Professor Shantini Paranjothy & Dr Lisa Hurt – Cardiff University
The Challenge
The benefits of breastfeeding for the health of babies and mothers are well known. However, in the UK, although 81% of women start breastfeeding, fewer than half continue beyond 6 weeks and only 1% meet the World Health Organization’s recommendation of exclusive breastfeeding for 6 months.
Previous studies have indicated that young white British mums of lower socioeconomic status are less likely to start breastfeeding or continue beyond 6 weeks. Professional support for breastfeeding is widely available in the UK, but new approaches to support women who are at the highest risk of not continuing breastfeeding are urgently needed.
Research shows that there is usually a steep decline in breastfeeding rates in the period directly after childbirth. It is not known whether or not peer support during this time can increase the duration of breastfeeding. Breastfeeding peer supporter is provided by women from the community who have experience of breastfeeding and may come from a similar background to the women whom they support. Compared with health professionals, peer supporters may be more approachable, provide role models that mothers can relate to and have direct experience of the challenges of breastfeeding.
The Research
The first aim of this study was to develop an early contact breastfeeding peer support intervention. The intervention, which was named ‘Mam-Kind’, looked to use a motivational interviewing approach. This approach is a form of counselling that supports people in changing their behaviour by exploring their concerns and supporting them in setting their own goals. The research team wanted to see if it was possible to help women breastfeed for longer by using buddies trained in motivational interviewing.
The second aim was to carry out a feasibility study to assess whether or not ‘Mam-Kind’ can be delivered to women who live in areas with high levels of social deprivation. Previous studies of breastfeeding peer support effectiveness in the UK have highlighted problems with poor uptake and continuation to the intervention.
The study was conducted within community maternity services in three areas with high levels of social deprivation and low breastfeeding start rates in England and Wales. The majority of participants (94%) were white, employed and aged between 19 and 41 years. The ‘Mam-Kind’ intervention was well received, with a high uptake rate of 75%.
The ‘Mam-Kind’ intervention consisted of face-to-face contact at 48 hours after birth and one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2–6 weeks. The study recorded data on the:
- Recruitment and retention of Mam-Kind buddies
- Uptake of Mam-Kind by participants
- Feasibility of delivering Mam-Kind
- Acceptability of Mam-Kind to mothers, buddies and health-care professionals.
The Findings
The research team wanted, before embarking on a larger test of ‘Mam-Kind’, to see if the intervention was acceptable to women and feasible to deliver. Eight buddies delivered Mam-Kind to seventy women from three areas with high levels of social deprivation and teenage pregnancy and low rates of breastfeeding. The team interviewed mothers, buddies and health-care professionals to get their views. Mothers reported that buddies provided reassurance, were non-judgemental and were easily contactable. However, the buddies reported that it was sometimes difficult to use their motivational skills while providing breastfeeding support.
The results and information gathered during the feasibility study was then used to make improvements to the training and content of the ‘Mam-Kind’ intervention.
The Impact
The feasibility study indicated that the ‘Mam-Kind’ intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a larger multicentre trial. A larger trial would explore and provide more robust evidence to show if ‘Mam-Kind’ is an effective way to support and help women continue breastfeeding for longer.
The study further highlighted the need to strengthen strategies for birth notification and retention of participants and provided some insights on how this could be achieved in a full trial.
