Infant-feeding strategies to prevent post-natal HIV transmission

Promotion of breastfeeding is a key component of infant health policies globally. However, maternal HIV infection is a possible contraindication for breastfeeding since it can result in mother-to-child transmission. Research into infant-feeding strategies which will promote the health of all infants but also protect against HIV transmission is handicapped by technical difficulties in determining the exact timing of when an infant becomes infected. Nevertheless, progress is being made both in defining and promoting 'safer breastfeeding' for HIV-infected women who choose to breastfeed and in supporting the use of breastmilk substitutes by women who choose not to breastfeed. A common feature of all strategies is the need to optimize maternal health and support of women by midwives and other health care providers.     

Communicating human biomonitoring results to ensure policy coherence with public health recommendations: analysing breastmilk whilst protecting, promoting and supporting breastfeeding

This article addresses the problem of how to ensure consistency in messages communicating public health recommendations on environmental health and on child health. The World Health Organization states that the protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. International public health policy recommends exclusive breastfeeding for six months, followed by continued breastfeeding with the addition of safe and adequate complementary foods for two years and beyond. Biomonitoring of breastmilk is used as an indicator of environmental pollution ending up in mankind. This article will therefore present the biomonitoring results of concentrations of residues in breastmilk in a wider context. These results are the mirror that reflects the chemical substances accumulated in the bodies of both men and women in the course of a lifetime. The accumulated substances in our bodies may have an effect on male or female reproductive cells; they are present in the womb, directly affecting the environment of the fragile developing foetus; they are also present in breastmilk. Evidence of man-made chemical residues in breastmilk can provide a shock tactic to push for stronger laws to protect the environment. However, messages about chemicals detected in breastmilk can become dramatized by the media and cause a backlash against breastfeeding, thus contradicting the public health messages issued by the World Health Organization. Analyses of breastmilk show the presence of important nutritional components and live protective factors active in building up the immune system, in gastro intestinal maturation, in immune defence and in providing antiviral, antiparasitic and antibacterial activity. Through cohort studies researchers in environmental health have concluded that long-term breastfeeding counterbalances the effect of prenatal exposure to chemicals causing delay in mental and psychomotor development. Therefore caution should be exercised when presenting the results of biomonitoring of breastmilk. The results should be a motivation to enact strong legislation on chemicals and review the use of chemical substances present in breastmilk, but the results should not be used to undermine the confidence in breastmilk as the optimal food for infants and young children.     

The “pumpgate” incident: Stigma against lactating mothers in the U.S. workplace

ABSTRACT

Studies conclude that breastfeeding for six months is associated with better lifelong health for the mother and the child. Mothers in the U.S. returning to work after maternity leave report difficulty with the need to take frequent breaks to pump breastmilk so many stop breastfeeding. Factors discouraging pumping breastmilk in the workplace motivated a content analysis of public comments posted in response to a legal deposition that occurred in January of 2011 in which an attorney who was a new mother was challenged about taking a break to pump breastmilk. A total of 899 public comments posted on Yahoo in 2015–2016 in response to this earlier incident were analyzed for content. Of these, only 336 mentioned breastfeeding. Overall, 148 comments showed support for breastfeeding or pumping breastmilk at work, while 182 comments showed moderate to strong disapproval (six unclassified). The majority of disapproving comments were critical of pumping breastmilk in the workplace. Implications of these findings for the duration of breastfeeding after returning to work are discussed.     

Women's social space and the reference for breastfeeding practice

This study aimed to identify agents or institutions taken as reference by women when breastfeeding. A qualitative study was carried out on 20 primiparous who were assisted, for reasons not related to breastfeeding, in the five health services selected by this study. Data were collected by semi-structured interviews carried out in the participants' households and were analyzed by content analysis in the thematic mode. We identified that health professionals play a standardize role of breastfeeding based on scientific knowledge. In the daily breastfeeding routine, the family is the first reference for women, transmitting beliefs, habits and behaviors. We believe in the valorization of the family context by the health professional, in which actions and interactions in the breastfeeding issue are developed in order to constitute the foundations for a new care model in breastfeeding. This model should, therefore, consider the practice diversity, adapting actions to the multiple roles of being mother/fortress/wife/worker in the social context.     

