Smoking and caesarean deliveries: major negative predictors for breastfeeding in the mother–child cohort in Crete,Greece (Rhea study)

Although benefits of breastfeeding have been widely promoted and accepted, exclusive breastfeeding for the first 6 months of life is far from the norm in many countries. In a prospective mother–child cohort study in Crete, Greece (‘Rhea’ study), we assessed the frequency of breastfeeding and its socio‐demographic predictors. Information on breastfeeding was available for a period of 18 months post‐partum for a cohort of 1181 mothers and their 1208 infants. The frequency of exclusive and predominant breastfeeding in the first month post‐partum was 17.8% and 3.4%, respectively, with almost three‐quarters of women (73.6%) ceasing any breastfeeding after 4 months post‐partum. Women were less likely to initiate breastfeeding if they had a caesarean delivery (CD), whereas they were more likely to initiate breastfeeding if they had a higher education or gave birth to a private clinic. Among women breastfeeding, those who had a CD, were ex‐smokers or smokers during pregnancy had a statistically significant shorter duration of breastfeeding, whereas higher education and being on leave from work were associated with a longer duration of breastfeeding. Study findings suggest suboptimal levels of exclusive and any breastfeeding and difficulty maintaining longer breastfeeding duration. CD and smoking are common in Greece and are strong negative predictors for breastfeeding initiation and/or duration, necessitating targeting women at risk early in the prenatal period so as to have a meaningful increase of breastfeeding practices in future cohorts of mothers.     

Breastfeeding in the workplace

More than 50% of women of reproductive age are employed, and most return to work post partum at a time when exclusive breastfeeding is the ideal. Public health efforts target a goal of increased breastfeeding initiation and duration rates. To be successful at integrating the roles of breastfeeding mother and employee, women need practical advice, the encouragement and support of health care providers, and societal and workplace support. This article discusses the current state of employed breastfeeding women and provides practical guidelines for assisting women to be successful at meeting breastfeeding goals.     

Predictors of breastfeeding exclusivity among migrant and Canadian‐born women: results from a multi‐centre study

The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian‐born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post‐partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post‐partum. Among migrant women, factors predictive of breastfeeding exclusivity included non‐refugee immigrant or asylum‐seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender‐related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post‐partum. Among Canadian‐born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post‐partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian‐born women was not exclusively breastfeeding at 1 week post‐partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.     

The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to 1 year post‐partum. However, it is currently unclear whether these findings extend to specific countries with resource‐rich environments. This mixed‐methods systematic review aims to (a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the United Kingdom (UK) and (b) explore the experiences and views of women receiving BFI‐compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Two quantitative studies indicate that Baby Friendly Hospital Initiative implementation has a positive impact on breastfeeding outcomes up to 1 week post‐partum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (n = 3) on breastfeeding up to 8 weeks post‐partum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer term breastfeeding and wider maternal and infant health outcomes in the UK. A meta‐synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI‐compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource‐rich settings.     

Severe maternal morbidity and breastfeeding outcomes in the early post‐natal period: a prospective cohort study from one English maternity unit

Previous research has identified potential issues of establishing and maintaining breastfeeding among women who experience severe maternal morbidity associated with pregnancy and birth, but evidence in the UK maternity population was scarce. We explored the association between severe maternal morbidity and breastfeeding outcomes (uptake and prevalence of partial and exclusive breastfeeding) at 6 to 8 weeks post‐partum in a UK sample. Data on breastfeeding outcomes were obtained from a large cohort study of women who gave birth in one maternity unit in England to assess the impact of women's experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe hypertensive disorder or high dependency unit/intensive care unit admission) on their post‐natal health and other important outcomes including infant feeding. Results indicated that among women who responded (n = 1824, response rate = 53%), there were no statistically significant differences in breastfeeding outcomes between women who did or did not experience severe morbidity, except for women with severe hypertensive disorder who were less likely to breastfeed either partially or exclusively at 6 to 8 weeks post‐partum. Rather, breastfeeding outcomes were related to multi‐dimensional factors including sociodemographic (age, ethnicity, living arrangement), other pregnancy outcomes (neonatal intensive care unit admission, mode of birth, women's perceived control during birth) and post‐natal psychological factors (depressive symptoms). Women who experience severe maternal morbidity can be reassured that establishing successful breastfeeding can be achieved. More studies are required to understand what support is best for women who have complex health/social needs to establish breastfeeding.     

