Women’s Perceptions of Hospital-Based Breastfeeding Care and the Association With Exclusive Breastfeeding

ObjectiveTo examine the differences in women’s perceptions of hospital-based breastfeeding care and the association of these perceptions with exclusive breastfeeding.DesignObservational, mixed-methods study.Setting/Local ProblemA 932-bed, Baby-Friendly Hospital Initiative–designated, university hospital with approximately 2,000 births per year, where 50% of women who wanted to breastfeed were supplementing with formula before hospital discharge.ParticipantsThirty-four women who gave birth to a term, singleton newborn and had a desire to breastfeed exclusively.MeasurementsWomen’s perceptions were assessed using a modified version of the Questionnaire for the Breastfeeding Mother.ResultsWomen’s perceptions of breastfeeding care were positively associated with exclusive breastfeeding (p = .049). In addition, the influence of how a woman’s own mother fed her as an infant was shown, because women who themselves were breastfed as infants were more likely to exclusively breastfeed their own newborns. Content analysis showed that women appreciated the care received in the hospital from lactation consultants and access to a hospital-administered breastfeeding clinic after discharge.ConclusionCreating a hospital environment supportive of breastfeeding could yield positive breastfeeding outcomes for women and newborns.     

Using Social Media for Breastfeeding Support

ObjectiveTo explore the variables that lead to sustained, exclusive breastfeeding to 6 months for breastfeeding women of the millennial generation who follow social media breastfeeding support groups (SMBSGs).DesignRepeated-measures, longitudinal, mixed-methods design.SettingOnline across 21 countries.ParticipantsConvenience sample of exclusively breastfeeding millennial women (N = 241) who followed at least one of 17 SMBSGs.MeasurementsParticipants completed the following: a demographic questionnaire; the Perceived Work Demand Scale; the Perceived Family Demand Scale; the Perceived Health-Related Social Support From Facebook Friends Measure; and the Breastfeeding Confidence, Knowledge, and Attitudes Measure.ResultsUsing structural equation modeling, I examined relationships among personal factors; competing situational demands; social support; and confidence in, knowledge of, attitude toward, and sustainability of breastfeeding. Age, education, and competing work and family demands were all predictive of social support. Breastfeeding social support had a direct effect on participants’ breastfeeding confidence, knowledge, and attitudes (F = 4.96, R² = .07, p < .002). Furthermore, within SMBSGs, exclusive breastfeeding to 6 months was reported to be three times (66%) greater than the U.S. national average (22%).ConclusionInterventions aimed at providing women with resources to gain breastfeeding social support, such as SMBSGs, may be vehicles to improve women’s confidence, knowledge, and attitudes and, therefore, increase the potential for exclusive breastfeeding to 6 months.     

An exploration of the breastfeeding behaviors of women after cesarean section: A qualitative study

ObjectivesTo explore the factors affecting breastfeeding behaviors in women after cesarean section.MethodsThis is a qualitative study that used a phenomenological approach. This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019. Information saturation was used to determine sample size. Data were analyzed using a thematic content analysis method. Themes were developed based on the theory of planned behavior.ResultsThirteen (68.42%) had a planned cesarean section, and six (31.58%) cesarean sections were unplanned or emergent. Three major themes emerged: ambivalent attitude about breastfeeding, motivation to comply with the traditional cultural norms, and barriers and challenges. The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk, support from healthcare professionals, and responsibility for breastfeeding. The challenges for breastfeeding after cesarean sections included physical discomfort, knowledge and skills deficit of breastfeeding, lactation deficiency, and lack of knowledge and coping skills in managing their depressive mood after cesarean sections. There were a couple of neutral factors, such as the influences of family and peers. These factors could influence women either positively as facilitators or negatively as barriers.ConclusionsThe findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections. To promote women’s breastfeeding behaviors after cesarean sections, it is necessary to change women’s attitudes, belief systems, and the external environments and help them become more confident.     

