Influence de la proximité mère-bébé sur le sommeil du nouveau-né et celui de sa mère, et sur l’allaitement. Quelle proximité recommander sans mettre en danger la sécurité de l’enfant ?

Newborn babies show moreslow-wavesleep and wake periods (and breastfeeds) when close to their mothers. Newborns sleeping in close proximity to their mothers (bedding-in) facilitates frequent feeding in comparison with rooming-in. After six weeks, the rates of exclusive breastfeeding (and any kind of feeding) are two times more. The lactant mother has modified Sleep-wake patterns and diurnal vigilance, and the mother can wake up instantly at any moment. Mother-baby closeness helps breastfeeding, which helps mother’s sleep. With regard to the current recommendations in France, it seems necessary and possible to adopt a higher closeness between the mother and the newborn. A lot of studies on factors of risk for unexpected infant deaths did not neither differentiate groups according to the place of cosleeping (bed, sofa or other) nor the type of feeding (breastfeeding or other), thus leading to recommendations not always adapted to the needs of breastfed infants and their parents. Familial counselling allows to deliver adapted information to answer the mother’s resting needs as well as the infant’s closeness needs, without endangering the baby’s security, whether in the hospital or at home.     

Parent Visiting and Participation in Infant Caregiving Activities in a Neonatal Unit

ABSTRACT: Background: Active parent involvement in caring for their infants in the neonatal care unit is thought to improve parent‐infant attachment and to moderate the psychological stress for parents, but few recent studies have examined parent visiting patterns and participation in infant caregiving. The study purposes were to describe the frequency and duration of parent visiting and participation in infant caregiving activities, and to identify parent and infant factors associated with parental participation. Methods: Parental visiting frequency, duration, and participation in social, cleaning, and feeding activities with their infant (n=110) were recorded on 12 days during a 3‐month period in a tertiary neonatal unit. Results: Mothers visited more frequently (85% vs 45% of possible days) and for longer than fathers, and visited less frequently if the infant had other siblings, if the infant was over age 1 month, or if fathers made fewer visits. Fathers visited less frequently if the infant was over age 7 days and more frequently if the mothers visited more frequently. All mothers and most (96%) fathers carried out social activities, such as talking, stroking or holding, during their visits. Over 75 percent of mothers engaged in infant cleaning and feeding activities during visits in contrast with less than 20 percent of fathers. Mothers’ participation in infant feeding was best predicted by the duration of their visit and their participation in infant cleaning. Fathers’ participation in infant feeding was only related to their participation in infant cleaning. Conclusions: Significant differences were found in this neonatal unit between mothers’ and fathers’ visiting patterns and infant caregiving activities. Neonatal unit staff should consider factors that may influence parental visiting and explore strategies to improve parental involvement in caregiving. (BIRTH 30:1 March 2003)     

Interaction between feeding method and co-sleeping on maternal-newborn sleep

Background: Previous studies have demonstrated that breastfed newborns spend more time awake than bottle-fed newborns, breastfeeding mothers have more fragmented sleep than bottle-feeding mothers, and mother-newborn sleeping arrangements may affect the sleep/wake pattern of mother-newborn pairs.
Objective: To address the unsolved question of whether there is an interaction between type of feeding and sleeping arrangements that affects postpartum sleep during the 4th postpartum week.
Design: Correlational, two-way design using feeding method and location of newborn at night as independent variables, and sleep patterns as the dependent variables.
Setting: Patient's home during 4th week after giving birth.
Patients/Participants: First-time mothers and their newborns (n = 33).
Main Outcome Measures: Amount of total sleep, amount of night sleep, number of night awakenings, and number of sleep periods in 24 hours using a modified version of the self-report sleep instrument by Barnard and Eyres.
Results: Breastfed newborns had less total sleep per day than bottle-fed newborns, and breastfeeding mothers had more sleep periods in 24 hours than bottle-feeding mothers. Breastfeeding mothers slept more than bottle-feeding mothers when co-sleeping, but bottle-feeding mothers' sleep was unaffected by location of newborn. Average total sleep for 4-week-old newborns was about 14 hours daily.
Conclusions: More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.     

Family characteristics associated with duration of breastfeeding during early infancy among primiparas.

This investigation examined the association of relationship characteristics and parental gender roles with duration of breastfeeding among primiparous women during the early postpartum period. An ethnically diverse group of urban middle-class women (n = 115) who initiated breastfeeding were individually surveyed by telephone along with their male partners. Results of the Cox regression analyses confirmed earlier findings reported in the literature. Reporting higher relationship distress was predictive of early breastfeeding cessation at a marginal level of significance. However, levels of maternal responsibility for household tasks and infant care were highly significant predictors of breastfeeding cessation but in opposite directions. These results suggest that the effects of paternal gender roles on breastfeeding success may vary depending on the area of involvement. Findings have implications for further research examining breastfeeding duration, gender roles, and relationship quality and for clinical practice that facilitates adaptive roles and relationships among new parents.     