Association between maternal prepregnancy obesity and breastfeeding duration: Data from a nationwide prospective birth cohort

Association of maternal obesity with shorter breastfeeding duration may involve different factors and might be modified by parity. In a national birth cohort, we aimed to estimate the association between prepregnancy body mass index (pBMI) and breastfeeding duration after adjustment for sociodemographic, pregnancy, and other characteristics and assess the effect modification of parity in such associations. In 2012, 3,368 mother–infant dyads were randomly included at birth in the French Epifane cohort. Breastfeeding information was collected in maternity wards and by phone interview at 1, 4, 8, and 12 months postpartum. Poisson regression analyses estimated the association of pBMI with the number of days of “any breastfeeding” (ABF) and “exclusive breastfeeding” (EBF) in unadjusted and adjusted models. Interactions between parity and pBMI were tested. Obesity before pregnancy was independently associated with shorter ABF duration (incidence rate ratio [IRR] = 0.86, 95%CI [0.74, 0.99]) compared to normal‐weight status. Parity showed an effect modification only with EBF duration. Among primiparae, no association was found for obesity, but overweight was significantly associated with shorter EBF duration independently of all covariates (IRR = 0.74 [0.58, 0.95]). Among multiparas, obesity was associated with shorter EBF duration after controlling for sociodemographic factors (IRR = 0.71 [0.53, 0.95]). This association was no longer statistically significant after controlling for other covariates. Obesity appears to be a strong risk factor in shorter ABF duration. Furthermore, parity is a key factor in the relationship of pBMI to shorter EBF duration. Overweight primiparous and obese multiparous women need additional support to prolong breastfeeding duration.     

Breastfeeding experiences and support for women who are overweight or obese: A mixed‐methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.     

Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal,qualitative study

Obese women are at risk for shorter breastfeeding duration, but little is known about how obese women experience breastfeeding. The aim of this study was to understand obese women's breastfeeding experiences. We enrolled pregnant women in upstate New York, who were either obese [n = 13; body mass index (BMI) ≥30 kg/m²] or normal weight (n = 9; BMI 18.5–24.9 kg/m²) before conception and intended to breastfeed. A longitudinal, qualitative study was conducted from February 2013 through August 2014 with semi‐structured interviews during pregnancy and at specific times post‐partum through 3 months. Interviews were audio recorded, transcribed and analyzed using content analysis. Themes that emerged in analysis were compared between obese and normal‐weight women. Differences were identified and described. Prenatally, obese women expressed less confidence about breastfeeding than normal‐weight women. Post‐partum, obese women and their infants had more health issues that affected breastfeeding, such as low infant blood glucose. Compared with normal‐weight women, they also experienced more challenges with latching and positioning their infants. Breastfeeding required more time, props and pillows, which limited where obese women could breastfeed. Obese women also experienced more difficulty finding nursing bras and required more tangible social support than normal‐weight women. In conclusion, obese women experienced more challenges than women of normal weight; some challenges were similar to those of normal‐weight women but were experienced to a greater degree or a longer duration. Other challenges were unique. Obese women could benefit from targeted care prenatally and during the hospital stay as well as continued support post‐partum to improve breastfeeding outcomes. © 2016 John Wiley & Sons Ltd     

Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post‐partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post‐partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio‐economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed‐effects models. The average cumulative weight loss at 6 months post‐partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post‐partum. After adjustment, the data indicated that for every 1‐point increase in breastfeeding score, the estimated average post‐partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post‐partum weight loss at all stages of the study during the 24‐month follow‐up.     

