Breastfeeding Advice Research Articles

Competing infant feeding information in mothers' networks: advice that supports v. undermines clinical recommendations.

To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas. Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices. Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA. Eighty-one low-income mothers of infants between 0 and 12 months old. Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95% CI 1·2, 38·1) and not adding cereal in the infant's bottle (OR=15·9; 95% CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours. Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers' networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers' social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers' infant care career may be beneficial.

The development of a new breast feeding assessment tool and the relationship with breast feeding self-efficacy

Objectiveto develop a breast feeding assessment tool to facilitate improved targeting of optimum positioning and attachment advice and to describe the changes seen following the release of a tongue-tie. Designdevelopment and validation of the Bristol Breastfeeding Assessment Tool (BBAT) and correlation with breast feeding self-efficacy. Settingmaternity hospital in South West England. Participants218 breast feeds (160 mother–infant dyads); seven midwife assessors. Findingsthe tool has more explanation than other tools to remind those supporting breast-feeding women about the components of an efficient breast feed. There was good internal reliability for the final 4-item BBAT (Cronbach׳s alpha=0.668) and the midwives who used it showed a high correlation in the consistency of its use (ICC=0.782).Midwives were able to score a breast feed consistently using the BBAT and felt that it helped them with advice to mothers about improving positioning and attachment to make breast feeding less painful, particularly with a tongue-tied infant. The tool showed strong correlation with breast feeding self-efficacy, indicating that more efficient breast feeding technique is associated with increased confidence in breast feeding an infant. Conclusionsthe BBAT is a concise breast feeding assessment tool facilitating accurate, rapid breast feeding appraisal, and targeting breast feeding advice to mothers acquiring early breast feeding skills or for those experiencing problems with an older infant. Accurate assessment is essential to ensure enhanced breast feeding efficiency and increased maternal self-confidence. Implications for practicethe BBAT could be used both clinically and in research to target advice to improve breast feeding efficacy. Further research is needed to establish its wider usefulness.

G283(P) How good are we at providing breastfeeding advice?

IntroductionEngland has one of the lowest breastfeeding rates in Europe. Initiation rates are 83% but within one week the rate of exclusive breastfeeding drops to 46% and by 6 months...

Determinants of the gap between breastfeeding knowledge and practices in Vietnamese mothers (119.1)

We conducted this analysis to examine determinants of the knowledge‐practice gap in early and exclusive breastfeeding (BF). In a cross‐sectional survey, we interviewed 10,834 mothers with children aged 0−23 months old in 11 of 63 provinces of Viet Nam about BF practices, knowledge, barriers and support. The knowledge‐practice gap was defined when a mother knew about the benefit but did not perform the corresponding practice. The proportion of mothers with a knowledge‐practice gap in early and exclusive BF was 34% and 66%, respectively. Mothers were ~10% less likely to have a knowledge‐practice gap in early BF if they received BF advice and support from a health worker during pregnancy or at birth (P < 0.05; Poisson regression). The gap, however, was 60%, 140% and 20% more likely to occur among those with hospital delivery, cesarean delivery and BF difficulty, respectively (P < 0.05 for all). For exclusive BF, a 25% reduction in the gap was found if a mother believed that people who are important to her support exclusive BF (P < 0.001). A 5% increase in the gap was found among mothers who were exposed to infant formula advertising daily (P < 0.01). To reduce the knowledge‐practice gap in early BF, programs should focus on strengthening support by health staff and minimizing health‐facility related barriers. For exclusive BF, programs should focus on addressing socio‐cultural barriers.Grant Funding Source: Bill & Melinda Gates Foundation, through Alive & Thrive Initiative, managed by FHI360

Validity and reliability of breastfeeding advice and coping with breastfeeding instruments.

