A PILOT SURVEY OF AN ATTEMPT TO PROMOTE BREAST-FEEDING

Margsret Gilmore*, D. O'Driscoll and H. Murphy

Obstetr ics and Gyn,aeco~ogy Unit, County Hospital , Wexford.

Summary A QUESTIONNAIRE survey on infant

feeding was conducted in Wexford maternity Hospital for a 3 month period. Positive intervention in favour of breast feeding in the form of an explanatory and encouraging leaflet was given to one group of expectant mothers, while, no leaflet was given to the other group. Actual feeding method prior to discharge from hospital was subsequently noted. Little change in feeding pattern resulted and it is concluded that an explanatory leaflet alone is insufficient encourage- ment.

Introduction Artificial feeding (A.F.) has become

the predominant method of infant feeding in the so-called developed world, most surveys reporting a breast feeding rate of less than 30% (Kevany e,t al, 1975a; Eastham e t al, 1976; Bacon and Wylie, 1976). This decline is disturbing to those involved in neonatal care, as present evidence points to overwhelming advan- tages of natural feeding (Jelliffe and Jelliffe, 1977).

Successful breast feeding (B.F.), even for as short a time as 2 weeks, is recog- nised as the best method of infant feed- ing (Sacks e,t at, 1976). It provides a balanced, easily digestible food with no problems of sterilization or heating; it is readily available, economical, and it assists in the early bonding of mother and baby (Editorial, 1977). Studies have confirmed that relative obesity is found more commonly at age 5 years in those artificially fed from birth (Kevany et at, 1975b). Cot deaths may occur less fre- quently in breast fed babies (Gunther, 1975) and breast feeding reduces the

* Present address : Department of Paediatrics, International Missionary Hospital, Drogheda.

risk of allergic reactions (Taylor et al, 1973).

Resistance to infection is increased by optimum nutrition and by transfer of specific antibody, notably Ig A, which resists proteolytic digestion in the gut (Editorial, 1976). This gives protection against gastroenteritis and respiratory syncitial virus infections (Downham et a,I, 1976). Breast feeding helps uterine involution and may act as a protective factor against development of breast cancer (Ing e,t at, 1977).

The commonest reason given for not breast feeding is embarrassment (East- ham e t al, 1976). There is a significantly higher rate of breast feeding among higher social groups, those with longer education, older age and primiparas (Bacon and Wylie, 1976). It has been suggested that national social attitudes to breast feeding need changing and that this should be started in schools (Sacks eta l , 1976; Davis, 1976).

Breast feeding rates are low in this semirural population, despite encourage- ment from nurses and doctors. A pilot survey was therefore undertaken to find whether the introduction of an educa- tional leaflet promoting breast feeding influenced infant feeding method.

Sample and Method All mothers attending 2 ante-natal

clinics over a 3 month period were given a questionnaire (Appendix) at least 8 weeks prior to delivery. The sample consisted of 162 mothers. Those who admitted to difficulty in reading or writ- ing were helped. One hundred and nine- teen patients (73%) returned question- naires of which 8 were unsuitable for analysis. The survey, therefore, consis- ted of 111 mothers, of whom 36 were primigravidas.

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A PILOT SURVEY OF AN ATTEMPT TO PROMOTE BREAST-FEEDING 273

The questionnaire showed that the mean age of primigravidas and multi- gravidas was 23 and 30 respectively. Almost all belonged to social groups, III, IV and V. Eight patients were working outside the home. Six intended to con- tinue working after delivery and gave this reason for A.F. Sixteen primigrav- idas and 7 multigravidas were living with relatives; none of this group intended to breast feed.

Thirteen had been successful but only 4 intended to B.F. again. Patients in- tending to B.F. got information from various sources. Husbands and own mothers were the main influence in pri- migravidas and reading matter in multi- gravidas. The La Leche League, which has a well advertised local branch, was contacted by only 3 mothers. Peer group relatives and friends influenced only one mother to B.F.

Twenty patients were unaware of their own mother's infant feeding practice. Thirteen primigravidas (36%) and 28 multigravidas (37%) knew their mothers had B.F. These patients were more in- clined to attempt B.F. Four primigravi- das and 17 multigravidas had seen another mother B.F.

