Exploring best practice interventions to protect, promote and support breastfeeding

Abstract

Across Canada (CA) and Newfoundland and Labrador (NL), most women intend to breastfeed; however in actuality rates of EBF tend to decrease drastically. The significant decrease in EBF over time suggests further intervention is needed to provide an environment that promotes breastfeeding. Guided by the Lancet Framework “The components of an enabling environment for breastfeeding—a conceptual model” this dissertation advances the evidence base on the best practice interventions that can enable an environment that supports breastfeeding mothers. The framework outlines three determinants (Structural, Setting, and Individual) that are associated with evidence-based interventions that, if implemented, have a high likelihood of increasing EBF rates. The primary focus of this thesis is to explore the best practice interventions associated with one of three determinants: the Setting. Interventions associated with Setting include those aimed at Health System, Policy and Community. In the first study on the Health System, I evaluated the efficacy of Domperidone, an off-label galactagogue prescribed to mothers by physicians with insufficient human milk production (Chapter Two). In the second study, with a Policy focus, I conducted a data linkage study to examine the differences in health service use (HSU) and associated costs by infant feeding mode, in an infant’s first year of life (Chapter Three). Paired with this study on HSU, my third study explored mothers' perceptions of the costs associated with infant feeding, using a patient-oriented research approach (Chapter Four). In my final study, I evaluate the effectiveness of virtual lactation support for breastfeeding mothers in the Community (Chapter Five). Creating an environment that protects, promotes, and supports breastfeeding involves efforts from Structural, Setting, and Individual levels. The aim of this dissertation is to investigate the best practice interventions that will allow parents to have access to a seamless system of breastfeeding support services in the transition from hospital to the home and community. Policy recommendations will support the additional efforts and funding required for an increase in access to evidence-based breastfeeding support.