Joyce Marshall

Association between timing of introducing solid foods and obesity in infancy and childhood: A systematic review

Determining early-life risk factors for obesity in later life is essential in order to effectively target preventative interventions to reduce obesity. The aim of this systematic review was to investigate current evidence to determine whether the timing of introducing solid foods is associated with obesity in infancy and childhood. Relevant randomized and observational studies from developed countries were identified by searching the following six bio-medical databases (Medline, Embase, British Nursing Index, CINAHL, Maternity and Infant Care, and PsycINFO) and hand-searching reference lists. Studies of pre-term or low birthweight infants were excluded. Twenty-four studies met the inclusion criteria for the systematic review. Data from over 34,000 participants were available for interpretative analysis. No clear association between the age of introduction of solid foods and obesity was found. It is likely that a whole family approach to obesity prevention will be most effective and health professionals should continue to promote healthy infant feeding in line with national recommendations.

Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England

BACKGROUNDncaesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England.nnnOBJECTIVEnto evaluate the Focus on Normal Birth and Reducing Caesarean section Rates programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants׳ perceptions of factors that sustain or hinder work within participating maternity units.nnnDESIGNna mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews.nnnPARTICIPANTSntwenty Hospital Trusts in England (selected from 68 who applied) took part in the Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation.nnnMETHODSncollection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts.nnnFINDINGSnthere was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline.nnnCONCLUSIONSnit is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.

Parents’ views on how health professionals should work with them now to get the best for their child in the future

Backgroundu2002 Pregnancy and the first years of life are important times for future child well-being. Early identification of families and children who might be likely to experience poorer outcomes could enable health professionals and parents to work together to promote each child’s well-being. Little is known about the acceptability and feasibility of such an approach to parents. n n n nObjectiveu2002 To investigate parents’ views about how health professionals should identify and work with families who may benefit from additional input to maximize their children’s future health and well-being. n n n nDesignu2002 A qualitative study using focus groups. n n n nSetting and participantsu2002 Eleven focus groups were conducted with a total of 54 parents; 42 mothers and 12 fathers living in the north of England. n n n nResultsu2002 Parents welcomed the idea of preventive services. They strongly believed that everyone should have access to services to enhance child well-being whilst recognizing that some families need additional support. Making judgements about who should receive additional services based on specific criteria evoked powerful emotions because of the implication of failure. Parents projected a belief in themselves as ‘good parents’ even in adverse circumstances. n n n nConclusionsu2002 Targeted additional preventive services can be acceptable and welcome if health professionals introduce them sensitively, in the context of an existing relationship, providing parents are active participants.Backgroundu2002 Pregnancy and the first years of life are important times for future child well‐being. Early identification of families and children who might be likely to experience poorer outcomes could enable health professionals and parents to work together to promote each child’s well‐being. Little is known about the acceptability and feasibility of such an approach to parents.

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

Shifting Identities: Social and Cultural Factors That Shape Decision-Making Around Sustaining Breastfeeding

In the United Kingdom, women’s beliefs, attitudes and behaviours around breastfeeding are shaped by myriad influences and by changing social and structural factors and cultural mores. Whilst public health discourse equates breastfeeding with ‘good mothering’ and health professionals emphasise ‘breast as best’, these normative values compete with other standards or criteria of ‘good mothering’ held by others within women’s social networks that exert influence on them. Moreover, cultural and structural factors affecting the pattern of women’s labour market participation, specifically public policy emphasis on return to paid work aligned with policies directed at reconciling work and family act as constraints on sustaining optimal breastfeeding, i.e. exclusive breastfeeding for 6 months as advised by the World Health Organization (2003). For women in this study, initiating and sustaining breastfeeding was subject to a complex process that contributed to multiple valued outcomes: nurturing thriving and healthy babies, experiencing themselves as ‘competent’ mothers, successfully managing shifting identities and negotiating competing pressures in the real-life context of their daily lives and relationships with ‘significant others’. Even as women struggled to present and see themselves as ‘good mothers’, they were active agents and not just acted upon. They sought to reconcile the value they placed on breastfeeding with seeing themselves and being seen by others as ‘good mothers’. Thus, they sought out situations where breastfeeding was highly valued (such as support groups), and developed strategies to counter or avoid threats to their sense of themselves as nurturing and competent mothers that was related to, but not synonymous with, sustaining breastfeeding. Midwives and health visitors in this study encouraged women to breastfeed but not in the way that this is generally portrayed in much of the current literature. Analysis of observed interactions between women who had chosen to breastfeed and midwives and health visitors suggests more of a negotiated encounter in which these health professional considered the whole situation of the woman and her struggle to be a ‘good mother’.