The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results

The UK has low breastfeeding rates, with socioeconomic disparities. The Assets‐based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets‐based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention – delivered through face‐to‐face, telephone and text message by trained Infant Feeding Helpers (IFHs) – ran from 30‐weeks' gestation until 5‐months postnatal. Outcomes included recruitment rates and follow‐up at 3‐days, 8‐weeks and 6‐months postnatal, with collection of future full trial outcomes via questionnaires. A mixed‐methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow‐up rates were 68.0%, 85.4% and 80.6% at 3‐days, 8‐weeks and 6‐months respectively. Breastfeeding at 8‐weeks was obtained for 95.1% using routine data for non‐responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention‐related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.     

Delivery mode and breastfeeding outcomes among new mothers in Nicaragua

Breastfeeding has been shown to benefit infants and mothers. Women who have caesarean deliveries (C‐sections) are expected to be less likely to initiate and continue breastfeeding than those who have vaginal deliveries. Given the high rate of C‐sections in Nicaragua, the importance of breastfeeding, and the centrality of culture in choices about breastfeeding, this study sought to examine if mode of delivery relates with breastfeeding initiation and exclusivity in Nicaragua. Two hundred fifty mothers were surveyed about birth experiences and breastfeeding behaviour in 3 public clinics in León, Nicaragua, between June and August 2015. Logistic regression analyses were performed to examine the association of mode of delivery with initiation of breastfeeding within 1 hr of birth (early initiation) and exclusive breastfeeding for 6 months post‐partum. The rate of early initiation was 68.8% and that of exclusively breastfeeding for 6 months was 12.7%. Mode of delivery was not significantly associated with early initiation (p = .383) or exclusive breastfeeding (p = .518). Early initiation was negatively associated with prelacteal feeding, AOR = 0.30, 95% CI [0.16, 0.58]; p = .001. Mothers who had perceived their infants as large at birth were significantly less likely to exclusively breastfeed for 6 months, AOR (95%CI) = 0.25 (0.06–0.97); p = 0.046. Mode of delivery was not significantly associated with optimal breastfeeding initiation and exclusivity among mothers in Nicaragua. The 2 risk factors identified for delayed initiation of breastfeeding and lack of exclusive breastfeeding were prelacteal feeding and maternal perception of a large infant at birth, respectively.     

Why women don't breastfeed: a national survey

Breastfeeding is a behaviour that is influenced by many complex factors and confounders. Various social and psychological factors may thus be missed in studies of the prevalence and duration of breastfeeding. The prevalence of breastfeeding is extremely high in the rich Scandinavian countries where the mothers are given paid maternity leave for at least one year.

Conclusion: National and international women's organizations could improve the conditions for breastfeeding by pressing for a prolongation of the period of maternity leave worldwide.     

Measuring exclusive breastfeeding social support: Scale development and validation in Uganda

The World Health Organization recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather they assess social support for any breastfeeding. Further, they are tailored towards high‐income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low‐income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes' Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda, at 1 (n = 238) and 3 (n = 237) months post‐partum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items and exploratory factor analysis at 1 month post‐partum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3 months post‐partum. We then conducted tests of predictive, convergent, and discriminant validity against EBF, self‐efficacy, general social support, and depression. The modification of the Hughes' scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional, and Informational, with alpha coefficients of 0.79, 0.85, and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was supported. The EBFSS scale is valid and reliable for measuring EBFSS in northern Uganda and may be of use in other low‐income settings to assess determinants of EBF.     

