Establishing individual peer counselling for exclusive breastfeeding in Uganda: implications for scaling-up

Exclusive breastfeeding remains critical for child survival, potentially reducing childhood morbidity and mortality. In Uganda, 98% of children are ever breastfed, but exclusive breastfeeding levels remain low. Supporting mothers in breastfeeding exclusively can improve breastfeeding practices. This paper describes experiences of establishing individual peer counselling for exclusive breastfeeding in the Uganda site of the Promoting Infant Health and Nutrition in Sub-Saharan Africa: Safety and Efficacy of Exclusive Breastfeeding Promotion in the Era of HIV trial, and highlights some implications for scaling-up. Twelve women were identified by their communities, one from each of 12 clusters. They were trained for 6 days and followed up for 1 year while they counselled mothers. Their knowledge and attitudes towards exclusive breastfeeding were assessed before and immediately after training, and also 10 months into peer counselling. Observations, field notes and records of interactions with peer counsellors were used to record experiences from this intervention. The communities were receptive to peer counselling and women participated willingly. After training and 10 months' follow-up, their knowledge and attitude to exclusive breastfeeding improved. All were retained in the study, and mothers accepted them in their homes. They checked for mothers several times if they missed them on the first attempt. Husbands and grandmothers played key roles in infant feeding decisions. Involving the communities in selection helped to identify reliable breastfeeding peer counsellors who were acceptable to mothers and were retained in the study. Other key issues to consider for scaling-up such interventions include training and follow up of peer counsellors, which led to improved knowledge and attitudes towards exclusive breastfeeding (ClinicalTrials.gov no: NCT00397150).     

Breastfeeding promotion in non-UNICEF-certified hospitals and long-term breastfeeding success in Germany

Aim: To assess breastfeeding practices using the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Ten Steps to Successful Breastfeeding for Baby-Friendly Hospitals in unselected non-UNICEF certified German hospitals and to examine the influences of breastfeeding promotion on long-term breastfeeding success as assessed by WHO criteria. Methods: Information on the fulfilment of the Ten Steps was collected in 177 randomly chosen maternity hospitals by a postal questionnaire. Breastfeeding duration was assessed in 1487 mothers delivering in these hospitals. Multiple logistic regression was used to estimate the association between a low breastfeeding promotion index, defined as fulfilment of fewer than five steps, and the risk of short-term breastfeeding, less than 4 mo. Results: A higher breastfeeding promotion index was not associated with early breastfeeding but was significantly associated with full breastfeeding at 4 and 6 mo. After adjusting for confounding factors, delivering in a hospital with a low breastfeeding promotion index was associated with an increased risk of short-term breastfeeding [odds ratio (OR) 1.24], although associations with maternal demographic variables (young age: OR 3.34), low educational level (OR 2.81) and upbringing in East Germany (OR 2.27) were stronger.

Conclusion: In unselected German hospitals even moderate levels of breastfeeding promotion identified by WHO/UNICEF criteria were associated with long-term breastfeeding success.     

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.     

Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial

AIM: Exclusive breastfeeding increases survival and optimizes growth of low-birthweight (LBW) infants. If supported, mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo. We tested the efficacy of postnatal peer counselling among first-time mothers that aimed to increase exclusive breastfeeding of term LBW infants. METHODS: In a Manila hospital, 204 mothers were randomized into three groups. Two intervention groups receiving home-based counselling visits, one by counsellors trained in breastfeeding counselling (n=68), the other by counsellors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive counselling. RESULTS: Eighty-eight per cent of the participating pairs completed the trial. At 6 mo, 44% of the breastfeeding counselled mothers, 7% childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding. More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo. Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea. All groups had improved mean weight-for-age Z-scores at 6 mo. CONCLUSION: This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants. By improving health outcomes, enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants.     

