Breastfeeding Continuation Rates Research Articles

The Support Needs and Current Practices of Public Health Nurses in the Republic of Ireland Who Provide Support to Breastfeeding Mothers: A Cross-Sectional Survey.

Breastfeeding continuation rates are low in Ireland. The Breastfeeding Observation and Assessment Tool (BOAT) was developed to assist public health nurses in assessing breastfeeding challenges; however, little is known of its actual usage, the level of training experienced or desired by public health nurses, or their level of confidence in the support they provide to breastfeeding mothers. To identify the current practices and support needs of public health nurses who provide breastfeeding support in Ireland. An online questionnaire was devised to collect respondents' confidence with breastfeeding issues, caseload, and practices. It was distributed to public health nurses with a current child health caseload in one Community Healthcare Organization. Mann Whitney U tests were used to ascertain the relationship between public health nurses' confidence level and those with qualifications in midwifery or as an International Board Certified Lactation Consultant (IBCLC). The survey was completed by 66 public health nurses. Only 14 respondents (21.2%) indicated that they always used the BOAT. The most common reason for not doing so was a lack of education on its use (n = 17, 25.8%). Postholders also certified as IBCLCs were considered by participants to be the most appropriate professionals to resolve certain breastfeeding issues. Confidence levels to manage breastfeeding issues were highest among public health nurses with IBCLC credentialing (U = 12.5, p = .001) while no difference was seen when comparing those with a midwifery degree to those without (U = 184.0, p = .92). Face-to-face workshops and blended-learning approaches were ranked as the preferred formats for breastfeeding education (Median rank = 2). Breastfeeding education incorporating a face-to-face component is needed to support public health nurses who work with breastfeeding mothers, as is prioritization of recruitment in the community of public health nurses with IBCLC credentials.

Effectiveness of a breastfeeding program for mothers returning to work in Japan: a quasi-experimental study

BackgroundMaternal employment has been described as a barrier to breastfeeding in many countries. In Japan, many mothers quit breastfeeding after returning to work because they do not know how to continue breastfeeding. The primary objective of this study was to investigate the effectiveness of a breastfeeding support program for mothers. The secondary objective was to explore the effectiveness of a pamphlet for mothers returning to work.MethodsThis was a quasi-experimental design study with a program group (n = 48), pamphlet group (n = 46) and comparison group (n = 47) that took place from February 2017 to August 2018. Participants in the program and pamphlet groups were women who planned to return to work within 4–12 months after giving birth, while the comparison group included women who had been back at work for at least 3 months. The program involved a 90-min breastfeeding class, a pamphlet, a newsletter, and email consultation. The pamphlet group was sent only the pamphlet, while the comparison group received no intervention. The outcome was breastfeeding continuation rate at 3 months after returning to work.ResultsThe breastfeeding continuation rate 3 months after returning to work was significantly higher in the program group than in the comparison group (79.2% vs. 51.1%, p = 0.004). After adjusting for background factors, the program intervention had an effect on breastfeeding rates (adjusted odds ratio = 4.68, 95% confidence interval: 1.57, 13.96; p = 0.006). However, comparing the pamphlet and comparison groups revealed no significant differences in breastfeeding continuation rates at 3 months after returning to work (69.6% vs. 51.1%, p = 0.07).ConclusionsProgram intervention was associated with a significant increase in breastfeeding continuation rates 3 months after returning to work. Randomized controlled trials are needed to make this program applicable in practice. Pamphlet intervention resulted in no significant difference. Further study is necessary after examining the contents of the pamphlet.

