Creating change for breastfeeding: the world breastfeeding trends initiative in Australia

The evidence that breast milk feeding reduces mortality and morbidity among premature and small babies is well established, but breastfeeding rates in neonatal units in the UK remain low. We present a case study of how a tertiary hospital unit in Coventry, England assessed staff training by interviews and undertaking the Neonatal Unit Clinician Assessment Tool (NUCAT), an on line objective knowledge test with ratings of confidence and knowledge in breastfeeding support skills. Fifty-one medical and nursing clinicians completed NUCAT. More staff scored better on the practical than knowledge domains. Doctors, those with more neonatal experience and more years since qualifying were not more knowledgeable than other clinicians overall. But senior clinicians knew more about physiology of lactation and why breastfeeding is beneficial. As prior training and experience, self assessed knowledge and confidence in practice, are not reliable predictors of knowledge, we recommend objective assessment is used to target training to individual needs.