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Background: Family culture and beliefs are passed through the generations within families and influence what constitutes appropriate infant care. This includes infant feeding decisions where a family history and support network congruent with women's infant feeding intentions has been shown to be important to women's breastfeeding experience. This is reflected in breastfeeding rates where women who were not breastfed themselves are less likely to initiate and continue with breastfeeding. Given the importance of family infant feeding history in the initiation and duration of breastfeeding, and the limited ability of some families to provide support; it is unclear why infant feeding family history and support networks are not explored during pregnancy., Methods: The Infant Feeding Genogram was adapted from a simple pictorial device that is widely used in psychotherapy and genetic counselling. This tool was developed as part of a study investigating the experience of women when they were the first to breastfeed in their family. Fourteen Scottish participants completed their Infant Feeding Genogram as part of a semi-structured interview. The tool was adapted alongside their narratives to give a visual representation of each participant's family infant feeding history., Results: The utility of the genogram is illustrated through two contrasting case examples with very different family feeding histories. The genogram showed family structures, patterns of infant feeding over time, and supportive or conflicting relationships. In the research setting it assisted women to explore their infant feeding history, identify challenges and sources of support and build rapport with the interviewer., Conclusions: The infant feeding genogram is proposed as a time efficient tool that could assist health professionals and other breastfeeding workers to support women and their families and by stimulating discussion around breastfeeding, Bby identifying strengths or possible deficits in social support for each individual, the tool could inform tailored support and care interventions. The effectiveness and acceptability of the Infant Feeding Genogram requires testing in the clinical environment. However, its successful application in other clinical contexts, combined with the interest in genealogy in popular culture, mean this is likely to be an acceptable, family friendly way to develop more effective breastfeeding conversations.

Aim: This paper is a report of a synthesis of mothers' and healthcare professionals' experiences and perceptions of breastfeeding support., Background: Despite increasing knowledge, breastfeeding rates remain relatively static and mothers continue to report dissatisfaction with their experiences of breastfeeding. Greater understanding of breastfeeding may be achieved through rigorous qualitative research, and there has been a recent increase in such studies., Data Sources: Electronic databases and citation lists of published papers were searched for articles listed between 1990 and 2005 and updated in May 2007. Studies were included if they used qualitative methods, were published in English, explored an aspect of breastfeeding and were based in a westernized country., Review Methods: Papers were included if they reported studies using qualitative methods to explore breastfeeding and were published in English and based in a westernized country. Each study was reviewed and assessed independently, key themes extracted and grouped, and secondary thematic analysis used to explore key concepts., Results: From the 1990-2005 search, five themes emerged in health service support of breastfeeding: the mother-health professional relationship, skilled help, pressures of time, medicalization of breastfeeding and the ward as a public place. Social support had two themes: compatible and incompatible support. One additional theme emerged from the update to 2007: health professional relationships., Conclusion: Mothers tended to rate social support as more important than health service support. Health service support was described unfavourably with emphasis on time pressures, lack of availability of healthcare professionals or guidance, promotion of unhelpful practices and conflicting advice. Changes are required within the health services to address the needs of both mothers and staff.

Aim: to document the process of implementing and maintaining a community-based peer-support programme., Design and Setting: a community-based study located in a socio-economically disadvantaged housing estate on the outskirts of Glasgow., Participants: pregnant women residing in a target postcode area., Intervention: a programme of peer counselling and support for breast feeding, comprising antenatal and postnatal home visits over a period of three years., Implications for Practice: peer support may provide an acceptable and appropriate role model for breast-feeding mothers. However, further research is required on other influential factors such as the social network and the impact of this programme on the peer supporter., Conclusions: despite a low prevalence of breast feeding, initiating and maintaining peer breast-feeding support was possible. Peer support appeared to be acceptable to mothers and health professionals. Study mothers spoke enthusiastically of the intervention and mentioned increased confidence and self-esteem.

Background: The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow., Methods: The study was designed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme. The intervention comprised peer counselling of pregnant women, support of breastfeeding mothers and local awareness-raising activities. The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area. Data were collected by means of four self-completion questionnaires, two administered antenatally and two post-natally. The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time., Results: Of the 995 women enrolled in the study, data were available for analysis on 919 (92 per cent) to 6 weeks postnatally. At booking, 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed. At delivery, the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls, and by 6 weeks post-natally, the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group. Using multivariate analysis to adjust for factors (such as socio-economic status) known to influence breastfeeding, the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [odds ratio (OR) 2.0; 95 per cent confidence interval (CI) 1.2-3.1, p = 0.006]. By 6 weeks post-natally the difference between the two groups was not statistically significant (OR 1.8; 95 per cent CI 1.0-3.4, p=0.07)., Conclusions: As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally, it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities.