Bringing in milk from home: an exploratory study

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Bringing in milk from home: an exploratory study

Survey for mothers

Neonatal Unit, Mercy Hospital for Women

Mother & Child Health Research, La Trobe University

Researchers:

Ranmali Rodrigo Gillian Opie Kerri McEgan Lisa Amir Della Forster

Mother & Child Health Research 215 Franklin Street

Melbourne VIC 3000 Australia

Phone: +61 3 9479 8800 Fax: +61 3 9479 8811 Email: [email protected]

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Study ID

S

TUDY

T

ITLE

:

BRINGING IN MILK FROM HOME: AN EXPLORATORY STUDY

Survey for mothers bringing in breast milk from home

Thank you for agreeing to take part in this study.

This questionnaire asks about your experiences with expressing, storing and transporting breast milk from home to the hospital. We will also ask about your understanding of breast milk storage practices and about the support you received in starting to express and maintaining your breast milk supply.

Your views are important to us. The feedback you give us will help us to improve the support and advice we provide to other mothers in your situation, not only at Mercy Hospital for Women, but also elsewhere in Australia and in developing countries which are establishing neonatal units.

We know that you are probably very busy, but we would really like to hear about your experiences. There are no right or wrong answers to most of the questions. We will not know who has filled this questionnaire once you have returned it, and will not be able to identify you. The information you provide will be strictly confidential and used only in the preparation of the combined study report.

The questionnaire will take you about 10-15 minutes. If there are any questions you would prefer not to answer that is fine – simply move on to the next question.

The research team conducting this survey is from Mercy Hospital for Women and Mother

& Child Health Research at La Trobe University.

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How to fill in the questionnaire

The questions are in capital letters, with instructions for specific questions (where needed) in italics. The response options are in normal letters.

• Most of the questions can be answered by putting a tick ‘√’ in the box next to the answer/s that best represents your experience or understanding, as in the example below:

HOW DID YOU FIRST EXPRESS YOUR BREAST MILK?

By hand √ 1 By breast pump 2

The numbers next to the boxes are for coding purposes only.

• Some questions need to be answered by writing the response in the space provided.

For example,

IN WHICH HOSPITAL WAS YOUR BABY(S) BORN?..Mercy Hospital....

Or

HOW OLD IS YOUR BABY(S) TODAY? days

• Questions 54 to 56

These questions can be answered by circling the relevant number in the appropriate row as demonstrated in the example below,

WHAT IS THE LONGEST TIME PASTEURISED BREAST MILK CAN BE KEPT AT ROOM TEMPERATURE BEFORE USE?

1 / 2 / 4 / 6 / 8 / 12 / 18 hour(s) OR 1 / 2 / 3 / 4 / 5 / 7 / 14 days(s) OR 1 / 2 / 3 / 4 / 5 / 6 / 12 month(s) OR Not sure

Please place the completed questionnaire in the boxes provided at the Neonatal Intensive Care Unit / Special Care Nursery nurses’ desks. The boxes are labelled as

‘Bringing in milk from home study.’

1 2

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Please tell us a little about this pregnancy, your baby(s) and his/her birth

3. DID YOU HAVE MORE THAN ONE BABY (E.G. TWINS OR TRIPLETS) THIS TIME?

Yes 1

No 2

4. WHAT TYPE OF BIRTH DID YOU HAVE? 5. IN WHICH HOSPITAL WAS YOUR BABY(S) BORN?...……… If you gave birth at Mercy Hospital for Women skip to Question 9. 9. WHEN DID YOU FIRST GET TO SEE / HOLD YOUR BABY(S)? (Please tick ‘√’ one response in each column) 10. WHILE PREGNANT, WERE YOU PLANNING TO BREASTFEED YOUR BABY(S)? Yes 1 Go to Question 11. No 2 Go to Question 12. 11. FOR HOW LONG WERE YOU PLANNING TO BREASTFEED YOUR BABY(S)? 1. HOW MANY WEEKS PREGNANT WERE YOU WHEN YOUR BABY(S) WAS BORN? (in weeks) 1