The Effect of Postpartum Fatigue on Exclusive Breastfeeding Rates at Discharge: A Comparison of Birth Methods

Exclusive breastfeeding is recommended for the first six months of life due to the benefits it offers to both baby and mother. Although breastfeeding initiation rates are high, breastfeeding continuation rates at six and twelve months and exclusive breastfeeding rates remain lower than Healthy People recommendations. The purpose of this study was to determine if postpartum fatigue had any impact on the success of exclusive breastfeeding when comparing birth methods. Although postpartum fatigue has been reported as a common occurrence, less is known about its effect on exclusive breastfeeding rates. A quasi-experimental study with 157 participants was completed to evaluate the effect of postpartum fatigue on exclusive breastfeeding rates at discharge using the Visual Analog Scale to Evaluate Fatigue (VAS-F). Both mothers who delivered vaginally and by cesarean section took part in this study at no less than one day after delivery. One hundred percent of mothers in the study reported varying levels of fatigue postpartum, with 47% breastfeeding exclusively. An independent samples T-test compared fatigue levels in vaginal and cesarean births. Statistical significance was noted in that cesarean section mothers were more fatigued than those who gave birth vaginally (p=0.015). Findings from a chi squared test showed exclusive breastfeeding rates in women who gave birth vaginally higher than cesarean section (χ2=12.47,p<.01) suggesting exclusive breastfeeding rates were dependent on birth type. Further research needs to be completed to determine what education or strategies relative to postpartum fatigue need to be identified to diminish the effects of postpartum fatigue which could lead to improved exclusive breastfeeding rates.

Effect of Follow-Up Intervals on Breastfeeding Rates 5-6 Months Postpartum: A Randomized Controlled Trial.

To compare the effect of early versus traditional postpartum follow-up intervals on breastfeeding continuation rates 6 months postpartum. This randomized controlled trial enrolled primiparous women planning to breastfeed to a postpartum appointment either 2-3 weeks or 6-8 weeks after delivery. The primary outcome was the breastfeeding rate in each group 5-6 months after delivery. The study was powered to detect a 50% difference between groups assuming a 34% rate of breastfeeding at 6 months. Participants were contacted by phone 5-6 months after delivery to assess outcomes. From March 2014 to July 2016, 649 women were screened and 344 enrolled as follows: 172 to 2-3 week and 172 to 6-8 week follow-up. Demographic, delivery, and support characteristics were similar between groups; however, average infant birth weight and the distribution of gestational ages at the time of delivery were different between groups (p < 0.05). Participants in the 2-3 week group had a breastfeeding rate of 57.7% 6 months following delivery and participants in the 6-8 week group had a rate of 59.3%. Early follow-up was associated with a relative risk of 0.97 (95% CI 0.79-1.19, p = 0.80) and an adjusted relative risk of 1.45 (95% CI 0.71-2.95, p = 0.31), when adjusted for confounding variables, for breastfeeding continuation at 5-6 months. Breastfeeding rates at 5-6 months postpartum were comparable between both groups; early follow-up was not associated with an increased rate of breastfeeding. At 6 months postpartum, the breastfeeding rate in both groups approximated the Surgeon General's Healthy People 2020 goal of 60.6%. ClinicalTrials.gov (Identifier NCT02221895).

Impact of an Infant Friendly Business Designation

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

247: Should the gold standard breastfeeding measure in socioeconomically disadvantaged (SED) women be breastfeeding continuation, not initiation?

Public-health interventions like the Baby Friendly Hospital Initiative aim to improve breastfeeding (BF) rates among SED women by increasing BF initiation. However, BF initiation may not correlate with BF continuation. We investigated the breastfeeding attrition rate among SED women within 48 hours of delivery at a Baby Friendly hospital and reasons for formula supplementation. This cross-sectional study occurred in 2016 at a university-based Baby Friendly Hospital. SED women without a BF contraindication who delivered non-anomalous singletons were recruited at scheduled visits within 6 months of delivery. Consenting women completed a validated BF survey. The primary outcome was exclusive BF at postpartum day #2 (PPD2). Secondary outcomes were BF initiation and reasons for initiating formula. We compared outcomes in women who exclusively breastfed to those who supplemented with formula. Of the 149 women included, 129 (86.6%) initiated BF. By PPD2, only 51 (34.3%) were exclusively BF, while 47 (31.5%) supplemented with formula and 51 (34.3%) exclusively formula fed. There were no differences in age, race, education level, or annual household income between women who exclusively BF and those who supplemented with formula. However, those who supplemented with formula were more likely to have enrolled in the Women and Infant Care Program (97.9% versus 84.3%; p=0.02). They were also more likely to believe their babies were not interested in nursing (17.0% vs. 4.0%; p=0.045) or their milk letdown took too long (27.7% vs. 10.0%; p=0.03). The rates of reported latch difficulty and concern for neonatal weight loss or low milk supply were similar. While women in both groups were similarly likely to ask for help from hospital staff for breastfeeding issues, those who chose to supplement with formula were less likely to believe they received help (53.3% vs 73.3%; p=0.049). Though most SED women at a Baby Friendly Hospital initiated BF, the majority added formula by PPD2, suggesting BF initiation rates do not correlate with BF continuation rates in this population. To increase exclusive BF rates among SED women, educational measures should focus on improving understanding of normal neonatal behavior and train hospital staff to effectively respond to patient inquiries about BF challenges.

