>Bad bedside teaching (rough handling of the baby or the breast, shame-based
instruction, inaccurate instruction on positioning that stresses rules not
comfort, inadequate assessment that fails to identify red flags -- thus
dooming mothers to failure that they blame themselves for, stupid use of
tools --wrong size nipple shields, dumb advice to wear bras 24/7, inaccurate
pumping instruction) I could go on and on. This kind of teaching is worse
than no help at all. <
Barbara, I think you might be posting the above in response to my posts
about the rct in Birth (Henderson et al). I totally agree with what you say
above, but, from the description in the article it does not sound like we
can
clearly say that this is what was going on in this study.
Within the first 24 hours "the researcher...provided a one-to-one
standarized education session lasting 30 minutes. She negotiated with the
woman to conduct the session at the infant's next breastfeed. Visual,
written, and verbal information covered simple breast anatomy, various
positions of the infant at the breast, principles of correct attachment, and
the three stages of suckling. A cloth breast model was used to explain
breast anatomy and physiology and the importance of positioning the infant's
jaws behind the nipple so milk sinuses could be compressed. Advice and
verbal assistance were given with positioning and attachment during the
breastfeed using a hands-off technique...the cues she could use to determine
her technique was correct were the main foci of the intervention."
Frankly, given the restrictions of 'journal speak' that sounds like it could
be ok. I could equally imagine lots of things about it that I might not
like -- too long, no mention of asymmetrical latching, baby's body weight
into mum, too standardised, given whether or not mother wanted, etc etc.
The
positioning and attachment were assessed using LATCH, a tool I have
reservations about, but which I know has been assessed. On day 2 of the
study (after the intervention) 39% experimental group women reported nipple
pain, whereas 62% of the control group reported pain. On day 3 it was 51%
and 68%. An intervention that leaves so many women in pain should surely be
suspect.
However, to say that we could learn from the Avoa study is difficult. The
intervention is given in less detail, and the bit about colostrum seems
likely to be very culture specific for Zaire. We don't know anything about
how the mums were helped with positioning if they needed it. Comparing the
two studies, which looked at different outcomes (weight vs nipple pain and
duration of bf, plus bf satisfaction) is difficult. Could be the Australian
babies weighed more in the intervention group than the control group, but
that this did not outweigh other aspects of the intervention (for all we
know -- I would be happy to bet not, I guess, but is that good enough?)
My guess is that, unless there are other studies in the pipeline (and I do
know of one in progess in the UK, this study is likely to be THROWN IN OUR
FACES. that is why I want to know in more detail about the intervention.
Ideally someone would publish a critique of it so we have something to
counter-quote.
I guess I really should contact the authors of the study -- and I will, but
no email address was given, so not only do I have to print, find a stamp,
I'll need to wait at least 2 weeks for an answer!!!!
Has anyone else read the study??? Any Australian Lactnetters have any
comments? I am indebted to my colleague Mary Broadfoot who had heard a
presentation of this study in Scotland, for talking to me about it.
Magda Sachs
Breastfeeding Supporter, BfN, UK
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