To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings. Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments. Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland. The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues. Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

Beyond the Typical: One Mother's Unique Challenge to Continue Providing Breastmilk for Her Special Needs Baby

Background Breastfeeding is the undisputed optimal feeding method for infants. In response, Healthy People 2020 called for an increase in the number of infants who are breastfed at 1 year to 34.1%. The Centers for Disease Control and Prevention reported the breastfeeding rate for 2012 as only 25.5%. To accomplish the breastfeeding goal of Healthy People, mothers need excellent breastfeeding support throughout the entire first year. In 2005, the American Academy of Pediatrics recommended that infants breastfeed exclusively for 6 months and should continue breastfeeding for at least 1 year as complimentary foods are added. Studies have shown an overwhelming number of infant health benefits associated with breastfeeding, including protection of the infant from bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late‐onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges that put her at risk for breastfeeding cessation. Case The mother (MB) of a 9‐month‐old infant called the lactation resource line at our institution seeking breastfeeding advice. She shared her infant's history, which was significant for severe gastrointestinal (GI) symptoms since birth, including blood in stool, vomiting, and fussiness. When MB was exclusively breastfeeding, she was able to control his symptoms with maternal diet elimination. With the introduction of solid foods however, the symptoms returned. With the help of her pediatrician MB was able to determine and eliminate the offending foods. At the time of the call, MB was suffering from mastitis and was placed on an antibiotic, which seemed to be triggering the same GI symptoms for her infant. Faced with the prospect of pumping and discarding her milk until the completion of the antibiotic treatment, she was calling for advice. The lactation consultant was able to research this otherwise safe medication and devise a feeding plan with MB. It was paramount to feed the infant when the concentration of the medication in MB's milk was at its lowest to minimize the infant's symptoms. Conclusion The implementation of this creative feeding plan allowed MB and her infant to continue breastfeeding with minimal GI disturbances. MB was extremely happy to be able to continue providing the optimal nutrition for her infant. Breastfeeding is the undisputed optimal feeding method for infants. In response, Healthy People 2020 called for an increase in the number of infants who are breastfed at 1 year to 34.1%. The Centers for Disease Control and Prevention reported the breastfeeding rate for 2012 as only 25.5%. To accomplish the breastfeeding goal of Healthy People, mothers need excellent breastfeeding support throughout the entire first year. In 2005, the American Academy of Pediatrics recommended that infants breastfeed exclusively for 6 months and should continue breastfeeding for at least 1 year as complimentary foods are added. Studies have shown an overwhelming number of infant health benefits associated with breastfeeding, including protection of the infant from bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late‐onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges that put her at risk for breastfeeding cessation. The mother (MB) of a 9‐month‐old infant called the lactation resource line at our institution seeking breastfeeding advice. She shared her infant's history, which was significant for severe gastrointestinal (GI) symptoms since birth, including blood in stool, vomiting, and fussiness. When MB was exclusively breastfeeding, she was able to control his symptoms with maternal diet elimination. With the introduction of solid foods however, the symptoms returned. With the help of her pediatrician MB was able to determine and eliminate the offending foods. At the time of the call, MB was suffering from mastitis and was placed on an antibiotic, which seemed to be triggering the same GI symptoms for her infant. Faced with the prospect of pumping and discarding her milk until the completion of the antibiotic treatment, she was calling for advice. The lactation consultant was able to research this otherwise safe medication and devise a feeding plan with MB. It was paramount to feed the infant when the concentration of the medication in MB's milk was at its lowest to minimize the infant's symptoms. The implementation of this creative feeding plan allowed MB and her infant to continue breastfeeding with minimal GI disturbances. MB was extremely happy to be able to continue providing the optimal nutrition for her infant.

A Survey of Child Care Centers about Breastfeeding Support in Adelaide, South Australia

