Post-Discharge Breastfeeding Support Phone Calls

Research Critique

PICOT question: For a postpartum mother, would post-discharge breastfeeding support phone calls increase the likelihood of breastfeeding success versus mothers receiving no post-discharge support phone calls at six-week postpartum?

Borra, C., Iacovou, M., & Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19(4), 897-907. Web.

• Purpose of the research: To establish the breastfeeding motivation effect on postpartum depression utilizing data on mothers obtained from a British survey.
• Research Design: Quantitative study.
• Sample: N = 14,541 pregnancies that developed into 14,676 known fetuses; there were 14,062 live births, and 13,988 babies surviving to 1 year.
• Data Collection Methods: Data were collected from the Avon Longitudinal. Survey of Parents and Children (ALSPAC), a survey of nearly 14,000 children born in Bristol and neighboring towns (England) in the early 1990s. Mothers were invited to participate in the survey by doctors. The time of recruitment was when women first reported their pregnancy.Data were collected with the help of questionnaires given to both parents at four points during pregnancy and at several stages after birth. Details of the data gathered in the ALSPAC survey may be accessed on the study website. The authors received ethical approval from the ALSPAC Law and Ethics Committee and the Local Research Ethics Committees.
• Results: There is a weak relationship between breastfeeding and postpartum depression.
• Strengths: A large longitudinal data set; measuring maternal mood at several different points of pregnancy; using several different measures for initiating breastfeeding and its duration.
• Limitations: No clinical diagnoses of antenatal and postpartum depression.

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(5), 1226-1232. Web.

• Purpose of the Research: To assess whether the support provided by telephone could expand the duration of breastfeeding in women who suffer from obesity.
• Research Design: Quantitative study.
• Sample: N = 226 dyads of obese mothers and their healthy, term infants. The mothers were randomly appointed to standard case-control or six months of breastfeeding. After six months, there remained 207 dyads: 102 were control subjects, and 105 were given support. An intervention was carried out by One International Board Certified Lactation Consultant. The intervention was grounded on structured interviews and was performed by encouraging phone calls.
• Data Collection Methods: The authors obtained informed consent from all parents before including infants in the study. Data were collected through surveys and self-reports.
• Results: The support group breastfed exclusively for an average of 120 days (25th–75th percentiles: 14–142 days) compared with 41 days (3–133 days) for control subjects (P = 0.003). Any breastfeeding was kept for an average of 184 days (92–185 days) for the support group compared with 108 days (16–185 days) for control subjects (P = 0.002). While breastfeeding duration was related to infant length at six months and infant weight, breastfeeding support did not indicate a crucial impact on infant growth.
• Strengths: the participants formed a homogeneous group, which decreased the risk of additional bias.
• Limitations: the probably growth-related benefits related to breastfeeding were not investigated. Since primiparity harms breastfeeding success, a high proportion of women who gave birth for the first time might have impaired the results’ validity.

Figueiredo, B., Canário, C., & Field, T. (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine, 44(5), 927-936. Web.

• Purpose of the research: To investigate the impact of prenatal and postpartum depression on breastfeeding; To explore the consequences of breastfeeding on postpartum depression.
• Research Design: Quantitative study.
• Sample: N = 145 women. The Edinburgh Postpartum Depression Scale was carried out by 145 women at the first, second, and third trimester. Later, the Scale was administered to the same women 3 months after giving birth.
• Data Collection Methods: During pregnancy – survey. After giving birth: self-report. Women collected data about themselves at birth and then at every three months until the twelfth month. Upon collection, data were analyzed with logistic and multiple linear regressions.
• Results: Depression scores were the most effective predictors of the duration of exclusive breastfeeding in the third trimester. However, they were not the best predictors at three months postpartum. In women who continued exclusive breastfeeding for longer than three months, there was noticed a meaningful decline in depression scores.
• Strengths: the time frame and the prospective design from the beginning of pregnancy to 12 months after giving birth.
• Limitations: too small effect sizes due to a small number of women in the group who did not start breastfeeding.

Hatamleh, W. (2012). Prenatal breastfeeding intervention program to increase breastfeeding duration among low-income women. Health, 4(3), 143-149.

• Purpose of the research: To investigate the role of the prenatal breastfeeding intervention program in increasing breastfeeding duration among low-income women.
• Research Design: Quantitative study. Quasi-experimental design.
• Sample: N = 37 women (a convenience sample).
• The participants were pregnant women who had not previously breastfed a child longer than a fortnight. They were between 28 and 38 weeks of pregnancy at the time of enrollment. The participants received prenatal care at the Middletown Regional Hospital prenatal clinic or the Warren County Health Clinic.
• Data Collection Methods: The investigator gathered demographic data. The following aspects were included: marital status, income, number of children, race, education, employment, pregnancy history, and intention to breastfeed.
• Results: There was a significant association between breastfeeding self-efficacy and duration (r = 0.531, p = 0.01; and, r = 0.370, p = 0.05). The hypothesis was supported—women who received prenatal breastfeeding intervention breastfed for a longer time.
• Strengths: the study is a valuable source in investigating breastfeeding and ways of its increase.
• Limitations: the choice of a sample (non-probability convenience) did not allow analyzing the data from a diverse population. A sample was too small. There was a great possibility of response bias.

