Breastfeeding and weaning practices in Bahrain: the role of mothers' education

This rapid assessment survey was undertaken to find out the current practices of infant feeding in Bahrain and the impact of educational level of the mothers on these practices. A total sample of 200 Bahraini mothers of children less than 2 years were interviewed in the health centers. The age of mothers ranged from 18 to 47 years. About one third of mothers (39.8%) initiated breastfeeding at the first hour of delivery, and there was no significant association between education of mothers and initiating of breastfeeding. Most infants were placed in the same bed as their mothers (71%), however the proportion was lower among infants with high education (61.8%) compared to low (73.7%) and middle (72.5%) education mothers. The introduction of foods during the first 3 days of the infant's life as well as the practising of breastfeeding on schedule increased with the increased of educational level of mothers. Highly educated mothers tended to introduce rice, wheat, infant formula and fruit at an earlier age of the infant's life than other education groups. The study demonstrates an improvement in infant feeding practices during the last decade. However, the practice of sound infant feeding was less among highly educated mothers when compared to low and middle education mothers. This is mainly due to socio-economic factors rather than lack of awareness.     

Design and implementation of a citywide breastfeeding promotion program: the New York City approach

Breastfeeding has regained more popularity in the US since 1970, but there has been a definite disparity in its resurgence among minority, poor, and less educated mothers. This article outlines the history of breastfeeding prevalence in the US and New York City as an introduction to explaining the design and implementation of New York City's breastfeeding promotion program. In 1982, the Steering Committee to Promote Breastfeeding in New York City was generated and it designed task forces to address each of their defined barriers to breastfeeding promotion (e.g. lack of relevant data, centralized compilation, data analysis, health care professional education, inhibitory practices by hospitals and ambulatory services, public misinformation, and unsupportive public policy). The Research Task Force, Professional Education Task Force, Hospital Practices Task Group, Policy and Legislation Task Group, and Public Information Task Group were outlined and some policies, strategies, and practices they have enacted were described. Some of their accomplishments include: educational kits on breastfeeding for health care professionals, guidelines for work-site health and nutrition programs for pregnant and lactating workers, research on the economics of breastfeeding, breastfeeding information posters on the subway, and establishment in 1984 of a breastfeeding coordinator in each municipal hospital. These strategies demonstrate a successful model for breastfeeding promotion in large urban areas as seen by the rise in breastfeeding at the time of newborn discharge from New York City hospitals.     

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6% practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3% of the mothers, and 64% of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27% of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.     

What New Mothers Need to Know: Perspectives from Women and Providers in Georgia

Identifying the educational and resource needs of new mothers is of paramount importance in developing programs to improve maternal and child health outcomes. The primary purpose of this study was to explore the educational needs of new mothers and identify opportunities to enhance healthcare providers’ current educational efforts. A two-part methodology was utilized to qualitatively explore the topic of parenting information needs for new mothers in Georgia. Data collection included information from 11 focus groups with 92 first-time, new mothers and 20 interviews with healthcare providers who serve new mothers. Discussions with both new mothers and providers clearly indicated that new mothers face a significant informational deficit, especially regarding very basic, daily infant care information and health literacy challenges. Educational materials already exist; however, mothers report difficulty accessing and understanding this information. For this reason, both the mothers and the providers stressed a focus on developing programs or interventions that allow in-person education and/or alternative modalities to access information, as opposed to development of new written materials solely. Information from the focus group and interviews provided important insight regarding what improvements need to be made to help new mothers and their families during the early stages of parenthood. By improving the education of new mothers and their families, it is proposed that maternal and infant health status could be improved.     