Australia has high rates of breastfeeding initiation, with a consistent decline over the first year. Furthermore, there is a growing trend of maternal employment and rising numbers of children enrolled in different types of child care services, both of which can have a negative impact on breastfeeding. To provide evidence to better inform implementation of breastfeeding-friendly strategies in child care settings, this study examined breastfeeding policy and practice in child care centers in metropolitan Adelaide. The paper reports on a survey sent to 292 child care centers in metropolitan Adelaide in 2010. The survey collected information on center location and type, number of enrolled children under age 2, and number of breastfed babies. The survey also included questions about breastfeeding facilities and support, breastfeeding policies, staff training, and barriers to and recommendations to enhance breastfeeding support in child care centers. Of the 62 completed returned surveys (21% response rate), 43 centers (69.4%) reported that they currently have children who receive breast milk at the center; however, in most centers, the total number of breastfed children was reported to be between 1 and 4; 76% reported that the center was supportive of exclusive breastfeeding for 6 months; and 80.6% had statements on breastfeeding as part of their food and nutrition policies or guidelines. Furthermore, 64.5% reported there was no formal or informal training for staff on breastfeeding support, but 50% reported that staff members do provide breastfeeding advice to mothers of children in their center. Despite some strategies in place to support breastfeeding, there are no standards on breastfeeding policies, practices, and training in child care settings. Therefore, the extent and scope of such support depend on parental request and the perceptions and attitudes of child care center staff toward breastfeeding.

Fatores associados ao aleitamento materno em dois municípios com baixo índice de desenvolvimento humano no Nordeste do Brasil

To determine the duration of breastfeeding and to identify factors associated with exclusive / predominant breastfeeding in children under two years old. This is a cross-sectional study conducted from March to June 2005 in the municipalities of Gameleira and São João do Tigre, located in the interior of Pernambuco and Paraiba States. The sample comprised 504 children under two years (280 residents in Gameleira and 224 in São João do Tigre). Survival analysis was used to estimate the median duration of survival time of breastfeeding and the associations with socioeconomic conditions, factors related to mothers and children and health care. The duration of exclusive and exclusive/predominant breastfeeding and breastfeeding were of 19, 79 and 179 days in Gameleira and 23, 91 and 169 days in São João do Tigre, respectively. Mothers with better socioeconomic conditions, as represented by education, sanitation, and possession of consumer goods, had a higher median duration of exclusive/ predominant breastfeeding in both towns. Prenatal care represented by higher number of attendance, earlier onset and feeding and breastfeeding advice had a positive influence on breastfeeding duration. Breastfeeding duration was lower than the recommendation. Despite the families precarious living conditions, a better socioeconomic status and prenatal care were protective factors for exclusive/ predominant breastfeeding duration in these areas.

Use of an Eye Mark Recorder to Identify the Places to Observe When Providing Breastfeeding Advice

Use of an Eye Mark Recorder to Identify the Places to Observe When Providing Breastfeeding Advice

Interventions for preventing mastitis after childbirth

Despite the health benefits of breastfeeding, initiation and duration rates continue to fall short of international guidelines. Many factors influence a woman's decision to wean; the main reason cited for weaning is associated with lactation complications, such as mastitis. To assess the effects of preventive strategies for mastitis and the subsequent effect on breastfeeding duration. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 August 2012). We included randomised controlled trials of interventions for preventing mastitis in postpartum breastfeeding women. We independently identified relevant studies and assessed the trial quality. We contacted trial authors for missing data and information as appropriate. We included five trials (involving 960 women). In three trials of 471 women, we found no significant differences in the incidence of mastitis between use of antibiotics and no antibiotics (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.11 to 1.61; or in one trial of 99 women comparing two doses (RR 0.38; 95% CI 0.02 to 9.18). We found no significant differences for mastitis in three trials of specialist breastfeeding education with usual care (one trial); anti-secretory factor cereal (one trial); and mupirocin, fusidic acid ointment or breastfeeding advice (one trial).Generally we found no differences in any of the trials for breastfeeding initiation or duration; or symptoms of mastitis. There was insufficient evidence to show effectiveness of any of the interventions, including breastfeeding education, pharmacological treatments and alternative therapies, regarding the occurrence of mastitis or breastfeeding exclusivity and duration. While studies reported the incidence of mastitis, they all used different interventions. Caution needs to be applied when considering the findings of this review as the conclusion is based on studies, often with small sample sizes. An urgent need for further adequately powered research is needed into this area to conclusively determine the effectiveness of these interventions.