Theoretical Framework

The suggested PICOT presupposes the use of adaptation theory for the chosen project. This theoretical framework is based on the approach developed by Roy (Papathanasiou, Sklavou, & Kourkouta, 2013). According to the adaptation approach, every person is a bio-psycho-social individual who is constantly interacting with the changing environment. To cope with the challenges presented by alterations in the environment, people employ innate mechanisms and acquired measures that may be of social, biological, or psychological nature (Papathanasiou et al., 2013). Such a framework is rather suitable for the current study as postpartum mothers experience an extremely significant change in their lives, which inevitably influences their attitudes to themselves and the world around them.

A common adverse outcome of giving birth is postpartum depression (Borra, Iacovou, & Sevilla, 2015; Figueiredo, Canário, & Field, 2014). The theory of adaptation is rather helpful in investigating this issue. According to the theory, health and illness are indispensable elements of any person’s life. To react to environmental changes positively, people need to adapt (Papathanasiou et al., 2013). Postpartum women, as well as pregnant ones, have to accommodate to several issues. Their body changes significantly, they no longer belong to themselves, and they cannot afford many of the usual things that they enjoy. Adaptation theory states that there are four adaptation modes: physiological needs, the concept of self, role function, and interdependence.

Each of these modes is reflected in postpartum women, and breastfeeding is considered to be one of the ways of making the process of adaptation easier (Carlsen et al., 2013; Hatamleh, 2012). At physiological needs level, postpartum women need to adapt to a new sleeping pattern, some painful experience following childbirth, and discomfort associated with breastfeeding. To decrease the seriousness of the last aspect, the current project suggests a phone-based intervention to encourage postpartum women to breastfeed. The second adaptation model incorporates self-concept. New mothers need to identify with their new functions and accept their changed identity. The role function mode presupposes the comprehension of a new role and several responsibilities that a woman acquires after giving birth to a baby. Finally, the factor of interdependence involves a woman’s understanding that her physical and mental state now depends on the mood and health, and vice versa.

One of the assumptions of adaptation theory is that patient’s values should be respected (Papathanasiou et al., 2013). In light of the current project, such an assumption means that every woman should decide whether she wants to breastfeed. However, taking into consideration the nutritional and immune defense value of mother’s milk for infants, it is necessary to explain the benefits of breastfeeding and encourage women to choose this method.

Change Model

No progress is possible without changes and adjustments. This requirement holds particularly true when talking about research in healthcare. Professionals constantly work to develop more effective drugs, equipment, and treatment methods. In the suggested project, change is also necessary. Implementing an intervention presupposes that there will be alterations in the participants’ attitudes after the planned campaign is launched.

The change model chosen for the project is Lewin’s model that incorporates three stages: unfreezing, moving, and refreezing (Mitchell, 2013). At each of these phases, there are specific aims of the research, the fulfillment of which leads to positive outcomes. The first step of Lewin’s model is unfreezing. Considering the chosen PICOT question, unfreezing will incorporate teaching women about the benefits of breastfeeding and encourage them to choose this option of feeding their babies. At this stage, the need for change is established.

The second step is moving. At this phase, the change is initiated (Mitchell, 2013). In the current project, the initiated change is a phone-based intervention. It is suggested that the women who receive post-discharge phone calls will express more willingness to breastfeed than those who do not receive such support. The third step in Lewin’s model is refreezing (Mitchell, 2013). At this point, the changes are expected to become permanent. Women participating in the intervention are likely to adapt to their new status and stop feeling uncomfortable or depressed because of their maternity. If the intervention proves to be successful, the third step will be the phase at which a new way of things will be established.

The chosen change model presents several significant benefits to the selected PICOT question. First of all, the positive results of this model’s employment have been indicated by many researchers, which means that the project will have a high potential to be successful. Also, the number of steps in Lewin’s change model is rather suitable for the PICOT question. There are not too few phases, which makes it possible to structure the project in several parts. Simultaneously, the number of steps is not too big, which will guarantee that the intervention does not become too complicated. Lewin’s model is useful for the PICOT question because it gives the researcher time between the pre-experimental, experimental, and post-experimental stages when the participants’ attitudes will be analyzed. Therefore, the use of Lewin’s change model for the present study is rather beneficial. It will enable the researcher to arrange work in a well-structured way.

References

Borra, C., Iacovou, M., & Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19(4), 897-907.

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(5), 1226-1232.

Figueiredo, B., Canário, C., & Field, T. (2014). Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychological Medicine, 44(5), 927-936.

Hatamleh, W. (2012). Prenatal breastfeeding intervention program to increase breastfeeding duration among low income women. Health, 4(3), 143-149.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Papathanasiou, I., Sklavou, M., & Kourkouta, L. (2013). Holistic nursing care: Theories and perspectives. American Journal of Nursing Science, 2(1), 1-5.