Mater Research Institute, Mater Mothers' Hospital, South Brisbane, Australia; College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia.
Parent Support Centre, Mater Mothers' Hospital, South Brisbane, Australia.
Int J Nurs Stud. 2023 May;141:104474. doi: 10.1016/j.ijnurstu.2023.104474. Epub 2023 Feb 26.
How hospital clinicians facilitate breastfeeding in the first 48-72 h is critical to breastfeeding exclusivity and duration. Mothers who discharge hospital directly breastfeeding are more likely to continue exclusively breastfeeding at 3-months.
To assess the impact of facility-wide implementation of a physiological breastfeeding method (the Thompson method) on direct breastfeeding at hospital discharge and exclusive breastfeeding at 3-months of age.
Multi-method design using interrupted time series analysis and surveys.
SETTING(S): An Australian tertiary maternity hospital.
13,667 mother-baby pairs (interrupted time series analysis) and 495 postnatal mothers (surveys).
The Thompson method includes cradle position and hold, alignment of mouth-to-nipple, baby-led connection and seal, maternal fine-tuning for symmetry, and leisurely duration. We used a large pre-post implementation dataset and conducted interrupted time series analysis using a 24-month baseline period (January 2016 - December 2017); and a 15-month post-implementation period (April 2018 - June 2019). We recruited a sub-sample of women to complete surveys at hospital discharge and 3-months postpartum. Surveys were primarily used to measure impact of Thompson method on exclusive breastfeeding at 3-months, compared with a baseline survey conducted in same setting.
Following implementation of the Thompson method, the declining trend in direct breastfeeding at hospital discharge was significantly averted by 0.39% each month relative to baseline (95% CI: 0.03% to 0.76%; p = 0.037). While the 3-month exclusive breastfeeding rate in the Thompson group was 3 percentage points higher than the baseline group; this result did not reach statistical significance. However, a subgroup analysis of women who discharged hospital exclusively breastfeeding revealed the relative odds of exclusive breastfeeding at 3-months in the Thompson group was 0.25 (95% CI: 0.17 to 0.38; p < 0.001), significantly better than the baseline group (Z = 3.23, p < 0.01) where the relative odds was only 0.07 (95% CI: 0.03 to 0.19; p < 0.001).
Implementation of the Thompson method for well mother-baby pairs improved direct breastfeeding trends at hospital discharge. For women who discharged hospital exclusively breastfeeding, exposure to the Thompson method reduced the risk of exclusive breastfeeding discontinuation by 3-months. The positive impact of the method was potentially confounded by partial implementation and a parallel rise in birth interventions which undermine breastfeeding. We recommend strategies to strengthen clinician buy-in to the method, and future research using a cluster randomised trial design.
Facility-wide implementation of the Thompson method improves direct breastfeeding at hospital discharge and predicts breastfeeding exclusivity at 3-months.
医院临床医生在最初的 48-72 小时内如何促进母乳喂养，对母乳喂养的排他性和持续时间至关重要。直接在医院进行母乳喂养的母亲更有可能在 3 个月时继续进行纯母乳喂养。
评估在全院范围内实施生理母乳喂养方法（汤普森方法）对出院时直接母乳喂养和 3 个月龄时纯母乳喂养的影响。
使用中断时间序列分析和调查的多方法设计。
澳大利亚一家三级产科医院。
13667 对母婴（中断时间序列分析）和 495 名产后母亲（调查）。
汤普森方法包括摇篮式抱姿和握持、奶嘴对齐、婴儿主导连接和密封、母亲对称微调以及悠闲时长。我们使用了一个大型的实施前-后数据集，并进行了中断时间序列分析，使用了 24 个月的基线期（2016 年 1 月至 2017 年 12 月）和 15 个月的实施后期（2018 年 4 月至 2019 年 6 月）。我们招募了一部分女性在出院时和 3 个月产后完成调查。调查主要用于衡量汤普森方法对 3 个月时纯母乳喂养的影响，与同一环境下进行的基线调查相比。
在实施汤普森方法后，与基线相比，每月直接在医院出院时母乳喂养的下降趋势明显缓解了 0.39%（95%CI：0.03%至 0.76%；p=0.037）。虽然汤普森组的 3 个月纯母乳喂养率比基线组高 3 个百分点，但这一结果没有达到统计学意义。然而，对出院时纯母乳喂养的女性进行亚组分析显示，在汤普森组中，3 个月时纯母乳喂养的相对几率为 0.25（95%CI：0.17 至 0.38；p<0.001），明显优于基线组（Z=3.23，p<0.01），其相对几率仅为 0.07（95%CI：0.03 至 0.19；p<0.001）。
对健康母婴实施汤普森方法改善了出院时直接母乳喂养的趋势。对于出院时纯母乳喂养的女性，接触汤普森方法将 3 个月时纯母乳喂养中断的风险降低了 3 倍。该方法的积极影响可能受到部分实施和破坏母乳喂养的分娩干预措施增加的混杂。我们建议采取策略来加强临床医生对该方法的认可，并在未来的研究中使用集群随机试验设计。
全院范围内实施汤普森方法可提高出院时的直接母乳喂养率，并预测 3 个月时的母乳喂养排他性。
