Quality of breastfeeding support
Breastfeeding difficulties are common for nursing mothers, highly personal and can vary from one infant to the next with the same mother. Multiple sources of support, help and advice for breastfeeding are available, some more helpful than others. What characterizes beneficial breastfeeding support? In this qualitative study, 86 new mothers in Calgary were asked to write open-ended accounts describing their experiences with all sources of breastfeeding support in the first six months following delivery of a healthy full-term infant. In their analyses, the authors found four major themes: knowledge, effectiveness, sensitivity/emotional support and accessibility (Box 1). Nursing mothers would like advice and support from those with the knowledge base to ensure resolution of problems, but it is important that this support be delivered without pressure and with emotional sensitivity to both mother and baby. The authors suggest that a greater understanding of the maternal experience of breastfeeding supports and services can inform appropriate approaches, and potentially reduce stress and anxiety, leading to improved maternal mental health. CMAJ Open 2015; 3: E305–9.
Positive breastfeeding support themes
Knowledge: mothers felt the person had knowledge, skills and experience with regard to breastfeeding and could accurately identify problems.
Effectiveness: suggestions and support were effective in resolving the problems or ameliorating the breastfeeding experience.
Emotionally positive: the person showed care for mother and baby, was sensitive to emotional strain and did not add to the “pressure” of breastfeeding.
Accessibility: support was available and accessible when needed/solicited.
Regional variation in use of surgery
Although differences in disease burden across populations may be a contributing factor, regional variation in the use of surgery implies that there is uncertainty regarding appropriate use. The authors of this descriptive study calculated procedure rates for the 84 most common procedures performed in hospitals or ambulatory clinics and measures of variation in use (quartile ratio and systematic component of variation) among 49 counties in Ontario. The most commonly performed procedure was colonoscopy (average adjusted rate 2012 per 100 000 population), while cataract surgery was the most common performed surgical procedure (984 per 100 000). Procedures with the highest variation between counties tended to be those performed less frequently, such as iridectomy, colposcopy, cervical biopsy and femoral arteriography (Figure 1). Common procedures were associated with less regional variation. The authors suggest that further research is required to determine why there is a high rate of variation for some procedures, which in turn may improve decision-making regarding their use. CMAJ Open 2015;3: E310–6.