南京市0～12月婴儿母亲母乳保存知信行现况调查

目的了解南京市0~12月婴儿母亲对母乳保存的认知及母乳保存现状,对建立一种安全、有效、接受程度高的母乳保存方式有一定指导意义。方法 2013年4-5月在江苏省妇幼保健院儿童保健科门诊随机调查210名0~12月婴儿母亲,调查内容包括母亲基本信息及其对母乳保存相关知识的了解和实践情况。结果 80.49%受调者曾经通过网络、医院等途径了解过母乳保存相关知识;62.27%受调者认为24h是母乳冷藏保存的可接受期限;44.85%受调者认为1个月是母乳冷冻保存的可接受期限;47.80%受调查者有过母乳保存行为,其中54.17%的母亲因担心营养成分丢失、保存安全性以及保存复温后口感异常,未将保存的母乳复温后喂养婴儿;母亲受教育程度和喂养方式均与母乳保存的知晓率显著相关(P0.05)。结论母乳冷藏或冷冻是目前南京市婴儿母亲主要的母乳保存方法,但是保存母乳的再喂养率较低。建议加强对孕产妇母乳保存知识的普及和释疑,提高保存母乳的再喂养率。     

Changes in public attitudes toward breastfeeding in the United States, 1999-2003

Data from the HealthStyles survey, an annual national mail survey to US adults, were examined to understand changes in public attitudes toward breastfeeding. The 1999 and 2003 HealthStyles surveys included four breastfeeding items related to public attitudes toward breastfeeding in public and toward differences between infant formula and breastmilk. The percentage of respondents in agreement with the statement, "Infant formula is as good as breastmilk," increased significantly from 14.3% in 1999 to 25.7% in 2003. The increase was particularly large among people of low socioeconomic status. The percentage increase in agreement that "feeding a baby formula instead of breastmilk increases the chances the baby will get sick" grew at a statistically significant level, but the total change was small (2.7 percentage points). No significant total changes were found for the other two survey items. The perception that infant formula is as good as breastmilk would be expected to soften a woman's commitment to breastfeeding should she be faced with obstacles to doing so. The findings underscore the need to educate the general public that breastfeeding is the best method of feeding and nurturing infants. Pediatricians and other health professionals should recommend human milk for all infants for whom breastfeeding is not specifically contraindicated.     

Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets

OBJECTIVE: The purpose of this study was to explore first-generation Bangladeshi women's understandings and experiences of postnatal distress, and to describe coping strategies during the postnatal period. METHODS: This was a qualitative study using focus groups. Subjects were drawn from three existing community groups in Tower Hamlets, a multiethnic, socially deprived borough in east London. Thematic content analysis was used to explore and present the data. RESULTS: Many women received little practical or emotional support once home from hospital with a new baby, because of the lack of extended family networks; this contrasts with the 40 day rest period common in Bangladesh. These women understood emotional distress as separate from physical symptoms or illness, and recognized that one may influence or cause the other. Distinctive language was used to describe these thoughts and feelings. The roles of health visitors, midwives and GPs were understood solely in terms of physical care. Accordingly, they did not access professionals for emotional or psychological problems. Lack of language support services contributed to the women not seeking help. CONCLUSIONS: Information about services, and professional roles in the postnatal period should be extended to include key family members such as husbands and mothers-in-law. Dialogue with Bangladeshi women may ensure that women understand the extended roles of GPs, health visitors and midwives in providing help for emotional distress, alongside their role in physical health care. More language support and advocacy is needed if women are to access the full range of health services.     

Women's health and social change: the case of lay midwives

One reaction to the medicalization of birth has been the comeback of lay midwives in the past 10 years. While many practice alone as did midwives 80 years ago, now midwives are networking and organizing in regional and statewide groups, an important new distinction in the light of increasing regulatory policy formation by many states. Are these groups the beginnings of traditional bureaucratic health professional organizations or are they better described as alternative women's health groups that espouse nonhierarchical philosophies of women's health? In this article, we describe an empirical study of one such group, the Michigan Midwives' Association, and explore the philosophies and practices of individual members as well as the internal organization of the group and its influence on members. Data were collected using individual telephone interviews with 48 of 50 members, group newsletters and documents, and two spokespersons who developed an oral history of the Association since its origin in 1978. Results suggest that the group plays an important role in reinforcing individually held philosophies about women-controlled birth and in providing social support to health workers practicing outside the traditional system.     

Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory

OBJECTIVE: To estimate the attributable ACT hospital system costs of treating selected infant and childhood illnesses having known associations with early weaning from human milk. METHOD: We identified relative risks of infant and childhood morbidity associated with exposure to artificial feeding in the early months of life vs. breastfeeding from cohort studies cited by the American Academy of Pediatrics in 1997 as establishing the protective effect of breastfeeding. Data for ACT breastfeeding prevalence is assessed from a 1997 prospective population-based cohort study of 1,295 women. ACT Hospital Morbidity Data and DRG treatment costs were used to estimate the attributable fraction of costs of hospitalisation for gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. RESULTS: Although initiation rates were high (92%), less than one in 10 ACT infants are exclusively breastfed for the recommended six months, mainly due to supplementation or weaning on to formula within the first three months and the early introduction of solids by breastfeeding mothers. This study suggests the attributable hospitalisation costs of early weaning in the ACT are about $1-2 million a year for the five illnesses. CONCLUSIONS AND IMPLICATIONS: Early weaning from breastmilk is associated with significant hospital costs for treatment of gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. These costs are minimum estimates of the cost of early weaning as they exclude numerous other chronic or common illnesses and out-of-hospital health care costs. Higher rates of exclusive breastfeeding would reduce these costs. Interventions to protect and support breastfeeding are likely to be cost-effective for the public health system.     

The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review

Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question ‘what is the nature of the evidence relevant to the provision of mental health interventions by midwives?’ To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife‐led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife‐led counselling interventions are effective. Further research is needed to test midwife‐led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.     

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.     

Burning bridges: policy,practice, and the destruction of midwifery in rural Costa Rica

The trend toward hospitalization of birth has a long history in Costa Rica and currently approximately 98% of births take place in the clinical setting. Impoverished rural areas, like the town of Buenos Aires, lag behind national trends and only recently has birth moved from the home to the hospital. Costa Rica's midwife certification program co-opted rural midwives as bridges to biomedicalization, responsible for both pushing women into the biomedical setting and filling the gaps left by a limited national health care system. Despite the eventual illegalization of key practices and of home birth itself, local use of midwives' services continues, albeit with local demands that have transformed midwives into bridges to biomedical care in ways unanticipated by and invisible to national programmers. Midwives provide key services like prenatal massage, treatment of pregnancy crises, and attending unforeseen home births and women unable to afford the modest costs of hospitalization. Yet, midwives report increasing dissatisfaction and the desire to stop providing services in their communities. Practices like prenatal massage are in demand, but are no longer embedded in a system of local exchange that is socially and economically meaningful. Midwives blame their clientele for their dissatisfaction, but directly link these changes to the notions of professionalism, compensation, and changing community values. Thus, the social relationship between midwives and their clients must also be understood as a destructive force burning midwifery as a bridge to safe birth. In this essay, I argue that the process of both remodeling and subsequently destroying midwifery practices begun in the formal health care sector at the national level continues at the local level through changing values and meanings associated with midwives' practices.     

Keep Doing the Good Work: Impact of Coworker and Community Support on Continuation of Breastfeeding

ABSTRACT

Returning to work poses a challenge to new mothers’ breastfeeding success during the first 6 months postpartum. While previous research has shown that breastfeeding-related workplace policy plays a significant role in women’s decision to continue breastfeeding, the extent to which interpersonal factors such as coworkers’ (lack of) support and stigma affect women’s breastfeeding behavior is less understood. Through a cross-sectional survey with 500 working mothers, this research found that female coworker support of other women played an important role in affecting mothers’ decision to continue breastfeeding after returning to work and contributed to breastfeeding self-efficacy. The findings suggest that mothers’ perception of supportive coworker communication has an impact on sustained breastfeeding. Workplaces need to enhance the mother-friendly climate by encouraging and rewarding coworkers and providing support necessary for breastfeeding colleagues.     

Maternal care and breastfeeding experience of women suffering intimate partner violence

OBJECTIVE: To describe maternal care and breastfeeding experience of women suffering intimate partner violence. METHODOGICAL PROCEDURES: A qualitative study was conducted in 11 women suffering intimate partner violence during pregnancy. Women aged 16-41 years were recruited in a hospital in the city of Rio de Janeiro between January and March 2005. Data were collected through in-depth interviews using a life history approach and complemented by a semi-structured guide. ANALYSIS OF THE RESULTS: Women expressed mixed feelings of loneliness and good moments regarding maternal care and breastfeeding experience. Most had early cessation of breastfeeding and the reasons reported included: the need to resume their working activities, lack of information on breastfeeding and the violence experienced by these women. CONCLUSIONS: The study shows a need to approach women as key actors of a nursing model, offering opportunities to listen to their concerns as well as to provide care to intimate partner violence victims and differentiated support.     

Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa

While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in South Africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.     

