Intervention supporting breastfeeding for the substance exposed mother and baby

MacVicar, Sonya

Abstract

Background: the promotion and protection of breastfeeding is a priority global health objective as it is well-evidenced that it confers significant health, social and economic advantages. Breastfeeding has also been forwarded as a means of alleviating the severity of neonatal abstinence syndrome1. Abstinence syndrome is a condition of abnormal neurobehaviour indicative of withdrawal symptoms in a baby born to a women with a substance use disorder in pregnancy.
Breastfeeding is recommended as first line management of abstinence syndrome as the act of feeding can console the infant and transfer minute volumes of substitution medication in the breast-milk to minimise withdrawal symptoms. However, breastfeeding rates are typically low for substance dependent women with physical, psychological and institutional factors suggested as barriers 2. Despite, these acknowledged advantages and challenges there is minimal research on either supporting breastfeeding for this group or how this could be implemented in clinical practice.
Aim: the study explored the feasibility of an in-hospital, tailored breastfeeding support intervention.
Methods: mixed method feasibility study, in a tertiary maternity centre in Scotland from April 2014 to May 2015. Women were recruited from a joint obstetric/ substance use clinic. Participants were randomised to either standard Baby Friendly Initiative care only or to additionally receive the support of the breastfeeding intervention. The intervention was a proactive informative, practical, motivational and environmental model. It consisted of a 1-hour daily scheduled session with continuity of a dedicated carer, resources and instruction for neonatal self-soothing and a maternal capacity building approach to promote self-efficacy3. The intervention was delivered for 5 days to the mother and baby who were resident within a reduced stimuli environment.
A pilot RCT (n=14) with follow-up maternal questionnaire evaluated the intervention feasibility and acceptability; maternal breastfeeding confidence; infant feeding at 5 days and 6 weeks and severity of neonatal withdrawal as denoted by the need for pharmacotherapy and length of neonatal stay.
Results: 14 mother/infant dyads participated. The intervention was feasible to implement and the recruitment rate (77%) and retention (71%) indicated that the intervention was acceptable to the participants. The intervention group recorded higher levels of maternal confidence in their breastfeeding ability (p=0.016) and an increased rate of continued breastfeeding at day 5 (p=0.051). Women reported that their experience of health care practices, attitudes and postnatal environment influenced their perceptions of breastfeeding support. Fewer intervention infants required pharmacological treatment for NAS (28% v 57%) and had shorter durations of hospital stay (p=0.022). Breastfed infants were less likely to experience severe withdrawal requiring pharmacological treatment than formula fed infants (p=0.055). The follow-up breastfeeding rate was equal for the control and intervention group.
Discussion: implications for practice include the endorsement, promotion and protection of breastfeeding for this group with particular attention to maintaining a low stimuli environment, providing socioculturally relevant information and avoiding discouraging actions and attitudes.
Conclusions: the findings highlight the acceptability and feasibility of implementing tailored breastfeeding support for the substance exposed mother and baby and the potential for improved outcomes. Future research is recommended to assess clinical efficacy.

References
1. World Health Organization, 2014. Guidelines for the identification and management of substance use and substance use disorders in pregnancy.
2. MacVicar, S., Humphrey, T. and Forbes-McKay, K.E., 2017. Breastfeeding support and opiate dependence: A think aloud study. Midwifery, 50, pp.239-245.
3. MacVicar, S., Humphrey, T. and Forbes-McKay, K.E., 2018. Breastfeeding and the substance exposed mother and baby. Birth

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: NHS Lothian NMAHPPS Research Conference
• Deposit Date: Aug 16, 2023
• Keywords: Breastfeeding; substance use; midwifery