Awareness of breast feeding in mothers

Dr. D.VeerappanDr. D.Veerappan

Dr. EzzatiDr. Ezzati

Under the kind guidance of

G.SubramanianG.Subramanian

J.RawalJ.Rawal

Background It was observed that a number of mothers It was observed that a number of mothers

were showing lack of awareness about were showing lack of awareness about issues in breast feeding in the postnatal issues in breast feeding in the postnatal wards.wards.

Aim The aim of this audit was to explore the The aim of this audit was to explore the

adequacy of education and support in breast adequacy of education and support in breast feedingfeeding

Method QuestionnaireQuestionnaire PALS approvalPALS approval Questionnaire was given by me and by my Questionnaire was given by me and by my

colleagues to 200 consecutive mothers (in colleagues to 200 consecutive mothers (in the postnatal ward) who consented to fill the postnatal ward) who consented to fill questionnairequestionnaire

Standards

Questionnaire Auditing the awareness/knowledge of mothers in HWH about breast feedingAuditing the awareness/knowledge of mothers in HWH about breast feeding

1-Do you want to give breast milk to your baby? 1-Do you want to give breast milk to your baby? Yes Yes No No if yes, for how long are you considering breast feeding? if yes, for how long are you considering breast feeding? 1 month 1 month 4-6 months 4-6 months 6-12 months 6-12 months > 1year > 1year

2-Have you had breast feeding experience before? 2-Have you had breast feeding experience before? Yes Yes No No 3-Do you feel confident in breast feeding? 3-Do you feel confident in breast feeding? Yes Yes No No

4-Do you think that breast feeding has health benefits for the baby? 4-Do you think that breast feeding has health benefits for the baby? Yes Yes No No

5- Do you think that breast feeding has health benefits for the mother? 5- Do you think that breast feeding has health benefits for the mother? Yes Yes No No

6-Have you had antenatal breast examination regarding to the breast feeding? 6-Have you had antenatal breast examination regarding to the breast feeding? Yes Yes No No

7-Did you like antenatal classes for breast feeding? 7-Did you like antenatal classes for breast feeding? Yes Yes No No Not attended Not attended If attended, do you think the teaching was adequate? If attended, do you think the teaching was adequate? Yes Yes NoNo

8-Have you been taught about the first feed? (The best time for it) 8-Have you been taught about the first feed? (The best time for it) Yes Yes No No

9- Have you been taught about the correct positioning and attachment? 9- Have you been taught about the correct positioning and attachment? Yes Yes No No If yes, do you feel that it was enough? If yes, do you feel that it was enough? Yes Yes No No    10-Do you know about the composition of the breast milk? 10-Do you know about the composition of the breast milk? Yes Yes No No

11- Do you know that the amount and composition of the breast milk changes during the day? 11- Do you know that the amount and composition of the breast milk changes during the day? Yes Yes No No 12- Do you know that the amount and composition of the breast milk changes as the baby is growing? 12- Do you know that the amount and composition of the breast milk changes as the baby is growing? Yes Yes

No No

13- Do you know about the differences in breast milk in mothers of term and preterm babies?  Yes 13- Do you know about the differences in breast milk in mothers of term and preterm babies?  Yes No No

14- Do you know how often you need to feed the baby during the early days after birth? 14- Do you know how often you need to feed the baby during the early days after birth? Yes Yes No No 15- Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk) 15- Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk) Yes Yes

No No

16- Do you know that let down reflex is a sign of enough milk production in your breast? 16- Do you know that let down reflex is a sign of enough milk production in your breast? Yes Yes No No

17- Do you know that passing enough urine (making 6 nappies wet) per day is a sign of 17- Do you know that passing enough urine (making 6 nappies wet) per day is a sign of enough milk intake by your baby? enough milk intake by your baby? Yes Yes No No    18-Do you think that during breast feeding, you need to change your diet? 18-Do you think that during breast feeding, you need to change your diet? Yes Yes No No If yes, what changes do you believe?If yes, what changes do you believe?   19-What do you believe will increase the amount of your breast milk?19-What do you believe will increase the amount of your breast milk? Specific diet Specific diet rest & sleeping rest & sleeping medication medication others others none none Baby’s suckingBaby’s sucking

