Hospital Breastfeeding Research Articles

Factors Associated with the Delay of Early Initiation of Breastfeeding in Hospitals: A Scoping Review

Factors Associated with the Delay of Early Initiation of Breastfeeding in Hospitals: A Scoping Review

Building Breastfeeding Research Relations and Beyond: An Interview With Fiona Dykes.

Professor Fiona Dykes is Professor Emerita of Maternal and Infant Health at the University of Central Lancashire in the United Kingdom (UCLAN). Fiona has a particular interest in the global, sociocultural, and political influences upon infant and young child feeding practices; her methodological expertise is in ethnography and other qualitative research methods. She founded the Maternal and Infant Nutrition and Nurture Unit (MAINN) in 2000 which she led until she retired from her full-time professorship in 2020. Fiona established the associated MAINN Conference in 2007. The MAINN conference is a 3 day, international, peer reviewed event held bi-annually in the United Kingdom and, more recently, in alternate years overseas (Sydney, Australia; Falun, Dalarna, Sweden; and Florida, United States). The conference draws together key researchers in the field of infant and young child feeding from around the world. Fiona was a founding member of the journal Maternal and Child Nutrition. She is author of Breastfeeding in Hospital: Mothers, Midwives and the Production Line (Routledge) and co-author, with Dr Tanya Cassidy, of Banking on Milk: An Ethnography of Donor Human Milk Relations (Routledge). She is also joint editor of several books including Infant and Young Child Feeding: Challenges to Implementing a Global Strategy (Wiley-Blackwell) and Ethnographic Research in Maternal and Child Health (Routledge). This interview was conducted on April 20, 2023, by Dr. Tanya Cassidy, and is based on a verbatim transcription and edited for readability.TC = Tanya Cassidy; FD = Fiona Dykes.

Breastfeeding challenges and support in a high initiation population

BackgroundThe breastfeeding initiation rate in Israel is approximately 90%, yet exclusive breastfeeding drops sharply in the early postnatal period. The study objective was to assess early postpartum professional breastfeeding support, its association with breastfeeding success and identification of risk factors for early breastfeeding discontinuation.MethodsAs part of a post-discharge newborn follow-up study, a convenience sample of 868 mothers attending Maternal and Child Health Centers (MCHCs) up to three months post-partum were interviewed using a 26-item questionnaire. Breastfeeding-related questions covered demographic variables, pregnancy and birth details; breastfeeding duration, lactation support in hospital and post-discharge; and problems experienced.ResultsMost mothers, 797 (91.8%), initiated breastfeeding in hospital. All women who initiated breastfeeding in the hospital reported exclusive breastfeeding; by two weeks postpartum, 70 women (13.2%) were supplementing with formula (partial breastfeeding). Kaplan–Meier Survival Analysis revealed an estimated mean duration of exclusive breastfeeding in the sample population of 66.8 ± 1.5 days. This duration was shorter for women with preterm births, low birthweight infants (LBW), cesarean births, and hospitalizations in neonatal intensive care units (NICU). A total of 472 (59.3%) breastfeeding mothers reported receiving in-hospital guidance. Of these, 290 (61.3%) were observed breastfeeding. Of all women who initiated breastfeeding, 280 (35.1%) attended MCHC follow-up within 72 h of hospital discharge. A higher proportion of women experiencing breastfeeding difficulties attended an MCHC within 72 h (131/297, 44.1%) compared to women not experiencing difficulties (148/499, 29.7%). The most frequently reported problems were mechanical (55.2%) or milk supply concerns (18.5%). First-time mothers were more likely to report problems, as were Jewish (vs Arab) mothers.ConclusionsEven in a population with high initiation rates of breastfeeding, breastfeeding duration, both exclusive and partial, is less than recommended. As much of this drop-off occurs during maternity leave, it is likely related to breastfeeding challenges other than employment. Breastfeeding support needs of women are currently not adequately met; staffing and time for both in-hospital and community-based counseling needs to be funded as well as mandated. Counseling hours should be tailored to assure adequate coverage of high-risk groups such as women after cesarean delivery and newborns requiring intensive care.

