Goals, dilemmas and assumptions in infant feeding education and support. Applying theory of constraints thinking tools to develop new priorities for action

Maternal and Child Nutrition - Tập 10 Số 1 - Trang 72-91 - 2014
Heather Trickey1,2, Mary Newburn3
1DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, UK
2Research Manager, NCT, Alexandra House, Oldham Terrace, London, UK
3Head of Research and Information, NCT, Alexandra House, Oldham Terrace, London, UK

Tóm tắt

AbstractThree important infant feeding support problems are addressed: (1) mothers who use formula milk can feel undersupported and judged; (2) mothers can feel underprepared for problems with breastfeeding; and (3) many mothers who might benefit from breastfeeding support do not access help. Theory of constraints (TOC) is used to examine these problems in relation to ante‐natal education and post‐natal support. TOC suggests that long‐standing unresolved problems or ‘undesirable effects’ in any system (in this case a system to provide education and support) are caused by conflicts, or dilemmas, within the system, which might not be explicitly acknowledged. Potential solutions are missed by failure to question assumptions which, when interrogated, often turn out to be invalid. Three core dilemmas relating to the three problems are identified, articulated and explored using TOC methodology. These are whether to: (1) promote feeding choice or to promote breastfeeding; (2) present breastfeeding positively, as straightforward and rewarding, or focus on preparing mothers for problems; and (3) offer support proactively or ensure that mothers themselves initiate requests for support. Assumptions are identified and interrogated, leading to clarified priorities for action relating to each problem. These are (1) shift the focus from initial decision‐making towards support for mothers throughout their feeding journeys, enabling and protecting decisions to breastfeed as one aspect of ongoing support; (2) to promote the concept of an early‐weeks investment and adjustment period during which breastfeeding is established; and (3) to develop more proactive mother‐centred models of support for all forms of infant feeding.

Từ khóa


Tài liệu tham khảo

Australian Institute of Health and Welfare, 2011, 2010 Australian National Infant Feeding Survey: Indicator Results

Bhavnani V., 2010, Left to Your Own Devices: The Postnatal Care Experiences of 1260 First‐Time Mothers

10.1046/j.1523-536X.2002.00202.x

Bolling K., 2007, Infant Feeding Survey 2005

Breastfeeding Manifesto Coalition, 2007, Breastfeeding manifesto

10.1089/bfm.2010.0097

10.1016/j.midw.2009.09.004

10.1111/j.1365-2648.2011.05647.x

Department of Health, 1998, Independent Enquiry into Inequalities in Health: The Acheson Report

Department of Health, 2002, Improvement, Expansion and Reform: The Next 3 Years. Priorities and Planning Framework 2003–2006

Department of Health, 2008, Health Inequalities. Progress and Next Steps

Department of Health(2011)Statistical Release: Breastfeeding Initiation and Prevalence at 6 to 8 Weeks. Available at:http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_128836(Accessed 30 April 2012).

Dettmer W., 1997, Goldratt's Theory of Constraints: A Systems Approach to Continuous Improvement

Dodds R., 2010, Caring and sharing – evidence on ways to improve breastfeeding support, Essentially MIDIRS, 1, 32

10.1016/j.midw.2004.12.006

Dyson L., 2006, Promotion of Breastfeeding Initiation and Duration: Evidence into Practice Briefing

Entwistle F., 2011, Working together, Midwives, 4, 29

Equality Act(2010)Equality Act 2010. Available at:http://www.legislation.gov.uk/ukpga/2010/15/contents(Accessed 30 April 2012).

10.1542/peds.107.3.543

EUPHIX(2009)European Union Public Health Information System: Breastfeeding. Percentage of infants breastfed at 6 months of age in Iceland Norway Switzerland and the EU‐27 1989–2004. Available at:http://www.euphix.org/object_document/o4710n27421.html(Accessed 12 March 2012).