Survey on breastfeeding among Chinese female physicians and nurses

The present study investigated knowledge of and beliefs about breastfeeding among Chinese female physicians and nurses and their breastfeeding practices. This study documented knowledge, attitudes and practices of breastfeeding among Chinese medical staff. A total of 367 female physicians and nurses completed a self-administered, anonymous questionnaire; 96.2% indicated that breastfeeding was natural, but 29.2% thought it difficult. Only 18.5% of the participants questioned breastfeeding women on feeding status, and 12.8% gave breastfeeding advice when asked. After graduation from school, 79.3% of the participants stated that they did not receive training in breastfeeding. In personal practice, 69.2% initiated breastfeeding; 19.1% were still breastfeeding at 4 months, and only three nurses continued breastfeeding for more than 1 year. In conclusion, breastfeeding-related knowledge is surprisingly poor, and attitudes are less positive. The exclusive breastfeeding rate was found to be low among Chinese female physicians and nurses. The findings highlight the need to re-educate medical staff on breastfeeding, and imply the need for Baby-Friendly Hospital Initiative implementation/training.

Admissions for early parenting difficulties among women with infants conceived by assisted reproductive technologies: a prospective cohort study

To describe rate of and risks for residential early parenting service (REPS) admissions in women with infants conceived with assisted reproductive technology (ART). A prospective study of women who conceived with ART. Self-report telephone interview and questionnaire data were collected in two pregnancy and three postpartum waves. Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia. A consecutive cohort of women with ART pregnancies. None. REPS admission up to 18 months postpartum. Of 239 eligible women. 183 (77%) were recruited, six experienced pregnancy loss, and 153/177 (86%) were retained. In total, 17% (26/153) of participants were admitted to a REPS, 3.37 times more than the population admission rate of 5.05%. Admission risk was increased by primiparity, inadequate breastfeeding advice, low caregiving confidence when discharged from maternity hospital, lower early postpartum mood, unsettled infant behavior, and insufficient help from others. Compared with spontaneous conception, women who conceived with ART are at elevated risk of early parenting difficulties. Early interventions to address breastfeeding difficulties, management of unsettled infant behavior, social isolation, and postpartum anxiety are indicated.

The effects of Baby Friendly Initiative training on breastfeeding rates and the breastfeeding attitudes, knowledge and self-efficacy of community health-care staff

To evaluate the effects of Baby Friendly Initiative (BFI) community training on breastfeeding rates, staff and mothers in a large Primary Care Trust (PCT). UK Government policy promotes the adoption and implementation of the World Health Organization/United Nations Children's Fund BFI as the best evidence to raise breastfeeding initiation and prevalence. A total of 141 health visitors and nursery nurses were trained on mandatory three-day BFI courses during 2008; 137 staff (100 health visitors, 37 nursery nurses) took part in the evaluation. Breastfeeding attitudes, knowledge and staff confidence in helping mothers to breastfeed were measured using a validated Breastfeeding Questionnaire and a self-efficacy tool at three time points before and after training. Breastfeeding rates at eight weeks increased significantly, and a baby born in 2009 was 1.57 times more likely to be breastfed than one born in 2006. Statistically significant improvements in staff breastfeeding attitudes, knowledge and self-efficacy were seen after attending the course, in addition to increases in the appropriate management of breastfeeding problems.Process evaluation interviews with 43 health visitors, nursery nurses and managers explored views of the training and changes in practice. The response to the course was overwhelmingly positive and felt to be extremely worthwhile. It has led to renewed enthusiasm, improved the consistency of advice among team members and raised confidence levels of all staff who help mothers with breastfeeding. Health visitors felt confident about enabling nursery nurses to take a greater role in breastfeeding support. A small survey of mothers reported increases in exclusive breastfeeding and signs of increased breastfeeding self-efficacy. Making the training mandatory across the whole PCT has improved the consistency of breastfeeding advice and confidence of all health-care staff who help breastfeeding mothers.

