Functional Assessment of Infant Breastfeeding Patterns

Abstract: As breastfeeding rates have increased in the United States, the need has arisen for coordinated approaches to the assessment of normal and problem situations. Since some difficulties are related to the manner in which baby feeds, guidelines are discussed for the visual assessment of breastfeeding. These include the when, why, and how of assessing seven common situations or problems: initial breastfeeding experiences, inadequate infant weight gain or low milk intake, insufficient milk supply (real or perceived), nipple problems, latch-on and sucking disorganization, high-risk situations, and the good baby syndrome.     

Nurses'' Knowledge of Breastfeeding

The purpose of this study was to survey nurses' knowledge of breastfeeding and to assess whether nurses' education, clinical experience, or personal experience predicted their breastfeeding knowledge. Results suggest that nurses have limited knowledge of breastfeeding, although no variable consistently predicted breastfeeding knowledge. Clinical experience produced the most consistent results, implying that leadership, variety in maternal and newborn nursing experiences, and years of experience result in nurses having more knowledge about breastfeeding.     

Candidiasis in the Breastfeeding Mother and Infant

Candidiasis in a breastfeeding mother and infant is described. The mother's breasts were a continuous source of Candida albicans, resulting in persistent thrush in the infant. The infant and mother were successfully treated with clotrimazole in a gel form. This report emphasizes the importance of treating both the infected mother and infant to prevent reinfection and ensure successful breastfeeding.     

Infant Feeding Practices of Middle-Class Breastfeeding and Formula-Feeding Mothers

ABSTRACT: Of 100 new mothers self-selected for study, 87 percent breastfed for at least 2 weeks, and a mean of 6.8 months. Upon weaning, 29 percent of infants were given cow's milk and the remainder were fed formula. Breastfeeding mothers introduced solid foods later, used more homemade baby foods, were more likely to have attended prenatal classes, and were more receptive to infant feeding advice from friends and classes, while formula-feeding mothers preferred the advice of their pediatricians.     

The Effect of Prenatal Breastfeeding Education on Breastfeeding Success and Maternal Perception of the Infant

A quasi-experimental design was used to determine the effect of prenatal breastfeeding education on maternal reports of success in breastfeeding and maternal perception of the infant. The sample consisted of 40 primiparous women who desired to breastfeed their infants. All subjects were enrolled to attend childbirth education classes and vaginally delivered full-term, healthy infants without complication. Twenty subjects attended a prenatal breastfeeding education class and 20 served as controls. Data revealed that primiparous women who received prenatal breastfeeding education reported a significantly higher frequency of success in breastfeeding than those who did not ( P = 0.01). There was a significant difference in the Neonatal Perception Inventory (NPI) I scores of experimental and control subjects at one to two days postpartum ( P = 0.05). The NPI II scores of the experimental mothers were significantly more positive at one month postpartum ( P = 0.001). Primiparous women who received prenatal breastfeeding education reported significantly more positive NPI II scores than the control group ( P = 0.001).     

The Effect of Infant Formula Samples on Breastfeeding Practice

To determine whether infant formula samples affect breastfeeding practice, 95 breastfeeding mothers were randomly assigned to receive or not receive formula samples on discharge from a postpartum unit. Unaware of the specific nature of the study, these mothers were interviewed by telephone six to seven weeks postpartum by an investigator blind to the randomization status. Although more women who had discontinued breastfeeding were among the group who had received samples than those who had not received samples, the difference was not statistically significant. Significant differences were not found in three subgroups hypothesized to be more vulnerable to the samples: less educated women, primiparas, and women who were ill postpartum.     

