"AD-MIRE Breastfeeding" Study : Antenatal Diabetes- Mothers Improving Rates of Exclusive Breastfeeding

Background: Women with Gestational Diabetes Mellitus (GDM) and their babies are at a high risk for developing health conditions that can be reduced if they breastfeed on discharge from hospital. The numbers of women with GDM around the world are rising, yet despite help from health professionals, women with GDM consistently have lower breastfeeding rates on discharge from hospital than women without GDM, and often introduce formula within the first few days of birth.
The early introduction of formula is known to affect exclusive breastfeeding, both on discharge from hospital and in the long-term. One reason for this may lie with the shortage of interventions to improve exclusive breastfeeding rates where the needs of women with GDM have been considered. This study aimed to develop a new strategy, in collaboration with women and staff at a regional Australian hospital, to improve rates of exclusive breastfeeding (EBF) on discharge from hospital for women with GDM.

Methods: Using a person-centred, participatory action research approach, the study had four phases. In phase one, background information was collected from hospital data and surveys of women with GDM and hospital staff to identify baseline data prior to any intervention. In phase two, person-centred workshops were conducted using practice development principles to identify women’s concerns and ideas for changing hospital practice for improved breastfeeding support when they had GDM. In phase three, the findings from phases one and two were disseminated to the hospital staff to develop an intervention. In phase four, the impact of the intervention was evaluated to compare exclusive breastfeeding outcomes on discharge from hospital, pre and post intervention. Thematic analysis was used for analysing qualitative data. Quantitative data were analysed by descriptive and inferential statistical tests using Statistical Package for the Social Sciences (SPSS, version 29).

Findings: In phase one, hospital data demonstrated low exclusive breastfeeding on discharge from hospital among women with GDM compared to women with no GDM. Although staff believed that women with GDM did not need extra support, the survey from women demonstrated a high level of need for support. In phase two, women requested three changes in practice: (1) online hospital-based information, (2) an opportunity to connect with other mothers who have GDM via community support, and (3) continuity of care models. In phase three, working within COVID restrictions, staff decided to implement online hospital-based information via a hospital website as the intervention. Four months after implementing the intervention, post-intervention data on breastfeeding outcomes demonstrated no significant change in exclusive breastfeeding on discharge from hospital compared to pre-intervention data.

Conclusion: Asking women what they want, and tailoring education to their specific needs cannot be achieved if only one of three recommendations they suggested are implemented. There is a need, therefore, to investigate the entirety of women’s suggestions to fully tailor an intervention to their needs to improve EBF rates on discharge from hospital.

This work © 2024, Leanne Cummins, is licensed under Creative Commons Attribution-Noncommercial 4.0 International.
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