Breastfeeding Duration in a Multiethnic Population in Hawaii

Background: The increasing ethnic diversity in the United States necessitates a study of variations in infant feeding patterns among ethnic groups. This study was conducted as part of Hawaii's surveillance system to identify infant feeding patterns in Hawaii; specifically, to identify factors influencing duration of breastfeeding among ethnically diverse mothers. Methods: All women who delivered an infant in Hawaii between January 1 and March 31, 1989, were mailed surveys 14 to 19 months after delivery. Fifty‐one percent (n= 2011) of women responded, of whom 1574 (78%) did some breastfeeding and are included in the analysis of prediction of weaning (cessation of breastfeeding). Cox regression (survival) analysis was used to predict weaning. Results: The median duration of breastfeeding was 150 days; 45 percent of infants were still breastfeeding at age 6 months and 16 percent at age 1 year. Factors associated with early weaning were Japanese ethnicity; mother born in a country other than the United States, Japan, or the Philippines; first language other than English, or two languages at home; employed full‐time outside the home; introduced formula or fruit before age 6 months; received formula from the WIC program; and stopped breastfeeding for convenience, breast problems, problems getting breastfeeding started, insufficient milk, baby refusing the breast, and a sick baby. Factors associated with late weaning were older maternal age; college education; living on a rural island; previous breastfeeding experience; helpful breastfeeding advice from family or friends; receiving WIC for breastfeeding mothers; introducing the cup before age 6 months; and not giving fruit to the baby. Conclusion: In Hawaii, programs that address how and when to introduce foods, use of formula, and management of outside employment and breastfeeding should be made available to those groups of women at risk for early weaning to lengthen their duration of breastfeeding.     

Infant and maternal factors associated with maternal perceptions of infant sleep problems

Aim: Infant sleep behaviours, particularly night wakings, have been identified as one of the most common concerns of parents. Despite this, few empirical studies have examined how mothers distinguish between normative and problematic infant sleep behaviours. Methods: In this study, we examined infant and maternal factors associated with maternal perceptions of infant sleep problems in an internet sample of Canadian mothers with 6- to 12-month-old infants whose infants wake at least one night a week. Results: While infant sleep behaviours accounted for 24% of the variance in maternal perceptions of infant sleep problems, including additional infant and maternal factors in the model accounted for 43%. Factors significantly associated with maternal perceptions of infant sleep problems were infant sleep behaviours (i.e. frequent night wakings, difficulties initiating sleep), difficult infant temperament, poor maternal daytime functioning and poor maternal sleep quality. Contrary to expectations, infant daytime functioning was not predictive of maternal perceptions of infant sleep problems. Conclusions: Our findings support a focus on the family, rather than the infant, when assessing and treating infant sleep problems     

The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents

ObjectiveTraditionally breastfeeding education programs target mothers solely. The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting resource developed to target both mothers and fathers. eHealth resources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals. Best practices to design such resources are not currently known.DesignA three phase pilot study was conducted. The three phases included conducting a needs assessment, creating the resource and pilot testing the resource with mother, father and health care professionals to determine their perspectives regarding the usability and design of the prototype resource. The interactive prototype resource was designed to provide information to parents on breastfeeding and co-parenting, which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals. Setting: Recruitment took place in a health region in Southern Ontario, Canada between June 2014 and March 2015. Online questionnaires were completed by participants in all phases of the study.Participants: Participants (n=149) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario, Canada.InterventionA prototype eHealth breastfeeding co-parenting resource was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery. The prototype eHealth resource was provided to the parents in Phase II and health care professionals in Phase III. The final resource was created based on feedback from these participants.Measurements and FindingsThe resource was pilot tested with new and expectant parents using pre- and post-test questionnaires which included measures for breastfeeding self-efficacy (Breastfeeding Self-Efficacy Short Form), infant feeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding knowledge (Breastfeeding Knowledge Questionnaire) and co-parenting relationship (Co-parenting Relationship Scale). Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test. However, there was no difference in the co-parenting relationship scores from pretest to post-test.Key ConclusionsThis study has used feedback from parents and health professionals to develop a prototype resource which appears to be effective in increasing parents’ breastfeeding knowledge, attitude and self-efficacy. The prototype resource was rated positively by parents and health care providers.Implications for PracticeAn eHealth breastfeeding co-parenting resource designed with input from the target population is an effective way of providing information to mothers and fathers. Further research with a randomized controlled design and more diverse populations is needed to determine effectiveness of the resource on breastfeeding duration and exclusivity.     