Breastfeeding,Bed‐Sharing,and Infant Sleep

Abstract: Background: Expectations for infant sleep development and for the appropriate degree of parental proximity for infant sleep are culturally weighted and historically shifting aspects of parenting behavior, and are known to affect breastfeeding prevalence and duration. This paper examined how new parents managed night‐time feeding in the first 4 months, with a particular focus on the relationship between breastfeeding, infant sleep location, and sleep bout duration. Methods: Sleep logs and semistructured interviews were used with a sample of 253 families in North Tees, United Kingdom, to explore how parents responded to their infant's sleep patterns, how breastfeeding parents managed night‐time feeding, and whether bed‐sharing was a common strategy. Results: A clear relationship between breastfeeding and parent‐infant bed‐sharing was demonstrated. Some evidence indicated that bed‐sharing may promote breastfeeding. Conclusions: An understanding of the role of infant feeding practice on infant sleep and parental caregiving at night is a crucial element in breastfeeding promotion and enhancement of infant health. Health professionals should discuss safe bed‐sharing practices with all parents. (BIRTH 30:3 September 2003)     

Inconsistencies Among Nurses in Breastfeeding Knowledge and Counseling

Two hundred three nurses involved in the hospital care of women and their newborn completed a pre-test survey associated with a telephone conference in support of the breastfeeding mother. Inconsistencies among the majority of nurses in their ability to support the breastfeeding women and understand the mechanisms of successful breastfeeding were demonstrated. Results of the survey are presented as well as implications for education of nurses who care for the childbearing family.     

Maternity Nurses' Knowledge of Factors Promoting Successful Breastfeeding

An investigator-designed questionnaire was used to survey 53 RNs and LPNs at two urban hospitals concerning knowledge far support of breastfeeding mothers. Maternity nurses demonstrated limited knowledge, especially in drugs, maternal emotions, and neonatal physiology as related to breastfeeding. Level of education affected test scores positively; length of experience affected test scores negatively.     

Establishing Breastfeeding with the Late Preterm Infant in the NICU

ObjectiveTo describe challenges that late preterm infants (LPIs) face with breastfeeding and to provide an overview of current policy statements and practice guidelines that support breastfeeding for LPIs. In addition, we describe current breastfeeding research related to the LPI and combine this research with policies and practice guidelines to provide evidence‐based recommendations to guide practice and future research in the NICU.Data SourcesCumulative Index to Nursing and Allied Health Literature and PubMed databases.Study SelectionPolicies, guidelines, and research relevant to breastfeeding the LPI were selected if they were published between January 1, 2009 and March 1, 2014. All documents were published in English and related to breastfeeding management or breastfeeding outcomes for the LPI.Data ExtractionInformation from articles, policies, and guidelines were chosen for their relevance to breastfeeding the LPI.Data SynthesisPolicy statements and practice guidelines were reviewed to provide an understanding of breastfeeding recommendations for the LPI. Additionally, recent research studies were reviewed and combined with the policy statements and practice guidelines to provide practice recommendations for NICU providers.ConclusionsLPIs require a unique set of interventions for breastfeeding success; though they might be perceived as small, full‐term infants, these infants often have greater challenges with breastfeeding than their term counterparts. Future research should be directed at identifying and testing specific strategies that will best support this at‐risk population. Findings from this article are applicable for the LPI in the NICU as well as other care areas such as special care and transitional nurseries.     

Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future

Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands‐on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.     