Prevalence of early skin-to-skin contact and its impact on exclusive breastfeeding during the maternity hospitalization

BackgroundEarly essential newborn care has been implemented in countries regardless high or low neonatal mortality. This study aims to investigate the current practice of skin-to-skin contact (SSC) and its effect on exclusive breastfeeding during the hospital stay.MethodsThis is a cross-sectional study of 1812 Vietnamese mothers in multicenter. A questionnaire answered by the mothers was used to assess the duration of both SSC and breastfeeding practices. Multivariable logistic regression was used to identify a dose–response relationship between early SSC and prevalence of exclusive breastfeeding in hospital.ResultsThere were 88.7% of mothers experiencing SSC with their infants right after birth and the highest prevalence of SSC was found in district hospitals. Among those experiencing SSC, 18.8% of the infants received more than 90 min of SSC and completed the first breastfeeding during SSC time. Prevalence of exclusive breastfeeding during maternity hospital stay was 46.7%. We found a significant dose–response relation between the duration of SSC and exclusive breastfeeding in hospital. Compared with infants without SSC, the prevalence of exclusive breastfeeding was higher in infants who experienced SSC for 15–90 min (adjusted odds ratio [aOR], 95% confidence interval [95%-CI]: 2.62 [1.61–4.27]) and more than 90 min (aOR [95%-CI]: 5.98 [3.48–10.28]). Completed first breastfeeding during SSC time (aOR [95%-CI]: 4.24 [3.28–5.47]) and being born in district hospitals (aOR [95%-CI]: 2.35 [1.79–3.09]) were associated with increased prevalence of exclusive breastfeeding during hospital stay. On the other hand, mother education level as high school/intermediate (aOR [95%-CI]: 0.58 [0.42–0.82]) and place of residence classified as rural decreased odds of exclusive breastfeeding in hospital (aOR [95%-CI]: 0.78 [0.61–0.99]).ConclusionOur results demonstrate a strong dose–response relationship between duration of SSC and exclusive breastfeeding in hospital. Interventions that support exclusive breastfeeding during hospital stay, especially achieving prolonged uninterrupted SSC, could improve the duration of breastfeeding.

Does COVID-19 Policy Affect Initiation and Duration of Exclusive Breastfeeding? A Single-center Retrospective Study

PurposeIt assessed the effect of a COVID-19 policy that involved maternal-neonatal separation on early initiation and duration of exclusive breastfeeding (EBF) at two weeks, three, and six months postpartum during the peak of the COVID-19 pandemic in 2020.Patients and MethodsThis retrospective study included consecutive mother-newborn dyads with deliveries between mid-March and the end of December 2020 who agreed to participate and were eligible according to the following criteria: full-term pregnancy, singleton birth, and healthy newborn. Participants were called at least twice during the study period to inquire about exclusive breastfeeding status at two weeks, three, and six months postpartum. Multivariate logistic regression analysis was carried out to identify associated factors with EBF.ResultsA total of 454 eligible mother-infant dyads were included. Mean maternal age (in years), gestational age (in weeks), birth weight (in kilograms), and 5-min Apgar score was, respectively, 32±5.4 years, 39±1.3 weeks, 3.1±0.42 kg, and 9.24±0.6. Most of the mothers (86.1%) had no known chronic diseases and had a normal spontaneous vaginal delivery (NSVD, 91.4%). Approximately 44.7% of the sample initiated breastfeeding either directly or with expressed breastmilk during their hospital stay. Prevalence of EBF during the first two weeks, three, and six months postpartum was, respectively, 30%, 19.8%, and 31.7%. EBF was associated with birth weight, hospital breastfeeding and EIBF at early postpartum period, while EBF at six months was associated with parity and method of delivery.ConclusionDuring the peak of the COVID-19 pandemic, the prevalence of breastfeeding initiation and EBF in the first six months postpartum were low among Saudi mothers. However, multicenter, prospective, cohort studies with adjustment for known confounding factors are required to explore the impact of infection control policies on breastfeeding. Meanwhile, these policies should support early and safe breastfeeding practices, especially with new and evolving information regarding the current pandemic.

Predicting Risk for Early Breastfeeding Cessation in Israel.