深圳市6个月内婴儿母亲纯母乳喂养知信行及手机利用需求调查

目的 了解深圳市6个月内婴儿母亲纯母乳喂养知信行情况,并根据婴儿母亲手机利用需求提出方便、有效、可行、易于接受的有针对性的健康教育干预措施.方法 随机抽取在深圳市3个区妇幼保健院儿保科进行6个月内儿童常规体检的婴儿母亲1000名进行问卷调查.结果 6个月内纯母乳喂养率为61.2%,非纯母乳喂养主要原因为自述母乳不足(42.01%),按需哺乳知识知晓率最低(47.7%),母乳喂养知识主要来源为医务人员(50.1%),纯母乳喂养组与非纯母乳喂养组在母乳喂养信心(χ2=7.131,P=0.008)、家人支持(χ2=5.648,P=0.017)、开奶时间(χ2=45.083,P<0.01)、母婴同室(χ2=19.765,P<0.01)、夜间哺乳(χ2=15.666,P<0.01)方面比较,差异有统计学意义.调查显示86.8%的婴儿母亲愿意通过手机接收母乳喂养知识.结论 为进一步提高6个月内纯母乳喂养率,医务人员应加强母乳喂养宣教,鼓励产妇家属共同参与,增强产妇母乳喂养信心,用工单位提供便利支持母乳喂养,医院落实爱婴医院政策,发挥手机快捷、互动平台作用进行母乳喂养健康教育干预.     

The success of breast feeding

Breastfeeding is a natural and unique system of supply and demand, which best serves both the mother and baby. It is not difficult; it is the attitudes toward breastfeeding that have created problems. Breastfeeding is an art that can be learned, and its skills can and should be made available to every mother who plans to breastfeed. Each mother requires individual teaching in the practicalities of breastfeeding to suit her particular needs and to achieve successful breastfeeding. Regard is paid to the mother's physique and the shape and size of her breasts so that the infant may be correctly positioned. This helps to prevent the development of sore nipples. Breastfeeding ought to be initiated as soon as practical after birth. Demand feeding should continue, taking into account the size and maturity of the baby. The duration of the feeds can be determined by the baby. Rigid timing of feeds leads to reduced efficiency of lactation, and the tension of "clock watching" makes for a fractious baby. Midwives and health workers should assess whether a baby is thrivinge without making the mother anxious by test weighing. A baby is not necessarily hungry when he/she cries, and mothers can be encouraged to assess their babies' needs. Once the basic physiology of breastfeeding has been explained, mothers are their own best therapists. Their need is for a calm individual to sit with them for the duration of an early feed, encouraging them to assess the situation and allowing them time to relax and adjust to their new role. Stress or anxiety in a mother can inhibit the "let down" reflex which releases the milk as the baby feeds. So anxiety results in a hungry baby and a mother who believes she cannot produce sufficient milk. Many mothers have found the continuity of 1 adviser on infant feeding a great support. On returning home this link is maintained over the telphone, where this is available. Often the query may appear minor to the health worker, but to the mother it may help her on the road to successful breastfeeding. Owing to a general lack of public facilities in British towns where mothers can breastfeed, the mothers must delay or cut short their outings in order to breastfeed at home. This added pressure can impede the "let down" reflex. The breastfeeding mother who works is under similar pressures. Possibly recognition of the problem, understanding that there is a maternal desire to breastfeed, and encouraging the mother to succeed, attitudes as professionals and as members of society can be improved.     

Insights in Public Health: Healthy Mothers Healthy Babies: Awareness and Perceptions of Existing Breastfeeding and Postpartum Depression Support among Parents and Perinatal Health Care Providers in Hawai'i

Healthy Mothers, Healthy Babies Coalition of Hawai‘i (HMHB) is a local nonprofit organization dedicated to eliminating health disparities and improving Hawai‘i''s maternal, child, and family health though collaborative efforts in public education, advocacy, and partner development. A review of HMHB services revealed overwhelming requests for both breastfeeding and postpartum depression (PPD) support. The purpose of this article is to present the findings of two surveys that highlight the awareness of existing breastfeeding and PPD resources based on both parents and health care providers; perceptions of where and how care is accessed; and whether mothers throughout Hawai‘i have equitable access to support. Results helped assess gaps in resources and determine barriers to care, as well as provide suggestions for new services or resources.Web-based surveys were sent to 450 providers and 2,955 parents with response rates of 8.9% and 4.0%, respectively. Less than half of parent participants reported that their health provider discussed PPD with them. Participants identified a number of barriers to increasing access and utilization of PPD support resources, including: not feeling like symptoms were server enough, feeling embarrassed to seek help, not knowing where to find support/information, and not able to afford or insurance wouldn''t cover PPD support. Only 40% of providers reported screening for PPD and 33% felt they had not received adequate training. Barriers identified by providers were a lack of trained providers, lack of PPD specific support groups, cultural stigma, and lack of PPD awareness among providers.Of the women who did not exclusively breastfeed for the full six-month recommendation, the most common breastfeeding concerns included: perceptions of low milk supply; lack of lactation support; medical reasons; and pain. Providers described an environment of uneven distribution of resources, general lack of awareness of available resources, along with a widespread lack of support for breastfeeding efforts.Recommendations for future efforts include comprehensive breastfeeding and PPD training for health care providers enhanced support groups, and improving awareness and access to information and support resources.     

