Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2012

Open Access 01-12-2012 | Research article

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

Authors: Debra Bick, Trevor Murrells, Annette Weavers, Val Rose, Julie Wray, Sarah Beake

Published in: BMC Pregnancy and Childbirth | Issue 1/2012

Login to get access

Abstract

Background

Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women’s views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated.

Methods

Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women’s views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression.

Results

Data were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3 months post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively post-intervention. Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care.

Conclusions

It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement.
Literature
1.
Yelland J, Krastev A, Brown S: Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals. Midwifery. 2009, 25: 392-402. 10.1016/j.midw.2007.01.004.CrossRefPubMed
2.
Sandall J, Mansfield A, Manthorpe J: Support Workers in Maternity Services. A National Scoping Study of NHS Trusts Providing Maternity Services in England. Kings College London. 2006,  ,  
3.
Glazener C, Abdalla M, Naji Stoud P, Templeton A: Postnatal maternal morbidity: extent, causes, prevention and treatment. Br J Obstet Gynaecol. 1995, 102: 282-287. 10.1111/j.1471-0528.1995.tb09132.x.CrossRefPubMed
4.
Brown S, Lumley J: Changing Childbirth: Lessons from an Australian survey of 1336 women. Br J Obstet Gynaecol. 1998, 105: 143-155. 10.1111/j.1471-0528.1998.tb10044.x.CrossRefPubMed
5.
Redshaw M, Rowe R, Hockley C, Brocklehurst P: Recorded delivery: A national survey of women’s experience of maternity care 2006. 2007, National Perinatal Epidemiology Unit, University of Oxford
6.
7.
The Information Centre: NHS Maternity Statistics, England 2009/10. 2010, The Information Centre, London
8.
Liu S, Liston RM, Heaman M, Sauve R, Kramer MS: Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007, 176: 455-460. 10.1503/cmaj.060870.CrossRefPubMedPubMedCentral
9.
National Institute for Health and Clinical Excellence: Caesarean Section. 2004, NICE, London
10.
Bick D, MacArthur C, Winter H: Postnatal care: Evidence and Guidelines for Management. 2008, Churchill Livingstone, London, Second Edition
11.
Health Improvement Scotland: 7th Annual Report 2011. Scottish Confidential Audit of Severe Maternal Morbidity. 2011
12.
British Journal of Obstetrics and Gynaecology: Saving Mother’s Lives: reviewing maternal deaths to make motherhood safer 2006–2008.The Eight Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Obstet and Gynaecol 2011. 2011, 1:
13.
The Information Centre: Infant Feeding Survey 2010: Early Results. 2011, The Information Centre, London
14.
Bolling K, Grant C, Hamlyn B, Thornton A: Infant Feeding Survey 2005. 2007, The Information Centre, London
15.
National Institute for Health and Clinical Excellence: Routine postnatal care of women and their babies. 2006, NICE, London
16.
Bhavnani V, Newburn M: Left to your own devices: The postnatal care experiences of 1260 first-time mothers. 2010, The National Childbirth Trust, London
17.
Shortell SM, Bennett CL, Byck GR: Assessing the impact of continuous quality improvement on clinical practice: what will it take to accelerate progress. The Milbank Quarterly. 1998, 76: 593-624. 10.1111/1468-0009.00107.CrossRefPubMedPubMedCentral
18.
Beake S, Rose V, Bick D, Weavers A, Wray J: A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit. BMC Pregnancy Childbirth. 2010, 10: 70-10.1186/1471-2393-10-70.CrossRefPubMedPubMedCentral
19.
NHS Litigation Authority: Clinical Negligence Scheme for Trusts, Maternity Clinical Risk Management Standards 2011/12. 2011, NHSLA
20.
Cox JL, Holden JM, Sagovsky R: Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry. 1987, 150: 782-786. 10.1192/bjp.150.6.782.CrossRefPubMed
21.
Department of Health: Infant Feeding Recommendations. 2003, Department of Health, London
22.
HM Government: improve the health and wellbeing of children and young people. PSA Delivery Agreement 12. 2008, HMSO, Norwich
23.
World Health Organisation: Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis. 2007, WHO, Geneva
24.
Quigley MA, Kelly YJ, Sacker A: Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics. 2007, 119 (4):
25.
