A lecturer at Edinburgh Napier University on her doctoral study.
In addition to the generic benefits, breastfeeding also offers the substance-exposed mother and baby the potential to alleviate the severity of neonatal abstinence syndrome. Yet this is a group which typically have poor breastfeeding rates.
To develop and test the feasibility of an evidence-informed and theory-based intervention to support breastfeeding for the opiate-dependent mother and baby.
The research was a two-phase feasibility study recruiting within maternity services in Scotland. Phase one informed intervention development using a mixed methodology approach of a systematic literature review of breastfeeding support for women from disadvantaged groups (MacVicar et al, 2015; MacVicar and Kirkpatrick, 2014); healthcare professional/lay representative advisory group; and ‘think aloud’ interviews with substance dependent women (n=6) (MacVicar et al, 2017). Phase two tested intervention feasibility with a pilot RCT (n=14 mother/baby dyads).
The literature review revealed three themes influencing breastfeeding continuation: maternal breastfeeding skill and knowledge; psychological factors impacting on self-efficacy; the provision of person-centred feeding support. The ‘think aloud’ participants reported barriers to breastfeeding of low maternal self-esteem due to feelings of guilt; neonatal feeding difficulties caused by withdrawal symptoms; institutional factors such as discouraging healthcare practices and attitudes. Integrating these findings resulted in a model providing continuity of a dedicated support worker, advice on breastfeeding in the context of substance use, encouragement to build maternal self-efficacy and maintenance of a low stimuli environment.
The RCT demonstrated the intervention was feasible to implement, there was a trend towards continued breastfeeding and women reported increased confidence and satisfaction. Breastfed infants were less likely to require pharmacotherapy and were discharged earlier. Adverse findings were perceived judgemental attitudes and lack of confidentiality negatively influencing maternal receptiveness of support and difficulties maintaining a low stimuli environment.
Implications for practice include endorsing the promotion and support of breastfeeding for this group with attention to the environmental conditions, socioculturally relevant information and avoidance of discouraging actions and attitudes. Further statistically powered research is recommended
to assess clinical efficacy.
Dr Sonya MacVicar is a lecturer in woman and children’s health and wellbeing at Edinburgh Napier University
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