20-What do you believe will decrease the amount of your breast milk?20-What do you believe will decrease the amount of your breast milk? Specific diet Specific diet stress stress medication medication others others None None

21- Do you think that culture in health staff/community is supportive enough regarding the breast feeding? 21- Do you think that culture in health staff/community is supportive enough regarding the breast feeding? Yes Yes No No

22-Have you had any conflicting advice regarding breast feeding from any health staff?22-Have you had any conflicting advice regarding breast feeding from any health staff? Yes Yes No If yes, what was it?No If yes, what was it?

23- Do you feel that there is enough support for Breast feeding in HWH? 23- Do you feel that there is enough support for Breast feeding in HWH? Yes Yes No No

24-If you want to return to work, do you know how long at least you have to do breast 24-If you want to return to work, do you know how long at least you have to do breast feeding in order to establish Breast feeding? feeding in order to establish Breast feeding? Yes Yes No No    25- Do you know that you can keep your expressed milk in fridge for one day? 25- Do you know that you can keep your expressed milk in fridge for one day? Yes Yes No No    26- Do you know that you can keep your expressed milk in freezer for 3 months? 26- Do you know that you can keep your expressed milk in freezer for 3 months? Yes Yes No No    27-Which kind of training for breast feeding do you think is best and most helpful?27-Which kind of training for breast feeding do you think is best and most helpful? Self study (eg.journals, books, internet) Self study (eg.journals, books, internet) Observation of other breast feeding mothersObservation of other breast feeding mothers Training by health staff Training by health staff Training by GP Training by GP Training by Paediatrician Training by Paediatrician    28- Do you know that exclusive breast feeding can be used as contraception? 28- Do you know that exclusive breast feeding can be used as contraception? Yes Yes No No    29- Do you know that some medication can be passed to the baby by breast feeding? Yes 29- Do you know that some medication can be passed to the baby by breast feeding? Yes No No    30-If breast feeding, what are your concerns? (You may give more than one answer)30-If breast feeding, what are your concerns? (You may give more than one answer) Job Job Discomfort Discomfort Self figure Self figure Any painful experience Any painful experience Lack of freedom/interfere with daily routines Lack of freedom/interfere with daily routines Other Other

Results Maternal age groupMaternal age group

Marital statusMarital status

Age Age groupgroup

15-2015-20 21-2521-25 26-3026-30 31-3531-35 36-4036-40 >40>40

No No 1515 3434 6060 6161 2828 22

Marital Marital statusstatus

Single Single Married Married Not Not knownknown

No No 6363 117117 2020

Maternal age group

15

34

60 61

28

20

10

20

30

40

50

60

70

15-20

26-30

36-40

No

Marital Status

0

20

40

60

80

100

120

Numbers

SingleMarried

Not Known

SingleMarriedNot Known

EthnicityEthnicity

Sex of the babySex of the baby

Mode of deliveryMode of delivery

EthnicityEthnicity CaucCauc AfrocaAfroca AsianAsian OrientOrient OtherOther NGNG

No No 113113 3636 2525 11 1010 1515

SexSex MaleMale Female Female NGNG

No No 100100 9696 44

Type Type NVDNVD For/venFor/ven Em C/SEm C/S El C/SEl C/S NGNG

No No 136136 2121 2828 1010 55

Ethnicity

25

36

113

1

10

15

0 20 40 60 80 100 120

Numbers

NGOthersOrientalCaucasianBlackAsian

Sex

MaleFemaleNot given

Mode of Delivery

NVDNVD InstrumentalInstrumental Em.LSCSEm.LSCS El.LSCSEl.LSCS NGNG

136136 2121 2828 1010 55

Maternal w ish

1 m on th1 5

4 -6 m on th s5 8

6 -1 2 m on th s3 0

> 1 yr1 8

N ot g iven1 1

Y es1 3 2

N o6 4

N ot g iven4

B reas t feed in g

Questions Have you had breast feeding experience before? Have you had breast feeding experience before?

