Parental distress around supplementing breastfed babies using nasogastric tubes on the post-natal ward: a theme from an ethnographic study.

There is abundant evidence of the benefits of breastfeeding. In the UK, supplementation in hospital has consistently been shown to be associated with shortened duration of breastfeeding. This paper reports on a subset of the data from an ethnographic study that explored the expectations, beliefs and experiences of mothers and health professionals concerning supplementation, using a variety of methods, of breastfed babies in an English maternity unit in 2002. This paper aims to describe the expectations, beliefs and experiences of mothers and health professionals concerning supplementation by nasogastric (NG) tube on the post-natal ward. Participant observation was carried out on day and night shifts and at weekends over 9 months. Mothers, midwives, neonatal nurses, health care assistants and senior paediatricians were interviewed. Categories and themes were generated. The researchers' constructs of 'the essential method', when the tube was the method needed for medical reasons, and 'the chosen method', when other methods of oral feeding should have been possible, emerged. The latter included time pressures and the avoidance of any form of oral activity that might perhaps make return to the breast more difficult. The data concerning the use of NG tubes for supplementation yielded the specific theme of parental distress. In the absence of evidence that supplementation by NG tube on the post-natal ward is associated with greater breastfeeding success than other methods, the use of the tube to avoid any form of 'oral confusion' should be discontinued. Its use primarily to save time should not be considered acceptable.

A UK-wide postal survey to evaluate palliative care education amongst General Practice Registrars.

OBJECTIVES: To evaluate the content of General Practice Registrars' (GPRs) palliative care education in the U.K. METHODS: Postal questionnaires were sent to 492 eligible GPRs across six purposively sampled U.K. postgraduate deaneries. RESULTS: GPRs were satisfied with their course coverage on control of pain, other symptoms and communication skills, and were also moderately confident in applying the knowledge gained in these areas. They showed a high level of knowledge in the management of cancer-related pain. There was less satisfaction with the coverage given to syringe driver use (38%) and bereavement care (36%), with fewer expressing confidence in applying their knowledge to these areas. CONCLUSIONS: GPRs have mixed perceptions about their palliative care education. Future educational packages should ensure that GPRs receive planned systematic training in bereavement care and some practical experience in the use of syringe drivers. Both Postgraduate General Practice Education departments and specialist palliative care providers should explore ways of working more closely together to provide GPRs with more expertize in palliative care.

The cup-versus-bottle debate: a theme from an ethnographic study of the supplementation of breastfed infants in hospital in the United kingdom.

This article reports 1 theme from an ethnographic study that aimed to describe the experiences, expectations, and beliefs of mothers and health care professionals concerning supplementation in a UK maternity unit. Observation was conducted on the postnatal ward and the newborn infant unit, and 30 mothers, 17 midwives, 4 neonatal nurses, 3 health care assistants, 3 senior house officers, and 3 senior pediatricians gave in-depth interviews during a 9-month period in 2002. One of the major themes that emerged was the cup-versus-bottle debate. There were 3 categories strongly linked to this theme: difficulties returning to the breast, ease of use, and necessary skills and knowledge. It appears there is an urgent need to determine which is the best method of giving supplementary feeds, so that full, accurate information can be given to mothers, appropriate policies be devised, and the necessary resources and staff training be provided.

Supplementing breast-fed babies in the UK to protect their mothers from tiredness or distress.

OBJECTIVE: To explore mothers' and healthcare professionals' beliefs, expectations and experiences in relation to supplementation of breast feeding in the postnatal ward and newborn-baby unit. DESIGN AND METHOD: A qualitative study using an ethnographic approach which involved participant observation and interviews. Analysis of the observation data informed who would be approached for interview and interviews also guided further observation work. Categories and themes were generated from the field notes and interviews. SETTING: A maternity unit in the South of England using six methods of supplementary feeding. PARTICIPANTS: 30 mothers, 17 midwives, four neonatal nurses, three paediatricians, three senior house officers and 3 healthcare assistants were interviewed in the postnatal ward and newborn-baby unit over a period of nine months in 2002. FINDINGS: A major theme was the healthcare professionals' desire to protect the mothers from tiredness or distress, although this at times conflicted with their role in promoting breast feeding. The categories 'protecting the mother from guilt', 'making it easy to give up' and 'protecting the mother from distress' were linked to this theme. Sometimes midwives suggested supplementation because they perceived mothers to be tired, sometimes mothers themselves made the request. Thus the researcher constructs of 'midwife led' and 'mother led' supplementation emerged. KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare professionals need to be aware that they may not be helping mothers in the longer-term when supplementation is used as a quick 'solution' to a mother's tiredness or distress. However, other strategies such as providing emotional support or role modelling 'settling' skills are time consuming and have resource implications for the maternity services.