Breastfeeding Experiences of Taiwanese Mothers of Infants with Breastfeeding or Breast Milk Jaundice in Certified Baby-Friendly Hospitals

PurposeThe purpose was to explore the breastfeeding experiences of mothers of infants with breastfeeding or breast milk jaundice.MethodsIn-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum.ResultsMothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mother–infant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting.ConclusionBreastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.     

Sport,scales, or war? Metaphors speech-language pathologists use to describe caseload management

Abstract

Professionals’ experiences, perceptions, and attitudes may be reflected in the metaphors they use to describe and discuss important professional issues. This qualitative study explored speech-language pathologists’ experiences of caseload management through metaphorical analysis. Metaphors provided a lens for reflecting participants’ lived experiences and professional knowledge construction. Data was obtained from 16 practising speech-language pathologists during individual work place interviews. Participants included new graduate and experienced speech-language pathologists who were employed in hospital and community settings. Metaphors for caseload management were identified from participants’ transcribed narratives, then coded and organized into themes. Participants produced a total of 297 metaphors during professional practice narratives. Thematic analysis indicated that participants used three salient metaphors of sport, measuring scales, and war when they addressed caseload issues. Metaphors of sport, scales, and war reflected speech-language pathologists’ concerns about managing clients efficiently, perceived caseload burdens, and the conflict they experienced when resources were inadequate. These metaphors may also represent a continuum in speech-language pathologists’ personal and professional responses to caseload demands. Shared metaphors may contribute to the professional socialization of individuals entering a profession and to changing or maintaining workplace culture. Hence, speech-language pathologists need to consider the impact of using metaphors of sport, measuring scales, and war during interactions with clients and colleagues.     

Promoting Breastfeeding and Lactation Among Mothers of Premature Newborns in a Hospital in China

ObjectiveTo promote breastfeeding and lactation in mothers separated from their premature infants admitted to the NICU in a hospital in China.DesignFor this evidence-based practice project we used a mixed method of survey measures and interviews and were guided by the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice framework.Setting/Local ProblemObstetric unit of a Women and Children’s Hospital in China from September 2017 to August 2018. Before the project, the partial breastfeeding rate in the hospital was 17.9%, and the exclusive breastfeeding rate of premature infants was 1.8%; these rates were much lower than the national breastfeeding rate in the country.ParticipantsSeventeen nurses and 70 mothers of premature infants.Intervention/MeasurementsThe project included three phases: (a) finding the best evidence to promote breastfeeding in the literature and identifying the gaps between best practice and current practice, (b) implementing best practice strategies, and (c) comparing pre- and postintervention outcomes. Based on the evidence in the literature and the barriers, strategies were implemented in practice to promote breastfeeding and lactation among women separated from their preterm newborns. Chi-square and t tests were performed to compare the pre-/postintervention differences.ResultsPartial breastfeeding rates increased from 17.9% to 52.7%, and exclusive breastfeeding rates increased from 1.8% to 4.1%. Compliance with breastfeeding guidelines and measures of maternal lactation volume both improved significantly.ConclusionPromoting breastfeeding and lactation among mothers of premature infants requires not only scientific knowledge but also a caring environment and family-centered practice.     

Quiet Time to Increase Breastfeeding Rates and Enhance Women’s Hospital Experiences in the Postpartum Period

