Optimising baby to breast attachment (OBBA) : a mixed methods study

Abstract

Purpose – Only around 1% of mothers breastfeed their infants exclusively for the recommended first 6 months of life. Many problems causing early breastfeeding (BF) cessation can be caused by poor baby to breast attachment (BBA). The purpose of this research was to use BF mothers as co-designers to develop, refine, feasibility test and process evaluate a complex intervention which would teach new mothers how to optimise BBA in the first six weeks of BF. Design – The research was designed in three phases with the MRC framework as the overarching architecture Methodology – A mixed methods methodology enabled the collection of qualitative and quantitative data. Methods - Phase one used cognitive interviewing techniques to elicit women’s responses to undertake development and refinement of the intervention; Phase two was a pilot randomised controlled trial (RCT) to test the feasibility of delivering the intervention within a clinical setting and collect data to inform the design of a future definitive study; Phase three used in-depth interviews with women to undertake a thorough process evaluation and collect contextual information which was further expanded using focus groups with BF supporters. Findings – Feasibility was demonstrated and data collected to inform the design of a future definitive study. Although women used the intervention in different ways the key messages of when and how to optimise attachment was delivered. Possible enhancements to the intervention were identified. Health professionals felt the intervention was useful and had the potential to reduce their workload. Limitations – The pilot RCT was not powered to compare outcomes. A maximum variation sample used throughout all three phases sought to include as many different perspectives as possible. Originality – An intervention co-designed by women for women easily transfers information on why, when and how to optimise BBA, which may reduce the number of BF problems causing BF cessation. Next – A test of effectiveness including costs is now required.