| Summary: | Employing an anthropological perspective, this thesis explores whether alterations in postnatal care can impact on lactation physiology and long-term breastfeeding outcomes. The intervention examined was designed to facilitate mother-infant close proximity on the postnatal ward (using a side-car crib, as opposed to a standard cot), and outcomes were examined for first-time mothers who intended to breastfeed. The intrinsic and extrinsic factors that influence the duration and exclusivity of breastfeeding were also investigated, particularly the role of labour analgesia and delivery interventions. I collected the data presented in this thesis via two separate research studies, both of which investigated the impact of hospital postnatal care on breastfeeding outcomes. Both studies were conducted at the Royal Victoria Infirmary, Newcastle upon Tyne, UK. First, I conducted a non-randomised pilot study to investigate the effect of mother-infant postnatal proximity on maternal lactation physiology (maternal prolactin levels) and breastfeeding outcomes. The pilot study was considered an important stage prior to the implementation of a larger trial, and aimed to assess: the feasibility of novel data collection methods (dried blood spot (DBS) sampling), recruitment strategies, the management of the research and the required sample size. The pilot study included 57 women after receiving either a side-car crib or a standard cot on the postnatal ward, following an unassisted delivery. Blood spot analysis aimed to assess differences in prolactin increase. Results from the non-randomised pilot study generated useful information regarding the recruitment of participants and collection of biological samples via novel methods (DBS sampling), despite experiencing shortcomings with the analysis of the DBS samples. Recruitment rates were higher among women recruited from antenatal breastfeeding workshops, as opposed to women recruited following delivery on the postnatal ward. Descriptive statistics suggested that participants recruited at antenatal breastfeeding workshops reported high affluence than participants recruited on the postnatal ward. Equal numbers of participants in the two groups provided the DBS samples requested and data generated supported the use of DBS sampling as an alternative to venepuncture for research. The pilot study highlighted issues regarding the provisioning of the intervention (fidelity of implementation) and constraints to recruitment and data collection imposed by being a lone researcher. Second, I worked as the nominated Ph.D researcher on a large randomised controlled trial, referred to as the North-East Cot Trial (NECOT), where I contributed fully to the recruitment, data collection and management of the trial. I recruited participants at antenatal ultrasound clinics at 20 weeks gestation, midwifery staff provided the allocated cot type (side-car crib or standard cot) on the postnatal ward and data on breastfeeding duration were collected via a weekly telephone follow-up from birth until six months postpartum. I performed subgroup analysis on data from 366 first-time mother-infant dyads and employed three methods of analysis (intention-to-treat, per-protocol and as-treated) to assess the intervention on breastfeeding outcomes following differing birth experiences (vaginal unmedicated (VU), vaginal medicated (VM), instrumental medicated (IM) and caesarean section (CS)) and prenatal breastfeeding attitudes. The intrinsic and extrinsic factors that influence the duration and exclusivity of breastfeeding among these first-time mothers were also investigated. Results from the analyses indicated that birth interventions (VM, IM, CS) increased the risk of early breastfeeding cessation (both exclusive and any); postnatal ward cot type was not associated with breastfeeding duration among these groups. Following a VU delivery, facilitating mother-infant close proximity significantly improved the duration and exclusivity of breastfeeding among women whose commitment to breastfeeding was more uncertain. However, analysis also indicated that some women experienced inexplicably better breastfeeding outcomes following birth intervention (IM delivery). Maternal socio-demographic variables and prenatal breastfeeding attitudes increased the risk of early breastfeeding cessation at different time-points from birth to 26 weeks postpartum. Results from this analysis can be used to generate hypotheses for future research. This research highlighted that: (1) mother-infant dyads are more receptive to the benefits of postnatal proximity for breastfeeding following a VU delivery and (2) birth intervention and prenatal breastfeeding attitudes impact on breastfeeding longevity. Essentially, women rework breastfeeding behaviours in line with changing internal and external factors throughout the postpartum period, especially during times of vulnerability.
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