No abstract

Background There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant’s diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation. Objectives To assess the effectiveness of support for breastfeeding mothers. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (3 October 2011). Selection criteria Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother-infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of ‘any breastfeeding’ (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported. Authors’ conclusions All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.

The continuity of carer model of care for midwifery is set to roll out exponentially. However, setting up and sustaining midwifery teams primed to deliver this model is a new process for many healthcare professionals. In this article, a case study is presented of a continuity of carer team set up in London to enhance the quality of midwifery care. Reflections on the associated challenges, learning, recommendations and sustainability are shared to assist others embarking on similar journeys. During its first 2 years, the team was able to achieve high levels of continuity and were able to consistently meet set targets. Quality improvement strategies were embedded throughout. Challenges, including data collection techniques and poor communication, were also explored. Improved communication, safe staffing levels, continuous evaluation, shared learning and co-creation will be essential in future quality improvement activities in this area.

A large, urban London teaching hospital has a strategic objective of “develop all our diverse staff to deliver their potential and foster talent” (trust intranet, updated march 04, 2022). In drafting the new strategy, the words “commitment to equality and diversity” were suggested. Was there any change created by the strategy? Do such words on a website stop racist discrimination, bullying and harassment within departments?