The family management of breastfeeding low birth weight infants.

Human milk plays a vital role in the health and development of low birth weight (LBW) infants, yet the initiation and duration rates of breastfeeding in this population are far below those of term infants. Families play an important role in the breastfeeding experience and therefore may contribute to the overall success or lack thereof of the experience. This qualitative study used naturalistic inquiry to describe the family management styles of 13 breastfeeding families of LBW infants. The family management style conceptual framework guided this inquiry, with management styles emerging from the families' definition of the experience and their management behaviors within their unique sociocultural context. These families described facilitating, maintaining, and obstructing family management styles. Through the identification of distinct management styles, interventions may be developed that will assist these families to achieve their breastfeeding goals.     

Impact of Baby‐Friendly Hospital Practices on Breastfeeding in Hong Kong

Abstract: Background: The World Health Organization (WHO) developed the Baby‐Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby‐Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby‐Friendly hospital practices on breastfeeding duration. Methods: A sample of 1,242 breastfeeding mother‐infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby‐Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming‐in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge. Results: Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby‐Friendly practices. After controlling for all other Baby‐Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42–0.88). Compared with mothers who experienced all six Baby‐Friendly practices, those who experienced one or fewer Baby‐Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41–6.95). Conclusions: Greater exposure to Baby‐Friendly practices would substantially increase new mothers’ chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines. (BIRTH 38:3 September 2011)     

Association between Intrapartum Interventions and Breastfeeding Duration

Introduction : Few women who reside in Hong Kong exclusively breastfeed, and one‐half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration. Methods : A sample of 1280 mother‐infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan‐Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes. Results : Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09‐1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06‐1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01‐1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08‐1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05‐1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions. Discussion : Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.     

Effectiveness of a Breastfeeding Peer Coaching Intervention in Rural Scotland

Abstract: Background: Breastfeeding initiation in Scotland in 2000 was 63 percent, compared with over 90 percent in Norway and Sweden. Although peer support is effective in improving exclusivity of breastfeeding in countries where over 80 percent of women initiate breastfeeding, the evidence for effectiveness in countries with lower initiation is uncertain. Our primary aim was to assess whether group‐based and one‐to‐one peer breastfeeding coaching improves breastfeeding initiation and duration. Methods: Action research methodology was used to conduct an intervention study in 4 geographical postcode areas in rural northeast Scotland. Infant feeding outcomes at birth and hospital discharge; at 1, 2, and 6 weeks; and at 4 and 8 months were collected for 598 of 626 women with live births during a 9‐month baseline period and for 557 of 592 women with live births during a 9‐month intervention period. Groups met in 5 locations, with 266 groups meeting in the period when intervention women were eligible to attend. Data on place of birth and length of postnatal hospital stay were also collected. Control data from 10 other Health Board areas in Scotland were compared. An intention‐to participate survey about coaching participation was completed by 206 of 345 women initiating breastfeeding. Group attendance data were collected by means of 266 group diaries. Results: There was a significant increase in any breastfeeding of 6.8 percent from 34.3 to 41.1 percent (95% CI 1.2, 12.4) in the study population at 2 weeks after birth compared with a decline in any breastfeeding in the rest of Scotland of 0.4 percent from 44 to 43.6 percent (95% CI ?1.2, 0.4). Breastfeeding rates increased compared with baseline rates at all time points until 8 months. However, the effect was not uniform across the 4 postcode areas and was not related to level of deprivation. Little difference was seen in receipt of information and knowledge about the availability of coaching among areas. All breastfeeding groups were well attended, popular, and considered helpful by participants. A minority of women (n = 14/206) participated in formal one‐to‐one coaching. Women who received antenatal, birth, and postnatal care from community midwife‐led units were more likely to be breastfeeding at 2 weeks (p = 0.007) than women who received some or all care in district maternity units. Conclusions: Group‐based and one‐to‐one peer coaching for pregnant women and breastfeeding mothers increased breastfeeding initiation and duration in an area with below average breastfeeding rates. (BIRTH 33:1 March 2006)     

ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial [ISRCTN21556494]

Background  

It has proven difficult to reach World Health Organization (WHO) recommendations that infants be exclusively breastfed from birth to six months of age [1, 2], yet there is limited knowledge about interventions that are effective in increasing breastfeeding initiation and duration. Particularly lacking is evidence about how to maintain breastfeeding rates in countries which already have a high initiation of breastfeeding. This study aims to determine whether mid-pregnancy breastfeeding education, with a focus on either attitudes to breastfeeding or on technical aspects of breastfeeding, has an effect on rates of breastfeeding initiation and duration. Secondary aims of the study are to: explore what factors might affect the duration of breastfeeding and evaluate the interventions from the participant and childbirth facilitator perspectives.     