267 The impact of nicu admission on breastfeeding initation and continuation in late preterms in 36 u.s. states, 2000–2013

Purpose of studyTo compare the rates of breastfeeding (BF) initiation and continuation among mothers of late preterm infants (LPIs) who were cared for in a NICU versus those who were not cared for in a NICU (non-NICU).Methods usedData from the Pregnancy Risk Assessment Monitoring System (PRAMS) was

Both Prenatal and Postnatal Interventions Are Needed to Improve Breastfeeding Outcomes in a Low-Income Population.

Breastfeeding provides many health benefits for mothers and their infants that span their life course. Despite this, national breastfeeding rates are below benchmarks set by the CDC (Centers for Disease Control and Prevention). Breastfeeding rates in the Detroit low-income population are particularly low. To measure the effect of hospital-based prenatal and postnatal breastfeeding interventions on breastfeeding initiation and continuation rates in a low-income population. The interventions implemented were a prenatal breastfeeding education curriculum and a hospital-based breastfeeding support group. A total of 650 women were tracked via chart review and telephone survey after delivery to assess breastfeeding initiation, continuation, and goal achievement. The baseline group (n = 330) received care in the hospital-associated prenatal clinic before intervention implementation; the postintervention group (n = 320) received breastfeeding education and had a hospital-based breastfeeding support group made available to them, in which some participated. Data were analyzed using the chi-squared test and the Student's t-test. Breastfeeding initiation rates were greater in the postintervention group (p < 0.0001). The breastfeeding continuation rate at or beyond 6 months did not differ among baseline and postintervention groups (p = 0.5), but was greater among women who also participated in the breastfeeding support group compared with women who participated in the prenatal intervention alone. Participation in interventions did not affect the rate, at which women reported meeting their breastfeeding goals. Both prenatal education and ongoing postdischarge support are needed to improve breastfeeding continuation.

Promoting improved social support and quality of life with the CenteringPregnancy® group model of prenatal care.

This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N=120) with those in standard individual care (N=221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p<0.05) with associated improvements in quality of life in the psychological and relational domains (p<0.05) compared to standard care participants who showed higher scores of perceived support from family (p<0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.

Nutrition in the preterm infant

The increasing recognition of the role of nutritional care for preterm infants continues to result in a proliferation of review articles, systematic reviews, observational studies and trials. In this article, we review a selection of important studies published in the last 12–18 months. The selected studies demonstrate the potential importance of light protecting parenteral nutrition solutions, the benefits of standardized concentrated parenteral nutrition solutions and the importance of insulin-like growth factor I in early life. Trials of immunonutrients (such as bile salt-stimulated lipase) and other bioactive peptides such as lactoferrin are in progress, and emerging data highlight the importance of vitamin D for immune regulation, and therefore its role in sepsis and gut function. Early oro-pharyngeal administration of colostrum appears to safely improve early immune development, and supports the increasingly common practice of immediate commencement of mothers’ own breast milk. Despite this, studies continue to show that breastfeeding continuation rates could be improved. Data also highlight the potential role of macronutrient supply on other functional outcomes, such as retinopathy of prematurity. Finally, the importance of the unique nutritional needs of late and moderately preterm infants is starting to be recognized – a much larger group than the extremely preterm infants in whom many studies are focused. Earlier, more aggressive nutrient supply and feeding regimes, including optimal support of breastfeeding mothers to ensure adequate provision of own mother’s milk, appear to improve growth and neurodevelopmental outcomes. The addition of bioactive proteins shows promise. Special focus needs to be reestablished for late and moderately preterm infants, who have particular nutritional and feeding support requirements. This review has highlighted the need for further research particularly in the areas of early parenteral nutrition, the optimal regime to improve early growth and neuronal effects, the optimal rate of growth and/or catch-up, and the role of immune nutrients.

