A qualitative approach to social support and breast-feeding decisions

Objective

to explore pregnant women's perceptions and personal experiences of the influence of formal and informal social support on breast-feeding decision-making, in relation to breast-feeding initiation and duration.

Design

qualitative focus groups and interviews.

Setting

four primary-care centres in Valencia, Spain.

Participants

19 primiparous women in their first trimester of pregnancy participated in focus groups and 12 primiparous and multiparous women in their third trimester of pregnancy participated in interviews. Women had different socio-demographic backgrounds and socio-economic status.

Findings and conclusions

women's perceptions and personal experiences of formal and informal social support of breast feeding may be linked to age and socio-cultural status. Women from higher socio-cultural backgrounds took their partner's opinion and support more into account when choosing breast feeding. They also conceded great importance to formal health support, and employed mothers wished to have more institutional support. Among women from lower socio-cultural backgrounds, friends were the closest social network and had the greatest influence on feeding decisions. They perceived some contradictions in health-promotion messages on breast feeding, and most of them preferred to leave work after birth to exclusively care for their baby. Younger women, without previous experience of breast feeding or possibility of receiving tangible support from their mothers, wanted more practical health-care support (e.g. providing skills in breast-feeding technique).

Implications for practice

breast-feeding promotion strategies should take into account women's different characteristics. Health professionals should consider offering postnatal support as a follow-up to practical support (e.g. breast-feeding workshops).     

A survey on difficulties and desires of breast-feeding women in Wuhan,China

Objectivesexclusive breast feeding in China is relatively low and no research has been conducted to explore the difficulties and desires of Chinese lactating mothers. Currently, Chinese women turn to massage therapists to increase breastmilk volume, implying that many breast-feeding women faced problems but had few support mechanisms.This study aimed to explore the difficulties and desires of Chinese breast-feeding women and to propose strategies for increasing the rate of exclusive breast feeding.Methodsthree hundred and seventy-five primiparous women were recruited from two randomized cluster communities in Wuhan following ethical approval. Face-to-face semistructured interviews were conducted with 76 of the participants to collect data on their infants' feeding status, duration of exclusive breast feeding, reasons for stopping, difficulties encountered, and sources of support for lactation.Resultsthe breast feeding initiation rate was 93.6%, but exclusive breast feeding was only 6.2% at six months. The most frequently cited reason for giving up exclusive breast feeding was perceived breastmilk insufficiency. Women cited a desire for professional and individualised instruction from following resources: (1) lactation consultants in hospital and communities; (2) Qualified cuirushi; (3) breast feeding website;(4) Relatives, friends and peers;(5) Telephone hotline.Conclusionsto improve the rate and duration of exclusive breast feeding in China, effective and available resources must be available. Timely,professional and face-to-face lactation counselling such as lactation consultant, qualified cuirushin is needed.     

不同剂量醋酸甲羟孕酮用于哺乳期妇女避孕的临床研究

目的 探讨不同剂量醋酸甲羟孕酮（DMPA）用于哺乳期妇女避孕对其避孕效果、副反应发生率及停用原因的影响。方法 将受试对象按剂量随机分为120mg和150mg两组,排除不符合研究标准者,纳入研究对象共计173例,120mg组87例,150mg组86例。每3个月深部肌肉注射1次,共4次。结果 两组避孕成功率均为100．00％;发生副反应中,点滴出血120mg组为6．90％,明显低于150mg组的16．28％（P＜0．05）。结论 120mg DMPA用于哺乳期妇女避孕不影响其有效性,且可减少副反应发生率。     

Healthcare providers' role regarding the safe and appropriate use of herbal products by breastfeeding mothers: A systematic literature review

BackgroundBreastfeeding women often use herbal products to increase their milk supply. The aim of this study was to summarize the literature about the role of healthcare providers in advising breastfeeding women about herbal product use.MethodsPubmed, ScienceDirect, Web of Science, and CINAHL databases were searched for articles written in English using the Keywords: “breastfeeding” or “lactation” and “herbal medicine*“, “botanical*“, “dietary supplement*“, “natural product*“, “traditional medicine*” or “complementary medicine*“.ResultsTwenty-two articles were included in this review. A lack of inter-professional communication and guidelines, a lack of provider confidence and knowledge about the evidence for the efficacy and safety of herbal products were identified as causing a ‘gap’ between current practice and expectations of breastfeeding women seeking advice about their use herbal products.ConclusionsStrategic and collaborative efforts between key stakeholders are required to ensure the needs of women who are considering herbal product use while breastfeeding are met.     

