'You likes your way, we got our own way': Gypsy and Travellers' views on infant feeding and health professional support

Background: Gypsies and Travellers are known to have poor health status and access to health services, even in comparison to other ethnic minority groups. People from this stigmatised ethnic group are rarely consulted about their health needs or health service provision. Optimal infant feeding in the first year of life has the potential to improve life long health. Objective: The aim of this study is to explore mothers and grandmothers' views on feeding in the first year of life, including the support provided by health professionals. Methods: Semi-structured interviews were conducted with a purposively selected sample of 22 mothers and grandmothers of English Gypsy, Irish Traveller and Romanian Roma ethnicity between November 2011 and February 2012 in a city in South-West England. Results Few women perceived themselves as requiring help from health professionals in infant feeding, as acceptable and accessible support was available from within their own communities. Roma mothers described a tradition of breastfeeding and appropriately timed weaning, while English Gypsies and Irish Travellers customarily practised less healthy infant feeding. When mothers requested support, health service provision was often found inadequate. Conclusion: Exploring the views of Gypsies and Travellers is important to gain insight into the provision of health services for this marginalised ethnic group. This study has implications for policy and the practice of health professionals, in indicating the customary feeding behaviours of some Gypsy and Travellers, and highlighting areas meriting culturally sensitive health promotion

Breastfeeding and depression: a systematic review of the literature

Background: Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression. Methods: An electronic search in three databases was performed using the keywords: “breast feeding”, “bottle feeding”, “depression”, “pregnancy”, and “postpartum”. Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of antidepressants were excluded. 48 studies were selected and included. Data were independently extracted. Results: Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum. Limitations: The selected keywords may have led to the exclusion of relevant references. Conclusions: Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.This research was supported by FEDER Funds through the Programa Operacional Factores de Competitividade – COMPETE and by National Funds through FCT – Fundaçãopara a Ciência e a Tecnologiaunder the project: PTDC/SAU/SAP/116738/2010. The sponsors had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication

Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial

<p>Abstract</p> <p>Background</p> <p>The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age.</p> <p>Method/Design</p> <p>This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion.</p> <p>The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..</p> <p>Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.</p> <p>Discussion</p> <p>Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical variability can be reduced and the care received by patients can be improved.</p> <p>Trial registration</p> <p>The trial was registered with ClinicalTrials.gov, number <a href="http://www.clinicaltrials.gov/ct2/show/NCT01474096">NCT01474096</a></p

Training needs survey of midwives, health visitors and voluntary sector breastfeeding support staff in England

This study, which was part of a learning needs assessment of health professionals in England, reports a survey of the training needs of healthcare practitioners in breastfeeding support skills. Respondents rated their competence on 26 breastfeeding support skills, importance of update, actual and potential helpfulness of training, and accessibility in the next 2 years. Perception of organizational barriers to breastfeeding support and practitioners' knowledge of policies and guidance on breastfeeding were measured. Data are reported on 549 healthcare practitioners, mostly midwives and health visitors working for public health services, and some voluntary-sector practitioners, 58 had worked with women and their infants for more than 10 years, and 56 were currently spending at least 25 of their working time providing direct care to breastfeeding women. Those already competent were most likely to want more updating. Those with longer experience of breastfeeding support were more competent on three of the four competence subscales. Relationships between self-assessed competence and current intensity of breastfeeding experience were inconsistent. Respondents preferred training with a practical component. Respondents had poor knowledge of evidence-based policy, and only 51 had access to a breastfeeding policy. Organizational barriers to breastfeeding support were experienced by all, and especially by those with fewer years of experience (t = -2.32, d.f. = 547; P = 0.02) and those currently spending less time supporting breastfeeding women (t = -10.35, d.f. = 547; P < 0.0001). Core training is relevant to all practitioners, and practice-based training with access to evidence-based policies is required

'But is it a normal thing?' Teenage mothers' experiences of breastfeeding promotion and support

Aim: To explore teenagers' experiences of the breastfeeding promotion and support delivered by health professionals. Design: A qualitative study conducted in an English city. Methods: Pregnant teenagers and teenage mothers (n = 29) took part in semi-structured interviews and focus groups between March and July 2009. Results: Breastfeeding is presented by health professionals as incontrovertibly the best choice of feeding method, but teenagers experience an array of conflicting norms which influence their infant feeding choices and behaviours. Conclusions: The social barriers to continuing breastfeeding are insufficiently recognized and addressed by health professionals. It is likely that teenage mothers would breastfeed for longer if they perceived that breastfeeding was a normal way to feed baby in their social milieu. © The Author(s) 2011