Mother-infant skin-to-skin contact after delivery results in early recognition of own mother's milk odour

Aim: To determine the effects of mother-infant skin-to-skin contact immediately after birth on infant recognition of their own mother's milk odour and breastfeeding duration until 1 y of age. Methods: Sixty healthy, full-term neonates were randomly assigned to group A with skin-to-skin contact and group B without. One and 4 d after birth, infant responses to the following odour stimuli were observed: own mother's milk, another mother's milk, formula, orange juice and distilled water. Infant facial action was videotaped and the frequency of mouthing movements was evaluated for each stimulus. Nutritional assessment, focused particularly on breastfeeding, was performed every 3 mo on participating infants. Statistical analysis comparing the frequency of mouthing movements with the aforementioned five different odour exposures was performed by ANOVA with Fisher's PLSD. Kaplan-Meier analysis with a log-rank test was used to compare breastfeeding rates between groups. Results: Infants in both groups responded differently to mother's milk odour (either their own or another mother's milk) compared to the other stimuli on days 1 and 4. However, infants in group A demonstrated a larger difference in mouthing movements between their own and another mother's milk odour at 4 d of age (2.6 ± 1.6) compared to infants in group B (0.9 ± 2.0, p = 0.01). Infants in group A were breastfed an average of 1.9 mo longer than the others.

Conclusion: Our study provides evidence that mother-infant skin-to-skin contact for more than 50 min immediately after birth results in enhanced infant recognition of their own mother's milk odour and longer breastfeeding duration.     

Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia

Aim: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia. Methods: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders. Results: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90).

Conclusions: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.     

Prevalence and determinants of exclusive breastfeeding during hospital stay in the area of Athens, Greece

AIM: To assess breastfeeding practices, focusing on the prevalence and the determinants of exclusive breastfeeding during hospital stay. METHODS: A cross-sectional study of 1603 healthy women, who delivered healthy infants weighing more than 2500 g, was conducted in the area of Athens, Greece. Participants completed a self-administered questionnaire on the day they were discharged from the maternity ward. Classification of breastfeeding and recall period from birth to discharge were in accordance with the WHO criteria. Hierarchical logistic regression analysis was used to study determinants of exclusive breastfeeding initiation. RESULTS: Breastfeeding initiation was reported by 96.1% of the participants. However, exclusive breastfeeding was initiated only in 19.1% and predominant breastfeeding in 7.2% of the cases. The univariate analysis showed that maternal younger age, low educational level, unemployment, vaginal delivery, infant birthweight >3000 g, multiparity, early initiation of breastfeeding, rooming-in and awareness on the existence of breastfeeding centres were associated with higher rates of exclusive breastfeeding. Logistic regression analysis revealed that rooming-in (OR 3.72, p<0.01), demand feeding (OR 2.18, p<0.01), type of delivery (OR 1.61, p<0.01) and the source of information received about breastfeeding are more important determinants of exclusive breastfeeding than the socio-demographic parameters. CONCLUSIONS: Exclusive breastfeeding during hospital stay in the area of Athens is low. Demand feeding and rooming-in positively influence exclusive breastfeeding initiation, while caesarean section and information by mass media have a negative impact.     

Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use

OBJECTIVE: To determine whether infants of women randomized to a prenatal and postpartum lactation support intervention incur fewer otitis media-, respiratory tract-, or gastrointestinal-related visits than controls. DESIGN: Randomized, unmasked controlled trial recruiting women from prenatal care settings. Breastfeeding sensitive (BFS) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months. SETTING: Two urban community health centers. PARTICIPANTS: Analytic sample of 338 low-income, primarily Hispanic and/or black mother-infant dyads (n = 163 for the intervention group and n = 175 for the control group). INTERVENTION: Study lactation consultants attempted 2 prenatal meetings, 1 postpartum hospital and/or home visit, and telephone calls as needed. Controls received the standard of care. MAIN OUTCOME MEASURES: Combined outpatient and emergency department visits with illness and BFS illness diagnoses. RESULTS: There was a significant interaction between treatment and Medicaid; among those not receiving Medicaid, the number of otitis media visits was higher among controls (P相似文献   

Initiation and duration of breastfeeding in obstetrical hospitals of Aix-Chambery (France)]