Views of fathers in Ireland on the experience and challenges of having a breast-feeding partner

Objectivethis study investigated the relationship between fathers and breast feeding in Ireland.Design and methoda cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4–7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages.Findingsof the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n399), college-educated (76.7%, n320) and married (87.8%, n366). Most (75.5%, n315) fathers were involved in the breast feeding decision. The majority (77.5%, n323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n237), half (49.4%, n117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n143) if the woman in question was their partner.Key conclusionwhile fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner.Implications for practicewomen who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.     

Antenatal breast expression: A critical review of the literature

Objective

to critically review literature related to the practice of antenatal breast expression (ABE) and the reasons for this practice.

Method

a critical review of available literature was undertaken by accessing Internet and library resources. Articles were to be documented in English. No restrictions were placed on dates due to the important historical background of this topic. Keywords used to refine the search included antenatal breast expression, colostrum, antenatal breast-feeding education and midwives and International Board Certified Lactation Consultants (IBCLC).

Findings

the literature search discovered ABE has been performed historically to prepare breasts for breast-feeding postnatally. It is presently being taught to store colostrum to prevent neonatal hypoglycaemia or hasten production of Lactogenesis 2. Studies relating to nipple stimulation were also critically appraised due to concerns of premature labour.

Conclusions

the safety and efficacy of ABE has yet to be demonstrated. The three studies related to the benefits teaching of this skill were small in size with methodological flaws. Trials related to nipple stimulation were also found to have substantial limitations. The reasons for and physicality of performing ABE vs. nipple stimulation differed markedly. While recent teaching of ABE has been encouraged through available commentaries, case studies and policies (in view of the documented positive effects of early colostrum administration), the benefits of this practice are yet to be substantiated.

Implications for practice

large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care.     

UK-born ethnic minority women and their experiences of feeding their newborn infant

Objective

to explore the factors that impact on UK-born ethnic minority women’s experiences of and decisions around feeding their infant.

Design

in-depth semi-structured interviews.

Participants

34 UK-born women of Black African, Black Caribbean, Pakistani, Bangladeshi, Indian and Irish parentage and 30 health-care professionals.

Setting

women and health-care professionals were recruited primarily from hospitals serving large numbers of ethnic minority women in London and Birmingham.

Findings and conclusions

despite being aware of the benefits of exclusive breast feeding, many women chose to feed their infant with formula. The main barriers to breast feeding were the perceived difficulties of breast feeding, a family preference for formula feed, and embarrassment about breast feeding in front of others. Reports from women of South Asian parentage, particularly those who lived with an extended family, suggested that their intentions to breast feed were compromised by the context of their family life. The lack of privacy in these households and grandparental pressure appeared to be key issues. Unlike other participants, Irish women reported an intention to feed their infant with formula before giving birth. The key facilitators to breast feeding were the self-confidence and determination of women and the supportive role of health-care professionals.

Implications for practice

these findings point to common but also culturally specific mechanisms that may hinder both the initiation and maintenance of breast feeding in UK-born ethnic minority women. They signal potential benefits from the inclusion of family members in breast-feeding support programmes.     

Young mothers who choose to breast feed: the importance of being part of a supportive breast-feeding community

Objective

to examine factors associated with breast-feeding initiation and duration in young mothers (≤24 years).

Design

a retrospective questionnaire completed between six and 24 months post partum.

Setting

mothers were recruited from local mother and infant groups, nurseries and online mother and infant forums.

Participants

138 mothers aged between 17 and 24 years (mean age 21.93 years)

Measurements and findings

participants completed a retrospective questionnaire about their experience of breast or artificial milk feeding during the first six months post partum. A further 10 mothers who breast fed for at least six months completed a semi-structured interview. Breast feeding for at least six months was positively associated with attending a breast-feeding support group, believing breast feeding to be easy, being part of an environment where breast feeding is normative, and being encouraged to breast feed by others.

Key conclusions

themes raised highlight the importance of viewing breast feeding as the normal way to feed an infant and having others support the mother in this behaviour.

Implications for practice

increasing breast-feeding initiation and duration among this at-risk group is important for both infant and maternal health. Helping mothers to view breast feeding as the norm, creating an environment where breast feeding is accepted, providing professional and peer support, and encouraging the mother to continue breast feeding are important steps in raising breast-feeding rates among younger mothers.     