This study aimed to 1) Examine factors associated with cessation of exclusive breastfeeding in Israel and 2) Develop predictive models to identify women at risk for early exclusive breastfeeding cessation. The study used data from longitudinal national representative infant nutrition survey in Israel (n = 2119 participants). Logistic regression was used to identify risk factors and build predictive models. The rate of exclusive breastfeeding cessation increased from 45.4% at 2months to 85.7% at 6months. Five factors were significantly associated with higher odds of exclusive breastfeeding cessation at 2months: being a primapara, low educational level, lack of previous breastfeeding experience, negative attitude towards birth, and lack of intention to breastfeed. Six factors were significantly associated with higher odds of exclusive breastfeeding cessation at 6months: younger age, being in a relationship with a partner, lower religiosity level, cesarean delivery, not taking folic acid during pregnancy, and negative attitude towards birth. Both 2 and 6-months models had good predictive performance (C-statistic of .72 and .68, accordingly). This nationwide study successfully identified several predictors of exclusive breastfeeding cessation and created breastfeeding cessation prediction tools for two time periods (2 and 6months). The resulting tools can be applied to identify women at risk for stopping exclusive breastfeeding in hospitals or at community clinics. Further studies should examine practical aspects of applying these tools in practice and explore whether applying those tools can lead to higher exclusive breastfeeding rates.

544 Neonatal intensive care admission is associated with lower breastfeeding in late preterm infants

Breastfeeding is associated with improved maternal and infant outcomes. Infants who deliver during the late preterm period (34-0 to 36-6 weeks) represent over 70% of preterm births and have increased morbidity as compared to term infants. Whether NICU admission is associated with the likelihood of breastfeeding among late preterm infants is unknown. This is a secondary analysis of live births < 37 weeks in a Maternal Fetal Medicine Unit study of steroid use in the late preterm period. Prevalence of any breastfeeding in hospital was compared by infant NICU admission status. Chi square tests were used for bivariable analyses, and logistic regression was used to adjust for confounders. Median hours to first feed of any type (breast or bottle) was compared using Wilcoxon rank sum by NICU admission. Rate of breastfeeding was compared among infants who were fed within the first hour of life. Incidence of feeding problems, or inability to take all feeds by mouth, was compared by NICU admission among those breastfeeding. A total of 2329 subjects were included. The prevalence of any breastfeeding was 74.3% in infants not admitted to NICU and 65.8% in those admitted to the NICU (Table 1, p<0.001). NICU admission was independently associated with lower odds of any breastfeeding (adjusted odds ratio (aOR) 0.61, 95% CI 0.49, 0.77, p <0.001). NICU admission was associated with a significant delay to any first feed (Figure, p < 0.001). Analysis restricted to those with first feed within an hour revealed no difference in breastfeeding (70.6% admitted to NICU vs 77.4% not admitted to NICU p=0.08, aOR 0.62 95% CI 0.37- 1.02). Among breastfed infants, NICU admission was associated with higher odds of feeding problems (aOR 1.65, 95% CI 1.30 – 2.11, p<0.001). NICU admission is independently associated with decreased odds of any breastfeeding during delivery hospitalization in the late preterm infant. NICU admission is associated with longer time to any first feed. Among those infants who are fed in the first hour, there is no difference in breastfeeding rates by NICU admission.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Knowledge and practice among nurses regarding breastfeeding in a hospital with baby-friendly hospital initiative

Introduction: The baby-friendly hospital initiative is a global program launched by WHO and UNICEF in 1991 to encourage hospitals, mainly maternity wards to implement practices that protect, promote, and support breastfeeding. This study aimed to assess Knowledge and Practice regarding breastfeeding of BFHI among Nurses.&#x0D; Method: A cross-sectional analytical study design was used among nurses of Maternity, Children, Gynaecology, and Postpartum wards of Patan Hospital, from January 2019 to February 2020. Data on knowledge of baby-friendly hospital initiative and breastfeeding was collected by using a self-administered structured questionnaire and practice of breastfeeding by observation checklist. Descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, normality test, and Spearman’s rank correlation) statistics were used for data analysis with SPSS version 20.&#x0D; Result: The findings show that out of 100 nurses surveyed, more than half (58%) of the respondents had a good level of knowledge and less than one-fourth (23.8%) had a good level of practice of breastfeeding. There was no significant association between level of knowledge and baby-friendly hospital initiative in the nursing course (p=0.814), training on breastfeeding in hospital (p=0.069), or outside (p=0.944). There was a weak positive correlation between knowledge and practice of breastfeeding.&#x0D; Conclusion: Compared to knowledge on breastfeeding, the practice was quite low among the nurses.