Breastfeeding after assisted conception: a prospective cohort study

The aims were to investigate the prevalence of breastfeeding after conception with assisted reproductive technology (ART) and identify risk factors for breastfeeding duration <6 weeks and cessation of breastfeeding before the baby is 8 months old. A consecutive cohort of women who had conceived at one of two ART centres in Melbourne, Australia, was recruited in early pregnancy. The women completed telephone interviews and postal questionnaires in pregnancy and 3, 8 and 18 months after the birth. Of 239 eligible women, 183 (77%) agreed to take part. Participants were more likely than the general population of childbearing Australian women to initiate breastfeeding (89% vs 83.3%, p=0.05) but by 3 months, a smaller proportion was breastfeeding exclusively (46% vs 57.3%, p=0.004). The proportions not providing any breast milk at 6 weeks and 8 months were 23% and 57%, respectively. More anxiety in late pregnancy and sub-optimal breastfeeding advice predicted breastfeeding duration <6 weeks and breastfeeding cessation before 8 months. The predictors of less favourable breastfeeding outcomes after ART identified may be modifiable. Antenatal strategies to reduce anxiety in pregnancy and postnatal strategies to ensure consistent breastfeeding advice may improve breastfeeding outcomes among women who give birth after ART.

1040 Is Difficulty Feeding An Indication for Frenulotomy in Patients with Ankyloglossia?

Background:Ankyloglossia or “tongue-tie” is a common congenital anomaly that can restrict movement of the tongue and thus cause feeding difficulties. The immediate sequalae of this include distress to both mother and baby, and in the long term may result in sub-optimal weight gain. Thus ascertaining the value of frenulotomy in such patients is necessary. Aims: To analyse the experimental literature relating to frenulotomy in ankyloglossia patients with feeding difficulties. Methods: PubMed and Cochrane Library search of combinations of MeSH terms: “ankyloglossia”, “tongue-tie”, “feeding”, “frenulotomy”, “frenulectomy”, “frenotomy”, “frenuloplasty”, “frenectomy”, “tonguetie division” yielded 104 results; 22 relevant and accessible. Results: Few studies exist to date, and these have concluded in favour of frenulotomy over breastfeeding advice alone. However, the quality of evidence is somewhat questionable. In many cases, the supposed improvement in feeding is subjective, with no data on growth of the baby, which would be a more accurate long-term measure of outcome. Additionally, sample sizes are too small to provide a conclusion of strength. The only randomized control trial to date is hampered by significant bias, as mothers were given the option of frenulotomy if breastfeeding did not improve with counselling. Conclusion: Issues with diagnosing and assessing the severity of ankyloglossia contribute to the sparsity of evidence available. Additionally, lactation consultants are often in favour of frenulotomy, thus introducing bias into studies. While the evidence is controversial, the minimal adverse effects associated with the procedure lead the author to conclude that it should be offered when feeding difficulties arise.

Midwives’ and doulas’ perspectives of the role of the doula in Australia: A qualitative study

Objective to explore midwives’ and doulas’ perspectives of the role of the doula in Australia. Background doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives’ and doulas’ perspectives of the role of a doula in Australia? Design qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis. Setting New South Wales, Australia. Participants 11 midwives and six doulas. Findings the key theme that emerged was that ‘the broken maternity system’ is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are ‘filling the gap’ and midwives feel that doulas are ‘taking our role’. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the ‘broken’ maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births. Implications for practice despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women.

Assessing the quality of maternal health care in Indigenous primary care services