Breastfeeding initiation rates derived from electronic birth certificate data in New Jersey.

Increasing breastfeeding initiation has been a national goal since Healthy People targets were first set in 1979. Sensitive methods used to measure incidence of breastfeeding initiation are important in the evaluation of breastfeeding trends. The authors used the statewide electronic birth certificate (EBC) as a surveillance system to measure breastfeeding initiation rates in New Jersey from 1997 to 2000. Overall breastfeeding initiation rates rose over the 4 years surveyed, yet exclusive breastfeeding rates remained stable. Trends demonstrated persistent racial and ethnic disparities in breastfeeding practices. The EBC was a valuable tool for monitoring breastfeeding initiation rates and evaluating the statewide goal of increasing exclusive breastfeeding.     

Expressed breast milk feeding practices in Hong Kong Chinese women: A descriptive study

IntroductionThere is an increasing prevalence of breast milk expression and expressed breast milk feeding in healthy full-term infants. The purpose of this study was to provide up-to-date evidence on the practice of expressed breast milk feeding and to identify factors associated with expressed breast milk feeding in Hong Kong Chinese mothers of healthy full-term infants.MethodWe used a prospective cohort study design to recruit 821 mothers who gave birth to healthy full-term infants in two public hospitals in Hong Kong. Participants completed self-administered baseline questionnaires during their postpartum stay and were followed-up by a series of telephone calls over a 6 months period or until they stopped breastfeeding, whichever came first. The proportion, mode, and type of infant feeding (direct breastfeeding, expressed breast milk feeding and infant formula feeding) were assessed at each telephone follow-up.ResultsIn our sample, 14.6%, 20.2% and 15% of the participants fed expressed breast milk only to their infants at 1.5, 3 and 6 months respectively. Less than one-half were giving only direct breastfeeding only at 1.5 and 3 months. Within the first six months postpartum, 84.6% of the participants had given expressed breast milk. More than 80% of participants obtained a breast pump before giving birth, with the majority obtaining electric pumps. The most common reason for expressing breast milk within the first 1.5 months postpartum was experiencing breastfeeding difficulties (35%). Returning to employment was the strongest predictor of expressed breast milk feeding at three months postpartum (adjusted odds ratio [aOR]=8.71, 95% Confidence interval [CI]= 5.12–14.8).ConclusionA high proportion of Hong Kong Chinese mothers of healthy, full-term infants pump and feed expressed breast milk at some point during the first 6 months postpartum. Participants purchase or obtain breast pumps before giving birth, often in anticipation of breastfeeding difficulties and returning to work.     

Comparing Sociodemographic and Hospital Influences on Breastfeeding Initiation

Abstract: Background : Healthy breastfeeding practice in the United States depends decisively on high rates of initiation at the delivery hospital. We sought to estimate the component of hospital variation in rates of exclusive breastfeeding at discharge that was dependent on demographic composition. Isolating that component can help to illuminate the potential independent contribution of hospital policies, practices, and staff behaviors. Methods : Electronic birth certificate data in New Jersey from 1996 to 2001 (n = 545,837) were used to measure variations in hospital‐level rates of breastfeeding initiation. The method of infant feeding within 24 hours before hospital discharge was reported as exclusive breastfeeding, formula feeding, combination feedings, other methods, and unknown. Rates of exclusive breastfeeding by hospital were standardized to remove sociodemographic differences in hospitals’ service populations that influence initiation rates. Results : Sociodemographic variables predicted about 60 percent of the variation in hospital‐specific rates of exclusive breastfeeding at discharge. Hospitals that were designated intensive or regional perinatal centers, delivered higher volumes of infants, and served more breastfeeding‐prone populations were only slightly more likely to have higher adjusted rates compared with other hospitals; considerable unexplained variation remained. Conclusions : Standardized exclusive breastfeeding rates pointed to the contribution of population demographics to breastfeeding initiation, and other contributions, including hospital practices, are also important. To protect, promote, and support breastfeeding, a more detailed evidence base on hospital policies and practices should be developed, and hospitals should review their policies and practices in light of documented best breastfeeding practice. (BIRTH 32:2 June 2005)     

Two Mid‐pregnancy Interventions to Increase the Initiation and Duration of Breastfeeding: A Randomized Controlled Trial