2. HOW OLD IS YOUR BABY TODAY? (in days) 1

Normal vaginal 1

Instrumental (forceps, vacuum) 2

Caesarean section 3

6. IF IT WAS NOT MERCY HOSPITAL FOR WOMEN (MHW), 7. HOW OLD WAS YOUR BABY(S) WHEN TRANSFERRED TO MHW? (in days) 1

8. WHEN DID YOU FIRST COME TO MHW? (in days) 1

7.i) See your baby 7.ii) Hold your baby Less than 1 hour after birth 1 1

More than 1 hour, but < 24 hours after birth 2 2

After first day, but within first week following birth 3 3

After 1 week, but within 2^nd week following birth 4 4

More than 2 weeks after birth 5 5

For at least month/s 1

OR No plans for how long 2

A few days 3

More than a few days, but less than a month 4

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12. IS THIS YOUR FIRST BABY(S)?

Yes 1 Go to Question 16.

No 2 Go to Question 13.

Tell us about your previous experience with breast milk feeding.

13. HOW MANY CHILDREN HAVE YOU HAD, NOT COUNTING THIS BABY(S)?

14. DID YOU BREASTFEED OR PROVIDE YOUR BREAST MILK TO ANY OF THEM FOR MORE THAN ONE WEEK?

15. DID YOU EXPRESS YOUR BREAST MILK FOR ANY OF YOUR PREVIOUS CHILDREN FOR MORE THAN ONE WEEK?

Yes 1

No 2

Tell us how you found information on breast milk feeding 16. HAVE ANY OF THE FOLLOWING SOURCES PROVIDED YOU WITH INFORMATION RELATED TO BREAST MILK EXPRESSION, STORAGE OR TRANSPORT? (Please tick ‘√’ the relevant response in each row) (^*BS- birthing suite; PNW – postnatal ward; FBC – Family Birth Centre) 17. WHICH OF THE INFORMATION SOURCES MENTIONED IN QUESTION 16 HAS BEEN THE MOST IMPORTANT ONE FOR YOU? (Please write in the relevant letter from A-O) Yes No A Formal antenatal classes 1 2

B Midwife you saw during pregnancy 1 2

C Doctor you saw during pregnancy 1 2

D Midwives on BS^* / PNW^*/FBC^* 1 2

E Doctors in BS^* / PNW^*/FBC^* 1 2

F Lactation consultant 1 [ 2

G Nurses / midwives in neonatal unit ¹ 2

H Doctors in neonatal unit 1 2

I Family members 1 2

J Maternal and child health nurse 1 2

K Community support group 1 2

L Website (please specify)……… 1 2

M Leaflets (please specify)……… 1 2

N Hotline (please specify)………. 1 2

O Other (please specify) ………. 1 2

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Tell us more about the support you received from hospital staff to provide your breast milk to your baby(s)

18. HOW SATISFIED ARE YOU ABOUT THE SUPPORT RECEIVED ON DAY OF BIRTH?

Very dissatisfied Dissatisfied Not sure Satisfied Very satisfied

19. HOW SATISFIED ARE YOU ABOUT THE SUPPORT RECEIVED SUBSEQUENTLY?

Very dissatisfied Dissatisfied Not sure Satisfied Very satisfied

20. HOW WAS YOUR BREAST MILK FIRST EXPRESSED?

By hand 1 By breast pump 2

21. WHEN DID YOU START EXPRESSING YOUR BREAST MILK?

22. WHO FIRST SHOWED YOU HOW TO EXPRESS YOUR BREAST MILK, BY HAND?

Midwife / Nurse in

Lactation consultant

Other

(Please specify)

………….

