Integrative Review of the Factors That Influence Fathers’ Involvement in the Breastfeeding of Their Infants

Objective

To integrate research findings related to the factors that influence fathers’ involvement in the breastfeeding of their infants.

Prenatal Factors Associated with Breastfeeding Duration: Recommendations for Prenatal Interventions

This study of 198 urban breastfeeding women examined the psychosocial, demographic, and medical factors identified prenatally that may be associated with longer breastfeeding duration and may serve as suitable areas for prenatal breastfeeding promotion interventions. Of 11 psychosocial and demographic factors examined, 5 were important influences on breastfeeding duration: anticipated length of breastfeeding, normative beliefs, maternal confidence, social learning, and behavioral beliefs about breastfeeding. Methods of multivariate linear regression were used to identify prenatal factors that influenced anticipated length. Of the 10 factors entered into the regression model, parity, plans to return to work or school by six months postpartum, and maternal confidence were the most significant factors affecting anticipated length of breastfeeding. Our data suggest several factors amenable to intervention during the prenatal period that appear to influence breastfeeding duration. Prenatal promotion efforts could easily incorporate strategies that influence factors such as normative and behavioral beliefs and maternal confidence.     

Incidence and Duration of Breastfeeding for Term Infants in Canada,United States,Europe, and Australia: A Literature Review

Abstract: Background : Analysis of differences in the incidence and duration of breastfeeding across countries may provide information about practices that encourage breastfeeding. This comparative review examines variation in the incidence and duration of breastfeeding for term infants that has been reported in studies from Canada, the United States, Europe, and Australia. Methods : Searches were conducted in PubMed, MEDLINE (from 1966), CINHAL (from 1982), and the Cochrane Database of Systematic Reviews. Studies were limited to nonexperimental and observational research that addressed term infants (>37 weeks gestational age), performed in developed countries, written in the English language, and published since 1990. Additional studies were located from reference lists of meta‐analyses, systematic reviews, and previous articles. All studies that met study criteria were included in the review, regardless of the quality of methodology. Results : Although studies had methodological limitations that precluded conducting a formal systematic review or meta‐analysis, this comparative review revealed consistent differences among countries. For example, Europe and Australia reported a higher initiation and duration of breastfeeding term infants compared with Canada and the United States. Conclusions : Studies that examined reasons for a higher incidence and duration of breastfeeding term infants consistently document that women who initiate and continue to breastfeed are older, married, better educated, and have higher family incomes than women who do not breastfeed.     

Exploring Modifiable Risk Factors for Wheezing in African American Premature Infants

ObjectiveTo examine the degree to which obesity during infancy, consistent exposure to secondhand smoke, and parenting (positive attention, maternal involvement, and negative control) were related to early development of wheezing in a cohort of African American premature infants at 2, 6, 12, 18, and 24 months corrected age.DesignSecondary analysis of a subset of variables from a larger nursing support intervention study.SettingTwo regional perinatal centers in the southeastern United States.ParticipantsOne hundred and sixty‐eight African American premature infants (70 boys, 98 girls) who weighed less than 1,750 g or required mechanical ventilation and their mothers.MethodsThe presence of wheezing was obtained from maternal report at 2, 6, 12, 18, and 24 months. Infants were considered to have medically significant wheezing if they were using bronchodilators or pulmonary anti‐inflammatory medications.ResultsThe percentage of infants who had medically significant wheezing increased from 12% at 2 months to 24% at 24 months corrected age. Infants who received more positive attention from their mothers had a slightly higher increase in the probability of developing wheezing over time. Infants of mothers who received public assistance had an increased probability of wheezing. Consistent exposure to secondhand smoke, obesity during infancy, maternal negative control, and maternal involvement were not related to the development of wheezing.ConclusionThese findings suggest that the likelihood of developing wheezing in African American premature infants is associated with receiving more positive attention from their mothers and having mothers who receive public assistance. Because modifiable risk factors were not highly related to wheezing, intervention efforts need to focus on early identification and treatment of wheezing and asthma‐related symptoms.     