Abstract: Background : Despite high levels of breastfeeding initiation in Australia, only 46 percent of women are still breastfeeding (exclusively or partially) 6 months later, with marked differences between social groups. This study aimed to determine the influence of mid‐pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge, and on the duration of breastfeeding. Methods : A randomized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted, in which 981 primiparas who attended a public, tertiary women's hospital in Melbourne, Australia, were randomized to one of two interventions or to standard care (327 in each group). The interventions were a 1.5‐hour class on practical aspects of breastfeeding using a previously tested tool (Practical Skills), and two 1‐hour classes exploring family and community attitudes toward, and experiences of, breastfeeding (Attitudes). Both interventions took place in interactive small groups when women were in mid‐pregnancy. Breastfeeding initiation was ascertained by interview 2 to 4 days after birth, and breastfeeding duration was assessed by telephone interview 6 months after birth. Results : Neither intervention increased breastfeeding initiation or duration compared with standard care. Rates at initiation were 97 percent (296/306) for the Practical Skills intervention, 95 percent (291/308) for the Attitudes intervention, and 96 percent (297/310) for standard care. Rates at 6 months were, respectively, 55 percent (162/297), 50 percent (146/293), and 54 percent (162/299). Conclusions : In settings where breastfeeding initiation is already high, neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration.     

Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women

Background: The Baby‐Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods: Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother‐infant contact and breastfeeding practices. Results: Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby‐Friendly Hospital Initiative. Conclusion: Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.     

Long-term duration of breastfeeding in Swedish low birth weight infants.

The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (< 2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2,751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51. 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period.     

Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?

ABSTRACT: Background: A woman’s decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. Methods: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4‐hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding‐related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. Results: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03–1.69). Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates. (BIRTH 36:1 March 2009)     

Breastfeeding Trends at a Community Breastfeeding Center: An Evaluative Survey

OBJECTIVE: To evaluate the Community Breastfeeding Center's (CBC) impact on clients' breastfeeding experiences. DESIGN: Retrospective survey; participants were mailed a questionnaire. SETTING: A hospital-based drop-in center operated jointly by the Wellington-Dufferin-Guelph Health Unit and Headwaters Health Care Center and offering professional breastfeeding support and peer interaction. PARTICIPANTS: The 164 mothers of singleton births, both inpatients and community clients, who attended the CBC during a 10-month period in 1996-1997 and completed a survey. MAIN OUTCOME MEASURES: A mailed survey with forced-choice and open-ended questions. RESULTS: Of the respondents, 90.9% rated their overall CBC experience as excellent or good. Seventy-three percent of respondents breastfed for 4 months or longer. Primiparae and mothers of preterm infants tended to visit the CBC more frequently, while achieving duration rates similar to other subgroups. Returning to work was the reason most frequently cited for stopping breastfeeding (35%). CONCLUSION: The CBC is an effective community support strategy to lengthen breastfeeding duration and enhance clients' satisfaction with their breastfeeding experience.     

Initiation de l’allaitement maternel et sevrage précoce : étude prospective du réseau périnatalité Loire–Nord Ardèche

ObjectivesThe World Health Organization recommends exclusive breastfeeding of infants up to 6 months. The proportion of breastfeeding initiation and duration increased more slowly in France than in neighboring European countries. The perinatal network data are incomplete. The objective of this study is to evaluate within the perinatal network “Loire–Nord Ardèche” (ELENA), breastfeeding rates in hospital discharge and at 2 months, and identify needs for maternal support.Patients and methodsProspective and declarative study by written questionnaire, with all the women volunteers who gave birth in October 2011 in a maternity of our perinatal network.ResultsPopulation concerns 426 women volunteers of 968 new mothers. Two hundred and ninety-four questionnaires were used: 69% of women initiated breastfeeding, 63% have continued after the stay in the maternity and 50% at 2 months. Eighty percent chose to breastfeed before pregnancy, mainly for child health, 65% with the support of their spouse, 58% if their mother had breastfed. Simple pathologies of breastfeeding and childbirth were responsible for weaning. A third of women in difficulty have not consulted anyone, one third wanted more practical help and systematic support motherhood.Discussion and conclusionThe rate of initiation of breastfeeding or duration and the great influence of the surroundings of the mother, similar in this study to literature data, call for enhanced prenatal information for parents and systematic “lactation” consultation in the early post-partum, by trained professionals and with the help of support associations for breastfeeding. This study showed a clear need to support breastfeeding. It has also allowed targeting actions that would be able to avoid the majority of early weaning.     

