Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding,Temperature, and Crying

Background: Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns. Methods: Video recordings were made of 28 newborns who had been dried and placed in skin‐to‐skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n= 6) had received mepivacaine via pudendal block, and group 3 mothers (n= 12) had received pethidine or bupivacaine or more than one type of analgesia during labor. Results: All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand‐to‐mouth movements (p < 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p < 0.01), made licking movements (p < 0.01), and sucked the breast (p < 0.01). Nearly one‐half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p= 0.03) and they cried more (p= 0.05) than infants whose mothers had not received any analgesia. Conclusions: The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast‐seeking and breastfeeding behaviors and increase the newborn's temperature and crying.     

Skin‐to‐Skin Care with the Father after Cesarean Birth and Its Effect on Newborn Crying and Prefeeding Behavior

ABSTRACT: Background: Previous reports have shown that skin‐to‐skin care immediately after vaginal birth is the optimal form of care for full‐term, healthy infants. Even in cases when the mother is awake and using spinal analgesia, early skin‐to‐skin contact between her and her newborn directly after cesarean birth might be limited for practical and medical safety reasons. The aim of the present study was to compare the effects of skin‐to‐skin contact on crying and prefeeding behavior in healthy, full‐term infants born by elective cesarean birth and cared for skin‐to‐skin with their fathers versus conventional care in a cot during the first 2 hours after birth. Methods: Twenty‐nine father‐infant pairs participated in a randomized controlled trial, in which infants were randomized to be either skin‐to‐skin with their father or next to the father in a cot. Data were collected both by tape‐recording crying time for the infants and by naturalistic observations of the infants’ behavioral response, scored every 15 minutes based on the scoring criteria described in the Neonatal Behavioral Assessment Scale (NBAS). Results: The primary finding was the positive impact the fathers’ skin‐to‐skin contact had on the infants’ crying behavior. The analysis of the tape recordings of infant crying demonstrated that infants in the skin‐to‐skin group cried less than the infants in the cot group (p < 0.001). The crying of infants in the skin‐to‐skin group decreased within 15 minutes of being placed skin‐to‐skin with the father. Analysis of the NBAS‐based observation data showed that being cared for on the father’s chest skin‐to‐skin also had an impact on infant wakefulness. These infants became drowsy within 60 minutes after birth, whereas infants cared for in a cot reached the same stage after 110 minutes. Rooting activity was more frequent in the cot group than in the skin‐to‐skin group (p < 0.01), as were sucking activities (p ≤0.001) and overall duration of wakefulness (p < 0.01). Conclusions: The infants in the skin‐to‐skin group were comforted, that is, they stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cot group. The father can facilitate the development of the infant’s prefeeding behavior in this important period of the newborn infant’s life and should thus be regarded as the primary caregiver for the infant during the separation of mother and baby. (BIRTH 34:2 June 2007)     

Resident Physicians' Knowledge of Breastfeeding and Infant Growth

Background: It is well documented that breastfed infants grow differently from formula‐fed infants. The purpose of this study was to assess resident physicians' knowledge of breastfeeding and infant growth. Methods: A cross‐sectional, self‐administered survey was administered to family medicine and pediatric resident physicians from three large, hospital‐based public and private programs in North Carolina. Results: One hundred and seven (46%) of 235 residents completed the study, representing 55 percent of family medicine residents and 39 percent of pediatric residents. Ninety‐nine percent of participants reported frequently or always plotting infant growth at well‐child visits. None reported plotting breastfed babies on a chart specific to breastfeeding. Only 5 percent of participants knew that breastfed infants grew at a slower velocity than formula‐fed infants after 4 months of age. This knowledge was not significantly related to specialty, year of training, or gender; it was significantly related to breastfeeding experience (p < 0.04). Of the residents who did not have personal experience with breastfeeding, 99 percent answered incorrectly compared with 88 percent of those who had some personal experience in breastfeeding. Conclusions: In this sample of family medicine and pediatric residents, almost all were unaware that breastfed infants grow at slower rates after 4 months of age. Since the frequency of breastfeeding is increasing in the United States, it is important that physicians be able to monitor the growth of breastfed infants accurately and provide expert counseling for breastfeeding mothers.     

Does Continuity of Care by Well‐Trained Breastfeeding Counselors Improve a Mother's Perception of Support?

