In total, 267 women accessed the drop-in service during the two years of operation and 136 women provided an email address. We contacted women by email and also promoted the survey on the local ABA facebook groups. In total, 53 women accessed the online survey. Data was not included for the two women who did not complete all questions, leaving 51 responses for analysis. Women indicated that their main reason for accessing the drop-in service was for assistance with breastfeeding, rather than to hire equipment or attend a group class or meeting. The majority of women lived within 30 mins of the service location (71%, n=38) and others reported that they travelled up to an hour (25%, n=13) and a small number travelled between 1-2 hours (4% n=2).
Responses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women attended with infants aged 0-8 weeks of age (72%, n=37) and a significant number of presentations occurred at 0-4 weeks after birth (49% n=22).
The most common presenting problems included sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields (see Table 1).
Table 1: Reasons for attending the Drop-in Service
Insert table
Prior to attending the service women sought breastfeeding support from a variety of other services including early child health nurse 61% (n31), lactation consultant at hospital 55% (n28), ABA helpline 41% (n21), family and friends 39% (n20) and the local General Practitioner (GP) 25% (n13) (see Table 2).
Table 2: Sources of support prior to attending the Drop-in service
Insert table
Participants were asked to rate a total of 18 potential sources of care, accessed prior to the drop-in service, based on a 4 point Likert scale ranging from not helpful to extremely helpful. Four groups were rated as most helpful prior to accessing the drop-in service: local ABA counsellor, ABA 24 hour Helpline, Private midwife and Private Lactation Consultant (LC), see Table 3. Some participants in this study rated the least helpful sources of breastfeeding support as Early Child Health Nurses, General Practitioner Doctors (GPs), Paediatricians and Lactation Consultants at hospital.
Table 3: Rating of Breastfeeding Support prior to attending the Drop-in service
Insert table 3
Participants were asked whether the drop-in service was helpful, or not, based on the same 4 point Likert scale ranging from not helpful to extremely helpful. In total, 95% (n=49) rated the service as ‘very helpful’ or ‘extremely helpful’. A large majority, 90% (n=46) of women, reported that the ABA drop-in service helped them to achieve their breastfeeding goals. In particular, 70% (n=36) of women, who responded to the survey, stated that their baby was referred to a doctor, as a result of the visit to the drop-in service, and that tongue-tie was eventually diagnosed. Whilst the peer counsellors could not diagnose tongue-tie, listening to women’s concerns enabled them to make appropriate referral’s to health professionals for assessment. In 89% (n=31) of cases the infants tongue-tie was released by a health professional. When asked about the important aspects of the drop-in service, 58% (n29) of women indicated that not having to pay for the drop-in service was either important or extremely important.
In total, 50 women responded to the invitation to provide open text responses to two questions. Data was uploaded, cleaned and coded using NVIVO 10. The overarching theme in relation to participants experiences of the drop-in service was ‘Support to continue breastfeeding’. Within this umbrella theme, three subthemes existed; ‘feeling listened to and not judged’; ‘the importance of face-to-face, practical and emotional support'; and ‘the need for ongoing, free access’. See Figure 1.
Support to continue breastfeeding: “Without that visit I would not have still been breastfeeding”
Women described the importance of the drop-in service availability and how the support provided enabled them to continue to breastfeed. The open text responses were full of positive responses about the ‘enabling’ nature of the drop-in service support for continuing breastfeeding, with one participant saying, “Without that visit I would not have still been breastfeeding” (Survey Participant (SP) 50).