TO THE EDITOR: Improving access to appropriate, good-quality care in the antenatal and postnatal period is a key part of closing the acknowledged gap between Indigenous and other Australians in perinatal outcomes. Previous research in a large Aboriginal medical service in Queensland demonstrated sustained improvements in perinatal outcome ssociated with a quality improvement approach. Here we describe patterns of the delivery of maternity care and service gaps on a broad scale, using data from baseline clinical audits in 34 Indigenous primary health centres participating in a national quality improvement intervention. Participating services were located across the Northern Territory (Top End and Central Australia), North Queensland, Far West New South Wales and Western Australia. Details of the audit methods have been described previously. Briefly, a random sample of up to 30 clinical records in each service was assessed to determine the degree of adherence to recommended protocols and procedures in the antenatal and postnatal periods. Records of women with an infant aged 2–14 months and who had been resident in the community for at least 6 months of the infant’s gestation were considered eligible for our study. The study was approved by the human research ethics committees in each region, and their Indigenous subcommittees where required. Clinical records of 535 women were assessed. Eighty-nine per cent of the women were Indigenous. However, compared with services in the NT, WA and North Queensland, services in Far West NSW had a higher proportion of nonIndigenous women presenting for antenatal or postnatal care (34% v 0–6%; P < 0.05). Overall, less than half of all women presented for care in the first trimester of pregnancy (Box, page 598). Documentation of routine antenatal investigations and brief interventions or advice regarding health behaviour varied, but generally these services appeared to be underutilised. There was relatively good documentation of follow-up of identified problems relating to hypertension or diabetes, with over 70% of identified women being referred to a general practitioner or obstetrician. However, follow-up of other identified problems, such as inadequate rubella immunity, was poor. Although 53% of women had a recorded postnatal visit, documentation of advice regarding health risk factors during the postnatal period was poor. For about half of all women there was documentation about breastfeeding advice and contraception. But advice about smoking, nutrition or mood (depression) was recorded for only 19%–21% of all women, and advice about sudden infant death syndrome prevention, injury prevention or infection/ hygiene was recorded for only 4%–5% of all women. The clinical audit data presented here indicate that participating services had both strengths and weaknesses in delivering maternal health care. Nevertheless, improving adherence to recommended screening investigations and brief interventions or advice about health behaviours, particularly smoking cessation, in the antenatal and postnatal period were identified as clear areas for improvement across all services. This information represents baseline data to inform the long-term monitoring of a quality improvement intervention. More broadly, it should be useful for informing local, regional and national efforts to promote and assess the quality of primary maternal health care for Indigenous women, and thus help address the persisting unacceptably high rates of poor Indigenous perinatal outcomes in Australia.

Health and Medicine in Hapsburg Spain: Agents, Practices, Representations, Medical History Supplement No. 29 (London: The Wellcome Trust Centre for the History of Medicine at UCL, 2009). ISBN 0-85484-128-8 (HC). 5 B&amp;W illustrations, v + 158 pp. by Teresa Huguet-Termes