Designing a model of breastfeeding support in Australia: An appreciative inquiry approach

In Australia, one of the most frequent reasons for not breastfeeding is a previously unsuccessful experience. This qualitative study used an appreciative inquiry approach to co‐design a model of peer and professional breastfeeding support, in a metropolitan area of New South Wales (NSW) Australia, in collaboration with women who have had previous negative experiences of breastfeeding. In total, 30 mothers, health professionals and peer supporters participated in a two‐part study, involving interviews and a collaborative workshop. The data were analysed using content analysis. The appreciative inquiry approach led to a solution focused attitude among participants and a commitment to improving breastfeeding support. We noted a level of apathy when the participant groups were interviewed individually prior to the collective workshop. During the collaborative workshop, all three participant groups came together to look at what was currently working well and designed improvements for the future. Midwifery care was identified as important for the start of the breastfeeding journey, during pregnancy and for the first 1–2 weeks after birth, but thereafter it was community and trained peer counsellors who were prioritised for breastfeeding support. Participants identified the need for a variety of support options including face‐to‐face meetings, Skype meetings, phone calls and/or texting. Workshop participants emphasised the need for women, especially those with previous negative experiences, to be linked in with their local peer support community group. An appreciative inquiry approach brought together all key stakeholders to develop practice‐based change which included the end user and care providers. The collaborative workshop enabled participants to come together, as individuals, rather than as designated health professionals or trained peer counsellors, or breastfeeding women with negative experiences. This led to a unified approach and a harnessing of collective energy to initiate positive change.     

Effectiveness of professional breastfeeding home-support

The effect of professional home-support on the success of breastfeeding was investigated to determine whether breastfeeding women who received professional home-support would breastfeed longer than similar women who did not receive this support. Fifty-two volunteers of lower socio-economic status were recruited for this study from four obstetrical clinics and were randomly assigned to an intervention or a comparison group. Both groups received the standard clinic and in-hospital breastfeeding teaching and were given breastfeeding instruction in the hospital by the researcher. The women in the intervention group received, in addition, an average of seven home breastfeeding support contacts by the researcher over two months postpartum, and were provided with the researcher's phone number. Women in the comparison group did not receive home visits but had access to the clinic nutritionist if any questions or problems arose.More than half (61.5%) of the intervention group subjects were still breastfeeding at two months post-partum versus approximately one-third (34.6%) of the comparison group (p < 0.01). These results suggest that professional home breastfeeding support programs may be effective in increasing the duration of breastfeeding among this population, thereby achieving one of the Surgeon General’s health objectives.     

Being a 'good mother': managing breastfeeding and merging identities

Breastfeeding is not simply a technical or practical task but is part of the transition to motherhood, the relationship between mother and baby and the everyday experience of living with a new baby. Discussion of breastfeeding must therefore include the individual's personal and social context. This paper explores how women in England who have chosen to breastfeed their baby accomplish this task during the early stages of motherhood and the relative weight attached to different factors, which impinge on decision-making. Our findings, based on observing 158 interactions between breastfeeding women and midwives or health visitors from one Primary Care Trust in the north of England, UK, and in-depth interviews with a sample of 22 of these women, illustrate the dynamic between breastfeeding, becoming and being a 'good mother' and merging multiple identities as they embrace motherhood. In this context, the value attached to breastfeeding as synonymous with being a 'good mother' is questioned. In managing the balance between ensuring a healthy, contented baby and the reality of their daily lives, women negotiate the moral minefield that defines 'good mothering' and the diverse conceptions and influences that shape it--including health professionals, their social networks and the wider social and structural context of their lives. The implications for policy and practice are discussed.     

Professional Women's Well-Being: The Role of Discrimination and Occupational Characteristics

This study examined the association between perceived discrimination, workplace racial composition, and three outcomes—psychological distress, life dissatisfaction, and job dissatisfaction—among a sample of Black (n = 72) and White (n = 74) professional women. As a comparison, these relationships were analyzed to determine if they varied from those observed in more traditionally studied populations: Whites and non-professional Blacks, using data from a population of working women in the 1995 Detroit Area Study (N = 533). Perceived discrimination was associated with differences in psychological distress and job dissatisfaction but not with life dissatisfaction. The correlation between perceived discrimination and psychological distress was larger for White professional women than for Black professional women (White women odds ratio [OR]: 1.99; Black women OR: 0.80). A larger correlation between race and job dissatisfaction was observed for Black professional women than for Black non-professional women. The racial composition of the workplace was unrelated to any of the outcomes. Study results emphasized the importance of decreasing the frequency of discrimination for positive mental health and underscored the need for more systematic research on discrimination and health among Black women of higher socioeconomic status, a growing sub-population in the United States.