Scottish Improvement Science Collaborating Centre (SISCC)
Research, Development and Evaluation
SISCC Maternal and Child Health Snapshot – November 2016
SISCC is the Scottish Improvement Science Collaborating Centre, led by Dundee University. At SISCC we are collaborating to create new knowledge in health and Social Care and
promote evidence based, integrated and sustained ways of working. Maternal and child health is a priority area for action in the Route Map to the 2020 vision for health and
social care in Scotland. Our work in the SISCC will focus on creating sustained improvements to the quality of care given to mothers and infants across Scotland.
Our current focus
The first project in our m aternal and child health work stream focuses on breastfeeding and parent-baby
attachment for babies and their families in neonatal units. We know there is good evidence that skin-to-skin
care and early support for breastfeeding/feeding with breastmilk leads to better clinical and psycho-social
outcomes for babies and parents. The evidence would suggest that although these practices are
recommended in national guidance, they are not always applied consistently or routinely.
What’s been happening?
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There is good evidence that these practices can be implemented successfully. Work carried out by our
Director, Professor Mary Renfrew, in neonatal units across Yorkshire and Humberside to implement skin-toskin care and early support for infant feeding resulted in an increase of 30% in use of kangaroo care and a 20%
increase in breastfeeding at discharge. We have learned from their success and are now planning a similar
approach to improvements in Scotland. The first part of our work involved evidence reviews and consultation
with stakeholders to develop a set of evidence based strategies for improving breastfeeding and parent-baby
attachment. We now plan to work with individual neonatal units across Scotland to implement changes and
evaluate outcomes.
Visit us at www.siscc.dundee.ac.k
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We have collaborated with colleagues at NHS
Health Scotland to review systematic review
level evidence of best practices in
breastfeeding and skin-to-skin care for
neonatal infants.
From the review, we have identified 22
evidence based recommendations for
improving breastfeeding and parent-baby
attachment in neonatal units.
These recommendations have been
developed into an online questionnaire.
We have piloted our questionnaire with
clinicians, managers, colleagues from
organisations like Unicef UK and MCQIC, and
parents/service users.
We have formed a large advisory group, with
almost 40 representatives from academia,
NHS, social care, third sector organisations
and parent/service user representatives.
We held a discussion group with mothers to
get their ideas about how service users should
be involved in the project.
We have been building networks and gaining
support for our work.
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Scottish Improvement Science Collaborating Centre (SISCC)
Research, Development and Evaluation
What have we learnt so far?
Our evidence review examined 17 systematic review papers about skin-to-skin care and breast milk feeding
in neonatal units. We extracted the key evidence statements from each paper about increasing breastfeeding
and parent-baby attachment. We classified each statement according to outcome (whether it was positive,
negative or ineffective in increasing breastfeeding and/or parent-baby attachment) and the level of evidence
upon which it was founded (high, moderate, low). The table below gives some examples of the best practice
recommendations we identified:
What now?
Interventions that facilitate breastfeeding:
Any intermittent kangaroo skin-to-skin contact with mothers (of variable duration & frequency) is associated with an increase in
any breastfeeding from discharge from NICU until 1-2 months follow up in stabilized infants born<2,500g
Baby Friendly Initiative (BFI) accreditation of the associated maternity hospital results in improvements in several breastfeeding
-related outcomes for infants in neonatal units
Involving lay health workers as trained supporters increases breastfeeding initiation, any breastfeeding and exclusive
breastfeeding
Options that are unlikely to facilitate breastfeeding:
Weighing the infant before and after feeds leads to no significant difference in the mothers confidence and
competence in carrying out breastfeeding
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Early discharge from the neonatal unit , with home support for gavage feeding is unlikely to have a positive effect on
duration rates of any and exclusive breastfeeding among clinically stable pre-term infants
Interventions that facilitate attachment:
Intermittent kangaroo skin-to-skin contact with mothers is associated with an increase in mother-infant attachment
at 3 months follow up
Chat or social talk between nurses and parents has a positive influence on mothers confidence, their sense of control and their
feeling of connection (attachment) with their baby
To understand the feasibility of implementing these practices within neonatal units, a questionnaire has been
devised to ask staff within units to assess each statement on the basis of impact and feasibility. Working
with colleagues at the Unicef BFI programme, this questionnaire supports the BFI accreditation process and
has received endorsements from the RCM, MCQIC and BLISS, who are fully in support of our project and see this
work as complementary to the existing work within units.
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We are making contact with all units across Scotland
to understand current breastfeeding and kangaroo
care practice.
Units will be encouraged to complete the
questionnaire.
The completed questionnaires will form the basis of
our regional workshops; facilitating practitioners to
prioritise improvements and design local
improvement plans.
Following the workshops, we will work with staff to
implement and evaluate strategies for improving
breastfeeding and parent-baby attachment for
babies and their families in neonatal units; supporting
the delivering of their local improvement plans.
If you would like to speak to one of the team
about what this might involve, please get in touch!
Please take time to complete our questionnaire and thank you - https://los.dundee.ac.uk/lfserver/MCHQ1
For more information please contact: Julie Anderson [email protected] or Gill Milner
[email protected] Tel No: 01382 388658
Visit us at www.siscc.dundee.ac.k
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