Implementation of the SIDS guidelines in midwifery practice

The literature suggests that midwives strongly influence parenting practices immediately after birth and during early postnatal management of the newborn. Midwives must therefore be aware of the current evidence and public health recommendations for reducing the risk of Sudden Infant Death Syndrome (SIDS) and provide consistent information about use of the supine position. Midwives must also include information about environmental factors that are also known to increase the risk of SIDS such as exposure to cigarette smoke, covering the infant's face during sleep and other potential unsafe sleeping practices such as co-sleeping and bed sharing with their infant. The position midwives use to settle infants and place them for sleep is an important example for parents. The position favoured by midwives when placing a newborn to sleep will have a significant impact on parental practice after discharge home. A standardised evidenced based approach to the SIDS Guidelines immediately after birth will facilitate consistency in practice and uniformity in the message parents are given about safe sleeping practices for their newborn infant.     

Temporal Changes in the Determinants of Breastfeeding Initiation

Abstract: Background: Regular identification of factors that predict a woman's infant feeding choice is important so that breastfeeding promotion interventions can be targeted at those women least likely to breastfeed. The objective of this study was to compare determinants of breastfeeding at discharge from hospital in 2002/2003 with those reported for 1992/1993. Methods: Women participating in two longitudinal infant feeding studies in Perth, Australia, completed a baseline questionnaire just before, or shortly after, discharge from hospital. Data collected included infant feeding method and socio‐demographic, biomedical, and psychosocial factors known, or suspected, to be related to the initiation of breastfeeding. Multivariate logistic regression was used to identify independent predictors of “any” and “exclusive” breastfeeding at hospital discharge in both studies. Results: Although maternal age, level of education, and family income were independent predictors of breastfeeding at hospital discharge in the first study, no association was found between these factors and breastfeeding at hospital discharge in the second study. In both studies, a woman who perceived her husband to prefer breastfeeding was significantly more likely to leave hospital breastfeeding, and to be exclusively breastfeeding, than a woman who perceived her husband to prefer formula feeding. The strongest predictor in both studies for a woman to not be exclusively breastfeeding at hospital discharge was having an infant who had been admitted to the special care nursery after delivery. Conclusions: Given the importance of psychosocial factors to breastfeeding initiation, interventions that aim to increase breastfeeding initiation rates should be targeted on the basis of parental attitudes to breastfeeding rather than on sociodemographic factors. Similarly, interventions that aim to increase exclusive breastfeeding should address biomedical factors that hinder a woman's ability to establish exclusive breastfeeding. (BIRTH 33:1 March 2006)     

Parental Attitudes Toward Breastfeeding: Their Association with Feeding Outcome at Hospital Discharge

Abstract: Background : A woman chooses to breastfeed for many reasons. Recent research, however, suggests that parental attitudes toward breastfeeding are stronger predictors of infant feeding choice than commonly cited sociodemographic factors. The objective of the current study was to compare the infant feeding attitudes of expectant couples, and to determine to what degree their individual attitudes during early pregnancy were predictive of the method of infant feeding at discharge from hospital. Methods : A convenience sample of pregnant women (gestational age 8–12 weeks), who were attending maternity clinics in Glasgow, Scotland, in 2000, completed the 17‐item Iowa Infant Feeding Attitude Scale (IIFAS), together with their partners. Results : The IIFAS was completed by 108 expectant couples. At discharge from hospital 49.1 percent of women were exclusively breastfeeding, and 50.9 percent were exclusively formula‐feeding. A woman's total infant feeding attitude score was significantly correlated with her partner's score(r = 0.67, p < 0.001). There was no difference in the infant feeding attitudes of formula‐feeding couples(p = 0.987), but breastfeeding women tended to be more supportive of breastfeeding than their partners(p = 0.022). Maternal, but not paternal, infant feeding attitude was a significant predictor of the choice of feeding method (OR = 1.16 95% CI = 1.09–1.24). Conclusions : Infant feeding attitudes tended to be shared by expectant couples. Maternal infant feeding attitude was a better predictor of feeding choice than were demographic factors. Paternal attitudes were not found to be independently associated with feeding choice. Identification of women with neutral infant feeding attitudes using the IIFAS may be an effective way of targeting interventions at those women who are most likely to be receptive to such programs.     

Transitions in breastfeeding: daily parent diaries provide evidence of behavior over time.

This study addressed a key question for assessing breastfeeding duration: at what point is an infant considered no longer exclusively breastfed or no longer breastfed at all? Mothers provided longitudinal infant feeding data via daily checklists. Transitions between exclusive to partial breastfeeding and partial to no breastfeeding were compared across 11 time periods for 10 age groups of infants. Daily transitions between exclusive and partial breastfeeding were common, especially for infants 6 months of age and younger, and transitions from partial to no breastfeeding occurred much more quickly than transitions from exclusive to partial breast-feeding. Ages at supplementation and weaning calculated in 1-day or 7-day spans correlated highly (intraclass correlation = .99). These results support the Breastfeeding Definitions and Data Collection Periods guideline recently developed by the Breastfeeding Committee for Canada and may bring the breastfeeding research and clinical communities closer to a consensus on the definition of breastfeeding over time.     

