For mothers: Breast milk/breastfeeding is important Hand expression should not hurt, seek help if it does Find where it works best to compress Express from different areas, as needed If needed, encourage let-down It takes practice to learn to hand express quantities of milk For health workers: Hand expression works Mothers express for different reasons – milk quantity is not the only criteria Offer principles and suggestions rather than rules Assist individual learning depending on mother’s needs Offer to assist learning including a return demonstration Box 3: CORE SKILLS / KNOWLEDGE - DRAFT Assisting Mothers to Develop Skills of Breast Milk Expression - is there agreement on what are these skills? Genevieve Becker, MSc, MEd, IBCLC 1 , Mike Woolridge, DPhil 2 , Trudie Roberts, MBChB, PhD, FRCP 3 1 PhD student, 2 Senior Lecturer, School of Healthcare, 3 Professor, Medical Education Unit, University of Leeds, England Contact: becker@iol.ie Box 2: MATERIALS REVIEWED (n=6) Country of origin: Europe x 4 South Pacific x 1 Americas x 1 Videotape target audience: staff training: 2 mothers: 4 Text target audience: staff training: 3 mothers: 3 References: 1. American Academy of Pediatrics, Section on Breastfeeding, Breastfeeding and the Use of Human Milk, Policy Statement (2005). Pediatrics, Vol. 115 No. 2, February, pp. 496-506. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496 2. WHO (1986) The Ottawa Charter. World Health Organisation, Geneva. http://healthydocuments.info/public/doc10p.html. UNICEF/WHO. (1990). Baby Friendly Hospital Initiative. New York and Geneva. This research forms the first phase of study towards a PhD and continues until 2008. Other areas to be studied include guidelines for health workers assisting mothers to learn skills using adult education methods, development of instruments and assessment of health workers’ competence in assisting learning of skills. Findings: At the end of Delphi Round 3: 13 statements were rated (4 or 5) by more that 75% of the respondents as „important‟ for the mother to know. (Table 1) 8 statements were rated (1 or 2) by more that 75% of the respondents as „not important‟. (Table 2) Instructional materials did not always reflect statements that were rated as important and included statements rated as unimportant. The techniques used by these experienced mothers to hand express did not always reflect the materials in common use or the experts‟ views. What? What are the skills mothers need to learn in order to hand express breast milk? Why? Breast milk is important for infant health, and expressed milk is needed at times. 1 Developing personal skills is a key concept in Ottawa Charter for health promotion. 2 Health workers can assist clients to develop skills. 3 Little published research on hand expressing of breast milk. Conclusions: Lack of agreement on what are the basic skills of hand expression of milk that a mother needs to know. Instructional materials may not include important information. Mothers successful at hand expressing breast milk find a technique that suits themselves. A set of core knowledge/skills (Box 3) may need to be more generic and their application discussed individually with a mother. Limitations: All the videotaped mothers in the sample were experienced at hand expression and had an established milk supply. Mothers at an early learning stage might show different techniques. How? Three information sources: 1. “Expert” views in a 3 round Delphi study. (Box 1) The replies to: In order to hand express effectively, a mother need to be able to do and/ or to know the following: … yielded 200 items, sorted and condensed to 49. These 49 statements were sent for rating on a scale of 1-5. Then sent for re-rating with median and inter-quartile range (IQR) shown, plus comments the respondents had made on each statement where there was lack of clear agreement. 2. Analysis of instructional video and texts mentioned by the Delphi experts or the mothers, reviewed by two people for including or not including the 49 items from the Delphi section. (Box 2) 3. Convenience sample of 6 mothers were videotaped expressing milk. The videotapes were reviewed by two people for showing or not showing the 49 items from the Delphi section. Table 2: NOT IMPORTANT TO KNOW / DO (selected) Delphi rated as not important Materials included Mothers did Other mothers who have hand expressed 81% 8% 50%* Position fingers at edge of areola 76% 75% 33% Have a (non-alcoholic) drink 86% 33% 0% Know what prolactin/oxytocin do 90% 25% - * Knew someone who had hand expressed (from questionnaire) Table 1: IMPORTANT TO KNOW / DO n=21 n= 6 text, 6 n=6 (selected results) Delphi rated as important (4 or 5) Materials included as important Mothers did Breast milk is important 76% 83% Not able to see on videotap e Should not hurt, seek help 95% 42% There is a learning period 86% 92% What let-down is/how to stimulate 76% 67% Use both breasts 5% 83% Find own method that works 90% 75% 100% Know where to position fingers Position thumb & finger opposite ~ 95% 100% 100% Rotate finger positions around the breast 95% 92% 83% Assistance/verbal feedback with mother 81% 83% # 33%* Press back towards chest wall and press 76% 83% 0% Massage/stroke/knead/shake (any of) 52% 83% 50% # Percentage of videos that included a mother expressing with health worker observing (n=6) * Percentage of mothers that received assistance from any health worker ~ Two statements combined as answered same Box: 1 DELPHI PARTICIPANTS (n=21) Region of residence: Europe (4 countries): 16 Australia/NZ: 2 Americas: 3 Assist mothers with hand expression (mothers per month: participants) < 10 mothers: 9 10-25 mothers: 8 > 25 mothers: 4 Worked in breastfeeding education of health workers: < 10 yrs: 3 10-25 yrs: 14 > 25 yrs: 4 Produced staff or mother information on hand expression: 14 Current International Board Certified Lactation Consultant: 14 View publication stats View publication stats