Abstract: Background: Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Method: Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process‐oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Results: Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. Conclusions: After implementation of a process‐oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. (BIRTH 33:2 June 2006)     

One‐to‐One or Group‐Based Peer Support for Breastfeeding? Women's Perceptions of a Breastfeeding Peer Coaching Intervention

Abstract: Background: Studies reporting one‐to‐one peer support interventions have been successful in some countries with high breastfeeding initiation rates, but less so in Great Britain, where low uptake of peer support has occurred. We conducted a peer coaching intervention study in rural Scotland that improved breastfeeding initiation and duration. This study reports qualitative data about participants’ perceptions of the coaching intervention. The aim was to investigate why group‐based peer support was more popular than one‐to‐one peer support. Methods: Qualitative data were collected and analyzed from an initial focus group; 21 semi‐structured interviews; and 31 coaching group observations and respondents (n = 105/192) in response to an open question about reasons for not choosing a personal coach in a survey of breastfeeding experiences. We developed a coding frame, identified themes, and constructed charts for analysis and interpretation of data. Results: Analysis revealed that groups were more popular because they normalized breastfeeding in a social environment with refreshments, which improved participants’ sense of well‐being. Groups provided flexibility, a sense of control, and a diversity of visual images and experiences, which assisted women to make feeding‐related decisions for themselves, and they offered a safe place to rehearse and perform breastfeeding in front of others, in a culture where breastfeeding is seldom seen in public. Women often felt initial anxiety when attending a group for the first time, and they expressed doubt that one set of “breastfeeding rules” would suit everyone. Conclusions: Pregnant women and breastfeeding mothers will voluntarily engage in an activity to support breastfeeding if there is a net interactional (verbal, visual, emotional and gustatory) gain and a minimum risk of a negative experience. One‐to‐one peer coaching was perceived as a greater risk to confidence and empowerment than group‐ based peer coaching. (BIRTH 33:2 June 2006)     

Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women

Background: The Baby‐Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods: Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother‐infant contact and breastfeeding practices. Results: Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby‐Friendly Hospital Initiative. Conclusion: Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.     

Maternal Axillar and Breast Temperature After Giving Birth: Effects of Delivery Ward Practices and Relation to Infant Temperature

ABSTRACT: Background: Little is known about the development and control of skin temperature in human mothers after birth. The purpose of this study was to explore the effects of delivery ward practices and early suckling on maternal axillar and breast temperatures during the first 2 hours postpartum and to relate them to the infant’s foot and axillar temperatures. Methods: Three groups of 176 mother‐infant pairs were randomized as follows—group I: infants lying prone in skin‐to‐skin contact on their mother’s chest, named the “skin‐to‐skin group” (n = 44), group II: infants who were dressed and lying prone on their mother’s chest, named the “mother’s arms group” (n = 44), and group III: infants who were dressed and kept in the nursery, named the “nursery group” (n = 88). Maternal axillar and breast temperatures and infants’ axillar and foot temperatures were measured at 15‐minute intervals from 30 to 120 minutes after birth. Episodes of early suckling were noted. Results: The axillar and breast temperatures rose significantly in all mothers. The rise of temperature over time was significantly higher in multiparas than in primiparas but was influenced only slightly by group assignment. The variation in breast temperature was highest in mothers in the skin‐to‐skin group and lowest in mothers in the nursery group. In the mother’s arms group, variation in breast temperature was larger in those mothers exposed to early suckling than in those not exposed. A positive relationship was found between the maternal axillar temperature and the infant foot and axillar temperature 90 minutes after the start of the experiment (120 min after birth) in the skin‐to‐skin and mother’s arms groups. The rise in temperature in the infant’s foot was nearly twice that in the axilla. No such relationship was established in the nursery group. In addition, foot temperature in infants from the skin‐to‐skin group was nearly 2°C higher than that in infants from the mother’s arms group. Conclusions: Maternal temperature rose after birth, and the rise was higher in multiparas than in primiparas. Skin‐to‐skin contact and early suckling increased temperature variation. Maternal temperature was related to infant foot and axillar temperatures. (BIRTH 34:4 December 2007)     

Breastfeeding and Smoking among Low‐Income Women: Results of a Longitudinal Qualitative Study