Effect of Pre- and Postdischarge Interventions on Breastfeeding Outcomes and Weight Gain Among Premature Infants

ObjectiveTo investigate the effect of pre- and postdischarge interventions on breastfeeding outcomes and weight gain among preterm infants.Data SourcesPubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for study selection using MeSH terms infant/premature, breastfeeding, weight gain, patient discharge, postnatal care, and counseling.Study SelectionInclusion criteria included studies that involved preterm infants who were born less than or equal to 37 weeks of gestation, randomized controlled trials that were in English, conducted in developed countries, and had breastfeeding and weight gain outcomes. A total of 8 articles met inclusion criteria.Data ExtractionAll data related to breastfeeding outcomes including duration, exclusivity, maternal satisfaction, and weight gain were extracted from the randomized controlled trials for the purpose of data synthesis.Data SynthesisA total of 310 studies were reviewed. Eight randomized controlled trials met the inclusion criteria. Gestational age of the infants in the studies ranged from 26 to 37 weeks. The results revealed that kangaroo care, peer counseling, in-home breast milk intake measurement, and postdischarge lactation support improved breastfeeding outcomes among preterm infants, and that maternal satisfaction improved with postdischarge interventions. No significant evidence of pre- and postdischarge interventions on weight gain was found.ConclusionsPre- and postdischarge interventions were effective in promoting breastfeeding exclusivity, duration, and maternal satisfaction among mothers of preterm infants. These findings have important clinical implications that support the need for evidence-based breastfeeding interventions for preterm infants before discharge and vigilant postdischarge support. Research to determine more effective interventions to promote exclusive and long-term breastfeeding among preterm infants is required.     

Integrative Review of the Experiences of Registered Nurses Who Support Breastfeeding Women

ObjectiveTo describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.Data SourcesWe conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.Study SelectionWe included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.Data ExtractionWe used Whittemore and Knafl’s five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.Data SynthesisWe categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.ConclusionDespite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs’ abilities and confidence to support breastfeeding women.     

Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers

ObjectiveTo synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally.Data SourcesWe used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies.Study SelectionWe included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review.Data ExtractionWe abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings.Data SynthesisWe categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages.ConclusionWe found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.     

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)     

The Risks of Not Breastfeeding for Mothers and Infants

Health outcomes in developed countries differ substantially for mothers and infants who formula feed compared with those who breastfeed. For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome. Obstetricians are uniquely positioned to counsel mothers about the health impact of breastfeeding and to ensure that mothers and infants receive appropriate, evidence-based care, starting at birth.Key words: Breastfeeding, Antenatal care, Infant health outcomes, LactationHealth outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail¹:

• For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
• Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
• For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.

These findings suggest that infant feeding is an important modifiable risk factor for disease for both mothers and infants. The American College of Obstetricians and Gynecologists (ACOG) therefore recommends 6 months of exclusive breastfeeding for all infants.² The American Academy of Pediatrics (AAP)³ and the American Academy of Family Physicians (AAFP)⁴ similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.In the United States, breastfeeding durations fall far short of these guidelines.⁵ In 2005, 74.2% of US infants were breastfed at least once after delivery, but only 31.5% were exclusively breastfed at age 3 months, and just 11.9% were exclusively breastfed at age 6 months. These rates show considerable regional variation, with the highest rates in the Pacific Northwest and the lowest rates in the Southeast. Although some of this variation reflects cultural differences, recent data suggest that variations in hospital practices account for a considerable proportion of disparities in breastfeeding duration.⁶ This suggests that improvements in the quality of antenatal and perinatal support for breastfeeding could have a substantial impact on the health of mothers and infants.This article reviews the health risks of not breastfeeding, for infants and for mothers, as well as the obstetrician’s role in counseling women regarding infant feeding and ensuring an optimal start for breastfeeding at birth.     

窒息后早产儿肾功能动态变化

目的　研究窒息后早产儿尿蛋白变化 ,探讨窒息对早产儿肾功能的影响。　方法　利用免疫比浊法、EL ISA法、速率法、酶法和苦味酸法测定窒息早产儿及正常不同胎龄早产儿生后第 1、4、7天尿微量白蛋白 (m Alb)、视黄醇结合蛋白 (RBP)、 N-乙酰 -β-氨基葡萄糖苷酶 (NAG)、血尿素氮(BUN )、肌苷 (Cr)值。　结果　同一胎龄随日龄增加 ,尿 m Alb有下降趋势 ,但差异无显著性 (P>0 .0 5 ) ;同一日龄随胎龄增加尿 m Alb明显降低 ,差异有显著性 (P<0 .0 5或 <0 .0 1) ;窒息组早产儿随日龄增加尿 m Alb无明显变化 ,但显著高于正常早产儿组 [于生后第 7天为 (4 0 .2± 4 .8) mg/ mmolCr,P<0 .0 1]。尿 RBP、NAG在 2 8～ 31周组和 35～ 36周组随日龄增加 ,于生后第 4天达峰值 [(2 8～31周组 RBP为 (190 9± 2 4 5 )μg/ m mol Cr,NAG为 (30 .3± 14 .7) U / mmol Cr],而后明显下降 ,差异有非常显著性 (P<0 .0 1) ;在同一日龄随胎龄增加 ,尿 RBP、NAG明显降低 ,尤为生后第 4天和第 7天 ,各组间差异有显著性 (P<0 .0 5或 <0 .0 1) ;窒息组早产儿随日龄增加尿 RBP于生后第 4天达高峰为 (340 4± 10 17)μg/ mmol Cr,而后明显下降 ,且各日龄段均显著高于正常早产儿组 (P<0 .0 5或<0 .0 1) ;尿 NAG虽随日龄增加无明显变化     