Physicians' Knowledge of Future Vascular Disease in Women with Preeclampsia

Objective. Preeclampsia, a hypertensive disorder of pregnancy, affects 5–8% of women. Large studies demonstrate a strong association between preeclampsia and future cardiovascular disease (CVD). Despite CVD being the leading cause of mortality for women, there has been little education for internal medicine physicians or obstetrician-gynecologists (ob-gyns) about this association; published guidelines do not include preeclampsia as a risk factor for future CVD. Therefore, women with a history of preeclampsia may not receive adequate risk-reduction counseling for CVD. It is unclear whether primary care physicians are aware of the association; thus, we sought to determine whether primary care providers at our institution were aware of preeclampsia's association with future CVD and whether they were providing appropriate counseling. Methods. An anonymous online survey was sent to all internists and (ob-gyns) at our hospital. Results. Although most internists (95%) and (ob-gyns) (70%) provide routine cardiovascular risk-reduction counseling, a substantial proportion of them were unaware of any health risk associated with a history of preeclampsia. Many internists were unsure or did not know whether preeclampsia is associated with ischemic heart disease (56%), stroke (48%), and decreased life expectancy (79%). The corresponding proportions for (ob-gyns) were 23, 38, and 77%, respectively. Only 9% of internists and 38% of obstetrician-gynecologists were providing cardiovascular risk-reduction counseling to women with a history of preeclampsia. Conclusion. There is limited knowledge of the association between preeclampsia and future CVD; this deficiency may limit the application of this risk factor to clinical care.     

Getting Enough: Mothers' Concerns About Breastfeeding a Preterm Infant After Discharge

Objective : To describe maternal concerns about breastfeeding a preterm infant in the postdischarge period and to delineate the strategies mothers used in managing these concerns.
Design : Naturalistic inquiry was used.
Setting : A semistructured interview was conducted with the mother in the home 1 month after discharge of the infant.
Participants : Twenty mothers of preterm infants; the infants had been in a level 3 hospital nursery, and the mothers had received individualized breastfeeding support services in the hospital.
Main outcome measures : Three categories of maternal concerns emerged from the data: adequate milk consumption by infants; milk composition; and problems with the mechanics of breastfeeding a preterm infant. Mothers identified strategies for these concerns.
Results : The mothers' main concern was whether infants consumed an adequate volume of milk by breastfeeding alone. Strategies for managing concerns about getting enough included using supplemental and complemental feedings, using ongoing cues to tell that the infant is getting enough, and persevering with breastfeeding.
Conclusions : Mothers of preterm infants have unique concerns about breastfeeding in the postdischarge period and need individualized interventions.     

Personal Infant Feeding Experiences of Postpartum Nurses Affect How They Provide Breastfeeding Support

Objective

To describe the experiences of postpartum nurses when feeding their own infants and explore how these experiences influence the breastfeeding support they provide to new mothers.

Knowledge and Attitudes Toward Breastfeeding in an African American Male Population

ObjectiveTo measure knowledge and attitudes toward breastfeeding among African American men.DesignCross‐sectional survey.SettingThree barbershops in Dallas, Texas.ParticipantsAfrican American adult men (N = 81).MethodsSurveys were completed by African American men to evaluate their knowledge, attitudes, and involvement in breastfeeding.ResultsOne half of the participants were age 26 to 40. Eighty‐five percent were U.S.‐born, and others were born in several African countries. Education varied from some high school to postgraduate. Most had some college or a degree (78%). One half were fathers (51%), and most were single (61%). Most had witnessed breastfeeding (85%), and 58% preferred their infants to be breastfed. Only 47% knew that breastfeeding helps prevent infant infections, and 15% knew it can prevent breast cancer in the mother. Significant differences were found when comparing knowledge and attitudes by place of birth and age. Almost one half of men age 18 to 25 (43%) and age 25 to 40 (48%) felt that breastfeeding should not occur in public compared to only 4% of men older than 40 (p = .005).ConclusionOverall, we found that African American men were supportive of breastfeeding, knew that breastfeeding was best for infants, and had positive attitudes toward breastfeeding. However, we found consistent gaps in knowledge about the actual health benefits to mothers and infants and conflicting attitudes toward breastfeeding. Results emphasize the need for health education efforts to improve attitudes toward breastfeeding in public.     