148 BOOK REVIEWS in a lively and engaging style, this study will appeal to both early modernists and medical historians alike. MICHAEL PICKERING UNIVERSITY OF MELBOURNE Teresa Huguet-Termes, Jon Arrizabalaga, and Harold J. Cook, eds, Health and Medicine in Hapsburg Spain: Agents, Practices, Representations, Medical History Supplement No. 29 (London: The Wellcome Trust Centre for the History of Medicine at UCL, 2009). ISBN 0-85484-128-8 (HC). 5 B&W illustrations, v + 158 pp. As Harold J. Cook argues in the introduction to this volume, for too long English language readers have had a limited view of Spanish science, and little has been available to English speakers. The editors organised a conference in 2006 from which these papers (and others invited subsequently) stem. Not all the authors are specialists of medicine, but together their papers provide insight into Spanish medicine in a variety of ways. MaríaLuzLópezTerradasetsoutthesystemsofcontroldeveloped in Valencia to regulate practice, reveals the extent of medical pluralism, and finishes with a case study of Llorenç Coçar, named protomédico y soprevisitador real [royal physician and supervisor in chief] in 1589. He was practising chemical medicine with support from Philip II but was charged by colleagues at the medical faculty for developing Paracelsian medicines at home and overcharging. She reads this as an attempt to limit crown control of the practice and licensing of official medicine and argues that Coçar’s case highlights both the extent and support of pluralism, as well as the forces of regulation and their varied concerns. MarReyBuenoexploresPhilipII’sinterestinsecrets,distillations, and other alchemical ideas, which have previously been seen as attempts to acquire gold and to preserve his life. A more detailed analysis, she argues, suggests a deeper intellectual curiosity as he firstly employed diverse specialists across different cities, and later established a laboratory at El Escorial. Rey Bueno sees this not as an occult practice by the Counter-Reformation king, but as a natural interest in the world, which was directed towards outcomes for his Empire. María Tausiet explores the distinctions between witches and Health & History ● 12/2 ● 2010 149 those healers who claimed divine healing power. Her analysis suggests that secular court trials produced harsher outcomes, the majority legimitising the cases as witchcraft that came before them, whereas ecclesiastical courts allowed more investigation and were generally less willing to accept the notion of witchcraft generally. An increasing number of saludadores [charismatic healers] were however being prosecuted, not for the principles of healing that underpinned their activities, but for forging official documentation. Opinion on saludadores varied within the Church, which upheld the possibility that such healers might exist by granting licenses, although such faith healing could never be fully controlled. In her chapter, Teresa Huguet-Termes explores hospital developments in Madrid, which was made the capital in 1561. She argues that improvements to health care were used as political tools for change by the dynasty, and that the second half of the sixteenth century saw new charitable endeavours and a slow move towards medical specialisation. Although crown legislation focussed on the royal hospital and sick paupers, Huguet-Termes argues that by allowing healthy paupers to beg, Spain’s authorities were upholding key Counter-Reformation Catholic principles and giving alms-givers the opportunity to practice individual charity. Moving to literary presentations, Mónica Bolufer examines humanist physician Juan Huarte de San Juan’s Examen de ingenios para las sciencas [The Examination of Men’s Wits] (1575) which argued that the height of achievement was to perfect characteristics distinct to each sex. This mirrored notions of different and essential moral, intellectual qualities and social functions of the sexes to be found in popular literature. In the case of breastfeeding advice books, Bolufer notes that authors were sensitive to social class distinctions; although they encouraged breastfeeding, they were also aware of the social tensions among the elite that render it less likely. She concludes that whereas sixteenth- and seventeenth-century physicians justified contemporary social practices, by the eighteenth century maternal breastfeeding gained prominence among medical writers as new values towards privacy, family, and domesticity emerged. In the book’s final chapter, Jon Arrizabalaga situates Roderigo De Castro’s intellectual agenda within the context of...

Characteristics of Breastfeeding Practices Among US Mothers

Although much has been published about breastfeeding rates, little is known about how breastfeeding is practiced in the United States. We describe the distributions and characteristics of practices related to common advice about breastfeeding during the infant's first year of life. Participants in the 2005-2007 Infant Feeding Practices Study II received monthly questionnaires during their infants' first year of life. Among breastfeeding respondents, we investigated patterns and trends in types of breastfeeding (supplementing with formula or not, and at the breast or not) and maternal report of infant feeding behaviors corresponding to common breastfeeding advice on frequency, duration, and intervals of feedings. More than half of the breastfeeding mothers fed their infants nothing other than breast milk until 4 months of age. Formula supplementation declined from 42% at 1 month to 15% at 1 year; adding other foods/liquids increasingly surpassed supplementing with formula beginning at 5 months of age. Six percent of the mothers reported that the only breast milk the infant was fed was expressed, rather than at the breast. Frequency of breast milk feedings per day declined from 8 at 1 month to 3.5 at 1 year. Reported feeding durations of <20 minutes increased from 46% at 1 month to 88% at 1 year. Feeding from both breasts per feeding decreased 15% over the infant's first year (from 69% to 59%). Longest interfeeding intervals more than doubled over the year. Exclusive breastfeeding was common up to 4 but not to 6 months of age. Breastfeeding with only expressed milk was rare. Considerable variation existed in maternal report of practices that correspond to common breastfeeding advice. More research is needed to better understand how these variations relate to breastfeeding outcomes and the role of common breastfeeding advice in infant feeding decisions.

Evaluating bilingual peer support for breastfeeding in a local Sure Start

This third paper focuses on a specific project in a SSLP intended to increase outreach to Bangladeshi women known to experience unequal access to health-care services to support their breast-feeding. As with the previous study, the project employed a link worker from the Bangladeshi community to provide breastfeeding advice. The link worker received support and supervision from two midwives to enhance skills and knowledge in breastfeeding.