Our objectives were to estimate duration of breastfeeding and to identify factors associated with initiation and weaning. METHODS: A prospective study was carried out among 353 mothers delivering in three obstetric hospitals at Aix-Chambery (Savoie, France). Breastfeeding was considered as survival data with censored observations. Univariate and multivariate analyses were performed. RESULTS: Breastfeeding was initiated by 70.8% (66.1-75.5) (exclusive breastfeeding = 39.9% and complementary breastfeeding = 30.9%). Respectively, 58.1% (52.9-63.3) and 12.2% (8.3-16.1) were continuing some breastfeeding at one and six months. The median duration of breastfeeding was 13 weeks (11.6-14.4). Shorter duration was associated with contact beyond one hour from birth (adjusted Hazard Ratio [aHR] = 1.25 [1.03-1.52] and with contact beyond eight hours aHR = 1.78 [1.66-1.92]), pacifier use (aHR = 1.72 [1.19-2.47]), breastfeeding at fixed hours (aHR = 1.78 [1.29-2.45]), and decision to breastfeed during pregnancy or the postpartum period (aHR = 1.70 [1.45-2.00]). CONCLUSION: Breastfeeding initiation and duration were higher in maternity hospitals of Chambéry than estimations measured in the 1998 French perinatal survey and in other ad hoc surveys. Identified factors should be used in order to plan future programs designed to increase duration of breastfeeding.     

Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: a randomized controlled trial

Background

Among breastfeeding determinants, the marketing of breast milk substitutes might contribute to suboptimal breastfeeding rates. The aim of this study was to investigate the effect of receiving information on breast milk substitutes on breastfeeding rates.

Methods

We conducted a randomized, single-blind, controlled trial from 2012 to 2014 in a northern Italian maternity ward. We enrolled 802 Caucasian mothers who gave birth to healthy, full-term singletons with a birth weight?>?2500 g and who were exclusively breastfeeding from delivery to discharge. Mothers who gave birth to infants with congenital diseases, chromosomal abnormalities, perinatal infections and/or cardio-respiratory instability and/or mothers being affected by endocrine and/or metabolic and/or gastrointestinal and/or renal diseases were excluded.Mothers were randomized to either receive (group A, n?=?405) or not (group B, n?=?397) written information on a breast milk substitute at discharge. Breastfeeding was promoted and supported in all mother-infant pairs equally. The mode of feeding for up to 6 months after delivery was determined by phone interview. To detect a 10% difference between groups in the discontinuation rate of exclusive breastfeeding at three months of age at 5% significance and 80% power, a total of 356 mother-infant pairs per group were needed.

Results

The exclusive breastfeeding prevalence was 91% and 92% at 7 days, 79% and 70% at 1 month, 75% and 66% at 2 months, 72% and 62% at 3 months, and 3% and 2% at 6 months in groups A and B, respectively. The relative risk (95% confidence interval) of exclusive breastfeeding (group A vs B) at 7 days and at 1, 2, 3 and 6 months was as follows: 0.99 (0.95–1.03), 1.12 (1.03–1.21), 1.13 (1.03–1.24), 1.15 (1.04–1.27), and 1.49 (0.62–3.61).Nutritional, lifestyle and lactational factors were the primary contributing determinants to early breastfeeding discontinuation.

Conclusions

The present findings indicate that receiving written information on breast milk substitutes at hospital discharge, provided that breastfeeding support and education are offered, does not negatively affect breastfeeding rates.

Trial registration

NCT03208114. Registered 5 July 2017.

     

Morbidity in children born to women infected with human immunodeficiency virus in South Africa: does mode of feeding matter?

Aim: To examine infant morbidity risks associated with refraining from breastfeeding where it is used in an attempt to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Methods: The population consisted of infants born to HIV-infected women in South Africa who were participating in a vitamin A intervention trial to prevent MTCT of HIV. Women chose to breastfeed or formula feed their infants according to UNAIDS guidelines. Actual feeding practices and morbidity were recorded at clinic follow-up visits at 1 wk, 6 wk, 3 mo and every 3 mo thereafter until 15 mo of age or cessation of breastfeeding. The infant's HIV status was assessed according to a predetermined algorithm. Results: HIV-infected infants who were never breastfed had a poorer outcome than those who were breastfed; 9 (60%) of those who were never breastfed had 3 or more morbidity episodes compared with 15 (32%) of breastfed children [odds ratio (OR) 4.05, 95% confidence interval (95% CI) 0.91-20.63, p = 0.05]. During the first 2 mo of life, never-breastfed infants (regardless of HIV status) were nearly twice as likely to have had an illness episode than breastfed infants (OR 1.91, 95% CI 1.17-3.13, p = 0.006).