10.1080/13698571003789674

Goldratt E.M., 2004, The Goal: A Process of Ongoing Improvement

10.1111/j.0730-7659.2005.00367.x

10.1136/bmj.328.7430.26

10.1186/1746-4358-1-23

10.1136/bmj.318.7175.30

10.1136/bmj.39521.566296.BE

10.1136/bmj.a3026

10.1136/bmjopen-2011-000504

10.1136/adc.2008.151910

10.1111/j.1651-2227.2003.tb00519.x

10.1111/j.1471-6712.2007.00572.x

10.1111/j.1467-9566.2007.01020.x

10.1080/13698570802383432

10.1002/14651858.CD006425.pub2

10.1111/j.1740-8709.2006.00054.x

Mohrbacher N., 2010, Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers

National Institute for Health and Clinical Excellence, 2006, Routine Postnatal Care of Women and Their Babies

National Institute for Health and Clinical Excellence, 2008, Improving the Nutrition of Pregnant and Breastfeeding Mothers and Children in Low‐Income Households

National Childbirth Trust, 1999, NCT Baby Feeding Policy

National Childbirth Trust, 2005, The National Childbirth Trust Parenthood Policy

Newburn M., 2010, Breastfeeding support, active listening and guidance during matrescence, Essentially MIDIRS, 1, 32

Newburn M., 2011, Preparing for Birth and Parenthood: Report on First‐Time Mothers and Fathers Attending NCT Antenatal Courses

10.1093/phe/phr019

Public Health Agency of Canada, 2009, What Mothers Say: The Canadian Maternity Experiences Survey

Rogers C., 1951, Client‐Centred Therapy

10.1111/j.1523-536X.2010.00446.x

10.1177/0890334403255225

Scottish Parliament(2005)Breastfeeding etc. (Scotland) Act 2005. Available at:http://www.legislation.gov.uk/asp/2005/1/contents(Accessed 30 April 2012).

SeelR.&SeelS.(1990)An Introduction to Counselling for Breastfeeding Counsellors. Available at:http://www.articles.adsoft.org/introduction_to_counselling.htm(Accessed 30 April 2012).

Singh D., 2000, Access to Maternity Information and Support: The Experiences and Needs of Women before and after Giving Birth

Smale M., 1998, Psychological Perspectives on Pregnancy and Childbirth, 183

Statutory Instruments(2008)No. 2445 (Food) The infant formula and follow‐on formula (England) (Amendment) Regulations 2008. Available at:http://www.legislation.gov.uk/uksi/2008/2445/pdfs/uksi_20082445_en.pdf(Accessed 30 April 2012).

Stockdale J., 2008, Feasibility study to test Designer BreastfeedingTM: a randomised controlled trial, Evidence Based Midwifery, 6, 76

Sveriges officiella statistik och Socialstyrelsen, 2009, Amning och föräldrars rökvanor. Barn födda 2007 [Breastfeeding and smoking among parents of infants born in 2007]

The NHS Information Centre(2011)Infant Feeding Survey 2010: Early Results. Available at:http://www.ic.nhs.uk/pubs/infantfeeding10(Accessed 30 April 2012).

10.1111/j.1740-8709.2010.00251.x

UNICEF UK Baby Friendly Initiative(2012)The Baby Friendly Initiative. Available at:http://www.babyfriendly.org.uk/(Accessed 30 April 2012).

Wise P., 2003, The National Childbirth Trust breastfeeding counsellor training, The Practising Midwife, 6, 36

Wolf J.B., 2011, Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood

World Health Organization(1981)International Code of Marketing of Breast‐Milk Substitutes.Available at:http://www.who.int/nutrition/publications/code_english.pdf(Accessed 30 April 2012).

World Health Organization(1986)Ottawa Charter for Health Promotion. First International Conference on Health Promotion Ottawa 21 November 1986 ‐WHO/HPR/HEP/95.1. Available at:http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf(Accessed 30 April 2012).

World Health Organization(2003)Global Strategy for Infant and Young Child Feeding.Geneva: Available at:http://whqlibdoc.who.int/publications/2003/9241562218.pdf(Accessed 30 April 2012).