Community‐based father education intervention on breastfeeding practice—Results of a quasi‐experimental study

Although the benefits of breastfeeding are well‐documented, little is known about how best to encourage fathers to support breastfeeding. A quasi‐experimental study of a community‐based intervention was designed to examine whether health education to promote fathers' involvement in supporting women is associated with early initiation and exclusive breastfeeding practices. At baseline, 802 couples of fathers with pregnant wives from 12 to 27 weeks of gestational age were recruited to either the intervention group (n = 390) or a control group (n = 412) consisting of couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education and counselling services in health facilities and at home visits during the antenatal, delivery, and post‐partum periods. Peer education and social exchange concerning breastfeeding were organized in fathers' clubs. After 1 year of the intervention, mothers in the intervention group were more likely to initiate early breastfeeding 49.2 and 35.8% in the intervention and control group respectively, P < 0.001. At 1, 4, and 6 months after birth, 34.8, 18.7, and 1.9% of the mothers in the intervention group were exclusively breastfeeding their children because of birth, respectively, compared with 5.7, 4.0, and 0.0% of those in the control group (P < 0.001). Those practices were associated with the intervention in bivariate and multivariate logistic and Cox regression analyses. Intervention targeting fathers at antenatal and postnatal periods may positively influence the breastfeeding practices of mothers, and it should be an important component of breastfeeding programs.     

Exclusive breastfeeding among working mothers in Kenya: Perspectives from women,families and employers

Exclusive breastfeeding (EBF) for the first 6 months of life improves survival, growth and development. In Kenya, recent legislation and policies advocate for maternity leave and workplace support for breastfeeding and breast milk expression. We conducted a qualitative study to describe factors influencing EBF for 6 months among mothers employed in commercial agriculture and tourism. We interviewed employed mothers (n = 42), alternate caregivers and employed mothers'' husbands (n = 20), healthcare providers (n = 21), daycare directors (n = 22) and commercial flower farm and hotel managers (n = 16) in Naivasha, Kenya. Despite recognizing the recommended duration for EBF, employed mothers describe the early cessation of EBF in preparation for their return to work. Managers reported supporting mothers through flexible work hours and duties. Yet, few workplaces have lactation spaces, and most considered adjusting schedules more feasible than breastfeeding during work. Managers and healthcare providers believed milk expression could prolong EBF but thought mothers lack experience with pumping. The most frequently suggested interventions for improving EBF duration were to expand schedule flexibility (100% of groups), provide on‐site daycare (80% of groups) and workplace lactation rooms (60% of groups), improve milk expression education and increase maternity leave length (60% of groups). Returning to work corresponds with numerous challenges including lack of proximate or on‐site childcare and low support for and experience with milk expression. These factors currently make EBF for 6 months unattainable for most mothers in these industries. Interventions and supports to improve breastfeeding upon return to work are recommended to strengthen employed mothers'' opportunity for EBF.     

Early postpartum discharge and breastfeeding: An observational study from France

Background: Early postpartum discharge is a recent practice in France, but the influence of a shortened hospital stay on subsequent breastfeeding is unknown. The objective of the present study was to compare the breastfeeding mode after early discharge (ED) and conventional discharge (CD) from a hospital maternity unit. Methods: An observational study was conducted in a French university hospital among 135 breastfeeding mothers, who delivered between 1 January and 31 July 2006. Forty‐five ED mothers were matched with 90 CD mothers on 13 criteria. A structured questionnaire was used to collect data regarding feeding practices at 10 weeks postpartum, the period corresponding to paid maternity leave. Results: Exclusive breast‐, mixed, and bottle feedings were reported by, respectively, 35 (77.8%), three (6.7%) and seven (15.5%) ED mothers and 64 (71.1%), 12 (13.3%) and 14 (15.6%) CD mothers (no significant differences). Satisfaction with support for breastfeeding and reasons for switching to mixed or bottle feeding were comparable in the two groups. Multivariate analysis indicated that only the planned duration of breastfeeding and the mother's dissatisfaction with help significantly influenced breastfeeding prevalence. Conclusions: Early postpartum hospital discharge organized by skilled professionals is compatible with a satisfactory rate of exclusive breastfeeding up to the return to work. Formalized programs of instruction for perinatal professionals would help to reduce early abandonment.     