Conclusion: The significant extra morbidity experienced in the first few months by all never-breastfed infants and at all times by HIV-infected infants who are not breastfed needs to be considered in all decisions by mothers, health workers and policy makers so as not to offset any gains achieved by decreasing HIV transmission through avoiding breastfeeding.     

Breastfeeding practices in the United Kingdom: Is the neighbourhood context important?

Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide‐ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. sample. A cross‐sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual‐ and familial‐level socio‐demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area‐based approaches and the broader determinants of social inequalities.     

Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial

BACKGROUND: Breastfeeding peer counseling has improved breastfeeding rates in developing countries; however, its impact in this country has not been adequately evaluated. OBJECTIVE: To evaluate the effectiveness of an existing, breastfeeding peer counseling program within the United States. DESIGN: Randomized, prospective, controlled trial in which participants were recruited prenatally and randomly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling. SETTING: An urban hospital serving a large population of low-income Latinas. PARTICIPANTS: Pregnant women (< or =26 weeks' gestation) were recruited from the hospital's prenatal clinic. Inclusion criteria specified that participants be low income, be considering breastfeeding, have delivered a healthy, full-term singleton, and have access to a telephone.Intervention Breastfeeding peer counseling services included 1 prenatal home visit, daily perinatal visits, 3 postpartum home visits, and telephone contact as needed. MAIN OUTCOME MEASURES: Breastfeeding rates at birth and 1, 3, and 6 months postpartum. RESULTS: The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls (8/90 [9%] vs 17/75 [23%]; relative risk, 0.39; 95% confidence interval, 0.18-0.86). The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month (36% vs 49%; relative risk, 0.72; 95% confidence interval, 0.50-1.05) and 3 months (56% vs 71%; relative risk, 0.78; 95% confidence interval, 0.61-1.00). CONCLUSION: These findings demonstrate that, in the United States, peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum.     

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.     

Breastfeeding progression in late preterm infants from birth to one month

This study aimed to describe and compare breastfeeding progression, infants' feeding behaviours, maternal feeding difficulties, and mothers' usage of breastfeeding interventions for singleton late preterm (LPT) and term infants. A further aim was to identify associated factors for exclusive breastfeeding at breast at 1 month in LPT infants. This was a cohort study where mothers of LPT infants from a neonatal unit (n = 60), LPT infants from a maternity unit (n = 62), and term infants from a maternity unit (n = 269) answered a questionnaire approximately 1 month after delivery. Findings showed no significant differences in exclusive breastfeeding at breasts between LPT infants admitted to the neonatal unit compared with the maternity unit, during the first week at home (38% vs. 48%), or at 1 month of age (52% vs. 50%). Term infants were more likely to be exclusively breastfed at the breast (86% and 74%, p < 0.05) compared with LPT infants. Multiple regression analysis showed that usage of a nipple shield, not feeding breast milk exclusively during the first week at home, or feeding less than 10 times per day at 1 month were statistically significant for not exclusively breastfeed at the breast. A protective factor was the mothers' experience of having an abundance of milk during the first week at home. In conclusion, LPT infants are less likely to be exclusively breastfed at the breast than term infants, highlighting the need for further research to guide interventions aimed at optimising exclusive breastfeeding rates.     