ABSTRACT: Background: The benefits of breastfeeding for infants and mothers have been well established, yet rates of breastfeeding remain well below national recommendations in the United States and even lower for women who smoke during pregnancy. Primary goals of this study were to explore contextual factors that contribute to breastfeeding intentions and behavior and to examine how smoking status affected women’s decision making about breastfeeding. Methods: This paper is based on a longitudinal qualitative study of smoking, pregnancy, and breastfeeding among 44 low‐income women in the southwest U.S. who smoked during pregnancy. Each woman was interviewed 9 times; 6 times during pregnancy and 3 times postpartum using semistructured questionnaires. Interviews lasted 1 to 3 hours and were tape‐recorded, transcribed, and analyzed. Results: Despite 36 (82%) respondents stating that they intended to breastfeed for an average duration of 8 months, rates of breastfeeding initiation and duration were much lower than intentions. By 6 months postpartum, only two women were breastfeeding exclusively. Conclusions: Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months. The results indicate a need for more consistency and routine in educating women on the relationship between smoking and breastfeeding and in promoting breastfeeding in spite of smoking postpartum. (BIRTH 35:3 September 2008)     

Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants

ObjectiveTo investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants.DesignProspective longitudinal study.SettingNeonatal Intensive Care Units in four counties in Sweden.ParticipantsThe study included 103 VPT (<32 gestational weeks) and 197 PT (32‐36 gestational weeks) singleton infants and their mothers.MethodsData on KMC, measured in duration of skin‐to‐skin contact/day during all days admitted to a neonatal unit, were collected using self‐reports from the parents. Data on breastfeeding were obtained by telephone interviews.ResultsVPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not.ConclusionsThis study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.     

Onset of Vocal Interaction Between Parents and Newborns in Skin‐to‐Skin Contact Immediately After Elective Cesarean Section

Abstract: Background: Cesarean section is associated with delayed mother‐infant interaction because neither the mother nor the father routinely maintains skin‐to‐skin contact with the infant after birth. The aim of the study was to explore and compare parent‐newborn vocal interaction when the infant is placed in skin‐to‐skin contact either with the mother or the father immediately after a planned cesarean section. Methods: A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin‐to‐skin contact either with fathers or mothers after an initial 5 minutes of skin‐to‐skin contact with the mothers after birth. The newborns’ and parents’ vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns’ and parents’ soliciting, newborns’ crying and whining, and parental speech directed to the other parent and to the newborn. Results: Newborns’ soliciting increased over time (p = 0.032). Both fathers and mothers in skin‐to‐skin contact communicated more vocally with the newborn than did fathers (p = 0.003) and mothers (p = 0.009) without skin‐to‐skin contact. Fathers in skin‐to‐skin contact also communicated more with the mother (p = 0.046) and performed more soliciting responses than the control fathers (p = 0.010). Infants in skin‐to‐skin contact with their fathers cried significantly less than those in skin‐to‐skin contact with their mothers (p = 0.002) and shifted to a relaxed state earlier than in skin‐to‐skin contact with mothers (p = 0.029). Conclusions: Skin‐to‐skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin‐to‐skin contact and exposed to the parents’ speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin‐to‐skin contact after cesarean section, to support the early onset of the first vocal communication. (BIRTH 37:3 September 2010)     

How Are Effective Breastfeeding Technique and Pacifier Use Related to Breastfeeding Problems and Breastfeeding Duration?

Abstract: Background: Inconsistent findings leave uncertainty about the impact of pacifier use on effective breastfeeding technique. The purpose of this study was to investigate how breastfeeding technique and pacifier use were related to breastfeeding problems and duration of breastfeeding. Methods: Data were collected from the intervention group of a randomized trial in which health visitors followed up with mothers for 6 months after childbirth. The health visitors classified the breastfeeding technique at approximately 1 week after birth and repeated the observation if a correction was necessary. Effective technique included positioning, latch, sucking, and milk transfer. Data on breastfeeding problems and pacifier use were obtained from self‐reported questionnaires. The study population included 570 mother‐baby pairs with complete information on breastfeeding technique and pacifier use. The primary outcome was duration of exclusive breastfeeding. Results: One‐half of the mothers showed ineffective breastfeeding technique at the first\ observation, most frequently ineffective position (61%) and latch (52%). In the unadjusted analysis, only sucking and milk transfer were associated with breastfeeding duration. In the adjusted analysis, ineffective technique was significantly associated with mothers reporting early breastfeeding problems, which thereby influenced the breastfeeding duration. Pacifier use had an independent negative impact on duration of breastfeeding. A single correction of the breastfeeding technique was not associated with duration or occurrence of problems. Conclusions: Observation of breastfeeding technique may help mothers in the stage of when they are establishing breastfeeding to avoid early and later problems, but breastfeeding technique is less useful in predicting breastfeeding duration. Use of a pacifier should be avoided in the first weeks after birth. (BIRTH 36:1 March 2009)     