ObjectiveTo facilitate optimal hospital experiences and breastfeeding clinical outcomes among women by reducing interruptions during their first 24 hours in the postpartum period.DesignEvidence-based practice change initiated by a registered nurse staff member.Setting/Local ProblemThere was concern that numerous visitor and staff interruptions to women during their early postpartum hours were interfering with establishing breastfeeding and maintaining a restful environment on our 21-bed postpartum unit within a 377-bed, Magnet-recognized, religiously affiliated hospital in suburban southern California.ParticipantsMedically stable women with uncomplicated childbirth during the previous 24 hours and women in the postpartum period whose responses were recorded in facility databases maintained by the departments of Lactation Services and Nursing Research.Intervention/MeasurementsA daily quiet time from 1:00 p.m. to 3:00 p.m. was instituted on the postpartum unit. Measurements before and after implementing quiet time included data on (a) interruptions, as the number of times someone opened or entered women’s room doors; (b) exclusive breastfeeding rates; and (c) women’s postdischarge reports of their hospital experiences.ResultsAfter quiet time was implemented, interruptions fell from an average of 74 to an average of 37 per day (n = 21, p = .02), and the percentage of women breastfeeding rose from 34% to 48% (n = 193, p = .39). Women’s ratings of unit quietness improved significantly (n = 169, p = .008) to above the benchmark, and their overall facility rating and willingness to recommend the facility remained above the benchmark on surveys from the Hospital Consumer Assessment of Healthcare Providers and Systems.ConclusionA daily afternoon quiet time for women hospitalized in the postpartum period may reduce interruptions to women and thereby potentially increase breastfeeding rates and improve women’s perceptions of their hospital experiences. Unsolicited reports from staff suggested that quiet time was well received by nurses providing postpartum care.     

What knowledge of breastfeeding do nursing students hold and what are the factors influencing this knowledge: An integrative literature review

AimThe aim of this review was to explore the preregistration nursing students' breastfeeding knowledge and the sources they used to develop that knowledge as a health care professional.BackgroundNew registered nurses do not feel prepared to support breastfeeding women in neonatal and paediatric settings.ResultsPreregistration nursing students have sufficient knowledge of the physiology of lactation but insufficient knowledge on supporting women to decide on the practical aspects of breastfeeding and its challenges for healthy or sick babies. The sources of knowledge included the students' personal experiences and the education and training that they received during their nursing course. The two themes extracted from the data that related to the sources of knowledge were: a) informal knowledge through experience and b) formal education.ConclusionsThere is a need for new ways to align the students' informal sources of breastfeeding knowledge to their formal education, focusing on supporting women to make decisions on the practical aspects of breastfeeding, including the most common challenges.Tweetable abstractNursing students’ knowledge of breastfeeding practice: an integrative review     

Maternal Psychological Distress and Lactation and Breastfeeding Outcomes: a Narrative Review

PurposeDespite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75% of women do not meet exclusive breastfeeding guidelines, and 60% do not meet their own breastfeeding goals. Numerous observational studies have linked maternal psychological distress (eg, perceived stress, anxiety, and depression) with nonoptimal breastfeeding outcomes, such as decreased proportion and duration of exclusive breastfeeding. The physiological mechanisms underlying these associations, however, remain unclear.MethodsFor this narrative review, we evaluated the evidence of relationships between maternal psychological distress and lactation and breastfeeding outcomes in pregnancy and post partum and the possible physiological mechanisms that facilitate these relationships. We searched PubMed using the following terms: stress, anxiety, depression, breastfeeding, and lactation. Additional search by hand was conducted to ensure a thorough review of the literature.FindingsAmong the studies examined, methods used to assess maternal psychological distress were not uniform, with some studies examining perceived distress via a variety of validated tools and others measuring biological measures of distress, such as cortisol. Evidence supports a role for psychological distress in multiple breastfeeding outcomes, including delayed secretory activation and decreased duration of exclusive breastfeeding. One physiological mechanism proposed to explain these relationships is that psychological distress may impair the release of oxytocin, a hormone that plays a critical role in milk ejection during lactation. Continued impairment of milk ejection may lead to decreased milk production because of incomplete emptying of the breast during each feed. Maternal distress may also yield elevated levels of serum cortisol and decreased insulin sensitivity, which are associated with decreased milk production. The relationship between psychological distress and breastfeeding is likely to be bidirectional, however, in that breastfeeding appears to reduce maternal distress, again possibly via effects on the pleasure or reward pathway and calming effects of oxytocin on the mother. This finding suggests that interventions to support lactation and breastfeeding goals in women who score high on measures of psychological distress would be beneficial for both maternal and infant well-being.ImplicationsEvidence to date suggests that maternal psychological distress may impair lactation and breastfeeding outcomes, but stronger study designs and rigorous assessment methods are needed. A better understanding of the physiological mechanisms leading to impaired lactation may assist in the development of early interventions for mothers experiencing distress. In addition, stress-reducing programs and policies should be investigated for their potential to improve breastfeeding outcomes.     