Breastfeeding and Smoking among Low‐Income Women: Results of a Longitudinal Qualitative Study

ABSTRACT: Background: The benefits of breastfeeding for infants and mothers have been well established, yet rates of breastfeeding remain well below national recommendations in the United States and even lower for women who smoke during pregnancy. Primary goals of this study were to explore contextual factors that contribute to breastfeeding intentions and behavior and to examine how smoking status affected women’s decision making about breastfeeding. Methods: This paper is based on a longitudinal qualitative study of smoking, pregnancy, and breastfeeding among 44 low‐income women in the southwest U.S. who smoked during pregnancy. Each woman was interviewed 9 times; 6 times during pregnancy and 3 times postpartum using semistructured questionnaires. Interviews lasted 1 to 3 hours and were tape‐recorded, transcribed, and analyzed. Results: Despite 36 (82%) respondents stating that they intended to breastfeed for an average duration of 8 months, rates of breastfeeding initiation and duration were much lower than intentions. By 6 months postpartum, only two women were breastfeeding exclusively. Conclusions: Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months. The results indicate a need for more consistency and routine in educating women on the relationship between smoking and breastfeeding and in promoting breastfeeding in spite of smoking postpartum. (BIRTH 35:3 September 2008)     

Breastfeeding duration rates and factors affecting continued breastfeeding among infants born at an inner-city US Baby-Friendly hospital.

The effects of Baby-Friendly status on breastfeeding duration in the United States have not been published. The objectives of this study were to obtain breastfeeding rates at 6 months among babies born in a US Baby-Friendly hospital and to assess factors associated with continued breastfeeding at 6 months. The authors randomly selected 350 medical records of infants born in 2003 at Baby-Friendly Boston Medical Center. Of 336 eligible infants, 248 (74%) attended the 6-month well-child visit and 37.1% (92/248) were breastfeeding at 6 months. In multivariate logistic regression, the likelihood of breastfeeding at 6 months was decreased by presence of a feeding problem in the hospital (AOR 0.27; 95% CI 0.07-0.99), whereas the likelihood of breastfeeding at 6 months increased with maternal age (AOR 1.05; 95% CI 1.00-1.10) and for mothers born in Africa (AOR 4.29; 95% CI 1.36-13.5) or of unrecorded birthplace (AOR 3.29; 95% CI 1.38-7.85). Breastfeeding duration is traditionally poor in low-income, black populations in the United States. Among a predominantly low-income and black population giving birth at a US Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.     

Characteristics of teenage mothers and predictors of breastfeeding initiation in the Michigan WIC Program in 1995. Women, Infants, and Children.

Although breast milk is recommended as the optimal source of infant nutrition, breastfeeding initiation is below recommended levels, especially among teenage mothers. Breastfeeding initiation rates among Michigan (US) teenage mothers (12-19 y) were compared by demographics and health behaviors. Multivariate analyses determined which factors were significant independent predictors of breastfeeding initiation among teenage mothers enrolled prenatally in the Michigan Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in 1995. Significant predictors independently associated with breastfeeding initiation were race/ethnicity, education, marital status, postpartum anemia status, parity, prenatal trimester of WIC enrollment, and smoking. The strongest predictor of breastfeeding initiation differed for white mothers (positive predictor: education beyond high school [OR = 3.13]) and black mothers (negative predictor: multiparous [OR = 0.25]). Initiation rates for this population of teenage mothers fall below the national average for mothers of all ages and the US Healthy People 2010 goals. Research is needed concerning how breastfeeding support and education can be improved to reach the US national health goals.     

Predicting the Duration of Lactation: Evidence from a National Survey

ABSTRACT: Background : Despite caregiver and policy support for breastfeeding, rates for initiation and duration of breastfeeding fell far short of Healthy People 2000 goals during the 1980s. Methods : Data from the 1988 National Maternal-Infant Health Survey, collected from January 1989 through June 1991, were analyzed to examine predictors of duration of lactation for a sample of 2372 breastfeeding women. We conducted comparisons between women who fully breastfed and those who partially breastfed using logistic regression analysis. Results : Mothers were more likely to breastfeed for longer than six months if they fully breastfed during the first month postpartum, were nonsmokers, were of higher parity, were consistent in their prenatal intent to breastfeed fully or partially and in their postpartum behaviors, participated in childbirth education classes, and delayed their return to work postpartum. Conclusions : In this study sample, although rates did not meet Healthy People 2000 goals for duration of breastfeeding, some predictors of duration were identified that can be affected by programmatic support or public policy. Our findings indicated that variables that are associated with breastfeeding and longer duration of the practice are typically correlated with social status. To support the development of breastfeeding as the cultural norm, interventions targeting breastfeeding outcomes should consider social status, ethnicity, and cultural factors.