Maternity Care Practices: Implications for Breastfeeding

Background: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby‐Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby‐Friendly practices experienced on breastfeeding. Methods: A longitudinal mail survey (1993–1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby‐Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming‐in, not breastfeeding on demand, use of pacifiers), and number of Baby‐Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks. Results: Only 7 percent of mothers experienced all five Baby‐Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby‐Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. Conclusion: Increased Baby‐Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.     

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)     

Influence of Knowledge and Attitudes on Exclusive Breastfeeding Practice Among Rural Jamaican Mothers

Abstract: Background : A large number of mothers may not be practicing exclusive breastfeeding in rural Jamaica, although no recent systematic study has been conducted. The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. Method : A cross‐sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. Results : Information was documented for 599 mother‐child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR = 2.0; 95% CI = 1.4–3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. Conclusion : The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk.     

Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome

ObjectiveTo review the literature about the association between breastfeeding and neonatal abstinence syndrome (NAS) severity, need for pharmacologic treatment for NAS, and length of hospital stays in neonates with in‐utero exposure to methadone or buprenorphine opioid replacement therapy.Data SourcesPubMed, CINAHL, and Medline were searched for articles published between January 1990 and April 2013 using the terms opioid dependency in pregnancy, neonatal abstinence syndrome, methadone, buprenorphine, neonatal length of stay, breastfeeding, methadone in breast milk, buprenorphine in breast milk, swaddling, and rooming‐in.Study SelectionInclusion criteria included studies written in English on the topic of breastfeeding for management of NAS.Data ExtractionThe author independently reviewed each article.Data SynthesisBreastfeeding can effectively decrease NAS symptoms because methadone and buprenorphine are transferred to the breast milk. Maternal contact while breastfeeding also plays a role in ameliorating the NAS symptoms. Interventions that also support breastfeeding in the treatment of NAS include skin‐to‐skin contact, swaddling, and rooming‐in.ConclusionsUnderstanding the benefits of breastfeeding for opioid‐dependent pregnant women and their neonates will enable clinicians to safely recommend breastfeeding for long‐term health of these high‐risk women and their infants. This review of the effects of in‐utero exposure to opioids on infant development can assist clinicians to more effectively support opioid‐dependent women to breastfeed their infants.     

What Information,Advice, and Support Do Women Want With Breastfeeding?

ABSTRACT: Background: Breastfeeding conveys many benefits, but women often encounter difficulties in the first few weeks. The objective of this study was to examine women's perspectives on the information, advice, and support they receive with breastfeeding. Methods: A qualitative analysis was conducted of women's responses to open questions about their experiences of breastfeeding support. Participants were recruited as part of a randomized controlled trial of additional support from volunteer breastfeeding counselors, and they completed questionnaires when their babies were 6 weeks old. Results: Of the 720 women recruited to the trial, 654 began breastfeeding and completed postnatal questionnaires; 492 (75%) participants were first‐time mothers and 200 (31%) were of minority ethnic origin. At 6 weeks, 249 (38%) women were exclusively breastfeeding, 183 (28%) were both breastfeeding and bottle‐feeding, whereas 222 (34%) were exclusively bottle‐feeding. Although many women commented positively on their experiences, others thought they did not receive the information and support they needed. Thematic analysis of women's responses to open questions identified five components of the support that women wanted: information about breastfeeding and what to expect, practical help with positioning the baby to breastfeed, effective advice and suggestions, acknowledgment of mothers’ experiences and feelings, and reassurance and encouragement. Conclusions: Maternity services should address the components identified by the study findings as constituting good breastfeeding support. Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women's views on what support they want, together with when and how they want it provided.     