Knowledge and Health Beliefs of Gestational Diabetes Mellitus Associated with Breastfeeding Intention Among Pregnant Women in Bangladesh

PurposeThis study aimed to investigate the knowledge of gestational diabetes mellitus (GDM) and the health beliefs about GDM management, as well as to investigate the effects of these factors on breastfeeding intention in Bangladesh.MethodsThis study involved a cross-sectional survey of 358 healthy pregnant women who visited antenatal clinics in Bangladesh.ResultsPerceived susceptibility, perceived benefit, and self-efficacy were identified as significant factors for breastfeeding intention (p < .05). Participants had a poor understanding and a lack of knowledge of GDM, which can lead to inadequate health behavior. Health beliefs were significantly associated with participants’ breastfeeding intention related to GDM.ConclusionAntenatal education for breastfeeding in GDM mothers should focus on providing accurate information on GDM and strengthening their health beliefs such as self-efficacy within the context of the mothers’ culture.     

Design and Implementation of a Group Prenatal Care Model for Somali Women at a Low-Resource Health Clinic

ObjectiveTo design and implement group prenatal care (GPC) for Somali women and to evaluate participants’ satisfaction, knowledge, and care engagement.DesignQuality improvement project.Setting/Local ProblemA federally qualified health center in an urban Midwestern setting, which serves a largely East African immigrant and refugee population.ParticipantsPregnant Somali women at more than 20 weeks gestation receiving prenatal care at the project site. Many participants were non–English speaking.Intervention/MeasurementsWhile honoring the 13 essential elements of CenteringPregnancy, the model was adapted to the East African population at the project site and offered to all eligible women receiving individual prenatal care at the clinic. Women attended biweekly sessions, including individual assessment and education, exposure to integrative health therapies, and group discussion. Pre- and postintervention data were collected in surveys and in-depth interviews from March through August 2017.ResultsSeventeen Somali women attended a median of two sessions (range = 1–7). Self-reported results for knowledge of safe exercise in pregnancy (p = .02), exclusive breastfeeding (p = .04), what happens in the hospital (p = .02), and stress management (p = .03) increased after GPC participation. Ninety-three percent of women preferred GPC to individual care.ConclusionWhen adapted to meet the needs of Somali women, GPC has the potential to improve care satisfaction, increase knowledge, and reduce stress during pregnancy and the postpartum period. This model may interest women and care providers in similar community health care settings.     

The impact of maternal stress on initiation and establishment of breastfeeding

ObjectiveThe aim of this study was to explore the impact of maternal stress on initiation, and establishment of breastfeeding.MethodsNinety five women were included in the study. Maternal stress was assessed: (1) objectively, with plasma cortisol levels taken from participants' as well as the umbilical cord blood, 10 min after delivery; (2) subjectively, with self-reported questionnaires administered 1 h and 4 days after delivery. Detailed records of breastfeeding parameters were obtained.ResultsMultivariate analyses indicated that controlling for age, and use of epidural during labor, post-delivery stress score was significantly associated with delayed initiation of lactation, lower milk volume, less frequent feedings and shorter duration of first feeding. Mothers' positive emotions were positively associated with feed frequency. Cortisol levels were not significantly related to initiation and establishment of breastfeeding.ConclusionMaternal stress after delivery can hinder the establishment of successful breastfeeding practices.     