Mothers attended clinics on 2 different days and were, therefore, divided into 2 groups on this basis. All were under the care of the same medical and nurs- ing team and received the usual verbal encouragement to B.F. Those attending one, clinic were given a leaflet promoting B.F. on returning the questionnaire, while those attending the second clinic did not receive it. Sixty-three patients (56.8%) received the leaflet. Distribution is shown in Table I.

TABLE I Distribution of B.F. leaflets.

Leaflet No leaflet given given Total

Primiparas 16(44.4%) 20(55.6%) 36(100%)

Multiparas 47 (62.7%) 28(37.3%) 75(100%)

TOTAL 63(56.8%) 46(43.2%) 111(100%)

The leaflet answered common ques- tions about breast feeding. It was ex- plained that breast milk was a perfectly balanced food, at the correct tempera- ture and germ free. They were informed that the risk of infection was less in B.F. infants. Fears of underfeeding the baby and overfeeding themselves were, ans- wered. Advice on suitable clothing and overcoming shyness was given. Breast preparation was explained. The special bonding created between mother and babq by B.F. was emphasized. Finally, mothers were encouraged to involve their husbands in the decision.

Results Breast feeding rate was 22.2% for

primigravidas and 25.3% for multigravi- das; an overall rate of 24.4%. Six pat- ients who attempted to B.F. but gave up before hospital discharge were classed as A.F. in results.

TABLE II

Change in feeding method from ante-natal decision.

(i)

Ante-natal decision Total Consistent Changed was A.F.

Controls 34 33 1

Those given B.F. leaflet 37 37 0

TOTAL 71 70 1

(ii)

Ante-natal decision Total Consistent Changed was B.F.

Controls 11 8 3

Those given 1 initially B.F. leaflet 23 16 6 at

discharge TOTAL 34 24 10

Ante-natal decision as established by the questionnaire and actual feeding method are shown in Table I!. It can be seen that no change in practice occur-

274 IRISH JOURNAL OF MEDICAL SCIENCE

red in the leaflet subgroup of mothers intending to A.F. though one multipara in the control group changed to B.F. Three controls of the mothers intending to B.F. abandoned their original inten- tion and A.F. from the start, whilst all but one in the leaflet subgroup at least at- tempted to B.F. It is possible with more active encouragement they may have continued to B.F.

Six multiparas were initially undecided as to feeding method. None of the 3 who received the obviously biased leaflet sub- sequently B.F., though 2 controls did.

Previous feeding experience may have important influence on choice of method in multiparas. This together with the effect of the B.F. leaflet is examined in Table II1. Here again, the B.F. leaflet seems to have been quite unsuccessful.

TABLE III

Previous method Present method A.F. A.F. B.F.

Controls 21 19 2 Those given B.F. leaflet 36 33 3 TOTAL 57 52 5

Previous method Present method A.F. A.F. B.F.

Controls 7 1 6 Those given B.F. leaflet 11 3 8

TOTAL 18 4 14

Discussion Artificial feeding has become such an

accepted feature of modern life that mothers who choose to breast feed are doing so despite commercial and often social and family pressures. This re- quirs strong motivation and encourage- ment if success is to result.

We attempted to explain the advant- ages of breast feeding and so to estab- lish a rational basis for this important

decision which would withstand the usual objections. The leaflet advocating breast feeding did not have any marked success. However, this could be due to many reasons. It may have lacked per- suasiveness; it may not have been read at all as it was simply handed out at the clinic; it may have come too late to in- fluence a decision on such a personal matter if attitudes are already formed by maternal or peer example. The ques- tionnaire showed that mothers working outside the home or living with relatives were unlikely to consider breast feeding.

Education at a much earlier and wider level, not merely in pregnancy, may help to change social attitudes and allow each mother to make a more considered decision as to method of infant feeding. We are currently investigating the effect of education in the form of ante-natal classes, as a more personal and direct approach to encourage breast feeding.

Sincere thanks are due to Dr. J. Kevany, Dept. of Community Health, Trinity College, Dublin, for his suggestions and encouragement, and also to Sr. P. Breen, the staff and patients of Wexford Maternity Hospital, who co-operated in this survey.

References

Bacon, C. J. and Wylie, J. M. 1976. Mothers' attitude to infant feeding at Newcastle General Hospital in Summer 1975. Brit. Med. J. i, 308.

Davis, J. G. 1976. Encouraging breast feeding. Brit. Med. J. i, 1468.