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge

AIM: To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS-R). The original instrument has well-established psychometrics for use in English-speaking countries. METHODS: Questionnaires including demographics and items about prior pregnancy and opinions about breastfeeding in public were administered to women in Cluj-Napoca, Romania, attending antenatal clinic (n = 336) and to a separate cohort of mothers within 24 h of delivery (n = 276). Postpartum follow-up was conducted with a sample of maternity cohort subjects who initiated breastfeeding in the hospital (n = 52). RESULTS: Internal consistency was adequate in both cohorts (antenatal alpha= 0.50; maternity alpha= 0.63), with improved reliability for antenatal multigravid (alpha= 0.60) and university-educated women (alpha= 0.57). Score distributions were comparable and item means were approximately central across cohorts. Among pregnant women, higher scores (more positive towards breastfeeding) were associated with longer planned maternity leave (chi2= 17.8; p = 0.02). Higher maternity cohort scores were associated with age (r = 0.31, p = 0.003), urban residence (chi2= 10.2, p = 0.04), breastfeeding a prior infant for at least 6 weeks (chi2= 6.4, p = 0.04), and with intending to breastfeed for at least 6 weeks (chi2= 4.7, p = 0.03). Postpartum women still breastfeeding at follow-up also scored higher (chi2= 9.3, p = 0.009). CONCLUSION: This is the first study to report on use of the IIFAS in Eastern Europe. The IIFAS-R is easy to administer, reliable and valid in Romania. The IIFAS-R can support data collection to promote and assess breastfeeding initiatives consistent with World Health Organization recommendations.     

Online participatory intervention to promote and support exclusive breastfeeding: Randomized clinical trial

The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post‐partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother–child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow‐up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.     

Making use of expertise: a qualitative analysis of the experience of breastfeeding support for first‐time mothers

There is now a body of research evaluating breastfeeding interventions and exploring mothers' and health professionals' views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first‐time mothers in the United Kingdom on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio‐diaries at two time points during the first 5 weeks post‐partum. We discuss a key theme within the data of ‘Making use of expertise’ and three subthemes that capture the way in which the women's orientation towards those assumed to have breastfeeding expertise varied according to whether the women (1) adopted a position of consulting experts vs. one of deferring to feeding authorities; (2) experienced difficulty interpreting their own and their baby's bodies; and (3) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and ‘normalising gaze’ of health care professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person‐centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way.     

Working mothers and early childhood outcomes: lessons from the Canadian National Longitudinal Study on Children and Youth

BACKGROUND: More mothers are choosing to return to work during the first 2 years of their child's life with an uncertain impact on early developmental outcomes. AIMS: To determine the association between duration of maternity leave and motor and social development of toddlers. STUDY DESIGN: Population-based, retrospective cohort study. SUBJECTS: The Canadian National Longitudinal Survey on Children and Youth (NLSCY) Cycle 3 provides data on the characteristics and life experience of Canadian children. For sampled households, the person most knowledgeable about the child completed a survey on demographics, parent characteristics and family environment. The analysis was limited to 6664 families with children up to 2 years. OUTCOME MEASURES: Logistic regression was used to assess the association between duration of maternity leave and impaired performance (<-1 SD below the mean) on the Motor and Social Development (MSD) scale adjusted for multiple covariates including maternal age, gender, breastfeeding and socioeconomic status. RESULTS: One month of maternity leave increased the odds of impaired performance on the MSD by 3% (OR 1.03, 95% CI 1.02, 1.04). This was also seen with categorized maternity leave duration. Being male (OR 1.53, 95% CI 1.35, 1.74) and having a younger mother (OR 1.48, 95% CI 0.98, 2.23) increased the risk of impaired performance on the MSD while being of higher SES reduced the risk (OR 0.96, 95% CI 0.93, 1.00). CONCLUSIONS: There is an association between duration of maternity leave and impaired performance in motor and social development in children up to 2 years.