Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English\ud maternity unit

摘要

Background\udMost women in the UK give birth in a hospital labour ward, following which they are\udtransferred to a postnatal ward and discharged home within 24 to 48 hours of the birth.\udDespite policy and guideline recommendations to support planned, effective postnatal care,\udnational surveys of women’s views of maternity care have consistently found in-patient\udpostnatal care, including support for breastfeeding, is poorly rated.\udMethods\udUsing a Continuous Quality Improvement approach, routine antenatal, intrapartum and\udpostnatal care systems and processes were revised to support implementation of evidence\udbased postnatal practice. To identify if implementation of a multi-faceted QI intervention\udimpacted on outcomes, data on breastfeeding initiation and duration, maternal health and\udwomen’s views of care, were collected in a pre and post intervention longitudinal survey.\udPrimary outcomes included initiation, overall duration and duration of exclusive\udbreastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction\udwith care. As most outcomes of interest were measured on a nominal scale, these were\udcompared pre and post intervention using logistic regression.\udResults\udData were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3\udmonths post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively postintervention.\udPost intervention there were statistically significant differences in the initiation\ud(p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding\udto 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post\udintervention, women were less likely to report physical morbidity within the first 10 days of\udbirth, and were more positive about their in-patient care.\udConclusions\udIt is possible to improve outcomes of routine in-patient care within current resources through\udcontinuous quality improvement.