Barely Attached

Abstract

Background/Problem: Maternal breastfeeding confidence is critical for successful breastfeeding. Midwives are well placed to improve maternal confidence by helping mothers learn how to attach their baby to initiate breastfeeding. This can be achieved by encouraging mothers to hold their nude baby against their bare chest. Continuous uninterrupted skin-to-skin contact is known to assist babies coordinate their suckling reflex to attach for effective breastfeeding. However, little attention has been given to events surrounding birth and the immediate postpartum in fostering effective breastfeeding. Some authors argue that many routine hospital procedures and midwifery practices adversely effect breastfeeding initiation and maternal confidence to breastfeed.

Aim: To explore women's experiences of the first breastfeed and impact on maternal confidence.

Setting: The participating site was a regional mother and baby unit seeking BFHI accreditation status.

Sample: Convenience sample of birthing women.

Design: Observation study and interviews.

Procedure: Observations were conducted with 61 mothers in the birthing room who gave birth vaginally. Mothers were followed up with a face-to-face interview prior to discharge, and a telephone interview at two weeks postpartum to determine satisfaction with care, maternal confidence, and incidence of common breastfeeding problems. The Breastfeeding Self-Efficacy Scale (BSES) (Dennis & Faux, 1999) was used to measure maternal breastfeeding confidence.

Results: The sample consisted of primipara (n = 28) and multipara (n = 32) women. Sixty-two percent (62%) of the mothers held their babies in continuous uninterrupted skin contact during the first hour of birth. Seventy percent of the babies attempted to attach to the breast within the first hour, and 57% successfully attached with deep rhythmical suckling. Participants reported a high level of satisfaction when offered the opportunity to hold their baby in skin-to-skin contact at the time of birth. At two weeks postpartum 76% of mother-baby dyads were exclusively breastfeeding. Further analysis is currently being conducted to understand relationships between optimal attachment to the breast in the birthing room and problem free breastfeeding in the early postnatal period. Associations between skin-to-skin contact holding, babies' attaching well in the first hour of birth, and mothers confidence scores at 2 weeks postpartum will be reported.

Discussion and implications for practice: This research contributes to our current understanding of how assistance to begin breastfeeding should be offered to mothers. Mothers' reported experience of holding their baby in skin-to-skin contact after birth and implications for breastfeeding initiation will be discussed. The study highlights the impact of midwifery practices on maternal confidence to breastfeed their newborn. Recommendations for practice change will be outlined.