Australian Breastfeeding Association Research Articles

Care in the time of COVID: An interpretative phenomenological analysis of the impact of COVID-19 control measures on post-partum mothers' experiences of pregnancy, birth and the health system.

BackgroundFindings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system.MethodsThis study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association’s social media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis.ResultsMothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience.ConclusionThis study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures.

O55 - LiveChat: the Australian Breastfeeding Association’s web-based service providing information and support

The Australian Breastfeeding Association’ s (ABA’s) LiveChat is a web-based information and support service available through the ABA website which is staffed by trained ABA volunteer breastfeeding educators and counsellors. LiveChat is a free, readily accessible, federal government-funded service. LiveChat volunteers guide visitors to find evidence-based information about breastfeeding and provide general breastfeeding information and support. LiveChat volunteers refer visitors to ABA counselling services, if more personalised information and support is required, and refer to other services when visitors’ needs go beyond the scope of practice of ABA volunteers. The aim of the study was to evaluate ABA’s LiveChat service to determine whether it was meeting the needs of visitors. In 2021, LiveChat users (n=190) were surveyed about their experience of using the service. Survey questions included 1) demographic information 2) reasons for contacting LiveChat, 3) level of satisfaction with the service and 4) the difference it made to them and their breastfeeding journey. Most visitors to LiveChat were mothers (98%) who heard about the service from the ABA website (43%), a midwife (21%), a child health nurse (19%), friends or family members (17%) and information/material provided by the hospital (16%) and Facebook (11%). The top 5 reasons visitors contacted LiveChat were: reassurance, information on feeding patterns, sore breasts or nipples, concerns with low milk supply and positioning and attachment. Contacting ABA’s LiveChat had immediate and measurable outcomes. Most mothers: • felt reassured, less stressed and less worried, • more confident and knowledgeable about breastfeeding and more determined to continue breastfeeding • agreed that the support they received helped them to resolve their issues and encouraged them to continue breastfeeding. ABA’s LiveChat is a valuable service which supports mothers to continue to breastfeed. Health professionals should be familiar with LiveChat so they can confidently refer to the service.

O47 - What modifiable factors improve breastfeeding exclusivity and duration in Australian women?

Australian breastfeeding rates, particularly exclusive breastfeeding rates, are low and have been low for many years because strategies to increase them have been inadequate. New approaches for promoting and supporting breastfeeding are required. Data collected in 2008 suggested that Australian Breastfeeding Association (ABA) members had much higher exclusive breastfeeding rates (41.2% at 5 to 6 months) than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted (EMBER) project was undertaken 1) to determine whether ABA volunteer trainees had better breastfeeding outcomes and were, in fact, positive deviants regarding breastfeeding practices, 2) to explore attitudes, characteristics and behaviours underpinning beneficial breastfeeding practices and 3) to identify modifiable characteristics to inform breastfeeding promotion and support. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with ABA and analysed using descriptive statistics. Participants in this project had much higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Modifiable factors that positively influenced breastfeeding outcomes included knowledge of and motivation to breastfeed, birthing outcomes, immediate skin-to-skin contact, lack of in-hospital formula supplementation and partner and peer support. EMBER participants can be defined as positive deviants with positive attitudes, characteristics and behaviours towards breastfeeding that lead to much better breastfeeding outcomes compared to the general Australian population. Many of the modifiable factors that positively impacted their breastfeeding outcomes can be influenced by midwives supporting pregnant women, women giving birth and breastfeeding mothers. Midwives are uniquely positioned to provide breastfeeding education and information, and timely and well-informed breastfeeding support to mothers, to give them the best chance to breastfeed exclusively and breastfeed for longer.

Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey

BackgroundIn Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women’s experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA.MethodsWomen who accessed the service were invited, in 2014, to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes.ResultsResponses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0–8 weeks of age (72%). The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme ‘Support to continue breastfeeding’ and four subthemes: ‘feeling listened to and not judged’; ‘emotional support and confidence building’; ‘the importance of face-to-face, practical support’; and ‘the need for ongoing, free access’.DiscussionIn this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was ‘safe’; and who could enhance a woman’s confidence with breastfeeding over the course of her full breastfeeding journey.ConclusionsReactive peer support, provided in response to need, at an Australian Breastfeeding Association drop-in service, was described by participants as pivotal to enabling their ongoing breastfeeding.