A comparison of the accuracy of two minimally invasive breast biopsy methods: a systematic literature review and meta-analysis

Objective: The primary objective was to quantify and compare the accuracy and failure rates of directional vacuum assisted biopsy (DVAB) and core needle biopsy (CNB) when used under stereotactic (ST) guidance to biopsy suspicious breast lesions identified with screening mammography. Methods: We performed a systematic review of the literature published from January 1996 to July 2004, reporting all-comers populations in Western-style health care systems (i.e., North America, Europe, Australia or New Zealand), referred after screening mammography for breast biopsy using DVAB or CNB under ST guidance. Meta-analyses were conducted for DVAB and CNB, using open surgical biopsy and/or long-term clinical and/or mammogram follow-up as the diagnostic reference standard. The main outcomes of interest were those of greatest clinical relevance, i.e., miss rates and underestimation rates for malignancy. Also, technical failure rate and non-diagnostic rate were assessed for each biopsy method. Results: Thirty-five studies qualified for the review. There were 12 studies with a DVAB group (n=5,119 patients), and 25 studies with a CNB group (n=6,236). There were no studies including both a DVAB and a CNB group, thus precluding any direct, within-study comparisons of accuracy. Overall agreement rate between DVAB and the reference standard was 97.3%, and between CNB and the reference standard, 93.5%. The frequency of technical failures with CNB was slightly higher than DVAB (5.7 vs. 1.5%), as was the frequency of non-diagnostic samples (2.1 vs. 0%). Of the non-diagnostic CNB samples, 23% were subsequently found to be malignant on reference standard. In multivariate analyses using four covariates (procedure type, geographic location, reference standard, and patient position), there were no significant predictors of agreement rates, but some variables were significant predictors of miss rates. For benign to malignant upgrades, study location was a significant predictor, with more upgrades in non-NA locations. For atypia to malignant upgrades, the type of procedure was a significant predictor, with more underestimations in CNB studies. Conclusion: The best available evidence suggests that, in screening populations referred for minimally invasive breast biopsy biopsy requiring ST guidance, DVAB may provide lower miss and underestimation rates for clinically relevant diagnoses than does CNB.     

A systematic review of the nature of support for breast-feeding adolescent mothers

OBJECTIVE: to review the evidence on the nature of support for breast-feeding adolescent mothers. METHODS: a systematic review of relevant English-language papers was conducted using an a-priori search strategy. Agreement on final inclusion was reached by consensus across the team. The findings were tabulated and described narratively and thematically. FINDINGS: of 209 studies identified, seven fitted the inclusion criteria. The papers included in this review varied in design, quality and focus. Five types of support were identified: emotional, esteem, instrumental, informational and network. The participants in the included studies seemed to find the emotional, esteem and network components of support most helpful. Support from the participants' mothers seemed to be particularly powerful. The provision of continuity of support from an expert individual who is skilled in both lactation support and working with adolescents was also highly valued by breast-feeding adolescents. There was also evidence to suggest that targeted breast-feeding educational programmes, specifically designed for the adolescent learner, may be successful in improving breast-feeding initiation and continuation rates in this population. However, a question still arises about which elements of the complex package on offer were most effective. CONCLUSION: the studies included in the review are diverse. Although the support provided by known and trusted individuals emerges as important to the adolescents, further research is required on the specific nature of that support and the person best placed to provide it. The acceptability and feasibility of other aspects of support and modes of provision also requires additional exploration. Further qualitative and feasibility studies are therefore warranted in order to inform future randomised-controlled interventions trials.     

A pilot quasi-experimental study to determine the feasibility of implementing a partograph e-learning tool for student midwife training in Nairobi

Objective

the partograph is a tool used globally to record labour progress. Although it has the potential to improve maternal and neonatal outcomes, some midwives struggle with using it in practice. Training in partograph use is limited, and the theory is often divorced from practice. Innovative ways of improving training are urgently required. We therefore aimed to determine whether the use of an e-learning tool is beneficial for learning partograph skills.

Design

an uncontrolled before-and-after study was conducted, informed by Kirkpatrick's four-stage model of evaluation; we report on the first two stages. We included a cohort of third and fourth year midwifery students who were studying at one university in Nairobi. The same hypothetical case scenario was used, pre- and post-implementation of the World Health Organization partograph e-learning tool, to assess students' partograph completion ability. Views on the tool were also sought, using semi-structured questionnaires. Data were analysed using standard statistical techniques and framework analysis.

Findings

92 (88%) students participated. Students expressed positive views about the e-learning tool. However, the mean post-intervention score (27.21) was less than half of the maximum obtainable score. There was some improvement in test scores; year three mean score pre-intervention was 21.39 (SD 5.72), which increased to 25.10 (5.41) post-intervention (paired-t=3.47, p=0.001); year four mean score pre-intervention was 24.39 (5.98) which increased to 29.30 (6.77) post-intervention (paired t=3.85, df=91, p<0.001). In the post-test, year four students scored higher than year three students (unpaired t=3.28, df=90, p=0.001). Students were unable to plot cervical dilatation correctly, once established labour had been confirmed.