Influence of Knowledge and Attitudes on Exclusive Breastfeeding Practice Among Rural Jamaican Mothers

Abstract: Background : A large number of mothers may not be practicing exclusive breastfeeding in rural Jamaica, although no recent systematic study has been conducted. The impact of knowledge about and attitude toward breastfeeding on the duration of exclusive breastfeeding is also poorly understood. The objective of this study was to gather information about factors that influence exclusive breastfeeding and its duration. Method : A cross‐sectional study was conducted in 11 health centers within the parish of Saint Ann, Jamaica. A pretested questionnaire collected information on breastfeeding knowledge and attitudes toward intention to breastfeed and other relevant sociodemographic characteristics. Results : Information was documented for 599 mother‐child pairs. The prevalence of breastfeeding initiation was 98.2 percent; of mothers who initiated breastfeeding, 22.2 percent practiced it exclusively (at least 6 months). No difference occurred between exclusive and nonexclusive breastfeeding mothers in terms of knowledge about and attitudes toward breastfeeding. Of potential predictors assessed, the male partner's role as the main source of income for the family was the only significant predictor for exclusive breastfeeding. Women whose male partner was the main source of income for the family were twice as likely to exclusively breastfeed their infants compared with the referent group (mothers as main source of income)(OR = 2.0; 95% CI = 1.4–3.0). In addition, the dominant reason for partial breastfeeding was maternal anxiety that breastmilk alone might not provide sufficient nourishment. Conclusion : The level of exclusive breastfeeding was extremely low at the study site. Formulation of strategies to aggressively promote exclusive breastfeeding practices is urgently needed there. Such interventions should consider involvement of the male partner, especially, with respect to the financial support, as well as alleviating maternal anxiety regarding nutritional adequacy of breastmilk.     

Success of an Educational Intervention on Maternal/Newborn Nurses' Breastfeeding Knowledge and Attitudes

Objective:o test the effect of a breastfeeding educational program for improving breastfeeding knowledge, attitudes, and beliefs of maternal/newborn nurses, and to improve their intentions to provide breastfeeding support to new mothers.Design:Quasi‐experimental, pretest/posttest design.Setting:Maternity units of 13 hospitals located in midwestern and east coast states.Participants:Nine experimental and three control hospital sites resulted in a convenience sample size of 240 registered nurses (RNs); 206 RNs in the experimental sites and 34 RNs in the control sites.Methods:Participation in the experimental groups involved the completion of two questionnaires upon study entry and then again after completion of a self‐study module. Participants in the control groups completed the two questionnaires twice with a 4‐ to 6‐week interval between them without access to the self‐study module.Main Outcome Measures:Nurses' breastfeeding knowledge, attitudes, beliefs, and intentions to support postpartum mothers who are breastfeeding.Results:Findings suggest that this educational strategy was effective in improving maternal/newborn nurses' breastfeeding knowledge, attitudes, and beliefs, and intentions to support breastfeeding mothers.Conclusion:This self‐paced, study module, which is guided by an on‐site, trained staff member, may be a cost‐effective strategy for improving nurses' breastfeeding knowledge and support to new breastfeeding mothers. Nurses may find this type of teaching modality to be less intimidating than a structured classroom setting, and more desirable for their busy schedules.     

Breastfeeding Patterns: Comparing the Effects on Infant Behavior and Maternal Satisfaction of Using One or Two Breasts

In the Western world advice given by breastfeeding consultants about the use of one or two breasts at each feed has resulted in apparently arbitrary changes over time. This study compared 1-month-old breastfed infants' reactions to single- and two-breast feeds in terms of restlessness, crying, sleeping, and frequency of feeds, wet diapers, and loose stools. Eighty mothers were randomly assigned at the maternity ward, 44 to the single-breast group and 36 to the two-breast group. At one-month follow-up no differences between the groups were seen regarding any infant behavior variables, or in terms of maternal satisfaction, confidence, and mood throughout the full 24-hour observation period or during a 4-hour period in the evening. Compliance with the assigned feeding method was better in the two-breast than in the one-breast group. This may partly be due to tradition, since the two-breast practice has been recommended by child health nurses in Sweden for over 50 years. It seems reasonable that a baby should be allowed to finish the first breast and, if still hungry, be offered the second breast. The baby's appetite is the deciding factor.