Breastfeeding prevalence and practices among Singaporean Chinese, Malay and Indian mothers

The National Breastfeeding Survey 2001 was the first comprehensive study on breastfeeding conducted on a national level in Singapore. It aimed to establish the prevalence of breastfeeding among Chinese, Malay and Indian mothers and to identify factors influencing breastfeeding. A total of 2098 mothers were interviewed in this two-phase study, with the first interview conducted 2 months after delivery and the second interview 6 months after birth among mothers who were still breastfeeding at 2 months. Frequency distributions of breastfeeding prevalence and types of breastfeeding practices at different time intervals (from birth to 6 months) were produced. Multivariate logistic regression was carried out to construct a model with predictive information on factors which influence continued breastfeeding till 2 months and 6 months after delivery respectively. The study found that about 94.5% of the mothers attempted breastfeeding. At 1 month, 71.6% were still breastfeeding, 49.6% continued to do so at 2 months, and 29.8% persisted till 4 months. By 6 months, the breastfeeding prevalence rate fell to 21.1%. The results of this study show higher breastfeeding prevalence rates compared to past studies in Singapore. Despite this, exclusive breastfeeding is still not a common practice. Various factors were found to be significant in influencing mothers' decision to breastfeed. Factors such as ethnicity, age, educational attainment, religion and baby's sex are non-modifiable in the short term or at an individual level. However, factors such as awareness of breastfeeding benefits, advice from health professionals and previous breastfeeding experience are potentially modifiable. Efforts aimed at promoting breastfeeding in Singapore need to take these modifiable factors into consideration so as to better tailor health promotion efforts on breastfeeding to women.     

Long-Term Breastfeeding Support: Failing Mothers in Need

This qualitative study analyzes mothers’ reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child’s first year. A convenience sample of 75 black and white WIC participants with infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers' comprehensive experiences of breastfeeding education and support from pregnancy through the interview date. Most mothers received education or support from a medical professional prenatally, at the hospital, or during the child’s infancy, but most also reported receiving no education or support at one or more of these stages. Mothers often felt provided education and support was cursory and inadequate. Some mothers received misinformation or encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not given referrals to available resources, even after reporting breastfeeding challenges. Mothers received inconsistent messages regarding breastfeeding within and across institutions. Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals. Medical professionals should follow guidelines issued by their own organizations as well as those from the US Surgeon General, Healthy People 2020, and the Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should coordinate to provide consistent messages and practices within and across sites of care.     

Exploring the Concept of Positive Deviance Related to Breastfeeding Initiation in Black and White WIC Enrolled First Time Mothers

Positive deviance inquiry is effective in identifying advantageous health behaviors and improving health outcomes among disadvantaged resource-poor populations. The objective of this study was to apply the positive deviance concept to explore the characteristics of positive deviants for breastfeeding among WIC-enrolled first-time mothers in Louisiana. The cross sectional study included data on 2,036 WIC-enrolled first time mothers (52.6% black) from the LaPRAMs, 2000?C2004. Chi-square test was used to compare groups. Multivariable logistic regression was applied to calculate adjusted OR and 95% CI by breastfeeding initiation status. The average age was 21.3?years, 31.5% had less than 12?years of education, and 44.6% of the sample reported having initiated breastfeeding. Black mothers were less likely to initiate breastfeeding than their white counterparts (OR 0.39 (95% CI: 0.31, 0.48)). Among 641 WIC-enrolled first time mothers with less than 12?years of education, 28.4% were identified as positive deviants for breastfeeding initiation. Among the black mothers 19.8% were positive deviants compared to 40.3% of the white mothers. Breastfeeding in the hospital after delivery (P?<?0.0001) and having received help on how to breastfeed in the hospital (P?<?0.0001) were significantly associated with breastfeeding initiation in white and black mothers. In addition, the black positive deviants were more likely, OR 2.80 (95% CI: 1.20, 6.56) to have initiated breastfeeding if their baby was low birth weight. Breastfeeding practices shortly after delivery including assistance and education from staff in the hospital, are related to breastfeeding initiation among less educated WIC-enrolled mothers.     