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)     

Does Maternal Smoking Have a Negative Physiological Effect on Breastfeeding? The Epidemiological Evidence

Background: Women who smoke are less likely to breastfeed their children than nonsmokers. It is thought that nicotine has a negative effect on breastmilk supply by suppressing prolactin levels. The aim of this review was to assess the epidemiological evidence that maternal smoking has a negative physiological effect on breastfeeding. Methods: The following data sources were searched: The Cochrane Library, Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Lactation Resource Centre (Australian Breastfeeding Association) using the key words “smoking” and “breastfeeding” or “infant feeding.” The Journal of Human Lactation and Birth were hand searched. Results: Women who smoke are less likely to intend to breastfeed, less likely to initiate breastfeeding, and likely to breastfeed for a shorter duration than nonsmokers. Several studies have found a dose‐response relationship between the number of cigarettes smoked each day and breastfeeding intention, initiation, and duration that persists after adjusting for confounding factors. In some population groups a high proportion of smokers breastfeed successfully. Conclusions: The association between maternal smoking and lack of breastfeeding is consistent across different study designs in a range of countries. Given that women who smoke are less likely to intend to breastfeed, however, it cannot be assumed that the relationship between smoking and duration of breastfeeding is a physiological one. If smoking had a consistent negative physiological effect on lactation, one would not expect to see such wide variations in breastfeeding rates among women who smoke. Therefore, it is likely that psychosocial factors are largely responsible for the lower rates of breastfeeding found in women who smoke compared with those who do not. (BIRTH 29:2 June 2002)     

Body Image,Maternal‐Fetal Attachment,and Choice of Infant Feeding Method: A Study in Taiwan

Abstract: Background : Many factors contribute to a pregnant woman's choice of infant feeding method, yet few studies have investigated which factors might be specific to pregnant women in Taiwan. The purpose of this study was to explore the relationships among factors of body image, maternal‐fetal attachment, and the choices made by pregnant Taiwanese women about infant feeding method. Methods : One hundred and ninety‐five pregnant women were recruited during their third trimester at five hospitals in Kaohsiung, Taiwan. Participants completed three questionnaires, including a demographic data form, an attitude to body image scale, and a modified maternal‐fetal attachment scale. Results : The results of stepwise logistic regression indicated that the best subset for predicting the criterion variable of breastfeeding intention included higher level of education, primiparity, and a higher level of maternal‐fetal attachment. Conclusions : Maternal‐fetal attachment, education, and parity are predictive of intended infant feeding method by pregnant women who choose breastfeeding, thereby adding to existing knowledge of the factors involved in feeding method choices of Taiwanese women. Further research should incorporate maternal‐fetal attachment into a supportive model of breastfeeding.     

Sleep in late pregnancy predicts length of labor and type of delivery

OBJECTIVE: The purpose of this study was to test the hypothesis that fatigue and sleep disturbance in late pregnancy are associated with labor duration and delivery type. STUDY DESIGN: In a prospective observational study of 131 women in their ninth month of pregnancy, objective (48-hour wrist actigraphy) and subjective (sleep logs and questionnaires) measures were used to predict labor outcomes using analysis of variance and logistic regression. RESULTS: Controlling for infant birth weight, women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries. Fatigue was unrelated to labor outcomes. CONCLUSION: Health care providers should prescribe 8 hours of bed time during pregnancy to assure adequate sleep and should include sleep quantity and quality in prenatal assessments as potential predictors of labor duration and delivery type.     

A systematic review of maternal obesity and breastfeeding intention, initiation and duration

Background

Breastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully. An association has been reported between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and the apparent association with increased artificial feeding will lead to a greater risk of obesity in children. The aim of this paper is to examine the relationship between maternal overweight and obesity and breastfeeding intention and initiation and duration.

Methods

A systematic review was conducted in January and February 2007, using the following databases: Medline, CINAHL and the Australian Breastfeeding Association's Lactation Resource Centre. Studies which have examined maternal obesity and infant feeding intention, initiation, duration and delayed onset of lactation were tabulated and summarised.

Results

Studies have found that obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding. Of the four studies that examined onset of lactation, three reported a significant relationship between obesity and delayed lactogenesis. Fifteen studies, conducted in the USA, Australia, Denmark, Kuwait and Russia, have examined maternal obesity and duration of breastfeeding. The majority of large studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors.

Conclusion

There is evidence from epidemiological studies that overweight and obese women are less likely to breastfeed than normal weight women. The reasons may be biological or they may be psychological, behavioral and/or cultural. We urgently need qualitative studies from women's perspective to help us understand women in this situation and their infant feeding decisions and behaviour.