Breastfeeding Initiation Rates Research Articles

Geographic Access to International Board-Certified Lactation Consultants in Pennsylvania.

Availability of professional lactation support has been associated with increased breastfeeding rates; however, data about access to international board-certified lactation consultants are limited. The aims were (a) to assess geographic access to international board-certified lactation consultants in Pennsylvania, (b) to compare access in rural/urban counties, and (c) to compare access by county-level breastfeeding initiation rates. Using geographic information systems methodology and a cross-sectional observational design, we calculated the proportion of young children living within 15, 30, and 60 miles of international board-certified lactation consultants in Pennsylvania. We calculated these proportions for all children in Pennsylvania, for children in urban and rural counties, and for children in counties with low, medium, and high breastfeeding initiation rates. Comparisons were done to answer the research aims. Over 90% of young children live within 30 miles of an international board-certified lactation consultant. Compared to children in urban counties, fewer children in rural counties live within 15 and 30 miles of these providers. In counties with high breastfeeding initiation rates, a larger percentage of children live within 15 miles of an international board-certified lactation consultant than in counties with low breastfeeding initiation rates. While most Pennsylvania children live in proximity of an international board-certified lactation consultant, this was true for a lower percentage of children in rural counties and in counties with lower breastfeeding rates.

Effect of a Home-Based Lifestyle Intervention on Breastfeeding Initiation Among Socioeconomically Disadvantaged African American Women with Overweight or Obesity.

Socioeconomically disadvantaged (SED) African American women with overweight or obesity are less likely to breastfeed. To test whether a home-based lifestyle intervention impacts breastfeeding initiation rates in SED African American women with overweight or obesity. This was a secondary analysis of a randomized controlled trial from October 2012 to March 2016 at a university-based hospital within the LIFE-Moms consortium. SED African American women with overweight or obesity and singleton gestations were randomized by 16 weeks to Parents as Teachers (PAT)-a home-based parenting support and child development educational intervention-or PAT+, PAT with additional content on breastfeeding. Participants completed a breastfeeding survey. Outcomes included breastfeeding initiation and reasons for not initiating or not continuing breastfeeding. One hundred eighteen women were included: 59 in PAT+; 59 in PAT. Breastfeeding initiation rates were similar in each group (78.00% in PAT+; 74.58% in PAT). On a one to four scale, with four denoting "very important," women in PAT+ and PAT were equally likely to rate their beliefs that formula was better than breast milk or breastfeeding would be too inconvenient as the most important reasons to not initiate breastfeeding. On the same scale, women similarly rated their difficulty latching or concern for low milk supply as the most important reasons for breastfeeding cessation. SED African American women with overweight or obesity who received a home-based educational intervention had higher breastfeeding rates than is reported nationally for black women (59%). However, the intervention with more breastfeeding content did not further increase breastfeeding rates or impact reasons for breastfeeding cessation. ClinicalTrials.gov : NCT01768793.

A Brief Economic Evaluation of Breastfeeding in Australia

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Factors associated with breastfeeding duration: SI of infant's grandmothers

Background: Breastfeeding benefits both mother and infant. U.S. breastfeeding initiation rates are steadily increasing, but duration rates still fall short of recommendations. Postnatal depression has a significant negative impact on breastfeeding duration. Studies show grandmothers may play an important role in infant feeding decisions. Objective: Evaluate the relationship of maternal postnatal depression and social influence (SI) of infant’s grandmothers on …

The private journey: An interpretative phenomenological analysis of exclusive breastfeeding

BackgroundExclusive breast milk provides complete nutrition for a baby’s first six months of life. In Australia, breastfeeding initiation rates are high, however duration rates are low. Although numerous studies have explored the reasons behind low levels of breastfeeding, few have examined the experiences of women who maintain exclusive breastfeeding for the recommended six-month duration. AimThis paper will present an in-depth, idiographic interpretation of first-time mothers’ experience of exclusive breastfeeding for six months in Australia. MethodInterpretative phenomenological analysis was used to explore how five new mothers understood their six-month exclusive breastfeeding journey. Face-to-face, semi-structured interviews were conducted retrospectively, transcribed in full, and analysed using the flexible seven-step approach of interpretative phenomenological analysis. FindingsThree higher-order themes were identified: (1) exclusive breastfeeding is a personal choice, (2) exclusive breastfeeding is harder than expected, and (3) everyone has something to say about breastfeeding. ConclusionThe mothers were not prepared for public debates around infant feeding methods, where mothers judge each other and give advice that supports their own goals, both of which create an unnecessary divide between mothers. Despite these issues, the findings highlight the personal and social meanings aligned with exclusive breastfeeding and point to the significance in fostering determination as a means to achieve exclusive breastfeeding goals. This qualitative reflection contributes a nuanced understanding of mothers’ lived experience of exclusive breastfeeding, deepening our understanding and enabling appropriate strategies and support for the longevity of exclusive breastfeeding, as well as direction for continued research.

Effectiveness of CenteringPregnancy on Breastfeeding Initiation Among African Americans: A Systematic Review and Meta-analysis.

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiation among only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed.