Mother's difficulties in breastfeeding premature babies at a neonatal ICU

This study aimed to describe the care and difficulties mothers face when breastfeeding their premature babies at a neonatal intensive care unit (ICU). Therefore, a qualitative approach was adopted. Data were obtained through structured interviews, which were recorded with five mothers of premature babies under 2,000 g who were assisted at the neonatal ICU in Cuiabá-MT, Brazil. The results revealed five subthemes: maintaining milk production by milking, facing discomfort during the stay at the neonatal ICU, living with medical food procedures for premature babies, facing the fragility of the premature baby and the neonatal ICU environment and needing logistic support for breastfeeding. A lack of systematic interventions was observed to stimulate breastfeeding while mothers and their premature babies are in hospital. Hospital professionals need to be trained and intervention protocols have to be implanted, in view of the maternal experiences and needs and the articulation between intrahospital and interinstitutional actions.     

Factors affecting the duration of breastfeeding in a rural population of Saudi Arabia.

A study was conducted to demonstrate factors influencing duration of breastfeeding in Al-Jamoom Western region of Saudi Arabia. Information was obtained on 476 children under the age of three years and their mothers in nine of the villages in this area. A predesigned questionnaire was administered to the mothers to obtain information on age, education, fertility parameters and antenatal care during pregnancy with the index children. Multiple regression analysis was used to analyze the effect of different biological and environmental factors on the duration of breastfeeding. The data showed that over 57% of the mothers breastfed their children for more than a year, and the mean duration of breastfeeding was 14.61 +/- 3.53 months. A considerable proportion of the mothers (42.3%) stopped breastfeeding during the first year. The most common reason for terminating breastfeeding during the first year was insufficient milk (30.9%), and recurrence of pregnancy (27.3%). A minority of the mothers (6.5%) were given advice about breastfeeding by health care professionals (physicians and nurses). Other factors such as the age of the mother, age of the infant when a supplement diet was first introduced, birth order of the child and attendance in an antenatal care clinic had a significant effect on the duration of breastfeeding. It is therefore recommended that Maternal and Child Health services must be strongly reinforced in the Primary Health Care Centers of the Ministry of Health and other health care providers.     

Predictors of health in new mothers.

This survey study was conducted to determine the variables that predict mothers' mental health, work readiness, and use of health services several weeks after they give birth to, or adopt a baby. Regression analyses on 313 married women (108 first-time adoptive mothers, 72 first-time biological mothers, and 133 controls) showed a strong link between biological mothers' postpartum health and their infants' health; this relationship was not observed for adoptive mothers and their infants. Biological mothers' postpartum health problems were also related to their smoking, fatigue, and current work at a job; further, their readiness to work at a job two months postpartum was greater if they were in good general health, had not had a cesarean section, and were not currently breastfeeding. The results suggest that many mothers continue to have unique health needs several weeks after delivery and, if substantiated by future studies, these findings may have implications for postpartum health care practices and for maternity leave policy.     

教练式培训在新生儿早期基本保健技术推广中的应用及效果评价研究

目的 研究教练式培训在新生儿早期基本保健技术推广中的应用及效果,为今后临床开展各项培训提供新的方法和思路。方法 在北京、陕西省和四川省各选择1所省级医疗保健机构和1所地市级医疗保健机构作为试点单位,医务人员接受2 d教练式培训,比较研究对象培训前后新生儿保健理论知识的得分、洗手情况以及对于出生时有自主呼吸和无自主呼吸新生儿临床操作技能的得分情况。培训3个月后,每个试点医院随机抽样10名产妇进行出院前访谈,分析干预后各项新生儿保健措施的实施情况。结果 培训后医务人员的理论知识得分(16.82±1.00)较培训前显著提高(11.90±2.68)(P<0.001)。三省及总体培训后洗手操作技能均提高,手部清洁程度显著改善(P<0.001)。培训后有呼吸和无呼吸新生儿操作技能得分中位数分别为41分和58分。培训3个月后,87%(52/60)的产妇分娩后进行了母婴皮肤接触,分娩后1 min内开始母婴皮肤接触率为55%(33/60),皮肤接触持续90 min的占47%(28/60);出院前母乳喂养率达到77%(46/60),纯母乳喂养率为48%(29/60)。结论 新生儿早期基本保健技术的教练式培训方法效果较好,培训后医务人员能迅速掌握正确的操作技能,有利于促进新技术在临床上的推广和使用。     