Breastfeeding Duration and Infant Sleep Location in a Cohort of Volunteer Breastfeeding Counselors.

Debate about mother and infant bed sharing has been polarized between supporters of bed sharing and public health policies that attempt to mitigate the risk of Sudden Infant Death Syndrome. Differences in group demographics may be an important aspect in co-sleeping acceptability. The first aim of this study was to investigate infant sleeping location in a dataset of mothers with strong breastfeeding outcomes. The second aim was to investigate the association between infant sleeping location and breastfeeding (exclusive breastfeeding to 6 months and total breastfeeding duration). Finally, we aimed to investigate predictors of breastfeeding duration. Participants comprised 174 women who had applied to train as counselors with the Australian Breastfeeding Association. Data were compiled from a survey of the participants' lactation histories, including questions related to the exclusivity and duration of breastfeeding, concerns about and problems encountered during breastfeeding, type of birth, medications during birth, demographics, and infant sleeping location. The study design was a cross-sectional, one-group survey design. A high proportion of participants in this study bed shared and room shared: At 0-1 month (n = 58), 33% of participants bed-shared, which increased to 58% by 6-12 months (n = 80). Infants who co-slept were more likely to be exclusively breastfed at 6 months (χ2 (2, n = 116) = 4.83, p = .03) and had longer breastfeeding duration (t (62.61) = 3.81, p < .001). Breastfeeding targets have been difficult to achieve globally, and innovative ideas are required to improve breastfeeding outcomes through public health messaging. There was a strong association in the current study between breastfeeding outcomes and degree of closeness of the infant to the mother at night. This finding should be brought into the discourse on breastfeeding and infant sleep arrangements, accompanied by evidence-based advice about safe sleeping and the promotion of breastfeeding.

Exploring breastfeeding support on social media

BackgroundLack of breastfeeding support is often cited by mothers as one of the key reasons for premature weaning. The experiences and perceptions of breastfeeding mothers in a range of contexts and their support needs have been studied, but there has been little exploration of the specific breastfeeding topics that women are investigating via social networking sites (SNSs) such as Facebook, and how breastfeeding peer supporters respond to queries about breastfeeding concerns on a SNS.MethodsThis online ethnography took place in the Australian Breastfeeding Association’s (ABA) closed Facebook groups. These groups have been created for breastfeeding mothers to seek and provide support to their peers. All wall posts, comments and images for 15 of these groups were captured over a four-week period between 21 July and 17 August 2013.ResultsThe data were collected on a total of 778 wall posts with a total of 2,998 comments posted into the initial wall posts. Analysis revealed that 165 (21%) of these wall posts were queries and 72 (44%) of the queries were specific breastfeeding questions. Twelve breastfeeding topic areas were identified, and the top three topic areas were further analysed for not only their content but the nature of informational and emotional support provided to the community members.ConclusionsThe closed Facebook groups hosted by the ABA provided both informational and emotional support that appeared to be facilitated by an authentic presence from both trained peer breastfeeding counsellors and other mothers. The group administrators played a vital role in both responding to the queries and overseeing the discussions to ensure they adhered to the ABA’s Code of Ethics.

High rates of breastfeeding exclusivity and duration amongst Australian Breastfeeding Association volunteer counsellors and community educators: The evidence

High rates of breastfeeding exclusivity and duration amongst Australian Breastfeeding Association volunteer counsellors and community educators: The evidence

Increasing Loyalty to Breastfeeding: Investigating a Product Development Strategy

This article demonstrates how social marketing insights were used to influence women's loyalty to breastfeeding. The article reports on a social marketing campaign undertaken by the Australian Breastfeeding Association and a government health department, which used a product development strategy in order to increase breastfeeding loyalty. Seeking new approaches to support breastfeeding behaviors is critical and timely, because while initiation rates of breastfeeding are high in developed countries such as the United Kingdom, Australia, Canada, and the United States, duration rates are significantly lower. Results indicate that a product- focused strategy influences pregnant women's loyalty to exclusively breastfeeding.