Effects of sociodemographic factors on adherence to breastfeeding and other important infant dietary recommendations

Aim: To examine in an affluent and healthy population the association between sociodemographic factors and the adherence to key infant dietary recommendations. Methods: In a longitudinal prospective study, healthy newborns were selected randomly in maternity wards around Iceland and their diet recorded every month for one year (n=124). In addition, a 48-hour-weighed-record, including information on added sugar, fruits, vegetables and the use of A and D vitamin drops was completed by 91 (73%) mothers at 9 and 12 months. Information about the mothers' education, smoking, age, parity, and family income was collected (n=98; 79%). Results: Regression analyses, including sociodemographic factors, showed exclusive breastfeeding to be positively associated with more education (P=0.022) and non-smoking (P=0.013) explaining 22% of the variance, and total breastfeeding (exclusive + partial) with non-smoking (P=0.006). Multiple regression also showed children's intake of added sugar from 9-12 months to be positively associated with mother's smoking (P=0.022) and negatively with age (P = 0.026), explaining 30% of variance. Sociodemographic factors were associated with children's fruit and vegetable consumption but not with the administration of AD-vitamin drops. However, when tested for significance between groups, younger mothers with fewer children seemed less likely to give AD-vitamin drops.

Conclusions: In a group of mothers getting regular antenatal care and giving birth to healthy infants, sociodemographic factors can predict which mothers need special guidance concerning recommendations about diet in infancy. These were mothers with less education, who smoked, were younger and were having their first or second child.     

Differential trends in breastfeeding according to maternal and hospital characteristics: results from the French National Perinatal Surveys

AIM: To assess breastfeeding trends in hospital, between 1998 and 2003, according to several characteristics of mothers and maternity units. METHODS: Two representative national samples of births, comprising 13,600 live births in 1998 and 14,580 in 2003 were used. Data were collected during hospital stay. All newborns fed entirely or partly on breast milk were considered 'breastfed'. Univariate and multivariate analyses were used to compare the results for the 2 years. RESULTS: Breastfeeding increased in all groups, but this increase varied slightly according to maternal age and the size of the maternity unit. For example, high rates of breastfeeding tended to be concentrated in large maternity units (> or = 1500 deliveries per year) in 1998, but were also found in middle-size units (1000-1499 deliveries per year) in 2003. In 2003, women were more likely to breastfeed if they were at least 25 years old, primiparous, non-French or from a highly qualified occupational group, or if they gave birth in a university hospital or in a maternity unit with more than 1000 deliveries per year. CONCLUSION: Despite recent efforts to increase the breastfeeding rate, clear social disparities persist and further efforts are required, targeting particular groups of mothers less likely to breastfeed.     

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity

ObjectiveTo describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity.MethodsThis is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature.ResultsBreastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001).ConclusionBreastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.     

Breastfeeding and the use of human milk

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF "Ten Steps to Successful Breastfeeding." National strategies supported by the US Surgeon General's Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The "Business Case for Breastfeeding" details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice.     

Breastfeeding after return to work: An Australian national workplace survey

Breastfeeding initiation rates in Australia are high but duration rates fall well below the World Health Organization targets. Return to work is a known factor impacting 6 months exclusive breastfeeding and continuation into the infants second year of life. Work related factors can influence a woman's confidence in maintaining breastmilk supply after return to employment and determine whether she meets her personal breastfeeding goals. This cross-sectional online survey is the first Australian study to explore women's experience of maintaining breastfeeding after return to work, in all work sectors. Results revealed variations across work sectors reflected in worker autonomy and confidence in speaking up about breastfeeding rights. Women who had autonomy or flexibility in planning their workday were more likely to be confident in maintaining breastmilk supply. The main predictors for milk supply confidence and meeting personal breastfeeding goals included having: a suitable place to express milk; confidence in speaking out about rights; a formal return-to-work plan; a supportive workplace; and returning to work after the period of exclusive breastfeeding. This study reveals that supportive workplace environments can lead to increased confidence in maintaining milk supply, extending durations of breastfeeding. Women who are confident in their rights to express breastmilk, or breastfeed at work, are more likely to meet their own breastfeeding goals. Education, and awareness raising, on the rights of breastfeeding women in the workplace, is a gender equity imperative that can improve experiences for breastfeeding women, and, increase manager and co-worker knowledge for creating enabling workplace environments for breastfeeding employees.