Παύλος Σαράφης, Επίκουρος Καθηγητής, Τμήμα Νοσηλευτικής, Τεχνολογικό Πανεπιστήμιο Κύπρου
Ιωάννης Τούντας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Καντζανού, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Introduction: "Ten Steps" (WHO / UNICEF) are a credible structured breastfeeding program for the successful initiation, continuation and support of breastfeeding. The world's research and statistical data clearly demonstrates the importance of the contribution of health professionals involved in acute maternity care units.The ten - step principles underpin the birthing mother - infant relationship to ensure the smooth and correct initiation, continuation, and establishment of exclusive breastfeeding. In addition, it brings to the surface insufficient knowledge of health professionals involved in breastfeeding issues. The lack of knowledge creates inappropriate guidance with concerted advice and tangled messages that act negatively on mothers and generally on effective support for breastfeeding.
According to the National Study of Frequency and Maternal Determination of Maternal Breastfeeding in Greece 2017 the breastfeeding rate is noticeably reduced after the mother leaves the obstetric structure.
Purpose: The general investigation, depiction and description of the current situation in our country regarding the practices applied to maternal structures, whether or not identified, is an "Infant - Friendly Hospitals Initiative" aiming at the protection, promotion and support of breastfeeding based on the views and attitudes of health care professionals involved in mother – infant care. Find out to what extent obstetric structures are basically and harmoniously linked to the ten - point principles with a basic pillar targeting the increase in maternally breastfeeding rates. Because the more these steps are applied, the greater the chances of successful breastfeeding are. Might this be why WHO and UNICEF have set the goal of expanding BFHI to as many obstetric structures as possible, in Primary Health Care and in intensive nursing care units. Additionally, the approach to the level of knowledge and attitudes of breastfeeding health professionals and their correlation with demographic and work factors.
Method: This is a descriptive study of the function of Maternity units to highlight whether the structured breastfeeding program of the "ten steps" and the International Code for breast milk substitutes that positively affect the onset and duration of exclusive breastfeeding. It is a study of the correlation of knowledge and attitudes among health professionals involved in breastfeeding. Anonymous and self-completed questionnaire was used to investigate, visualize and describe the current situation on practices that apply to obstetric structures whether or not they are recognized BFHI in relation to the views and attitudes of healthcare professionals involved in maternal baby care. We have correlated the knowledge and attitudes of these workers to breastfeeding and multifactorial linear regressions that relate to the rating of attitudes and knowledge, respectively, to the demographic and labor elements of the workers. Sample included midwives, pediatricians, gynecologists and nurses working in the Obstetrics and Neonatology structure of Aretaieio University Hospital, as well as the professionals of the above 4 specialties who are employed in various places of acute maternity care and attended the 12th Breastfeeding Seminar that took place from January 21 to 26, 2019. This seminar is organized annually by the Aretaieio University Hospital of Neonatology. The questionnaire has used attitudes and knowledge for breastfeeding (Ingram, 2006) and the WHO / UNICEF Midwifery Obstetrics Self - Assessment Questionnaire.
Data collection took place between December 2018 and March 2019.
Results: High compliance rates have garnered aspects of steps 1: 'written policy' ranging from 87.6% to 40.5%, 4: "direct placement of the baby to his mother after birth for at least one hour" ranging from 85.7% to 36.7%, 6: "mother's written consent" ranging from 84.8% to 59%, 7, 8, 9: "infant with his mother 24 hours a day and unlimited breastfeeding" ranging from 95.7% to 68%. However, a low compliance rate of step 10 was observed: "linking maternity structures to social structures, breastfeeding support groups and mother groups". Code 10 has the highest percentages of 92.2% and Code 4 has the lowest 51.9% percent in self-assessment of compliance with the International Code for Marketing of Breastmilk Substitutes. Increased rates of agreement of participants' attitudes and knowledge as regards to the role of health professionals in encouraging mothers to breastfeed (97%), the benefits of maternal breastfeeding for the mother (98.1%) and the infant (97.6%), breast milk is an ideal baby food and supplemental feed is detrimental to the establishment of adequate breast milk production (99.5%). Higher empathy and higher scores were observed in women by 1.72 units, suggesting a more positive attitude compared to men.
Multifactorial analyzes show that pediatrician - neonatologists and midwives had statistically significantly higher scores indicating a more positive attitude compared to gynecologists and baby nurses. There was a significant statistical difference on how educated and trained breastfeeding participants considered themselves to be, neonatologists (70%), midwives (77.9%), nurses (35.3%) and gynecologists (23.8%).
Conclusions: There is no universal implementation of the ten-step structured breastfeeding program as proposed by the WHO / Unicef than only partial implementation of some aspects of the steps. Discursive is the depiction of step 10 where the problematic interconnection of obstetric structures with social structures, nursing support groups and mother groups, which creates barriers to the continuation of breastfeeding after mothers leave the obstetric structures. There was a high level of attitudes and knowledge about breastfeeding among neonatologists / midwives and male-midwives while there is a low level of baby nurses and gynecologists / obstetricians. Generally, there was a statistically positive correlation of knowledge and attitudes with education. In particular, the knowledge gap among gynecologists / obstetricians, which are the weak link in the promotion and promotion of breastfeeding disrupt the effort of interconnecting with other healthcare professionals to increase breastfeeding rates in our country.
Ten Steps, Breastfeeding, Breastfeeding Hospitals, Establishment, Knowledge, Attitudes, Obstetric Structures, Education, Healthcare Professionals