OXTR rs53576 Variation with Breast and Nipple Pain in Breastfeeding Women

BackgroundThirty percent of women who seek professional breastfeeding support require assistance with ongoing breast and nipple pain and < 50% of women report resolution of their pain. It is unknown if there is a molecular risk for ongoing breast and nipple pain during breastfeeding. Aim –To evaluate associations among breast and nipple pain sensitivity and candidate pain sensitivity single-nucleotide polymorphisms [SNPs], (COMT rs6269, rs4633, rs4818, rs4680 and OXTR rs2254298, rs53576) in breastfeeding women. Design - A secondary analysis of a pilot randomized controlled trial of a pain self-management intervention conducted over 6 weeks postpartum. Setting and Participants - Sixty women were recruited from two hospital settings after birth. Methods – All participants underwent standardized mechanical somatosensory testing for an assessment of pain sensitivity and provided baseline buccal swabs for genetic analysis. At 1, 2, and 6 weeks postpartum, women self-reported breast and nipple pain severity using a visual analogue scale. Results - Women with the minor allele OXTR rs53576 reported 8.18-fold higher breast and nipple pain severity over time. For every 1-unit increase in Mechanical detection threshold and windup ratio, women reported 16.51-fold and 4.82-fold higher breast and nipple pain severity respectively. Six women with the OXTR rs2254298 minor allele reported allodynia. Conclusion - The presence of OXTR alleles in women with enhanced pain sensitivity suggests a phenotype of genetic risk for ongoing breast and nipple with potential for pain-associated breastfeeding cessation. Somatosensory testing identified women who reported higher breast and nipple pain during the first weeks of breastfeeding.     

Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women

PurposeThis study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women.MethodsThis study analyzed the data of 1,770 women based on the 2010–2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women.ResultsParity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12–24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07–4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18–6.32).ConclusionBreastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.     

Breastfeeding attitude,health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach

BackgroundIdentifying the factors influencing breastfeeding attitude is significant for the implementation of effective promotion policies and counselling activities. To our best knowledge, no previous studies have modelled the relationships among breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women; the current study attempts to fill this research gap.ObjectivesThis study investigated the relationships among maternal characteristics, health-related quality of life and breastfeeding attitude amidst normal weight and overweight/obese pregnant women using a multi-group structural equation modelling approach.DesignExploratory cross-sectional design was used.SettingAntenatal clinics of a university-affiliated hospitalParticipantsPregnant women were invited to participate; 708 (78.8%) agreed to participate in the study.MethodsWe examined a hypothetical model on the basis of integrating the concepts of a breastfeeding decision-making model, theory of planned behaviour-based model for breastfeeding and health-related quality of life model among 708 multi-ethnic pregnant women in Singapore. The Iowa Infant Feeding Attitude Scale and Medical Outcomes Study Short Form Health Survey were used to measure breastfeeding attitude and health-related quality of life, respectively.ResultsTwo structural equation models demonstrated that better health-related quality of life, higher monthly household income, planned pregnancy and previous exclusive breastfeeding experience were significantly associated with positive breastfeeding attitude among normal and overweight/obese pregnant women. Among normal weight pregnant women, those who were older with higher educational level were more likely to have positive breastfeeding attitude. Among overweight/obese pregnant women, Chinese women with confinement nanny plan were less likely to have positive breastfeeding attitude. No significant difference existed between normal weight and overweight/obese pregnant women concerning estimates of health-related quality of life on breastfeeding attitude (Critical Ratio = −0.193). The model satisfactorily fitted the data (Incremental Fit Index = 0.924, Tucker–Lewis Index = 0.905, Comparative Fit Index = 0.921 and Root Means Square Error of Approximation = 0.025). Health-related quality of life was found to affect breastfeeding attitude in multi-ethnic pregnant women.ConclusionsThis relationship implied the importance of early culturally specific interventions to enhance health-related quality of life for improving positive breastfeeding attitude among pregnant women across different ethnic groups.