The Postnatal Breastfeeding Observation Tool.

Abstract

Positioning and attachment of an infant at the breast for effective feeding prevents common breastfeeding problems such as nipple pain and breast engorgement. Existing tools to assess breastfeeding remain controversial. This paper reports on an observation study of 91 mother-baby dyads who were breastfeeding while in hospital. The 'Postnatal Breastfeeding Observation Tool' (PBOT) records maternal independence to breastfeed effectively prior to discharge from hospital. PBOT items relate to maternal nurturing, positioning, attachment, effective feeding and assistance received. Items were developed from a critical review of the literature, best available evidence, and reviewed by an expert panel of clinical midwives and International Board Certified Lactation Consultants. Validity was established in a pilot study with three midwives who observed seven mothers breastfeed. Intraclass correlation of scores between the three midwives who all observed seven individual mothers breastfeed were high 0.895 (p < 0.001). Results confirmed associations between mothers' positioning their baby for attachment to the breast (r = 0.635, p< 0.001) and effective breastfeeding (r = 0.474, p< 0.001) and between attachment and effective breastfeeding (r = 0.427, p< 0.001). The policy and practice implications of the PBOT will be addressed in terms of its utility (1) as a research tool to enhance best practice; (2) as a practice checklist used by clinicians to support and affirm principles of positioning and attachment while they observe an entire breastfeed; and (3) as a teaching strategy to improve consistency of practice supporting mothers to initiate and maintain breastfeeding.