In breastfeeding mothers, does use of combined oral contraceptives result in lower rates of breastfeeding continuation than progestin-only pills?

In breastfeeding mothers, does use of combined oral contraceptives result in lower rates of breastfeeding continuation than progestin-only pills?

Assessing Predictive Power of Psychosocial Factors on Breastfeeding Behavior of Mothers Attending Postnatal Clinics in Western Kenya

This cross-sectional study aimed at determining predictive power of psychosocial factors influencing breastfeeding behavior of breastfeeding mothers. The study was conducted from April to August 2010 in Kakamega Central District within 4 postnatal clinics that were purposively sampled. Proportionate stratified technique was employed to obtain 230 respondents. A structured questionnaire was used to collect quantitative data where exploratory factor analysis tested dimensionality of questions, whereas skewness and kurtosis assessed normality of data. Structural equation modeling determined predictive power of latent variables. The model fitted data acceptably well, χ2 = 156, P &lt; .001, Tucker–Lewis index = .93, comparative fit index = .95, root mean square error of approximation = .090, Hoelter’s critical N (0.01 = 230), with regard to breastfeeding behavior. Regression weights showed predictive power for maternal attitude (β = .38, P &lt; .01), subjective norm (β = .25, P &lt; .05), perceived behavioral control (β = .25, P &lt; .05), and intention (β = .95, P &lt; .001). This study provides information on a better approach for promoting optimal breastfeeding that will increase initiation, exclusivity, and breastfeeding continuation rates.

Effect of Progestin Compared With Combined Oral Contraceptive Pills on Lactation

To estimate the effect of progestin-only compared with combined hormonal contraceptive pills on rates of breastfeeding continuation in postpartum women. Secondary outcomes include infant growth parameters, contraceptive method continuation, and patient satisfaction with breastfeeding and contraceptive method. Postpartum breastfeeding women who desired oral contraceptives were randomly assigned to progestin-only and combined hormonal contraceptive pills. At 2 and 8 weeks postpartum, participants completed in-person questionnaires that assessed breastfeeding continuation and contraceptive use. Infant growth parameters including weight, length, and head circumference were assessed at 8 weeks postpartum. Telephone questionnaires assessing breastfeeding, contraceptive continuation, and satisfaction were completed at 3-7 weeks and 4 and 6 months. Breastfeeding continuation was compared between groups using Cox proportional hazards regression. Differences in baseline demographic characteristics and in variables between the two intervention groups were compared using χ tests, Fisher exact test, or two-sample t tests as appropriate. Breastfeeding continuation rates at 8 weeks (progestin-only 63.5%; combined hormonal 64.1%), contraceptive continuation, and infant growth parameters did not differ between users of progestin-only and combined hormonal contraceptive pills. Infant formula supplementation and maternal perception of inadequate milk supply were associated with decreased rates of breastfeeding in both groups. Choice of combined hormonal or progestin-only contraceptive pills administered 2 weeks postpartum did not adversely affect breastfeeding continuation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01465022.

