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Awareness of breast feeding in mothers Dr. D.Veerappan Dr. Ezzati.
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Transcript of Awareness of breast feeding in mothers Dr. D.Veerappan Dr. Ezzati.
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