Birthing suite

Operating theatre recovery

Postnatal ward

High dependency

unit

Neonatal Unit

23. WHO FIRST SHOWED YOU HOW TO EXPRESS YOUR BREAST MILK, BY PUMP?

Midwife / Nurse in

Lactation consultant

Other

(Please specify)

………….

Birthing suite

Operating theatre recovery

Postnatal ward

High dependency

unit

Neonatal Unit Before birth 1

≤ 6 hour after birth 2

7-24 hours after birth 3 25-48 hours (2^nd day) after birth 4 49-72 hours (3^rd day) after birth 5

>3 days after birth 6

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Tell us more about how your baby has been feeding in the last 24 hours

24. HAS YOUR BABY(S) BEEN RECEIVING MILK IN THE LAST 24 HOURS?

25. WHAT TYPES OF MILK HAVE BEEN USED IN THE LAST 24 HOURS?

(Please tick ‘√’ the relevant response in each row)

26. WHAT METHODS OF FEEDING HAVE BEEN USED IN THE LAST 24 HOURS?

27. HOW MANY TIMES DID YOU EXPRESS YOUR BREAST MILK IN THE LAST 24 HOURS? (Write ‘0’ if you did not express at all) times

Tell us more about your experience with expressing breast milk since the birth

28. HAVE YOU EXPRESSED YOUR BREAST MILK IN ANY OF THE FOLLOWING PLACES? (Please tick ‘√’ the relevant response in each row)

29. WHERE HAVE YOU EXPRESSED MOST OF YOUR BREAST MILK IN THE LAST 24 HOURS? (Please write in the relevant letter from A-G, mentioned in Question 28.)

Yes No

A Your breast milk 1 2

B Pasteurised donor milk 1 2

C Formula milk 1 [ 2

Yes No A Breastfeeding 1 2

B Bottle feeding (special bottle) 1 2

C Bottle feeding (normal bottle) 1 [ 2

D Cup feeding ¹ 2

E Syringe feeding 1 2

F Nasogastric (tube) feeding 1 2

G Other (please specify)……… 1 2

Yes No A Home 1 2

B Neonatal Unit – by baby’s bedside 1 2

C Neonatal Unit – milk expressing room 1 2

D Hospital –postnatal ward 1 2

E Friend / relative’s house 1 2

F Public places, eg: mall, restaurant 1 2

G Other (please specify) …….……… 1 2

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30. WHICH OF THE FOLLOWING METHODS HAVE YOU USED TO EXPRESS YOUR BREAST MILK? (Please tick ‘√’ the relevant response in each row)

31. WHICH OF THE ABOVE METHODS DO YOU USE MOST OFTEN?

(Please write in the relevant letter from A-E, mentioned in Question 30.)

32. DO YOU USE A BREAST PUMP? (YOUR OWN/HIRED/BORROWED)?

33. DO YOU HAVE A MANUAL (HAND-OPERATED) BREAST PUMP?

34. WHAT TYPE/S OF MANUAL PUMP/S DO YOU USE?

(Please tick ‘√’ all that apply)

Yes No

A Hand expression 1 2

B Manual (hand-operated) pump 1 2

C Electric pump 1 2

D Battery-operated pump 1 2

E Other (please describe) ……… 1 2

A Ameda

B Avent ISIS

C Cherub Natripump D Dr Browns Manual Breast Pumps E Kaneson

F Medela Harmony

G Medela Manual Breast Pump

H NUK

I Pigeon

J Tommee Tippee K Not sure what it is L Other (Please specify)

………..

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35. IS YOUR BREAST PUMP/S ELECTRICALLY OPERATED?

36. WHAT IS/ARE THE BRAND/S OF THE ELECTRIC PUMP/S YOU USE?

(Please tick ‘√’ all that apply )

37. DO YOU USUALLY EXPRESS MILK FROM BOTH BREASTS AT ONCE OR ONE BREAST AFTER THE OTHER?

38. HAVE YOU EVER COLLECTED AND STORED MILK THAT DRIPS FROM THE BREAST YOU ARE NOT EXPRESSING FROM, TO BE USED BY YOUR BABY WHO IS IN HOSPITAL?