Management of infants born to mothers with SARS-CoV2 infection: a prospective observational study

ObjectivesTo assess the clinical risk of mother-to-infant transmission of SARS-CoV2 and transmission during rooming in and breast feeding in infants born to mothers with COVID-19.DesignProspective observational study.SettingA large tertiary maternal...

Identifying priorities for practice improvement related to breastfeeding support in a neonatal intensive care unit (NICU) in Medellín, Colombia

PurposeTo identify priority areas and practice improvement strategies related to breastfeeding support, in a neonatal intensive care unit (NICU) in Colombia. MethodsAs part of a quality improvement initiative, this multi-method qualitative descriptive study involved 5 focus group interviews with NICU staff and 6 individual interviews with clinical leaders. Data were complemented by informal conversations with NICU staff and a document review of the hospital's breastfeeding policies and educational materials. Data were analyzed using qualitative content analysis. ResultsPriorities for practice improvement included (1) support for milk expression, (2) support for the transition to direct breastfeeding, and (3) creation of policies and tools related to breastfeeding. Findings highlighted ways in which resource limitations influence priority setting to favour the redistribution of existing assets and mobilization of local facilitators for breastfeeding support. ConclusionFindings will inform the development and implementation of future strategies to enhance breastfeeding support in this unit.

Knowledge of Mothers Towards Exclusive Breastfeeding in Erbil's Maternity Hospital

Knowledge of Mothers Towards Exclusive Breastfeeding in Erbil's Maternity Hospital

Mothers’ Perceptions of the Influence of a Breastfeeding Support Group in Achieving Their Breastfeeding Goals

ObjectiveThe study aims were to identify maternal perceptions about the influence of a hospital-based breastfeeding peer support group in addressing breastfeeding concerns, assisting them to achieve their breastfeeding goals, and providing additional benefits.MethodsA descriptive, cross-sectional, online survey was conducted with a convenience sample of women who attended a hospital's breastfeeding support group. Participants reported their breastfeeding concerns and breastfeeding goals prior to and after their attendance at the breastfeeding support group. Changes in reported breastfeeding concerns and breastfeeding goals were analyzed with chi-square statistics.ResultsAfter participating in the support group session, survey participants (N = 100) expressed less concern about latching (81%–66%), mother's milk production (77%–62%), breastfeeding while apart from infant (75%–65%), and all other reported breastfeeding concerns. Overall, participants reported the support group successfully addressed their concerns (92%, n = 89), provided adequate time for responses to their questions (87%, n = 87), and assisted them to achieve their breastfeeding goals (91%, n = 88). Over 90% of participants planned to exclusively breastfeed through 6 months.ConclusionHospital-based breastfeeding support groups can successfully address mothers’ key breastfeeding concerns and support extended duration of breastfeeding.

Conhecimento de mães sobre formas de aleitamento e hábitos deletérios

Introdução: O aleitamento materno exclusivo é fundamental até os seis meses, pois além de promover a saúde integral para o bebê, auxilia no desenvolvimento craniofacial e nas funções estomatognáticas. Objetivo: Investigar o conhecimento das mães sobre aleitamento materno, hábitos orais deletérios e outros métodos para ofertar a dieta ao bebê. Método: Trata-se de um estudo descritivo de caráter quantitativo. Foi aplicado um questionário semiestruturado com perguntas abertas e fechadas, em 80 mães de uma Clínica Escola de Fonoaudiologia, no período de junho a setembro de 2017. Resultados: 66,3% das mães possui idade entre 18 a 30 anos, 98,8% realizou pré-natal, 63,8% realizou aleitamento materno exclusivo até os seis meses de idade, a maioria (88,8%) demonstrou conhecimento acerca da amamentação exclusiva e 72,5% receberam informações sobre o aleitamento no hospital, 43,8% receberam informações sobre o uso da chupeta e 27,5% quanto ao uso da mamadeira. Observou-se que a mamadeira é a segunda forma mais conhecida para ofertar leite ao bebê, totalizando 52,7%. Em relação ao profissional que mais orientou sobre a amamentação, hábitos orais deletérios e utensílios de alimentação foi o enfermeiro (57,5%) e apenas 16,30% receberam orientações de fonoaudiólogos. Conclusão: Pode-se concluir que há grande adesão do aleitamento materno exclusivo, porém há ainda uma parcela que não realiza desta forma. As mães possuem conhecimento em relação à chupeta, mamadeira, aleitamento materno e outras formas de aleitar, porém, as informações sobre o Sistema Estomatognático estão escassas. Verificou-se que não houve muita atuação do fonoaudiólogo com essa população. Vale ressaltar que há maior número de enfermeiros, em comparação com o número de fonoaudiólogos.

