Literature Review
This present study aims at answering the following question: (P) in the postpartum mother, would (I) post-discharge breastfeeding support phone calls, (C) compared to mothers receiving no post-discharge support phone call, (O) increase the likelihood of breastfeeding success (T) at six-week postpartum? Odom, Li, Scanlon, Perrine, and Grummer-Strawn (2013) examined the reasons for premature cessation in mothers that were willing to breastfeed.
A cross-sectional survey that employed the use of questionnaires revealed that the primary causes of early termination were difficulties with lactation, concerns with infant nutrition, sicknesses, and inability to pump milk. Despite the possible voluntary response bias, the study provided meaningful insight into the reasoning behind premature cessation. At least two of the problems mentioned above could be tackled with the help of a health provider.
Keleher and Parker (2013) carried out a cross-sectional survey that aimed at gauging nurses’ awareness of their role in health promotion. After analyzing the data drawn from the questionnaires, the authors concluded that the respondents were cognizant of their ability to make a contribution to the community. Moreover, they were eager to take on responsibilities in more upstream work in partnerships. The reliability of the research results, however, might be compromised by rather small sample size.
There are numerous benefits to breastfeeding, and attempts to increase students’ knowledge of advantageous postnatal practices have been undertaken. Boznette and Posner (2013) evaluated the effectiveness of a respective pilot program for nursing students and reported a tangible difference in awareness through a series of tests. The study was innovative in terms of use evidence-based materials in lectures; however, its replicability might be questioned.
Powell, David, and Anderson (2014) discovered that 75% of the 21 interviewed breastfeeding mothers reported negative experiences regarding their interactions with healthcare providers. The study showed that not only the lack of support was detrimental to breastfeeding success but also incomplete information and dishonesty about potential complications. The study’s weaknesses, however, were a small sample and the possibility of voluntary response bias.
Such reports are alarming because the majority of mothers would like to continue breastfeeding but had to cease due to the factors above (Oakley, Henderson, Redshaw, & Quigley 2014). Oakley et al. explained that midwives’ ongoing encouragement decreased the odds of termination. Overall, 3840 respondents of the survey named midwives’ support as one of the determining factors of positive experience. However, the study’s reliability might have been compromised by the subjectivity in the perception of the issue.
Ishak et al. (2014) conducted a prospective cross-sectional study with the purpose of defining the determinants of breastfeeding success. They interviewed 213 mothers, in which they inquired about their choices regarding breastfeeding and the reasons for them. The findings revealed that mothers’ knowledge was not sufficient for successful breastfeeding as many respondents complained about the lack of support from their health providers. The study helped capitalize on the role of medical practitioners in facilitating uninhibited breastfeeding; however, voluntary response bias might have been introduced.
Heidari, Keshvari, and Kohan (2016) investigated the primary barriers to successful breastfeeding. For this purpose, they conducted a series of in-depth interviews with fourteen mothers, four involved family members, and six health practitioners to determine what may negatively affect their practice. Heidari et al. contributed to the research field by outlining three primary categories of obstacles: mothers’ lack of self-efficacy, family’s neglectful attitude, and healthcare providers’ incompetency. Nevertheless, one cannot dismiss a rather modest sample size and possible voluntary response bias.
Nabulsi et al. (2014) also found a positive relationship between intensive medical interventions during the first six months postpartum and satisfying breastfeeding experiences. In a randomized control trial, the intervention group received a full professional “support package” whereas the control group only received standard post-natal care. Quality of life was measured at one, three, and six months postpartum through a series of interviews. The study’s limitations were the exclusion of mothers not intending to breastfeed and the fact that it was single-blinded.
For the sake of being more specific, it is crucial to analyze how a health practitioner may provide counseling and the efficiency of each way. Tahir and Al-Sadat (2013) conducted a nonprobability controlled trial in which the intervention group was receiving phone calls from lactation specialists bi-monthly whereas the control group was only receiving standard postpartum care. The findings exposed an interesting tendency: support calls positively affected breastfeeding behaviors in the first month but not in the fourth and sixth months. Despite the study’s essential conclusions, one should note that the exclusion of mothers who gave birth through a Cesarean section might have imposed certain limitations.
Carlsen et al. (2013) evaluated whether telephone-based support could improve obese mothers’ chances to breastfeed since their unhealthy weight presented particular difficulties. 226 women were separated into intervention and control groups, with intervention group participants maintaining communication with medical professionals via telephone. The study revealed that telephone-based support helped the women in the intervention group not terminate breastfeeding prematurely. One should note, however, that the study was single-blind whereas a double-blind study would be ideal.
Research Design
The present study will employ an experimental quantitative design since the authors seek to answer a specific question. A randomized control trial is to be conducted to find a link or lack thereof between telephone-based support and breastfeeding success. The members of the intervention group will be interacting with nurses over the telephone whereas the participants in the control group will not. The success will be a dependent value that will be operationalized through the duration of breastfeeding and mothers’ comfort and positive experiences.
