinning zinc reference values. This systematic review included all RCTs, prospective cohort studies, nested case-control studies and cross-sectional studies in healthy pregnant and lactating populations published by February 2010 which provided data on zinc intake and biomarkers of zinc status. An intake-status regression coefficient (βˆ) was calculated for each individual study and calculated the overall pooled βˆ and SE (βˆ) using random effects meta-analysis on a double log scale. The pooled dose-response relationship between zinc intake and zinc status found that a doubling of zinc intake was associated with an increase in serum/plasma zinc status by 3% in pregnant women and by 1% in lactating women. These modest associations are likely to reflect the low-moderate zinc bioavailability dietary patterns and the widespread use of other micronutrients in the populations included in this review, physiologic adjustments of zinc homeostasis, insensitivity of serum/plasma zinc as a biomarker of zinc status, and wide heterogeneity between study results which reflect real uncertainty in the current evidence base. Although this review provides useful information for dietary zinc requirements in populations vulnerable to zinc deficiency, it also highlights a need for further studies in pregnant and lactating women with different dietary patterns in order to provide useful complementary evidence that can be utilized when setting zinc recommendations as a basis for nutrition policies in Europe.

The nutritional requirements of infants. Towards EU alignment of reference values : the EURRECA network

This paper presents a review of the current knowledge regarding the macro- and micronutrient requirements of infants and discusses issues related to these requirements during the first year of life. The paper also reviews the current reference values used in European countries and the methodological approaches used to derive them by a sample of seven European and international authoritative committees from which background scientific reports are available. Throughout the paper, the main issues contributing to disparities in micronutrient reference values for infants are highlighted. The identification of these issues in relation to the specific physiological aspects of infants is important for informing future initiatives aimed at providing standardized approaches to overcome variability of micronutrient reference values across Europe for this age group.

‘Being in a womb’ or ‘playing musical chairs’: the impact of place and space on infant feeding in NICUs

BackgroundBecoming a parent of a preterm baby requiring neonatal care constitutes an extraordinary life situation in which parenting begins and evolves in a medical and unfamiliar setting. Although there is increasing emphasis within maternity and neonatal care on the influence of place and space upon the experiences of staff and service users, there is a lack of research on how space and place influence relationships and care in the neonatal environment. The aim of this study was to explore, in-depth, the impact of place and space on parents’ experiences and practices related to feeding their preterm babies in Neonatal Intensive Care Units (NICUs) in Sweden and England.MethodsAn ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory approach was utilised throughout data collection and analysis.ResultsThe core category of ‘the room as a conveyance for an attuned feeding’ was underpinned by four categories: the level of ‘ownership’ of space and place; the feeling of ‘at-homeness’; the experience of ‘the door or a shield’ against people entering, for privacy, for enabling a focus within, and for regulating socialising and the; ‘window of opportunity’. Findings showed that the construction and design of space and place was strongly influential on the developing parent-infant relationship and for experiencing a sense of connectedness and a shared awareness with the baby during feeding, an attuned feeding.ConclusionsIf our proposed model is valid, it is vital that these findings are considered when developing or reconfiguring NICUs so that account is taken of the influences of spatiality upon parent’s experiences. Even without redesign there are measures that may be taken to make a positive difference for parents and their preterm babies.