Role of Donor Milk Supplementation in Newborn Nursery Level 1 in Improving Exclusive Breastfeeding Rate at Six Months of Life

Background and Aim: Despite the American Academy of Pediatrics’ (AAP) endorsement of the Baby Friendly Hospital Initiative ten steps to optimize breastfeeding, a percentage of newborns in the level one nursery ends up using formula for medical reasons including hypoglycemia, hyperbilirubinemia, weight loss greater than 8% or ineffective breastfeeding. Improving exclusive breastfeeding rates requires efforts in initiating exclusive breastfeeding in the postpartum hospital stay. Therefore, we introduced donor milk to newborns who needed nutritional supplements for medical reasons. We aimed to determine the benefits of Pasteurized Donor Human Milk supplement …

A Standardized Communication Approach to Promote Exclusive Breast Milk Feeding

Introduction: Breastfeeding is recognized and promoted by the AAP and ACOG as an important factor in neonatal growth and development, with numerous short- and long-term health benefits for both mother and baby, including ideal nutrition, decreased rates of childhood infections and atopic disease, and improved postpartum recovery. Focused review of the current literature yielded studies detailing barriers to successful hospital breastfeeding exclusivity, including disparities in provider knowledge and attitudes. Our children’s hospital is a BabyFriendly designated hospital with 4,800 deliveries per year. In late 2016, …

Impact of Hospital Breast Feeding Awareness Among Lactating Mothers in Maternal and Children Hospital, AL-Hassa, Kingdom of Saudi Arabia

BACKGROUND &amp;amp; AIM: Insufficient knowledge and practice of breastfeeding may have serious disadvantages both on mother and child health. This study explores methods used in MCH based breastfeeding awareness program, level of benefit gained by newly delivered mothers after receiving the awareness, and the impact of mother&amp;rsquo;s sociodemographic on the level of perceived benefit gained by them.&#x0D; &#x0D; SUBJECTS &amp;amp; METHODS: A prospective cross-sectional study applying random sampling technique was established. A self-administered questionnaire was distributed targeting newly delivered mother in maternal and child hospital in Al-Hassa, Saudi Arabia. It included two main parts: socio-demographic characteristics of the mothers, and questions related to the hospital breastfeeding awareness program.&#x0D; &#x0D; RESULTS: from the overall sample, hospital awareness was received by 47.5% of newly delivered mothers. The most common method to provide the knowledge was the Verbal demonstration representing 50% of the mothers. They were followed by brochures representing 39% and last, audios constituting only 3.6%. From these methods, the verbal demonstration showed to be the one with the highest level of satisfaction and benefit reaching up to 85%.&#x0D; &#x0D; CONCLUSION: Breastfeeding awareness has a significant impact among both newly and non-newly delivered mothers with Hospitals playing a major role in this health education. The choice of method to provide breastfeeding awareness can contribute to the compliance of mothers as well as the level of their benefit and satisfaction.

Breastfeeding Intention Versus Outcomes at Two to Three Weeks Postpartum

Breastfeeding is the optimal nutrition for infants, offering protection from many illnesses for both infant and mother. While breastfeeding initiation rates approach or exceed Healthy People 2020 goals, increasing duration remains a national public health priority. Hospital practices play an important role. An urban, academic hospital in the northeast United States with Baby-Friendly designation initiated a quality improvement (QI) project to learn how infant feeding outcomes at 2–3 weeks postpartum compare to initial breastfeeding intention. A lactation student made telephone calls to a convenience sample of breastfeeding mothers, questioning them about their current infant feeding practices and the breastfeeding support they received. The women participating in this QI project were those deemed most likely to meet their infant feeding goals. All the women gave birth in a Baby-Friendly facility, thus all their nurses had at least 20 hours of breastfeeding education, all medical providers had had at least 3 hours of breastfeeding education, and IBCLCs were available to inpatients 7 days a week. All were encouraged to call the hospital's Breastfeeding Warmline and were provided with a list of outpatient resources. However, just2–3 weeks postpartum, one-third were not exclusively breastfeeding despite their initial intention.

Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity.

Breastfeeding has many established health benefits for women and children. We examined the association between maternal education, newborn feeding in hospital, and long-term breastfeeding duration. We studied 3195 Canadian mother-infant dyads in the CHILD pregnancy cohort. Newborn feeding was documented from hospital records. Caregivers reported sociodemographic factors and infant feeding at 3, 6, 12, 18, and 24months. Overall, 97% of newborns initiated breastfeeding and 74% were exclusively breastfed in hospital. Exclusively breastfed newborns were ultimately breastfed longer compared with those who received formula supplementation during their hospital stay (median 11.0 vs 7.0months, P<.001). After controlling for maternal age, ethnicity, birth mode, and gestational age, exclusively breastfed newborns had a 21% reduced risk of breastfeeding cessation (HR=0.79, 0.71-0.87). This effect was strongest among women without a postsecondary education (HR=0.65, 0.53-0.79). Exclusive breastfeeding in hospital is associated with longer breastfeeding duration, particularly among women of lower socioeconomic status. Initiatives that support exclusive breastfeeding of newborns in hospital could improve long-term breastfeeding rates and help reduce health inequities arising in early life.

Hospital Breastfeeding Experiences of Women Receiving WIC Benefits: Findings from the WIC Infant and Toddler Feeding Practices Study-2

Hospital Breastfeeding Experiences of Women Receiving WIC Benefits: Findings from the WIC Infant and Toddler Feeding Practices Study-2

Determinants of breastfeeding initiation among mothers in Sydney, Australia: findings from a birth cohort study

BackgroundBreastfeeding has short-term and long-term benefits for both the infant and the mother. The objective of this study was to identify the incidence of breastfeeding initiation among women in South Western Sydney, and the factors associated with the initiation of breastfeeding.MethodsChild and Family Health Nurses recruited mother-infant dyads (n = 1035) to the Healthy Smiles Healthy Kids birth study in South Western Sydney, an ethnically and socio-economically diverse area, at the first post-natal home visit. A sample of 935 women completed a structured, interviewer-administered questionnaire at 8 weeks. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.ResultsIn total, 92% of women (n = 860) commenced breastfeeding in hospital. Women who completed a university degree were more likely to initiate breastfeeding compared to those who did not complete high school (AOR = 7.16, 95% CI 2.73, 18.79). Vietnamese women had lower odds of breastfeeding initiation compared to Australian born women (AOR = 0.34. 95% CI 0.13, 0.87). Women who had more than one child were less likely to breastfeed than those who had one child (AOR = 0.38, 95% CI 0.19, 0.79). Women who gave birth via a caesarean section were less likely to breastfeed their baby compared to those who had a vaginal delivery (AOR = 0.27, 95% CI 0.14, 0.52). Women who drank alcohol during pregnancy had 72% lower odds to breastfeed compared to those who did not drink alcohol during pregnancy (AOR = 0.28, 95% CI 0.11, 0.71). Women who reported that their partner preferred breastfeeding were more likely to initiate breastfeeding (AOR = 11.77, 95% CI 5.73, 24.15) and women who had chosen to breastfeed before pregnancy had more than 2.5 times the odds of breastfeeding their baby compared to those women who made their decision either during pregnancy or after labour (AOR = 2.80, 95% CI 1.31, 5.97).ConclusionsWomen with lower levels of education, who consume alcohol during pregnancy, have more than one child, and make infant feeding decision after becoming pregnant, and those born in Vietnam should be targeted when implementing breastfeeding promotion programs. Further, women who deliver by caesarean section require additional breastfeeding support post-delivery and it is important to include fathers in breastfeeding related decisions and encourage them to participate in antenatal programs.