Women disclosed that in some instances a problem that had been missed by various health practitioners had been picked up at the drop-in service, as illustrated by the following account:
They picked up the problem immediately and provided info and support and referred me to a lactation consultant…They were life savers and listened to me when I said there was something wrong. The [lactation consultant] I was later referred to discovered a 50% tongue tie and a 100% lip tie. Nobody else prior, out of all the people we saw, even noticed. (SP 42)
This type of response was common among respondents. Women stated that the drop-in service was unusual because “there is very little help out there for breastfeeding mothers” (SP 16). The practical nature of the help was appreciated by respondents of the survey, as the following quote reveals:
It is very difficult to get help from a GP or through a hospital if your baby is past the newborn stage. GP’s are not trained in lactation. And hospital-based lactation consultants are reluctant to see older babies. And private lactation consultants are expensive. Besides ABA, there is nowhere else for mums struggling to feed to go. (SP 19)
The weekly availability of the drop-in service helped women, who felt that without it they would have to wait for weeks to get help. Many women evidenced the value of the service by citing the length of time they had been able to continue to breastfeed, which ranged from 6 to 21 months, as these quotes highlight:
I was close to giving in [but] she is now 16 months and still breastfeeding. (SP 28)
I never would have kept going to 6 months without this free weekly support (SP 2)
Women described feeling a sense of “gratitude” to the peer counsellors, and ABA more generally, for their ongoing support, describing it as an “invaluable service”. This gratitude was shared by women who were unable to establish breastfeeding, but were supported to continue to feed their child breastmilk:
My daughter didn’t ever end up breastfeeding for more than a minute or two but thanks to the drop-in lounge and ABA support she had expressed breast milk for her first 4 months (SP39).
Feeling listened to and not judged: “She was a good listener, not pushy and very respectful”
The non-judgemental nature of support was a repeated theme in the analysis of women’s responses. The absence of judgement was particularly important for women who were bottle feeding artificial formula to infants, as the following quote highlights:
I felt that it was a place that I could go to receive helpful advice and tips without being judged for bottle feeding my baby (SP 25).
The “non-judgemental” support at the drop-in service was described as caring and sensitive and women described being given the time to talk and feel listened to. For some women they felt that this was the first time someone took their concerns seriously:
It was the first time someone had really listened to me as I voiced my concerns about my baby not putting on weight and took the time to watch me try to feed without hurrying me or intervening too much. (SP 7)
This non-judgemental support was important for women whose breastfeeding journey had not progressed as they expected, with one woman describing the way the counsellor helped her to “overcome guilt” for not breastfeeding:
They helped me in such a caring nature without prejudice or judgement, it helped me deal and overcome personal guilt about not being able to breastfeed. (SP 24)
Some women identified the qualities of a good peer counsellor, which included being a good listener, being kind and respectful.
I was met by a lovely breastfeeding counsellor and ushered into a private corner. She was kind, a good listener, not pushy and very respectful e.g. asking if I would mind feeding in front of her, shutting blinds and curtains, letting me decide what I wanted to do next, offering a drink. I warmed to her very quickly and really appreciated not being rushed – when you are that stressed and sleep deprived you need time to think, respond and make decisions. (SP 8)
Others made mention of the training and experience of ABA counsellors and the difference this made to the consultation:
I spent hundreds on private lactation nurses and nothing compares to the ABA. You can clearly see that their training and expertise is of another level, but combined with experience, empathy and understanding it brings their services to another level. (SP 25)
The importance of face-to-face, practical and emotional support
Many women commented on the opportunity to sit face-to-face with a peer support counsellor throughout a full breastfeed and to receive practical support. The drop-in service provided face-to-face support alongside access to practical aids such as electronic breast pumps, which were available for hire onsite. This allowed women to leave the centre with information, suggestions and equipment. The suggestions provided by the peer supporters were described as “useful tricks and tips” provided for free.
Being able to sit in a private space with “another mother” who had additional experience and knowledge was one of the most valued things about the drop-in service. Many women mentioned the importance of face-to-face support rather than telephone support:
My son’s tongue and lip tie was finally picked up. It is extremely important these services are face-to-face as there are some things that can’t be done or seen over the phone. (SP19)
The opportunity to receive face-to-face support was viewed as one of the most beneficial aspects of the drop-in service:
The most helpful part of my experience at the breastfeeding lounge was that someone could actually see what my baby was doing at the breast and see her attachment. This would not have been achieved over the phone or by email. (SP 29)
Watching an entire feed seemed to be very important to women, particularly in a relaxed environment. The social nature of a face-to-face interaction seemed to be compatible with effective support for breastfeeding as a ‘social’ activity, allowing women to sit, talk and have a “cuppa”.