Supporting mothers to breastfeed: the development and process evaluation of a father inclusive perinatal education support program in Perth, Western Australia

Entry into fatherhood is a challenging period with new responsibilities and changes in family dynamics. Hegemonic imagery of men portray them as capable, confident and able which can disadvantage expectant fathers who often struggle to make sense of the changes occurring around and within their own parenting journey. Although fathers historically have not been included in breastfeeding classes, antenatal education programs can be an opportunity to inform and support them in their new role. Forty-five antenatal sessions for fathers (n = 342) of 1h duration were conducted by five male educators between May 2008 and June 2009 in Perth, Western Australia. A theoretical framework from health promotion literature was used as a guide in the program's development. Fathers in the intervention group gained information about their role, the importance of communication and the benefits of breastfeeding to both mother and baby. An evaluation was obtained from fathers immediately after the session and again at 6 week post-birth, whilst mothers reported on the perception of their partners' support for breastfeeding in the 6 week survey. The aim of this paper is to describe the development and process evaluation of a perinatal education and support program for fathers to assist their partners to breastfeed.     

Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care

Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother–baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period.     

婴幼儿母乳喂养持续时间的影响因素研究——基于广州市越秀区抽样调查研究

目的 了解一线大城市母乳喂养现状,探讨影响母乳喂养时间的因素,为相关卫生法规的制定、社区宣教内容和模式的确定提供参考依据.方法 通过编制调查问卷对广州市越秀区3岁以下婴幼儿母亲进行抽样调查(共调查383人).利用生存分析的方法分析母乳喂养持续时间,通过Log-rank检验进行单因素分析,运用Cox比例危险模型分析影响母乳喂养持续时间的因素.结果 所调查的383名3岁以下婴幼儿母乳喂养持续时间的中位数为7个月.多因素分析显示,婴儿能否顺利吸食母乳(P=0.002)、是否过早给婴儿添加奶粉(P<0.0001)以及母亲对母乳喂养的认知程度(P=0.0025)显著影响母乳喂养持续时间;母亲对合理母乳喂养时间的认可(P<0.001)以及非城市户籍(P=0.002)会延长母乳喂养持续时间;此外,母亲文化程度较低和较高的婴幼儿母乳喂养时间较长.结论 母亲正确的母乳喂养意识在婴儿喂养中起到至关重要的作用;参加母乳喂养培养班有助于增强母亲对母乳喂养的认知;建议对中等学历和城市户籍的母亲进行有针对性的宣教,并制定相关保护性的政策法规.     

The influence of psychosocial factors on the duration of breastfeeding

AIM: A study was undertaken to examine to what extent psychosocial factors are related to the length of breastfeeding. METHODS: A cohort of Danish mothers giving birth to a single child was followed up for four months. Information on mother and baby including psychosocial variables was obtained from a self-report questionnaire. Breastfeeding status was subsequently monitored by a health visitor. RESULTS: A total of 471 (88%) mothers participated, 98.7 % initiated breastfeeding and after four months 277 (59%) were still exclusive breastfeeding; 99 mothers, 51% of those who stopped, stopped within the first five weeks. In Cox regression analyses the duration of breastfeeding showed a positive association with mother's schooling (p=0.002), her intention to breastfeed (p=0.001), previous experience with breastfeeding (p<0.001), self-efficacy with respect to breastfeeding (p<0.001), her confidence in breastfeeding (p=0.012) and knowledge about breastfeeding (p=0.001). The effect of the mother's knowledge depended on the parity of the child. Among primiparous mothers high knowledge was associated with long duration of breastfeeding, but this association was not found among the multiparous. CONCLUSIONS: To help the mothers who would like to breastfeed their baby, we must improve our ability to identify mothers at risk of early cessation. Mother's schooling, her intention, self-efficacy and earlier breastfeeding experience can be used as early predictors. An intervention should aim at improving the self-efficacy and resources of these mothers, with a focus on practical knowledge. The first five weeks, when the largest proportion of the cessations occurred, require special attention.