World Health Organization growth charts for monitoring the growth of Australian children: Time to begin the debate

The recently released World Health Organization growth charts are methodologically robust, as well as clinically useful tools for monitoring the growth of children. They have been endorsed by premier organisations such as the Royal College of Paediatrics and Child Health (UK), Canadian Pediatric Society, Australian Breastfeeding Association, United Nations Standing Committee on Nutrition, International Union of Nutrition Sciences, International Pediatric Association and the European Childhood Obesity Group. The Centers for Disease Control and Prevention (CDC) as well as the American Academy of Pediatrics have also recently endorsed these charts for the 0- to 24-month age group in USA. These growth charts have been adopted by many countries including Canada, UK and New Zealand. Nearly 140 countries are at various stages of implementing them. They offer significant advantages over the currently used CDC 2000 growth charts. They have the potential to contribute in reducing the worldwide incidence of obesity as well as under nutrition in children. Except Northern Territory, Australia continues to use the CDC 2000 growth charts. Paediatricians need to initiate and lead robust debate involving key stakeholders about the implementation of World Health Organization growth charts for monitoring the growth of Australian infants and children.

Human milk banking in the volunteer sector: Policy development and actuality in 1970s Australia

Objectiveto describe the development of rigorous milk banking policies in the voluntary sector in Australia, 1975–1979, by the non-government organisation, the Nursing Mothers' Association of Australia (now the Australian Breastfeeding Association), and the eventual abandonment of milk banking by the organisation. Designhistorical article. SettingAustralia in the years 1975–1979. Conclusionsduring the period in which the policy development described here took place, conducting a milk bank to the rigorous standards set by the organisation required too heavy an investment of hours by unpaid volunteer coordinators to be sustainable. Implications for practicein establishing and continuing a successful milk bank, models which depend less on volunteer hours may be more sustainable.

A systematic review of maternal obesity and breastfeeding intention, initiation and duration

BackgroundBreastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully. An association has been reported between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and the apparent association with increased artificial feeding will lead to a greater risk of obesity in children. The aim of this paper is to examine the relationship between maternal overweight and obesity and breastfeeding intention and initiation and duration.MethodsA systematic review was conducted in January and February 2007, using the following databases: Medline, CINAHL and the Australian Breastfeeding Association's Lactation Resource Centre. Studies which have examined maternal obesity and infant feeding intention, initiation, duration and delayed onset of lactation were tabulated and summarised.ResultsStudies have found that obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding. Of the four studies that examined onset of lactation, three reported a significant relationship between obesity and delayed lactogenesis. Fifteen studies, conducted in the USA, Australia, Denmark, Kuwait and Russia, have examined maternal obesity and duration of breastfeeding. The majority of large studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors.ConclusionThere is evidence from epidemiological studies that overweight and obese women are less likely to breastfeed than normal weight women. The reasons may be biological or they may be psychological, behavioral and/or cultural. We urgently need qualitative studies from women's perspective to help us understand women in this situation and their infant feeding decisions and behaviour.

How midwives learn about breastfeeding

Little is known about how midwives learn aboutbreastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n=3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n=1,105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n=34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach in-depth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

How midwives learn about breastfeeding

Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n=3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n=1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n=34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach indepth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

Does Maternal Smoking Have a Negative Physiological Effect on Breastfeeding? The Epidemiological Evidence

Women who smoke are less likely to breastfeed their children than nonsmokers. It is thought that nicotine has a negative effect on breastmilk supply by suppressing prolactin levels. The aim of this review was to assess the epidemiological evidence that maternal smoking has a negative physiological effect on breastfeeding. The following data sources were searched: The Cochrane Library, Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Lactation Resource Centre (Australian Breastfeeding Association) using the key words "smoking" and "breastfeeding" or "infant feeding." The Journal of Human Lactation and Birth were hand searched. Women who smoke are less likely to intend to breastfeed, less likely to initiate breastfeeding, and likely to breastfeed for a shorter duration than nonsmokers. Several studies have found a dose-response relationship between the number of cigarettes smoked each day and breastfeeding intention, initiation, and duration that persists after adjusting for confounding factors. In some population groups a high proportion of smokers breastfeed successfully. The association between maternal smoking and lack of breastfeeding is consistent across different study designs in a range of countries. Given that women who smoke are less likely to intend to breastfeed, however, it cannot be assumed that the relationship between smoking and duration of breastfeeding is a physiological one. If smoking had a consistent negative physiological effect on lactation, one would not expect to see such wide variations in breastfeeding rates among women who smoke. Therefore, it is likely that psychosocial factors are largely responsible for the lower rates of breastfeeding found in women who smoke compared with those who do not.

President's Report

Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n=3500) through the Australian College of Midwives Inc. (ACMI).A response rate of 31.6% (n=1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n=34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source.There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach indepth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women.The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.