Integrative Review of Mental Health and Feeding Styles in Parents of Bottle-Fed Infants

ObjectiveTo review the literature regarding the relationship between symptoms of anxiety and depression and feeding styles in parents of bottle-fed infants.Data SourcesWe conducted literature searches in PubMed, CINAHL, Scopus, and PsycINFO.Study SelectionWe used Covidence systematic review management software during the selection process to allow for full blinding of decisions by team members. Articles were eligible for inclusion if they were reports of primary research, written in English, and focused on the relationship between symptoms of anxiety or depression and feeding styles in parents of term, bottle-fed infants younger than 12 months of age. We placed no restriction on date of publication because of the sparse amount of published literature on this topic. We identified a total of 1,882 articles. After removing duplicates, we screened 988 articles and retained six articles that met criteria for our review.Data ExtractionWe used Whittemore and Knafl’s integrative review methodology to guide data extraction and reporting. We extracted relevant data from all primary data sources and compiled the data into a matrix. We used the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies to assess the quality of the studies.Data SynthesisUsing an a priori coding scheme, we summarized the data using categorization of established parental feeding styles in infancy applicable to bottle-feeding. We synthesized the data into two broad categories: responsive and nonresponsive feeding styles.ConclusionAlthough research on the topic is limited, our findings suggest that symptoms of postpartum depression may be associated with nonresponsive feeding styles in parents of bottle-fed infants. We suggest several areas for future research and recommend increased emotional and feeding support in practice for parents of bottle-feeding infants.     

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

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

Social Implications of Obstetric Fistula: An Integrative Review

Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub‐Saharan Africa.     

Women's Experience of Prenatal Care: An Integrative Review

The objective of this study was to identify, synthesize, and critically analyze published research on women's experiences of prenatal care. A search of online databases and relevant citations for research published from 1996 to 2007 was conducted. Thirty‐six articles were reviewed. Qualitative analysis methods were used, assisted by research software. This review found that some women were treated respectfully and reported comprehensive, individualized care. However, some women experienced long waits and rushed visits, and perceived prenatal care as mechanistic or harsh. Women's preferences included reasonable waits, unhurried visits, continuity, flexibility, comprehensive care, meeting with other pregnant women in groups, developing meaningful relationships with professionals, and becoming more active participants in care. Some low‐income and minority women experienced discrimination or stereotyping and external barriers to care. Further research is recommended to understand women's experiences and to develop and implement evidence‐based, women‐centered approaches. Clinicians should inquire regarding women's needs and modify care accordingly and also advocate for institutional changes that reduce barriers to care. Implementing comprehensive, redesigned models of care may be one effective way to simultaneously address a variety of women's needs and preferences. If prenatal care becomes more attractive and more accessible, women's experience and pregnancy outcomes may both improve.     

Effect of a Training Program for Maternity Ward Professionals on Duration of Breastfeeding

Abstract: Background : Training programs are commonly viewed as an effective way to improve breastfeeding‐related practices of health professionals. The objective of this study was to determine whether a 3‐day training program for maternity ward professionals was followed by an increase in duration of any breastfeeding. Methods : A before‐and‐after study was conducted involving two retrospective random samples of 308 mothers who had delivered a healthy singleton infant of 37 weeks’ or more gestation and 2,500 g or more birthweight in a level 3 maternity ward in a university hospital in France. Data were gathered from medical records and postal questionnaire. Results : Study participants included 169 mothers (54.9%) in the pre‐intervention sample and 178 (57.8%) in the post‐intervention sample. The prevalence of any breastfeeding at birth was 77.5 percent (70.5%–83.6%) in the pre‐intervention sample and 82.6 percent (76.2%–87.8%) in the post‐intervention sample(p = 0.24); the median duration of any breastfeeding was 13 weeks and 16 weeks, respectively(χ²log‐rank test = 5.8, p = 0.02). The decreased risk of weaning in the post‐intervention sample persisted after adjustment for baseline characteristics (adjusted hazard ratio = 0.70 [0.54–0.91]). It was paralleled by significant improvement in maternity ward practices that are known to affect the duration of breastfeeding. Conclusion : An intensive 3‐day training program for maternity ward professionals can be followed by a significant but moderate increase in the duration of any breastfeeding. Multifaceted interventions involving prenatal components and community support should be planned in Western countries with low to intermediate prevalence of breastfeeding.