The calmness of the environment and the ability to wait until the baby was ready to feed was also a bonus. Women commented that the drop-in service felt like a safe place to go where they were exposed to other women who were experiencing difficulties. Women said they found this helpful, with one woman explaining:
Seeing other mothers going through difficulties made it much easier for me to persevere with breastfeeding. (SP39)
Interacting with other women who were on a similar journey highlighted the benefits of group interactions for sustained breastfeeding. Referrals to local ABA groups were identified as enabling ongoing breastfeeding following their visit to the centre:
We joined the ABA then and there and felt it was an absolute bargain for the service we received. I then went on to join and really enjoy my local ABA mothers group... I went away feeling more confident and with a whole lot of strategies to try. (SP7)
Beyond practical and informational support, the peer support counsellors at the drop-in service also offered emotional support, which women described as “boosting” or “lifting” their confidence. In addition to boosting their confidence, emotional support was identified by women as a positive outcome of their drop-in visit:
The support provided was very helpful but they also helped with my emotions as I was a first time mum. I only stopped breastfeeding my son 3 weeks ago and he turned 18 months old today. The first time I attended, which was not a drop-in day, I was extremely emotional and struggling with getting my son to latch. The lady helped me and if it hadn’t been for her I may have stopped breastfeeding my son. (SP 41)
Some women discussed feeling that their mental health was deteriorating, and the service helped them when they were “…becoming anxious and depressed…” (SP 25). The emotional support increased women’s feelings of confidence with their chosen feeding option. According to survey respondents, the peer counsellors reportedly focused their discussion on the woman’s needs and her unique situation rather than being focussed on their own agenda. One woman offered the following account:
They didn’t advertise the “breast is best” slogan in my face while they tried helping me with my baby during the consult, which was a breath of fresh air. At the time my baby was crying at the top of her lungs because she was hungry and wanted milk but just wouldn’t latch on so I gave her a bottle instead. I thought they would frown upon it and judge me and use the slogan about “the breast being the best”. They were so understanding and told me that giving her a bottle would be fine and it wasn’t at all my fault or baby’s, I was reassured that I was trying and doing my best. (SP25)
The need for ongoing, free access: “I recommend it to all mothers”
Many of the respondents stated that following their experience, they recommended the ABA and the drop-in service to “everyone”. Women promoted the service to their friends and family:
It is a fabulous service that I recommend to all mothers that I meet who are experiencing any difficulties in feeding their babies. (SP5)
At the time of the survey, the drop-in service had stopped operating due to ongoing funding uncertainty. Some of the respondents were aware that the drop-in service had closed and expressed their disappointment that the service was no longer available to breastfeeding women. Many respondents described the service as “essential”, and some were worried about access to support with their next baby:
I am fairly terrified that I am pregnant again and won’t have access to this support the second time around! (SP2)
The fact that the service was free for members of ABA was appreciated. Women who were not members of ABA were also able to access the service, but were encouraged to join ABA to ensure ongoing support. Some women stated that they liked the service so much they would have paid if needed:
I attended as my baby wouldn’t latch on properly and was not putting on weight. I was worried I had low milk supply … It was helpful that the service was free although I would happily have paid. (SP8)
Other respondents felt that they were misled that the service was free when in reality they were expected to join the ABA for ongoing access. Participants stated that this misinformation mostly came from health professionals suggesting it was a free service when they may not have been aware that it was only a free service for members.
I didn’t like being told that it was free but then had to sign up for the ABA membership which cost money to use the lounge. (SP20)
There was the suggestion from one respondent that this type of service should be readily available for everyone and should be provided by the health department, as the following quote describes:
The early childhood centre did not have a breastfeeding clinic (unlike the centre I visited with my first child) and I was told to see the clinic at the ABA. On arrival the counsellors were really approachable and friendly and calm. They were busy seeing to two other mums but got to me as soon as possible. I was very surprised to find out that I had to join as a member of the ABA to get any support. I felt that this was something that the early childhood centre should be providing free of charge. But I was glad that I was able to get some help and guidance regardless, and understood that the ABA was not funded by Medicare or the health department. (SP35)
In particular, respondents identified wider benefits to society from a volunteer service such as this and the implications from its closure.
I was becoming anxious and depressed. If I hadn’t been to this service I would have been diagnosed with postnatal depression which poses another whole set of stresses upon my family. These services need to be open and kept open as it benefits society and the government as tax payers as it becomes cost effective - umbrella affect. (SP25)