Integrative Review of Fathers’ Perspectives on Breastfeeding Support

ObjectiveTo critically review and summarize the results of published articles on fathers’ perspectives regarding breastfeeding support for their partners.Data SourcesWe searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai.Study SelectionAfter duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review.Data ExtractionWe analyzed studies that met inclusion criteria and extracted and organized data related to fathers’ perspectives on breastfeeding support into a structured table.Data SynthesisThe data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers’ Perceptions of the Breastfeeding Support They Provided.ConclusionOur results showed that fathers’ perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.     

Integrative Review of Antenatal Milk Expression and Mother–Infant Outcomes During the First 2 Weeks After Birth

ObjectiveTo explore the practice of antenatal milk expression (AME) and related outcomes for mother–infant dyads during the first 2 weeks after birth.Data SourcesWe searched the electronic databases MEDLINE, Embase, CINAHL, Emcare, Maternity & Infant Care Database, Scopus, and Web of Science for relevant literature. We also conducted backward reference searches on relevant publications and nondatabase searches after review of the full texts.Study SelectionArticles were eligible for inclusion if they reported primary studies focused on AME, included samples of mother–infant dyads, and were published in English. We did not impose time or design limitations given the sparse availability of literature on AME. We identified 766 articles. After the removal of duplicates, we screened 588 articles, and of these, we included 15 articles in our review.Data ExtractionWe used the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines to guide data extraction and reporting. We evaluated the quality of evidence using the Melnyk and Fineout-Overholt rating system and the Joanna Briggs Institute critical appraisal tools.Data SynthesisWe synthesized data from the included articles into four themes: Breastfeeding Self-Efficacy, Milk Supply, Infant Well-Being, and Infant Feeding Methods.ConclusionAME may support breastfeeding by improving breastfeeding self-efficacy and milk supply and by decreasing early formula use. Synthesized literature on AME shows the safety of the practice and that infants of women who practice AME have a greater likelihood of breastfeeding exclusivity during the short term.     

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.     

Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

ObjectiveTo synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes.Data SourcesWe searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid.Study SelectionWe included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review.Data ExtractionWe extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT.Data SynthesisWe identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors.ConclusionThe results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.     

Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome

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

Breastfeeding Outcomes,Self-Efficacy,and Satisfaction Among Low-Income Women With Late-Preterm,Early-Term,and Full-Term Infants

ObjectiveTo assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants.DesignProspective, comparative, with repeated measures.SettingFour Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices.ParticipantsParticipants included 270 mother–infant dyads.MethodsWe assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding.ResultsMore than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p < .001; and 7%, 15%, and 28.46% at 5 months, p < .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants.ConclusionOngoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.     

A comparison of breastfeeding rates by obesity class

Purpose: The purpose of this study is to compare breastfeeding initiation rates for women across body mass index (BMI) classes, including normal BMI (18.50?24.99?kg/m²), overweight (25.00?29.99?kg/m²), obese (30.00?39.99?kg/m²), morbidly obese (40.00?49.99?kg/m²) and extreme obesity (≥50.00?kg/m²).

Materials and methods: Retrospective cohort of women with singleton pregnancies, delivering in St. John’s, NL between 2002 and 2011. The primary outcome was any breastfeeding on hospital discharge. Breastfeeding rates across BMI categories were compared, using univariate analyses. Multivariate analysis included additional maternal and obstetric variables.

Results: Twelve thousand four hundred twenty-two women were included: 8430 breastfed and 3992 did not breastfeed on hospital discharge. Progressively decreasing rates of breastfeeding were noted with increasing obesity class: normal BMI (71.1%), overweight (69.1%), obese (61.6%), morbidly obese (54.2%), and extremely obese women (42.3%). Multivariate analysis confirmed that increasing obesity class resulted in lower odds of breastfeeding: overweight (adjusted odds ratios (aOR) 0.86, 95%CI 0.76–0.98), obese (aOR 0.65, 95%CI 0.57–0.74), morbidly obese (aOR 0.57, 95%CI 0.44–0.74), and extreme obesity (aOR 0.37, 95%CI 0.19–0.74).

Conclusion: Women in higher obesity classes are progressively less likely to initiate breastfeeding. Women with the highest prepregnancy BMIs should be particularly counseled on the benefits of breastfeeding.     

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.

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.     

The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: a randomized trial

Objective.?The aim of this study was to determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge.

Methods.?The study included a total of 60 women who gave birth at Zübeyde Han?m Maternity Hospital located in Ayd?n, Turkey. In addition to a standard breastfeeding education in the first few hours after delivery, which was provided to all women in this “baby-friendly initiative” (BFI) hospital, the mothers in the intervention group received breastfeeding education at home on day 3 postpartum from supporters.

Results.?Both groups were comparable in terms of maternal and neonatal characteristics. The breastfeeding education/support offered during a home visit on day 3 postpartum was associated with a significant increase in the percentage of exclusively breastfed infants both at 2 weeks and 6 weeks, and at 6 months, and was also associated with a significant increase in exclusive breastfeeding and in total breastfeeding duration. In addition, increased breastfeeding knowledge scores were observed in the intervention group at 2 weeks and at 6 weeks after delivery, when compared with the respective scores in the control group.

Conclusion.?Breastfeeding education offered at home on day 3 postpartum was effective in increasing the breastfeeding duration and breastfeeding knowledge.     

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.     

Factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus

Objective: This study aimed to investigate the factors related to exclusive breastfeeding among postpartum Thai women with a history of gestational diabetes mellitus. Background: Postpartum women with diabetes are more likely to have delayed lactogenesis. Strict glycaemic control may affect lactation. Methods: A cross-sectional analytic research was designed to carry out the study. One hundred and fifty participants were included in the study. Data were collected in two phases using the Exclusive Breastfeeding questionnaire. Data were analysed using Pearson correlation, independent t-test and binary logistic regression. Results: The significant factors related to the 6-month exclusive breastfeeding were maternal age, employment, parity, body mass index, duration of newborn’s admission in NICU and exclusive breastfeeding intention. Conclusion: These findings indicate that effective nursing interventions need to be implemented for promoting exclusive breastfeeding among postpartum women with diabetes.     

Systematic Review of Newborn Feeding Method and Outcomes Related to Neonatal Abstinence Syndrome

ObjectiveTo critically appraise and synthesize existing studies on the relationship between newborn feeding method and neonatal outcomes related to neonatal abstinence syndrome (NAS).Data SourcesA systematic search of the literature on newborn feeding method in newborns with NAS was conducted with the use of the electronic databases PubMed, CINAHL, Nursing and Allied Health, PyschINFO, Evidence Based Medicine, Web of Science, and MEDLINE (Embase).Study SelectionStudies were eligible for inclusion if the following criteria were met: the authors reported original data on outcomes related to newborn feeding and NAS, the research followed any type of quantitative design that included comparison of breastfed and formula-fed newborns with NAS, and the articles were published in English in peer-reviewed journals from 1990 to February 2018.Data ExtractionTwo authors independently extracted the data from the full-text articles and entered them into a data extraction template developed for the systematic review. The data were synthesized narratively because of the diversity in assessment of newborn feeding methods and outcome measures.Data SynthesisWe identified eight studies in which newborn feeding method and outcomes related to NAS were evaluated in newborns exposed to opioids. The synthesis indicated that for newborns exposed to methadone, breastfeeding was associated with decreased incidence and duration of pharmacologic treatment, shorter hospital length of stay, and decreased severity of NAS. The association between newborn feeding method and NAS among newborns exposed to buprenorphine was unclear.ConclusionBreastfeeding may be effective to mitigate negative outcomes related to NAS among newborns exposed to methadone in utero. Women who are stable on opioid substitution treatment should be provided with appropriate education and support to breastfeed. However, to effectively promote breastfeeding among these mothers, evidence-based strategies are required, and barriers to breastfeeding need to be addressed.     

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.     

An Integrative Review of Factors that Influence Breastfeeding Duration for Premature Infants after NICU Hospitalization

ObjectiveTo determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high‐risk mothers and their premature infants.Data SourcesThe electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review.Study SelectionUsing exclusion and inclusion criteria, 292 articles were initially assessed for relevance to the research question through abstract review. Further screening resulted in full review of 52 articles. Reference list searching added an additional six articles. Finally, in‐depth review of these 58 articles resulted in 24 studies that fully met inclusion and exclusion criteria.Data ExtractionStudies were reviewed for information related to factors associated with breastfeeding duration for high‐risk mothers and preterm infants after NICU discharge home.Data SynthesisStudies were categorized into five themes, including NICU factors, feeding and soothing methods, maternal characteristics, maternal experiences, and support programs. Most significant factors affecting duration included exposure to kangaroo mother care, prenatal education, and quantity of maternal breast milk supply during the first week after discharge. Breastfeeding also was affected by maternal breastfeeding knowledge and perception of providing appropriate volumes.ConclusionsMothers face many challenges breastfeeding their premature infants after NICU discharge. Ideally, all mothers need to receive support after NICU discharge, and the transition to home can be challenging even if breastfeeding is well established. However, NICU professionals are in a perfect position to provide guidance to families so they are able to anticipate and effectively solve lactation challenges at home.     

Association Between Breastfeeding Discouragement and Breastfeeding Behaviors

ObjectiveTo examine the association between subjective norms and breastfeeding behaviors and to assess whether individual characteristics modify this association.DesignRetrospective cohort study.SettingFlorida, 2004 to 2005; Louisiana, 2004; and Ohio, 2009 to 2010.ParticipantsStratified systematic sample of respondents who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from three states (N = 5,378).MethodsWe used PRAMS data to examine the associations between three independent variables (breastfeeding discouragement by others and number and type of normative referents) and three breastfeeding behaviors (breastfeeding initiation and breastfeeding duration at 4 weeks and 10 weeks after birth) using multivariable log binomial regression. We also examined whether maternal characteristics modified the association between breastfeeding discouragement by others and breastfeeding behaviors.ResultsRespondents who reported that others discouraged them from breastfeeding were more likely to initiate breastfeeding (adjusted relative risk (RR) = 0.78, 95% confidence interval [CI] [0.64, 0.96]) than those who were not discouraged. Furthermore, in the total sample, breastfeeding discouragement from others was not associated with breastfeeding discontinuation by 4 weeks and 10 weeks after birth. Breastfeeding discouragement from health care providers was associated with a greater incidence of noninitiation among respondents who reported breastfeeding discouragement from others (adjusted RR = 2.82, 95% CI [1.88, 4.22]).ConclusionsFindings suggest that women may be motivated to initiate breastfeeding because of their beliefs and emotions despite being discouraged by others. However, discouragement by health care providers was associated with decreased initiation. This underscores a need for the continued implementation and scale-up of evidence-based maternity care practices and education of providers and the public to support breastfeeding.     

Randomized Controlled Trial of a Prenatal Breastfeeding Self-Efficacy Intervention in Primiparous Women in Iran

Objective

To determine the effects of a prenatal breastfeeding self-efficacy intervention on breastfeeding self-efficacy and breastfeeding outcomes.