Table 3

Balance sheet of qualitative and quantitative7 advantages and disadvantages of the proactive telephone intervention compared with reactive telephone calls alone

ProsConsComment
23% increase in any breast feeding and 22% increase in exclusive breastfeeding rates at 6–8 week follow-upEffect size may be an overestimation due to the small sample size and missing data
Other women not receiving the intervention received ward support at quiet times during the trialCost per woman may be an overestimation and might differ if recruitment extended to other postnatal and labour wards
The duration of calls was shorter than the team and ward staff expected, and women were very satisfied with frequency, length and content of callsThe intervention did not fully meet the needs of all women.
  • Some women would have liked and possibly would have benefited from calls beyond 2 weeks

  • Some would have liked a home visit from the team if watching a feed was considered helpful

  • Calls were not always at a convenient time. Staff needed to persevere to contact some women

  • Non-English language speakers required a landline to use language line services

  • Face-to-face return visits to the ward were not feasible due to lack of space and cost

  • Call length may be higher if extended to cover all postcode areas. Including a home visit would have implications for staffing levels and costs as the study included rural areas

  • Acceptability may not be generalisable to more advantaged women or to other teams or wards

Use of a mobile phone allowed flexibility as ward space was limited. Texting was sometimes usefulCost to women without access to the same mobile phone provider was higher than the cost of contacting a landline
  • Cost may be an issue particularly at the end of the month or for those with a different phone provider

  • Some women would prefer a landline number

  • Language line interpretation services were not available through a mobile phone

No one phone option will suit everyone. Consideration could be given to providing women with phone credits. Mobile and landline access are important; however, there are operational challenges to provide and staff a landline in a private room on a postnatal ward and transfer calls efficiently to the feeding team
The team were able to provide an intervention that was well integrated with existing servicesTeam configuration made it difficult to provide consistent and continuous cover over holiday, and non-standard hours. Alternative staffing configurations would need to be considered to deliver a service to overcome these logistical problems
  • Team commitment, consistency and skills were high, and reliability may vary in a larger multisite trial. Extending hours and/or having an additional team member would assist with providing 7 day feeding team rota cover when staff were on holiday and allow some weekly time to meet as a team

  • A band 7 midwife as team leader was seen as essential to ensure a high-quality service and integration with existing maternity services

The intervention was more costly (as a minimum £20 per woman more).Activity data collected does not reflect absences and assumes staff would have sufficient time to provide care
Configuration of the team promoted equity among those staff providing careA requirement for not having a service involving different bands in a team may promote equity but reduces organisation flexibility and may increase cost
Students and junior staff learnt from the FEST teamConcerns about skills of ward staff being lost and some staff did not want to lose their breastfeeding role, while others did not mindScenarios for including students, band 5 or other staff in the team either on staff rotation or on a longer term basis could be considered7 (online tables). It is unknown how important the stability and personal characteristics of the team are to effectiveness
  • FEST, FEeding Support Team.