Yes 76 Yes 76 No 117 NG 7No 117 NG 7

Do you feel confident in breast feeding? Do you feel confident in breast feeding?

Yes 99 Yes 99 No 84 NG 14No 84 NG 14

Do you think that breast feeding has health benefits for the baby? Do you think that breast feeding has health benefits for the baby?

Yes 178 Yes 178 No 13 NG 9No 13 NG 9

Do you think that breast feeding has health benefits for the mother? Do you think that breast feeding has health benefits for the mother?

Yes 162 Yes 162 No 24 NG 14No 24 NG 14

76

117

7

9984

14

178

13 9

162

2414

0

20

40

60

80

100

120

140

160

180

Experience Confidence Benefit M Benefit B

YesNoNot given

Questions Have you had antenatal breast examination regarding to the breast feeding? Have you had antenatal breast examination regarding to the breast feeding? Yes 12 Yes 12 No 178 NG 10No 178 NG 10

Did you like antenatal classes for breast feeding? Did you like antenatal classes for breast feeding? Yes 23 Yes 23 No 161 No 161 Not attended 16 Not attended 16

If attended, do you think the teaching was adequate? If attended, do you think the teaching was adequate? Yes 10 Yes 10 No 2 NG 11No 2 NG 11

Have you been taught about the first feed? (The best time for it) Have you been taught about the first feed? (The best time for it) Yes 68 Yes 68 No 123 NG 9No 123 NG 9

Have you been taught about the correct positioning and attachment? Have you been taught about the correct positioning and attachment? Yes 103 Yes 103 No 82 NG 15No 82 NG 15 If yes, do you feel that it was enough? If yes, do you feel that it was enough? Yes 52 Yes 52 No 9 NG 42 No 9 NG 42   

Antenatal Care

0

20

40

60

80

100

120

140

160

180

Examn Class 1st feed Technique

YesNoNG

Questions Do you know about the composition of the breast milk? Do you know about the composition of the breast milk? Yes 93 Yes 93 No 91 NG 16No 91 NG 16

Do you know that the amount and composition of the breast milk changes Do you know that the amount and composition of the breast milk changes during the day? during the day?

Yes 60 Yes 60 No 128 NG 12No 128 NG 12 Do you know that the amount and composition of the breast milk changes as Do you know that the amount and composition of the breast milk changes as

the baby is growing? the baby is growing? Yes 83 Yes 83 No 106 NG 11No 106 NG 11

Do you know about the differences in breast milk in mothers of term and Do you know about the differences in breast milk in mothers of term and preterm babies? preterm babies?

   Yes 37 Yes 37 No 151 NG 12No 151 NG 12

Do you know that milk composition changes during each breast feeding? Do you know that milk composition changes during each breast feeding? (Foremilk, Hindmilk) (Foremilk, Hindmilk)

Yes 93 Yes 93 No 95 NG 12No 95 NG 12

Composition of Milk

0

20

40

60

80

100

120

140

160

Comp Day Growth Difference Foremilk

YesNoNG

Questions Do you know how often you need to feed the baby during the early days after Do you know how often you need to feed the baby during the early days after

birth? birth? Yes 115 No 74 NG 11Yes 115 No 74 NG 11

Do you know that let down reflex is a sign of enough milk production in your Do you know that let down reflex is a sign of enough milk production in your breast? breast?

Yes 56 No 95 NG 14Yes 56 No 95 NG 14

Do you know that passing enough urine (making 6 nappies wet) per day is a Do you know that passing enough urine (making 6 nappies wet) per day is a sign of enough milk intake by your baby? sign of enough milk intake by your baby?

Yes 94 No 130 NG 8Yes 94 No 130 NG 8

If you want to return to work, do you know how long at least you have to do If you want to return to work, do you know how long at least you have to do breast breast

feeding in order to establish Breast feeding? feeding in order to establish Breast feeding? Yes 37 No 125 NG 38Yes 37 No 125 NG 38  

Adequacy

0

20

40

60

80

100

120

140

Frequency Let down Assesment Length

yesnong

Questions

Do you think that culture in health staff/community is supportive enough Do you think that culture in health staff/community is supportive enough regarding the breast feeding? regarding the breast feeding?