Acculturative type is associated with breastfeeding duration among low‐income Latinas

We sought to assess the relationship between acculturative type and breastfeeding outcomes among low-income Latinas, utilising a multidimensional assessment of acculturation. We analysed data derived from a breastfeeding peer counselling randomised trial. Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale. Analyses were restricted to Latinas who completed the acculturation scale and had post-partum breastfeeding data (n = 114). Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type. Participants were classified as integrated-high (23.7%, n = 27), traditional Hispanic (36.8%, n = 42), integrated-low (12.3%, n = 14) and assimilated (27.2%, n = 31). The integrated-low group was significantly more likely to continue breastfeeding than the traditional Hispanic, assimilated, and integrated-high groups (P < 0.05, P < 0.05, and P < 0.01, respectively). The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated-high group (P = 0.06). Breastfeeding continuation rates vary significantly between acculturative types in this multinational, low-income Latina sample. Multidimensional assessments of acculturation may prove useful in better tailoring future breastfeeding promotion interventions.

Using video narratives of women's lived experience of breastfeeding in midwifery education: exploring its impact on midwives' attitudes to breastfeeding

Strong evidence supports the health benefits of breastfeeding contributing to the public health campaign to improve initiation and duration of breastfeeding globally, yet breastfeeding continuation rates are persistently low in the UK. Inadequate support from health professionals appears to be an underlying feature, aggravated by a dearth of professional education that uses a biopsychosocial approach. This paper describes how using women's video narratives of their lived experience of breastfeeding within higher education impacted positively on the attitudes of a group of midwives in relation to supporting breastfeeding women. It reports on the qualitative element of a two-phase sequential mixed methods study where focus group methods generated rich data about how and why the educational intervention altered attitudes. Analysis was thematic. Six major themes emerged, 'listening and learning from real women's experiences'; 'generation of emotions'; 'acquisition of new knowledge and learning'; 'reflection on practice'; 'promotion of independent learning' and 'sharing learning and ideas with peers'. 'Listening and learning from real women's experiences' was central to learning, and was pivotal to attitudinal change, motivating an intense need to improve practice. Findings support the value of using women's video narratives within midwifery education, through their power to integrate affective and cognitive learning, and to promote a transformative learning process. This novel approach brings value-added learning benefits by enhancing the potential to improve attitudes towards supporting breastfeeding women and improving clinical practice.

Start4Life: a good start for a healthier life

The Department of Health's Change4Life campaign is expanding to include pregnant women and parents of babies with the launch of Start4Life. This new sister brand to Change4Life aims to support parents to provide better health outcomes for their children by improving exclusive breastfeeding continuation rates, increasing the average age of introducing solid foods to 26 weeks and encouraging active play.

Effect of Professional Postpartum Support on Infant Feeding Patterns Among Breastfeeding Participants in the WIC Program

The purpose of this study was to determine if professional breastfeeding support could postpone formula introduction and prolong breastfeeding among participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Fifty women in the experimental group received home visits and phone calls from a lactation educator following hospital discharge; 50 control group women were encouraged to contact a lactation educator as needed. Infants' ages at formula introduction and breastfeeding continuation rates were not significantly different between the groups. Common reasons for breastfeeding cessation included returning to work/school, inadequate milk supply, and latch‐on/suckling problems. Use of telephone contacts, delay of breastfeeding support until after hospital discharge, and early formula supplementation may have contributed to the ineffectiveness of the intervention.

Impact of early postpartum administration of progestin-only hormonal contraceptives compared with nonhormonal contraceptives on short-term breast-feeding patterns

Objective: The purpose of this study was to identify the impact on breast-feeding patterns of early postpartum initiation of progestin-only birth control methods compared with nonhormonal methods. Study Design: A prospective, nonrandomized trial was performed comparing progestin-only contraceptive methods administered before hospital discharge with nonhormonal methods on breast-feeding continuation rates, exclusive breast-feeding, and supplementation at 2, 4, and 6 weeks after delivery. Results: Three hundred nineteen women provided complete data until hospital discharge. The hormonal group had higher risk factors for not breast-feeding, but there was no difference among any of the subgroups in breast-feeding continuation rates except at week 4. Supplementation or perception of insufficient milk production did not differ between groups. By week 6, 23.5% of women discontinued breast-feeding, and 64.5% of those breast-feeding were supplementing. Conclusion: This study demonstrates that there is no detectable adverse impact on breast-feeding attributable to progestin-only contraceptive methods initiated within the first 3 days post partum. (Am J Obstet Gynecol 2002;186:1250-8.)