Early Postpartum Discharge and Subsequent Breastfeeding

Background: Early postpartum discharge of babies was gradually introduced in Sweden in the 1980s on ideological grounds, based on the premise that maternity wards were unnatural settings for mothers and babies and hampered breastfeeding. From about 1990, early discharge was used as a means to reduce costs. The purpose of this study was to examine if mandated early discharge at Central Hospital of Karlstad, Sweden, influenced subsequent breastfeeding. Method: Breastfeeding outcomes of infants up to six months of age of all births in 1993 (n= 3231) were compared with the outcome of newborns in 1990 (n= 1462). Results: Breastfeeding at six months postpartum continued to increase during the early 1990s for both healthy and sick infants, irrespective of whether or not they were discharged early. In infants born in 1995 the breastfeeding rate at six months was 64 percent for healthy newborns and 53 percent for sick newborns. Conclusion: Factors other than the time of discharge, most likely a positive change of attitude in society and vigorous introduction of the Baby Friendly Hospital Initiative, seem to have been more important for successful breastfeeding. (BIRTH 25:4 December 1998)     

Effect of Maternal Confidence on Breastfeeding Duration: An Application of Breastfeeding Self‐Efficacy Theory

ABSTRACT: Background: Although much research has focused on identifying factors that influence breastfeeding initiation and duration, many high‐risk factors are nonmodifiable demographic variables. Predisposing factors for low breastfeeding duration rates that are amenable to supportive interventions should be identified. The purpose of this study was to assess the effect of maternal confidence (breastfeeding self‐efficacy) on breastfeeding duration. Method: A prospective survey was conducted with 300 women in the last trimester of pregnancy recruited from the antenatal clinic of a large metropolitan hospital in Brisbane, Australia. Telephone interviews were conducted at 1week and 4 months postpartum to assess infant feeding methods and breastfeeding confidence using the Breastfeeding Self‐Efficacy Scale. Results: Although 92 percent of participants initiated breastfeeding, by 4 months postpartum almost 40 percent of mothers discontinued and only 28.6 percent were breastfeeding exclusively; the most common reason for discontinuation was insufficient milk supply. Antenatal and 1‐week Breastfeeding Self‐Efficacy Scale scores were significantly related to breastfeeding outcomes at 1 week and 4 months. Mothers with high breastfeeding self‐efficacy were significantly more likely to be breastfeeding, and doing so exclusively, at 1 week and 4 months postpartum than mothers with low breastfeeding self‐efficacy. Conclusions: Maternal breastfeeding self‐efficacy is a significant predictor of breastfeeding duration and level. Integrating self‐efficacy enhancing strategies may improve the quality of care that health care professionals deliver and may increase a new mother's confidence in her ability to breastfeed, and to persevere if she does encounter difficulties. (BIRTH 29:4 December 2002)     

Success of an Educational Intervention on Maternal/Newborn Nurses' Breastfeeding Knowledge and Attitudes

Objective:o test the effect of a breastfeeding educational program for improving breastfeeding knowledge, attitudes, and beliefs of maternal/newborn nurses, and to improve their intentions to provide breastfeeding support to new mothers.Design:Quasi‐experimental, pretest/posttest design.Setting:Maternity units of 13 hospitals located in midwestern and east coast states.Participants:Nine experimental and three control hospital sites resulted in a convenience sample size of 240 registered nurses (RNs); 206 RNs in the experimental sites and 34 RNs in the control sites.Methods:Participation in the experimental groups involved the completion of two questionnaires upon study entry and then again after completion of a self‐study module. Participants in the control groups completed the two questionnaires twice with a 4‐ to 6‐week interval between them without access to the self‐study module.Main Outcome Measures:Nurses' breastfeeding knowledge, attitudes, beliefs, and intentions to support postpartum mothers who are breastfeeding.Results:Findings suggest that this educational strategy was effective in improving maternal/newborn nurses' breastfeeding knowledge, attitudes, and beliefs, and intentions to support breastfeeding mothers.Conclusion:This self‐paced, study module, which is guided by an on‐site, trained staff member, may be a cost‐effective strategy for improving nurses' breastfeeding knowledge and support to new breastfeeding mothers. Nurses may find this type of teaching modality to be less intimidating than a structured classroom setting, and more desirable for their busy schedules.