A Ameda Elite

B Ameda Purely Yours

C Avent Medela Swing D Cherub Natripump Electric E GROW Diana

F GROW Sophia

G Medela Free Style

H Medela Lactina

I Medela Mini-electric

J Medela Pump in Style K Medela Swing L Medela Symphony

M NUK

N Pigeon

O Whittlestone

P Not sure what it is

Q Other Please specify)

………..

One breast after the other 1 Go to Question 38.

Both breasts at once 2 Go to Question 39.

Yes 1

No 2

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In questions 39 to 49 we would like to know what you have been told about washing and cleaning your hands, breasts and breast pump kits, as we understand that you may have been advised in different ways.

Therefore there are no right or wrong answers.

39. WHICH OF THE FOLLOWING HAND WASHING/CLEANING METHODS HAVE YOU BEEN ADVISED TO USE WHEN EXPRESSING YOUR BREAST MILK?

(Please tick ‘√’all that apply)

40. WHICH OF THE FOLLOWING PIECES OF ADVICE HAVE YOU BEEN GIVEN REGARDING PREPARATION OF YOUR BREAST BEFORE EXPRESSING?

(Please tick ‘√’all that apply)

41. HAVE YOU EVER USED THE BREAST PUMP AVAILABLE FOR COMMON USE IN THE HOSPITAL?

42. HOW DID/DO YOU CLEAN THIS COMMON BREAST PUMP BEFORE AND AFTER USE? (Please tick ‘√’ all that apply)

Yes No A Hand washing only with water prior to expression

B Use liquid hand wash or soap at home

C Use antiseptic hand washing liquid in hospital D Brushing under finger nails

E Trimming finger nails

F Avoiding use of rings with gems/designs G None

H Other (please specify) ………

Yes No A Wipe breast with a clean tissue /cloth only

B Wash breast with water only

C Wash breast using soap/hand washing liquid D Wipe breast with a clean tissue /cloth after washing E None

F Other (please specify)………

Yes No

A Wash with liquid antiseptic 1 2

B Wipe with detergent wipe (green packet) 1 2

C Other (please describe)

………

1 2

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Breast pump kits can be ‘washed’ to remove visible debris on them and / or

‘disinfected’ to remove most germs as well. There are various ways of doing these and you may have received differing advice on this.

43. HOW HAVE YOU BEEN ADVISED TO WASH (REMOVE VISIBLE DEBRIS) YOUR BREAST PUMP KIT? (Please tick ‘√’ all that apply)

44. HOW OFTEN DO YOU WASH YOUR BREAST PUMP KIT? (Please tick ‘√’ one response)

Before & after each milk expression 1

Before each milk expression only 2

After each milk expression only 3

Once a day 4

Less frequently than once a day 5

Never 6

Other, (Please describe) 7 ………...

45. HOW HAVE YOU BEEN ADVISED TO DISINFECT (REMOVE GERMS) YOUR BREAST PUMP KIT? (Please tick ‘√’ all that apply) 46. HOW OFTEN DO YOU DISINFECT YOUR BREAST PUMP KIT? (Please tick‘√ one response) Before & after each milk expression 1

Before each milk expression only 2

After each milk expression only 3

Once a day 4

Less frequently than once a day 5

Never 6

Other, (Please describe) 7 ………...

Yes No A Use cold water only and wash by hand

B Use warm water only and wash by hand C Use cold and warm water & wash by hand D Use dishwashing liquid when washing by hand E Use regular soap when washing by hand F Use dishwasher with dishwasher detergent G None

H Other (please specify) ………

Yes No A Boiling

B Steaming

C Wash using chemicals (e.g. Milton solution) D None

E Other (please specify)………

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47. HOW DO YOU USUALLY DRY YOUR BREAST PUMP KIT AFTER WASHING?