Key conclusion

e-Learning training is acceptable to student midwives and has the potential to be an effective means of teaching the practical application of the partograph. However, in this study, their inability to correctly plot transference from the latent to active phase of labour suggests that the partograph itself may be too complicated. Modifications and further evaluation of the e-learning tool would be required before any widespread implementation. Furthermore, students need the clinical support to operationalise their learning; educating qualified midwives and obstetricians to be positive role models when completing the partograph would be one potential solution. Further research is required, taking on board the recommendations from our pilot study, to investigate the impact of partograph e-learning on practice and clinical outcomes.     

The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: A systematic review and meta-analysis

Breast-feeding initiation within the first half hour after birth is one of the World Health Organization recommendations. However, in most hospitals, mother-infant contact and breast-feeding initiation are delayed due to routine mother and infant care. This study aimed to determine the effect of mother-infant skin to skin contact (SSC) immediately after birth on the success rate and duration of the first breast-feeding.In this review, databases of PubMed, Scopus, Cochrane, Google Scholar, SID and Magiran and reference sections of relevant articles were searched for both Persian and English randomized clinical trials from 2000 to December 2017, using the keywords of “(Breast-feeding OR Lactation) AND (mother-infant SSC OR KMC) AND (breast-feeding success OR breast-feeding duration)”. A total of nine trials were ultimately included. Data analysis was performed with Comprehensive Meta-analysis (CMA) software version 2.In total 597 participants were assigned to the intervention group and 553 participants were assigned to the comparison group. Quantitative analysis Based on mean differences or odds ratio showed that Mother-Infant SSC had a significantly positive effect on success in first breast-feeding (MD:1.90, 95%; CI 0.958–2.856; p = 0.00, OR: 2.771 95%; CI 1.587–4.838; p = 0.00) and first breast-feeding duration (MD:26.627 95%; CI 1.070–52.184; p = 0.041).Mother-infant SSC after birth has beneficial effects on breast-feeding and can increase the success rate and duration of the first lactation. Therefore, the results of this study can be used by healthcare providers in evidence-based decision-making about ways to increase breast-feeding rates.     

Empathy in pregnant women and new mothers: a systematic literature review

Objective: This systematic review explores changes in perinatal empathy and influence on maternal behaviours and child development.

Background: The well-being and development of infants are commonly linked to their mothers’ capacity for empathy. However, characteristic changes during pregnancy and childbirth including sleep deprivation, mood and cognitive difficulties may disrupt empathic processing.

Methods: Original research papers (n = 7413) published in English language peer-reviewed academic journals were obtained by searching four electronic databases PsycINFO, PubMed, Scopus and CINAHL. Inclusion criteria were studies reporting empathy of women in the period from pregnancy to 12 months postpartum. Empathy was operationalised as a general tendency of empathic emotional responding and cognitive perspective taking. Thirteen studies were systematically assessed using the Critical Appraisal Skills Programme criteria.

Results: Impaired empathy in mothers, due most notably to high personal distress, was associated with risk of neglect or maltreatment of children and was partially explained by mothers’ aversive response to infant crying.

Conclusion: Few studies present empathy as a central theme. There is a paucity of definitional parameters and theoretical linkages and over-reliance on brief self-report indices of empathy. Future studies need to be theory based, incorporate experimental approaches, and provide greater sampling diversity toadvance our understanding of empathy in perinatal women.     

A feasibility study of an intervention to enhance family support for breast feeding in a deprived area in Bristol, UK

OBJECTIVE: to assess fathers' and grandmothers' knowledge of breast feeding and their ability to support successful breast feeding. To design a suitable intervention for fathers and grandmothers to support breast-feeding mothers, to assess the acceptability and feasibility of the intervention and monitor its likely effects on breast-feeding rates. DESIGN: qualitative focus groups and interviews. Evaluation of the feasibility of an antenatal intervention. SETTING: Community Health Centre and family homes in an area of relative social and economic deprivation in South Bristol, UK, from November 2001 to May 2003. PARTICIPANTS: 10 grandmothers and five fathers in focus groups and interviews. Twenty-nine families in the intervention. INTERVENTION: an antenatal intervention for grandmothers or partners to support breast feeding, which combined the benefits and mechanics of breast feeding with ways of providing support for breast feeding. FINDINGS: using an antenatal session based around a leaflet, specifically written for grandmothers and partners, and including a demonstration of good breast-feeding positioning and attachment in addition to the discussion of specific issues around the health benefits and mechanics of breast feeding was found to be acceptable, useful and enjoyable by all participants, particularly for first-time parents. The importance of fathers and grandmothers in providing emotional and practical support for breast-feeding mothers is highlighted, since those who were still breast feeding at eight weeks all felt that they were receiving similar or better support postnatally than they were antenatally. Significantly more intervention mothers were breast feeding their babies at eight weeks than in the wider practice population of mothers outside the study who intended to breast feed. Fathers' attitudes to breast feeding postnatally were fairly similar to those before the baby was born with breast feeding in public and knowing how much milk the baby was getting having the most influence on whether they felt that their partner should continue to breast feed. IMPLICATIONS FOR PRACTICE: this type of intervention could be part of a multi-faceted approach towards improving breast-feeding initiation and continuation, particularly in areas of low prevalence. Health professionals should be opportunistic about involving other family members in discussions about breast feeding whenever possible, both antenatally and postnatally.     