Yes 134 Yes 134 No 39 NG 27No 39 NG 27

Have you had any conflicting advice regarding breast feeding from any health Have you had any conflicting advice regarding breast feeding from any health staff?staff?

Yes 12 Yes 12 No 177 NG 11No 177 NG 11

Do you feel that there is enough support for Breast feeding in HWH? Do you feel that there is enough support for Breast feeding in HWH?

Yes 133 Yes 133 No 39 NG 28No 39 NG 28

Support

0

20

40

60

80

100

120

140

160

180

Health Staff Advice HWH support

YesNoNot known

Questions Do you think that during breast feeding, you need to change your diet? Do you think that during breast feeding, you need to change your diet? Yes 106 Yes 106 No 74 NG 20No 74 NG 20

What do you believe will increase the amount of your breast milk?What do you believe will increase the amount of your breast milk?

Specific diet 61 Specific diet 61 rest & sleeping 73 rest & sleeping 73 medication 4 medication 4 others 6 others 6 none 14 none 14 Baby’s sucking 94 NG 34Baby’s sucking 94 NG 34

What do you believe will decrease the amount of your breast milk?What do you believe will decrease the amount of your breast milk?

Specific diet 29 Specific diet 29 stress 124 stress 124 medication 31 medication 31 others 8 others 8 None 14 None 14

NG21NG21

53% agrees diet change needed

Factors ImprovingFactors Improving 47% Suckling47% Suckling 36% Rest& Sleep36% Rest& Sleep 30% Specific diet30% Specific diet 4% Medication4% Medication 3%Others3%Others 4% None4% None

Factors affectingFactors affecting 62% Stress62% Stress 15% Medication15% Medication 14% Diet14% Diet 4%Others4%Others 7% None7% None

Questions Do you know that you can keep your expressed milk in fridge for one day? Do you know that you can keep your expressed milk in fridge for one day?

Yes 144 Yes 144 No 40 NG 15No 40 NG 15

   Do you know that you can keep your expressed milk in freezer for 3 months? Do you know that you can keep your expressed milk in freezer for 3 months?

Yes 125 Yes 125 No 61 NG 14No 61 NG 14

  

Storage

0

20

40

60

80

100

120

140

160

Fridge Freezer

YesNoNot given

Questions Which kind of training for breast feeding do you think is best and most Which kind of training for breast feeding do you think is best and most

helpful?helpful?

Self study (eg.journals, books, internet) 38Self study (eg.journals, books, internet) 38

Observation of other breast feeding mothers 47Observation of other breast feeding mothers 47

Training by health staff 113 Training by health staff 113

Training by GP 17 Training by GP 17

Training by Paediatrician 30Training by Paediatrician 30

NG 31 NG 31

    

Training 57% By Health staff57% By Health staff 24% Observing others24% Observing others 19% Self study19% Self study 15% by Paediatrician 15% by Paediatrician 8.5% By GP8.5% By GP

Questions Do you know that exclusive breast feeding can be used as contraception? Do you know that exclusive breast feeding can be used as contraception?

Yes 49 Yes 49 No 135 NG 16No 135 NG 16

   Do you know that some medication can be passed to the baby by breast Do you know that some medication can be passed to the baby by breast

feeding? feeding?

Yes 151 Yes 151 No 36 NG 13No 36 NG 13

OthersContraception

49

135

16

MedicationMedication

* 75% think will be * 75% think will be passed to the babypassed to the baby

* Remaining assume * Remaining assume they are not passed to they are not passed to the babythe baby

Questions 30-If breast feeding, what are your concerns? (You may give more than one 30-If breast feeding, what are your concerns? (You may give more than one

answer)answer)

Job 17Job 17

Discomfort 52 Discomfort 52

Self figure 10Self figure 10

Any painful experience 23Any painful experience 23

Lack of freedom/interfere with daily routines 29Lack of freedom/interfere with daily routines 29

Other 23Other 23

NG 46NG 46

Maternal concerns

17

10

52

23

29

23

0

10

20

30

40

50

60

Job Figure Discomfort Pain Freedom Other

Conclusions

Recommendations