Quantitative research relies on numerical data and not on mere observations which accounts for reliability whereas the fact that the design is predetermined and structured makes it replicable (Karlsen, 2014). However, it will not be possible to make the clinical trial double-blind. It is obvious that the information as to who belongs to which group cannot be hidden from the team members since they will have to provide constant communication with nurses.
Sampling
The target population is mothers who have recently given birth to normal babies through a spontaneous vaginal delivery with no complications. Another criterion is mothers’ clear intent to breastfeed since attracting participants with no such plans and educating them on the benefits would disrupt or at least complicate the research process. Mothers who have given birth through Cesarean section are excluded since they typically commence breastfeeding later, and it would not be convenient to adjust the starting date to take this particularity into account. The sampling method will be non-probability convenience sampling, and for this, a number of the city’s hospitals and birthing centers will be contacted.
The staff will inform mothers who have just given birth about the study and ask whether they might be interested. It is planned to involve at least fifty women with diverse backgrounds. Convenience sampling is time and cost-effective; however, on the other hand, it can lead to under-representation or over-representation of certain groups (Acharya, Prakash, Saxena, & Nigam, 2013). Each participant will be informed about anonymity and confidentiality, and the participants will only be possible on the grounds of informed explicit consent.
Implementation
The PDSA Change Model stands for plan, do, study, and act and thus, presents a cycle of change implementation including four main stages. First, the needed change should be tested or implemented whereas, at the second stage, the change is carried out. At the third change, the outcomes are measured, and the data before and after the change is compared. Lastly, the next cycle of full implementation is planned (Donnelly & Kirk, 2015). The PDSA Change Model applies to the present research since it may be aligned with the standard procedures of a clinical trial.
The Control group receiving lactation counseling over the phone corresponds to the first and second stages. The comparison between the outcomes in intervention and control groups relates to the Study stage. Lastly, at the end of the research, ideas for more extensive studies will be gathered. One of the barriers to the integration of the research results into practice may be medical practitioners’ commitment to standard procedures which may exclude telephone counseling. To overcome this barrier, an ongoing clinical inquiry should be fostered. Medical staff members should question and evaluate practice continuously to implement changes when needed.
References
Acharya, A. S., Prakash, A., Saxena, P., & Nigam, A. (2013). Sampling: Why and how of it? Indian Journal of Medical Specialties, 4(2), 330-333.
Boznette, M., & Posner, T. (2013). Increasing student nurses’ knowledge of breastfeeding in baccalaureate education. Nurse Education in Practice, 13(3), 228-233.
Carlsen, E. M., Kyhnaeb, A., Renault, K. M., Cortes, D., Michaelsen, K. F., & Pryds, O. (2013). Telephone-based support prolongs breastfeeding duration in obese women: A randomized trial. The American Journal of Clinical Nutrition, 98, 1226-1232.
Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Web.
Heidari, Z., Keshvari, M., & Kohan, S. (2016). Breastfeeding promotion, challenges, and barriers: A qualitative research. International Journal of Pediatrics, 4(5), 1687-1695.
Ishak, S., Adzan, N. A., Quan, L. K., Shafie, M. H., Rani, N. A., & Ramli, K. G. (2014). Knowledge and beliefs about breastfeeding are not determinants for successful breastfeeding. Breastfeeding medicine: The official journal of the Academy of Breastfeeding Medicine, 9(6), 308-12.
Karlsen, J. E. (2014). Design and application for a replicable foresight methodology bridging quantitative and qualitative expert data. European Journal of Futures Research, 2(40).
Keleher, H., & Parker, R. (2013). Health promotion by primary care nurses in Australian general practice. Collegian, 20, 215-221.
Nabulsi, M., Hamadeh, H., Tamim, H., Kabakian, T., Charafeddine, L., Yehya, N., … Sidani, S. (2014). A complex breastfeeding promotion and support intervention in a developing country: Study protocol for a randomized clinical trial. BMC Public Health, 14(36), 1-11.
Odom, E., Li, R., Scanlon, K. S., Perrine, C. G., & Grummer-Strawn, L. (2013). Reasons for earlier than desired cessation of breastfeeding. Pediatrics, 131(3), e726–e732.
Oakley, L. L., Henderson, J., Redshaw, M., Quigley, M. A. (2014). The role of support and other factors in early breastfeeding cessation: An analysis of data from a maternity survey in England. BMC Pregnancy Childbirth, 14(88).
Powell, R., Davis, M., & Anderson, A. K. (2014). A qualitative look into mother’s breastfeeding experiences. Journal of Neonatal Nursing, 20(6), 259-265.
Tahir, N. M., & Al-Sadat, N. (2013). Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial. International Journal of Nursing Studies 50, 16–25.