(Please tick ‘√’ one response)

48. WHERE IS YOUR BREAST PUMP KIT USUALLY STORED AFTER CLEANING?

(Please tick ‘√’ one response)

49. DO YOU BRING YOUR BREAST PUMP KIT TO THE HOSPITAL OR TAKE IT ANYWHERE ELSE AWAY FROM HOME?

Yes 1 No 2

Tell us about how you store your expressed breast milk

50. WHERE DO YOU STORE YOUR EXPRESSED BREAST MILK AT HOME IF IT IS NOT BROUGHT IN FRESH? (Please tick ‘√’ the relevant response in each row)

I use it before it dries 1

Dries in dishwasher 2

Drip dry 3 Use paper towel 4 Use dish cloth 5 Other (please specify)

………

6

In an air-tight hard container 1

In an air-tight plastic bag 2

In a non air-tight hard container 3 In a non air-tight plastic bag 4 Not stored in a hard container/bag 5 Other (please specify)

………

6

Yes No

A Refrigerator 1 2

B Freezer compartment within refrigerator 1 2

C Freezer compartment with separate door 1 [ 2

D Separate deep freezer ¹ 2

E Other (please specify)

………

1 2

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51. WHAT TYPE OF CONTAINER DO YOU USE TO STORE YOUR BREAST MILK IN?

52. HAVE YOU EVER USED ANY OF THE FOLLOWING METHODS TO CLEAN ANY PLASTIC CONTAINERS THAT YOU USE TO STORE MILK IN?

53. HOW LONG DOES IT USUALLY TAKE BETWEEN COMPLETING AN EXPRESSION OF BREAST MILK AND PLACING IT IN THE REFRIGERATOR OR FREEZER FOR STORAGE?

Other comments ………..

………..

Yes No A Sterile plastic container provided by hospital 1 2

B Other sterile plastic container with tight lid 1 2

C Clean plastic containers with tight lid, not sterilised ¹ ^[² D Sterile glass container with tight lid ¹ 2

E Clean glass containers with tight lid, not sterilised 1 2

F Sterile sealable plastic bag 1 2

G Clean sealable plastic bag, not sterilised 1 2

H Standard baby bottles, sterilised 1 2

I Standard baby bottles, not sterilised 1 2

J Other (please specify)

………

1 2

Yes No

A Microwave 1 2

B Dishwasher 1 2

C Boil in water saucepan 1 [ 2

D Boil/steam in steriliser ¹ 2

E Wash with water & soap 1 2

F None of the above 1 2

G Other (please specify)

………

1 2

Less than 10 minutes 1

10-30 minutes 2

31-60 minutes 3 More than >1 hour 4

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We understand that there are differences in the advice given about the duration that expressed breast milk that is to be used for a hospitalised infant can be stored safely in various temperature settings. We are interested in knowing what you have been told. There are no right or wrong answers.

Please respond to questions 54 to 56 by circling the relevant number in the appropriate row.

54. WHAT IS THE LONGEST TIME FRESHLY EXPRESSED BREAST MILK CAN BE KEPT AT ROOM TEMPERATURE BEFORE USE?

55. WHAT IS THE LONGEST TIME FRESHLY EXPRESSED BREAST MILK CAN BE KEPT IN THE REFRIGERATOR BEFORE USE?

56. WHAT IS THE LONGEST TIME FRESHLY EXPRESSED BREAST MILK CAN BE KEPT IN THE FREEZER BEFORE USE,

i) IF FREEZER COMPARTMENT IS INSIDE THE REFRIGERATOR?

ii) IF FREEZER COMPARTMENT HAS A SEPARATE DOOR?

iii) IF A SEPARATE DEEP FREEZER IS USED?

