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

BackgroundMost women in the UK give birth in a hospital labour ward, following which they aretransferred 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-patientpostnatal care, including support for breastfeeding, is poorly rated.MethodsUsing a Continuous Quality Improvement approach, routine antenatal, intrapartum andpostnatal care systems and processes were revised to support implementation of evidencebased postnatal practice. To identify if implementation of a multi-faceted QI interventionimpacted on outcomes, data on breastfeeding initiation and duration, maternal health andwomen’s views of care, were collected in a pre and post intervention longitudinal survey.Primary outcomes included initiation, overall duration and duration of exclusivebreastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfactionwith care. As most outcomes of interest were measured on a nominal scale, these werecompared pre and post intervention using logistic regression.ResultsData were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3months post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively postintervention.Post intervention there were statistically significant differences in the initiation(p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeedingto 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Postintervention, women were less likely to report physical morbidity within the first 10 days ofbirth, and were more positive about their in-patient care.ConclusionsIt is possible to improve outcomes of routine in-patient care within current resources throughcontinuous quality improvement