Stuebe AM, Willett WC, Xue F, Michels KB: Lactation and incidence of premenopausal breast cancer: a longitudinal study. Arch Intern Med. 2009, 169: 1364-1371. 10.1001/archinternmed.2009.231.CrossRefPubMedPubMedCentral
26.
Beake S, Pellowe C, Dykes F, Schmied V, Bick D: A systematic review of structured compared with non-structured breastfeeding programmes to support the initiation and duration of exclusive and any breastfeeding in acute and primary healthcare settings. Maternal and Child Nutrition.
27.
Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, Trevisanuto D: Elective cesarean delivery: does it have a negative effect on breastfeeding?. Birth. 2010, 37: 275-279. 10.1111/j.1523-536X.2010.00421.x.CrossRefPubMed
28.
Chalmers B, Kaczorowski J, Darling E, Heaman M: Maternity Experiences Study Group of the Canadian Perinatal Surveillance System. Cesarean and vaginal birth in Canadian women: a comparison of experiences. Birth. 2010, 37: 44-49. 10.1111/j.1523-536X.2009.00377.x.CrossRefPubMed
29.
Lewis G: The Seventh Report on Confidential Enquiries into maternal deaths in the United Kingdom. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives. 2007, The Stationery Office 2007, London
30.
MacArthur C, Winter H, Bick D, Knowles H, Lilford R, Henderson C, Lancashire RJ, Braunholtz DA, Gee H: Effects of redesigned community postnatal care on women’s health 4 months after birth: a cluster randomised controlled trial. The Lancet. 2002, 359: 378-385. 10.1016/S0140-6736(02)07596-7.CrossRef
31.
MacArthur C, Winter HR, Bick DE, Knowles H, Lilford R, Henderson C, Lancashire RJ, Braunholtz DA, Gee H: Redesigning postnatal care: a randomised controlled trial of protocol based, midwifery led care focussed on individual women's physical and psychological health needs. Health Technology Assessment. 2003, 37: 1-98.
32.
Singh D, Newburn M: Women’s experiences of postnatal care. 2000, National Childbirth Trust, London
33.
National Institute for Health and Clinical Excellence: Antenatal and postnatal mental health. Clinical management and service guidance. 2007, NICE, London
34.
Bick D, Howard L: When should women be screened for postnatal depression? Editorial. Expert Rev of Neurother. 2010, 10: 151-154. 10.1586/ern.09.156.CrossRef
35.
Department of Health: NHS White Paper (England). 2010, Liberating the NHS. Department of Health, Equity and Excellence
36.
Elwyn G, Crowe S, Fenton M, Firkins L, Versnel L, Walker S, Cook I, Holgate S, Higgins B, Gelder C: Identifying and prioritizing uncertainties: patient and clinician engagement in the identification of research questions. J Eval Clin Pract. 2011, 10.1136/bmjqs.2010.046524.
37.
Bick D, Weavers A, Rose V, Wray J, Beake S: Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative. BMC Health Services Research. 2011, 11 (1): 293-10.1186/1472-6963-11-293.CrossRefPubMedPubMedCentral
38.
Sandall J, Homer C, Sadler E, Rudisill C, Bourgeault I, Bewley S, Nelson P, Cowie L, Cooper C, Curry N: Staffing in Maternity Units.Getting the right people in the right place at the right time. 2011, The Kings Fund, London
39.
Glasziou P, Ogrinc G, Goodman S: Can evidence based medicine and clinical quality improvement learn from each other?. BMJ Qual Saf. 2011, 20 (Suppl1): i13-i17. 10.1136/bmjqs.2010.046524.CrossRefPubMedPubMedCentral
Metadata
Title
Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit
Authors
Debra Bick
Trevor Murrells
Annette Weavers
Val Rose
Julie Wray
Sarah Beake
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2012
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-12-41

Other articles of this Issue 1/2012

BMC Pregnancy and Childbirth 1/2012 Go to the issue

Study protocol

A cohort evaluation on arterial stiffness and hypertensive disorders in pregnancy

Research article

Intraclass correlation coefficients in the Brazilian network for surveillance of severe maternal morbidity study

Research article

Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap

Study protocol

Impact on postpartum hemorrhage of prophylactic administration of oxytocin 10 IU via UnijectTM by peripheral health care providers at home births: design of a community-based cluster-randomized trial

Research article

Father for the first time - development and validation of a questionnaire to assess fathers’ experiences of first childbirth (FTFQ)

Research article

Utilization of postnatal care for newborns and its association with neonatal mortality in India: An analytical appraisal