Bosom Buddies

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Sheila Knight Health Visitor Janet Dalzell
Breast-feeding Coordinator 26/04/06
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Breastfeeding RatesTarget - 50 at 6 weeks in
Scotland by 2005
Source CHSP-PS 2002
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Why telephone peer support?

• Previously focus was on medical, physical, and
  demographic reasons
• More recently researcher have been looking at
  social and confidence reasons
• Telephone peer support in middle class Canada
• Dennis(1999) developed Breast Feeding
  Self-efficacy Scale to measure maternal
  confidence
• It use so far has shown a correlation between low
  antenatal scores and formula feeding at 6 weeks

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Breast-feeding self-efficacy

• Breast-feeding self-efficacy refers to a mothers
• confidence in her ability to breast-feed her baby
  and is
• a significant factor as it predicts
• Whether a mother chooses to breast-feed or not
• How much effort she will expend
• Whether she will have self-enhancing or
  self-defeating thought patterns
• How she will respond emotionally to
  breast-feeding difficulties (Dennis1999)

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Breast-feeding self-efficacy

• Gaining confidence in breast-feeding is
• influenced by four sources of information
• performance accomplishment e.g. previously
  breast-feed baby
• vicarious experience e.g. watching other women
  successfully breast-feeding
• verbal persuasion e.g. factual information,
  encouragement from influential others such as
  family, friends and professionals
• physiological responses e.g. fatigue, stress,
  anxiety, pain
•  

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Bosom Buddy Project

• To investigate the feasibility, acceptability and
  satisfaction with telephone peer support to lower
  income women in two Dundee practices and one in
  Arbroath
• Funding from Queens Nursing Institute of
  Scotland
• Approval from Tayside Committee for Medical
  Ethics
• NHS Tayside Policy for Volunteers

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Plan

• Volunteers, experienced breast feeding mothers
  from caseloads of practices involved
• Telephone contact initiated by supporter before
  birth
• Up to eight weeks support
• Training provided
• Evaluation by interviews and questionnaires
  (provided by Dennis 2002 study)

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ResultsRecruiting volunteers

• In Dundee, 27 asked, 13 said yes, 7 completed
  training and became volunteers
• Age Yes No
• 20-29 6 8
• 30-39 5 6
• Over 39 2 0
• And in Arbroath

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Recruiting Mothers

• Midwives to provide information during pregnancy,
  this did not happen
• Opportunistic recruitment
• Planned antenatal by HV visit to recruit in
  Dundee
• Planned postnatal visit to recruit in Arbroath
• Bosom buddies invited to attend antenatal
  breastfeeding workshops in Arbroath to recruit
  women.

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Recruiting mothers

• 16 mothers were recruited
• 10 were prims and
• 6 had previous children
• 13 were had not previously breast feed at all
• 3 had breast fed for a short time before

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Being a volunteer

• Very enthusiastic about breast feeding
• Clearly understood the support role
• Clear understanding of the difference of
  professional problem solving role
• Enjoyed contacts once established
• Replacement buddy needed
• Overall positive experience for the buddy, would
  do it again
• Keen to support other women

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Training and Information Pack

• All said that training was adequate
• Bit about being non-judgmental was good
• Pack used for checking information

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Telephone contacts

• Diary sheets showed evidence of the buddies
  giving positive feedback to mothers
• Good rapport being established
• Bosom buddies checking usefulness of contact with
  the mothers
• Mobile phones in Dundee were useful

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No contact established

• Two mothers decided to formula feed their babies,
  both before hospital discharge
• One mother changed her phone number and the
  service was unaware of this
• One bosom buddy telephoned the mother around
  thirty times over a two to three week period and
  got no replies but when contact was made the
  mother had started formula feeding
• One mother was reluctant to talk and it was clear
  to the bosom buddy that she had changed her mind
  about taking part.

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Contacts

• Diary entries showed that there was a wide range
  of contacts and length of calls
• the number of contacts per mother ranged from 2
  to 11
• length of individual calls in minutes ranged from
  3 to 90 minutes
• total contact time per mother ranged from 15 to
  195minutes
• no replies to calls ranged from 2 to 30
• mother initiated calls were four from three
  mothers in Arbroath, none in Dundee

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Satisfaction with Infant Feeding

• Scores ranged from 12 to 59,
• Mean 50.3
• 13 intend to breastfeed next baby
• 13 found experience enjoyable
• 14 recommend to friends
• 4 unhappy with feeding method at 8 weeks (formula
  feeding)

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Maternal satisfaction with Peer Support

• Comments from 14 mothers who completed the
  evaluation and questionnaires
• Questionnaire Scores ranged from 33 to 50,
• and the mean was 46.5
• 7 said it extended the length of breast
  feeding
• 11 said helped to reach goals, kept me
  focused
• 12 said they would like a bosom buddy the next
  time
• 7 said she helped me continue breastfeeding
• 11 said all new mothers should have one
• 12 said they had enough contact

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Breastfeeding Self-efficacy
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Breastfeeding Questionnaire

• at 8 weeks 8 of the14 babies still receiving
  breast milk
• From data interpretation 5 of the 6 not
  breastfeeding at 8 weeks did not fully establish
  breastfeeding.

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Reasons given by mothers for giving formula feed

• Never attached successfully (2)
• Painful cracked nipples mastitis (1)
• Did not like breastfeeding (1)
• Baby feeding too long, too hungry(3)
• And did not have enough milk(2)

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Conclusion

• Feasibility
• Recruiting volunteers successful
• Volunteers positive and highly enthusiastic
• Mobile phones useful and added versatility
• Experience of breast feeding and 5 hours training
  gave volunteers enough confidence
• Women keen to support other breast feeding
  mothers

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Conclusion

• Acceptability
• Over half the mothers who were asked, accepted
  the offer of a buddy
• May have been more if not a research project
• Mothers found telephone contact acceptable
• Buddies viewed it as a worthwhile thing to do

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Conclusion

• Satisfaction
• Volunteers rated highly by mothers
• Mothers satisfied by experience of the project
• Mothers thought everyone should have one
• Would have buddy again with next baby
• Buddies happy with training and support

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Conclusion

• Telephone peer support cannot provide the
  intensive pre and post natal education guidance
  and support needed by mothers to establish breast
  feeding
• But when breast feeding is established it may be
  effective in increasing duration and exclusivity
  rates
• Volunteers need support, up-dating and deputy

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Recommendations

• An RCT is needed to evaluate the effectiveness of
  telephone peer support in extending duration of
  breastfeeding.
• Comparison of areas of high and low deprivation,
  and urban and rural areas would be useful in the
  evaluation of the effectiveness of this
  intervention