Breast-feeding intention,initiation and duration among Hong Kong Chinese women: A prospective longitudinal study

Objectives

to (1) estimate the breast-feeding intention, initiation and duration rate; (2) identify the reasons to initiate and wean breast feeding and (3) explore predictors of breast-feeding duration.

Design

a prospective longitudinal study

Setting

antenatal clinics of five regional hospitals from four clusters in Hong Kong

Participants

a population-based sample of 2098 women in the second trimester of pregnancy was recruited with a systematic sampling method.

Measurements

three different sets of self-administered questionnaires were used to measure the breast-feeding intention, initiation and duration, demographic, socio-economic, obstetric, complications of pregnancy and intrapartum variables at three time points. Reasons for initiating and weaning breast feeding, the formal and informal supportive resources of participants during breast feeding were collated at the third time points.

Findings

the rates of artificial feeding and breast feeding were 41.1% and 58.9%, whereas breast-feeding intention and initiation rates were 85.3% and 67.0%, respectively. The breast-feeding duration rates were 11.1%, 10.3%, 10.7% and 26.7%, for the ‘within <1 week’, ‘1–3 weeks’, ‘>3–6 weeks’ and ‘>6 weeks’ groups. The common reasons for initiating breast feeding were that breast feeding is beneficial for both the baby (89.8%) and mother (39.7%). Reasons for weaning breast feeding were insufficient breast milk (32.7%), tiredness and fatigue (39.7%) and return to work (29.6%). Partner, relatives and nurse midwives were important supportive resource during breast feeding. Ordinal logistic regression analysis identified five predictive factors of breast-feeding duration. Participants who were working part-time or were housewives (p=0.037), had monthly family income of <HK$10,000 (p=0.034), more than one child (p=0.001), positive breast-feeding intention (p=0.001) and early breast feeding within the first hour (p<0.0001) were more likely to have longer breast feeding than their counterparts.

Conclusion

mothers in Hong Kong do not meet the recommendation of the international standards for breast feeding. Understanding of reasons for initiation, weaning and predictors of breast-feeding duration can help nurse midwives to develop and customise effective strategies to promote and encourage breast feeding.

Implications for practice

the findings are important for a process-oriented breast-feeding training programme for nurse midwives. New strategies should be implemented for prolonging breast-feeding duration among perinatal women.     

Psychological impact of hypnosis for pregnancy and childbirth: A systematic review

BackgroundThe use of hypnosis as a complementary therapy in the perinatal field is expanding, however, there is little research for its impact on perinatal mental health. Here, we review studies that evaluate the effect of hypnosis on women's mental health and subjective experiences.MethodsA systematic review was conducted according to the PRISMA protocol for articles with experimental designs of hypnosis that measured their impact on several psychological variables, such as the presence of symptoms of anxiety, depression or fear of childbirth. Studies were evaluated according to the Critical Appraisal Skills Program Checklists (CASP), and analyzed for their designs and intervention themes.ResultsSeven studies were included and six themes emerged: preparation for birth and unexpected events; change in the perception and experience of pain; pregnant body as a natural process; connection with the baby during pregnancy; development of inner resources; and progressive relaxation and guided imagery. Although results were partly mitigated, most studies found positive effects of hypnosis in alleviating anxiety, depression, and fear towards birth, empowering women with a higher sense of confidence and improving the overall emotional experience. Two studies also indicate encouraging outcomes in postnatal wellbeing.ConclusionWhile it is still argued as to what extent hypnosis has positive effects on physical aspects of labor, the empowerment and the increase in confidence associated with hypnosis seem to bring a significant contribution to a more positive subjective experience of pregnancy and childbirth, and on women's overall wellbeing in the perinatal period.