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Tell us about how you bring your expressed breast milk to the hospital

61. HAVE YOU EVER TAKEN MORE THAN 4 HOURS TO BRING YOUR MILK TO HOSPITAL?

62. DID YOU DO ANYTHING DIFFERENT AFTER YOU BROUGHT THE MILK IN TO THE HOSPITAL?

Yes 1 Please describe what………

No 2

63. DURING THE LAST 7 DAYS, HOW MANY TIMES HAVE YOU COME TO VISIT YOUR BABY IN THE HOSPITAL? (Please tick one response)

57. WHEN WERE YOU DISCHARGED FROM THE HOSPITAL YOURSELF? (Please write number and circle applicable duration)

1

Days / weeks / months (Circle applicable) ago

58. HOW FAR AWAY DO YOU LIVE? (in kilometres - km) 1

59. HOW LONG DOES IT USUALLY TAKE TO COME TO THE HOSPITAL? (in hours and minutes)

1 hours and 1 minutes

60. WHAT IS LONGEST TIME IT HAS TAKEN YOU TO

COME TO THE HOSPITAL, WHEN BRINGING IN MILK?

(in hours and minutes)

1 hours and 1 minutes

More than 7 times 1

7 times 2

5-6 times 3 3-4 times 4 1-2 times 5

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64. DURING THE LAST 7 DAYS, HOW MANY TIMES HAVE YOU BROUGHT YOUR EXPRESSED BREAST MILK TO HOSPITAL? (Please tick one response)

65. HOW DO YOU TRAVEL TO THE HOSPITAL? (Please tick ‘√’ the relevant response in each row)

66. WHEN / IF YOU ARE NOT TRAVELLING BY PUBLIC TRANSPORT, WHERE IN THE VEHICLE DO YOU KEEP YOUR MILK? (Please tick ‘√’ the relevant response in each row)

67. WHEN TRANSPORTING MILK TO HOSPITAL, DO YOU BRING MILK WHICH,

More than 7 times 1

7 times 2

5-6 times 3 3-4 times 4 1-2 times 5

Yes No

A Drive own vehicle 1 2

B Vehicle driven by partner /relative/friend ¹ 2

C Taxi 1 [ 2

D Public transport ¹ 2

………

1 2

Yes No

A Not applicable (only use public transport) 1 2

B On the front seat 1 2

C In foot space of front seat 1 [ 2

D On the back seat ¹ 2

E In foot space of back seat 1 2

F In the boot 1 2

G Other (please specify)

………

1 2

Yes No

A Was in the freezer 1 2

B Was in the refrigerator 1 2

C Has been freshly expressed 1 [ 2

D Other (please specify)

………

1 2

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68. DO YOU TRANSPORT YOUR EXPRESSED BREAST MILK TO HOSPITAL IN A CONTAINER THAT KEEPS IT COLD (COOLER CONTAINER)?

69. WHAT TYPE OF COOLER CONTAINER DO YOU USUALLY USE?

70. DO YOU USE ANY OF THE FOLLOWING TO MAINTAIN THE TEMPERATURE OF MILK DURING TRANSPORT? (Please tick ‘√’ the relevant response in each row)

Please tell us a little bit more about yourself

72. WHAT IS YOUR HIGHEST EDUCATIONAL QUALIFICATION?

73. What is your home postcode?

Cooler bag 1

Esky 2

Other (please specify)

………

3

Yes No

A Freezer packs 1 2

B Normal ice 1 2

C Dry ice 1 [ 2

D None of above ¹ 2

………

1 2

71. HOW OLD ARE YOU? (in completed years)

Completed a degree or higher 1

Completed a certificate / diploma / apprenticeship 2

Completed secondary school to Year 12 (or equivalent) ³ Did not / have not completed secondary school 4

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If you have any suggestions on how we could help you further in expressing, storing and transporting your breast milk, please write them here.

. ………

……….

Thank you very much for taking the time to answer this questionnaire.

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