Downham, M. A., Scott, R., Sims, D. G. 1976. Breast feeding protects against respiratory syn- citial virus infection. Brit. Med. J. ii, 274.

Editorial. 1976. Breast feeding: the immunological argument. Brit. Med. J. i, 1167.

Editorial. 1977. Breast milk for all. New Engl. J. Med. 297, 939.

Eastham, E., Smith, D., Poole, D., Neligan, G. 1976. Further decline of breast feeding. Brit. Med. J. i, 305.

Gunther, M. 1975. The neonate's immunity gap, breast feeding and cot death. Lancet i, 4444.

Ing, R., Ho, J. H. C., Petrakis, N. L. 1977. Unilat, eral breast feeding and breast cancer. Lancet ii, 124.

Jelliffe, D. B. and Jelliffe, E. F. P. 1977. Current concepts in nutrition. "Breast is best". Modern meanings. New Engl. J. Med. 297, 912.

A PILOT SURVEY OF AN ATTEMPT TO PROMOTE BREAST-FEEDING 275

Kevany, J., Taylor, M., Kaliszer, M., Humphries, S., Torpey, A., Conway, M. and Goldsmith, A. 1975. Influences on the choice of infant feeding meth- ods. J. Irish Med. Assn. 68, 499.

Kevany, J., Humphries, S. N. and Corboy, A. F. 1975. Infant feeding patterns and weight status in five year old children. J. Irish Med. Sci. 144, 379.

Sacks, S. H., Brada, M., Hill, A. M., Barton, P., Harland, P.S.E.G. 1976. To breast feed or not to breast feed. Practitioner 216, 183.

Taylor, B., Normal, A. P., Orgel, H. A., Turner, M. W., Stokes, C. R., Soothill, J. F. 1973. Transient IgA deficienoe and pathogenesis of infantile atopy. Lancet ii, 111.

APPENDIX

BREAST FEEDING

Have you thought about breast feeding before? Maybe we can help to answer some of your questions.

Why bother with breast feeding ? Nature has prepared a perfectly balanced food

for your baby in your milk. You don't have to worry about the temperature of the milk; it is exactly right. You have no problems like boiling bottles and teats.

Is it good for the baby ? Yes. There is a much lower risk of infection,

as well as getting resistance to some diseases from you. Cot deaths are much less frequent in breast fed babies. Mothers who breast feed also say that it creates a special bond with the baby.

Isn't it bad for my health ? No. It helps your womb and muscles get back

to normal after the baby's birth, and the Iochia or discharge is reduced.

Wouldn't it ruin my figure ? No. With proper support, the shape of your

breasts is not affected. Breast feeding actually helps you to avoid overweight, and you should eat a balanced diet in any case, with plenty of protein, calcium and fluid.

Isn't it inconvenient ? Not really. It is very simple to wear a blouse

or dress that opens at the front, and nursing bra. With the minimum of undressing, your baby's meal is ready, and look at the time it saves !

But I'd be too shy ? Well, you're not too shy to have a baby, are

you ? Breast feeding is just as natural as having a baby. It's easy to cover up with a shawl or cardigan if the privacy you would like isn't avail- able.

How would I know if the baby is getting enough ? You could weigh the baby every few days.

Anyway babies aren't shy about letting you know when they are hungry. However, every time he cries, it doesn't mean that he is hungry; he might be wet, or need burping, for instance. You will soon get to know a 'hungry' cry.

Would I have enough milk ? The answer is usually yes. It takes a few days

after birth for the milk supply to become estab- lished, and if necessary, the baby can have a bottle supplement meanwhile.

Are there any medical reasons for not breast feed':ng ?

Yes. If you are prescribed medicines for any reason, the doctor should be reminded if you are breast feeding.

Would I need to prepare my breasts ? Ordinary daily washing, plus a little lanolin rub- bed gently into the nipples is quite sufficient.

How long should breast feeding continue ? This varies considerably. Even a short time is

valuable, of course. Perhaps the ideal is to begin weaning the baby from breast to spoon or cup at approximately four months.

What would my husband say ? Well, why not ask him? Bring this leaflet home,

and have a chat about it. Then if you decide to go ahead with breast feeding, we will be glad to answer any further questions you may have, on your next visits. And remember, apart from all those other benefits mentioned above, breast feeding can be most relaxing and enjoyable for you and your baby, and it is free!