Hospital Practices that Increase Breastfeeding Duration: Results from a Population‐Based Study

ABSTRACT: Background: A high percentage (83%) of mothers in Colorado initiate breastfeeding; but in keeping with national breastfeeding trends, many of them discontinue breastfeeding within the first few months. The objective of this study was to determine the effects of hospital practices on breastfeeding duration and whether the effects differed based on maternal socioeconomic status. Methods: Pregnancy Risk Assessment Monitoring System data were used to calculate breastfeeding duration rates for all Colorado mothers in 2002 to 2003. Breastfeeding duration rates were determined for recipients of each of nine hospital practices included in the survey compared with rates for nonrecipients. Practices that significantly increased breastfeeding duration rates were combined and then stratified by socioeconomic status. Results: Breastfeeding duration was significantly improved when mothers experienced all five specific hospital practices: breastfeeding within the first hour, breastmilk only, infant rooming‐in, no pacifier use, and receipt of a telephone number for use after discharge. Two‐thirds (68%; 95% CI: 61–75) of mothers who experienced all five successful practices were still breastfeeding at 16 weeks compared with one‐half (53%; 95% CI: 49–56) of those who did not. Breastfeeding duration was improved independent of maternal socioeconomic status. Only one in five mothers (18.7%) experienced all five supportive hospital practices. Mothers who experienced the five supportive hospital practices were significantly less likely to stop breastfeeding due to any of the top reasons given for stopping (p < 0.001). Conclusions: Implementation of the five hospital practices supportive of breastfeeding significantly increased breastfeeding duration rates regardless of maternal socioeconomic status. (BIRTH 34:3 September 2007)     

Breastfeeding Duration,Costs, and Benefits of a Support Program for Low‐Income Breastfeeding Women

Background: Breastfeeding can ameliorate some of the complex health issues faced by low‐income families. Women who breastfeed and their infants have lower health care costs compared with those who formula feed. Increasing the duration of breastfeeding is recognized as a national priority, particularly for low‐income women. This community‐based randomized clinical trial involving low‐income mothers compared usual care with an intervention comprising hospital and home visits, and telephone support by a community health nurse/peer counselor team for 6 months after delivery. Methods: Forty‐one women were recruited after delivery of a full‐term singleton infant and randomly assigned to intervention or usual care groups. Results: Women receiving the community health intervention breastfed longer than the women receiving usual care. The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group. The intervention cost ($301/mother) was partially offset by cost savings on formula and health care. Conclusions: Community health nurse and peer counselor support can increase breastfeeding duration in low‐income women, and has the potential to reduce total costs including the cost of support. (BIRTH 29:2 June 2002)     

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women

ObjectiveTo assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women.DesignSecondary analysis of a cross-sectional household survey.SettingHaiti Demographic and Health Survey, 2016 to 2017.ParticipantsWomen (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age.MethodsWe used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding.ResultsThe prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]).ConclusionAntenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.     

Timing and Predictors of Postpartum Return to Smoking in a Group of Inner‐City Women: An Exploratory Pilot Study

ABSTRACT: Background: Approximately 40 percent of women smokers will stop smoking cigarettes during pregnancy; however, 70 percent of those who stop will resume smoking by 6 months postpartum. This exploratory pilot study prospectively examined the timing and predictors of returning to smoking after pregnancy in a group of inner‐city women who stopped smoking cigarettes during pregnancy. Methods: We interviewed women who stopped smoking just before or during their pregnancies during their postpartum hospital stay and at their infants’ 2‐week health supervision visits. Urine cotinine levels were measured at each interview. Results: Forty‐nine women were interviewed during the postpartum stay and 37 women at the 2‐week follow‐up. At follow‐up, 40.5 percent (n = 15) of women had returned to smoking. Mothers more frequently returned to smoking if they had a lower level of education, that is, high school graduate/general equivalency diploma versus some college education (13/24 vs 2/13, p < 0.04); if they had someone else in the household who smoked (14/23 vs 1/14, p < 0.003); if they were formula feeding their infant at the time of interview (14/24 vs 1/13, p < 0.005); if they discussed smoking with a doctor or nurse during pregnancy (12/20 vs 3/17, p < 0.02); and if they were African American (10/15 vs 5/22, p < 0.02). Mothers reported the primary reasons for returning to smoking were stress (53%, n= 8) and being around another smoker (40%, n= 6). Conclusions: Almost one‐half of the women in this pilot study who stopped smoking cigarettes during pregnancy resumed in the days immediately after delivery. These data suggest that future studies should explore the initiation of postpartum relapse prevention during the prenatal and perinatal period. Interventions may be more effective if they include strategies aimed increasing breastfeeding rates and assisting household members to stop smoking. (BIRTH 34:3 September 2007)     

Men and Infant Feeding: Perceptions of Embarrassment,Sexuality, and Social Conduct in White Low‐Income British Men

Background: The views of fathers have been shown to be important determinants of infant feeding decisions, but men’s perceptions of breastfeeding and formula feeding are rarely explored. Our objectives were to address this gap and examine cultural associations and beliefs concerning infant feeding practices among men. Methods: Five focus groups were conducted with low‐income men (n = 28) living in areas of social deprivation in Leeds, northeast of England, and low‐income areas of Glasgow, west of Scotland. Participants were white British men, aged between 16 and 45 years, and included fathers, expectant fathers, and potential fathers. Results: Overarching themes concerning sexuality, embarrassment, and social conduct were identified across all groups. Participants perceived breastfeeding as “natural” but problematic, whereas formula feeding was mainly considered as convenient and safe. Participants without direct experience of breastfeeding assumed that it involved excessive public exposure and attracted unwanted male attention. Underpinning these fears were strong cultural associations between breasts and sexuality and anxieties concerning appropriate gender roles. Conclusions: In some communities few opportunities may occur to witness breastfeeding, and thus existing fears concerning the activity as attracting predatory male attention remain unchallenged. Perceptions of breastfeeding as a sexual activity and the dominant mass media emphasis on breasts as a sexual site may present additional obstacles to breastfeeding. Antenatal or perinatal education with men should address not only practical issues but also provide advice on tackling problems generated by wider sociocultural issues of sexuality and masculinity. (BIRTH 38:1 March 2011)     

Concordance as a Person‐Centered Measure of Breastfeeding Success: From Adequacy to Agency

Health benefits associated with breastfeeding are supported by extensive research. Measurements of breastfeeding success in clinical and research settings have focused on maximizing adherence to population‐level health recommendations for infant feeding (compliance). Concordance, a new adjunct measure of breastfeeding success, uses a comparison between the parent's intended feeding method and the actual feeding method to better assess whether the person's goals for infant feeding have been met. This measure uses a modified patient‐centered outcomes research question to evaluate success in a person‐centered framework and is congruent with patient‐centered individualized care and shared decision making. Use of concordance as an adjunct success metric in evaluation of interventions and clinical programs will provide an opportunity to approach breastfeeding promotion holistically and incorporate the parent's desired outcome(s) as central to that success.