Feeding practice of infant and young children and their nutritional status among tea worker community of West Tripura district, India: an observational study

Background: People working in tea gardens of Tripura differ from other people in terms of ethnicity, culture, food habit, literacy etc. and limited information is available regarding infant feeding practices and its association if any, with nutritional status of under-five children of this community. Methods: This community based cross-sectional study was conducted during 1st July to 31st August 2016, using a validated interview schedule, among 170 women working in different tea estates of West Tripura district, having children aged 6 months to 2 yr, chosen by multistage sampling. Descriptive statistics and χ2 test were used to present data. P value ≤0.05 was considered statistically significant. Results: Breastfeeding initiation rate within one hr of birth was 50.59%, colostrums was fed to 82.35%, prelacteal feeding was given to 30.59%, 65.88% were exclusively breast fed and overall feeding practice was proper in 51.76% of the study children. Khichdi (34.1%) was the commonest complimentary feed and katori and spoon (64.7%) were the commonest feeding utensils. Prevalence of underweight, stunting and wasting was 9.0%, 12.9% and 7.3% respectively and these were found to be more frequent among children who received prelacteal feeding, late initiation of breastfeeding and early complimentary feeding, though statistically these were not significant. Conclusions: Overall infant feeding practice was better among educated mothers and institutional births; hence improvement in literacy and promoting institutional deliveries will further improve feeding practice in this community. Though underweight, stunting and wasting was prevalent but these had no significant association with feeding practices. Hence further studies are required to investigate the causes of malnutrition among children of this community.

"I'm Doing the Best That I Can for Her": Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder.

Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States' population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. Qualitative description was used. We conducted semistructured, individual interviews with mothers ( N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.

Factors associated with breastfeeding intent among mothers of newborn babies in Da Nang, Viet Nam

BackgroundBreastfeeding is recognized as the single most cost-effective intervention to reduce child morbidity and mortality. However, few studies have explored perceived barriers to breastfeeding and factors associated with breastfeeding intent among mothers of newborn babies in Viet Nam. We conducted a study to assess breastfeeding initiation rates, intent to breastfeed exclusively for 6 months or more and perceived barriers to breastfeed among mothers of newborn babies in Da Nang, Viet Nam.MethodsWe conducted a cross-sectional questionnaire survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Viet Nam from 10 February 2017 to 24 February 2017, following implementation of the World Health Organization (WHO) Essential Newborn Care (ENC) package.ResultsOf 286 mothers surveyed, 259 (90.6%) initiated breastfeeding; 203/258 (78.7%) within 1 hour (h) of birth. Most (207, 72.4%) mothers indicated intent to breastfeed exclusively for 6 months or more, but this was lower among mothers of preterm babies (82.2% versus 20.0%, p < 0.001) and those without post-secondary school education (74.8% versus 55.6%, p = 0.02). Amongst mothers struggling to establish breastfeeding, 18/27 (66.7%) had a Cesarean section. Planned non-exclusive breastfeeding was mostly (39, 60.9%) motivated by mothers’ concern that their milk supply would be insufficient for their baby’s growth requirements. Most mothers had good knowledge about the benefits of breastfeeding and indicated strong decision autonomy.ConclusionsWe documented high rates of early breastfeeding establishment and intent to breastfeed exclusively for 6 months or more. This probably reflects high levels of maternal education and successful implementation of the WHO ENC package. Mothers of premature babies may benefit from additional support.

Impact of Group Prenatal Care Support on Breastfeeding Initiation Rates and Other Maternal and Perinatal Outcomes

Group prenatal care support has been studied in order to increase maternal and neonatal benefits, such as breastfeeding initiation rates, in front of standard care. In our area, especially in some high risk sub-groups, it could be an important intervention to improve individual care. The aim of the pilot initiative is to compare the effect of group prenatal care support versus only standard individual care on breastfeeding initiation rates and other perinatal outcomes. A retrospective cohort study was made analyzing all deliveries at Hospital del Mar in Barcelona during 1 year. All pregnant women were compared depending on whether they had received the group prenatal care support by midwifes or only standard care. 1383 women gave birth at Hospital del Mar in Barcelona in 2015. 207 received group prenatal care support (15% of total). In group prenatal care there significantly were more nulliparous and native women. Breastfeeding initiation rate was higher in group prenatal care women (94.2% vs. 86.7%, p=0.01). Other outcomes like cesarean section rates, prematurity and low birth weight rates also improved in group prenatal care support in front of standard care. Our study suggests that group prenatal care support improves breastfeeding initiation rates and some other maternal and perinatal outcomes.

Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia.

The noble practice of breast feeding is on the decline across the globe. Our objective was to research why women stop feeding their infants before the recommended 6 months of exclusive breast feeding and to assess the mothers' knowledge regarding importance and benefits of breast feeding. A cross-sectional study was conducted in two cities of Riyadh and Dammam using a structured questionnaire to 614 Saudi females in reproductive age group (15-45 years) from February to April 2016. Majority of the respondents were <30 years old, housewives and multiparous. The breast feeding initiation rate was 76% while only 37% continued to exclusively breast feed the infants until 6 months. Mothers of Dammam city showed higher rates of overall breast feeding, higher initiation of breast feeding within 24 hours of delivery and longer duration of breast feeding practices. Mothers older than 30years (p < 0.014), residents of Dammam city (P < 0.000) and receiving information on breast feeding during antenatal care (P < 0.001) were associated with higher knowledge scores. Residents of Riyadh, working mothers, delayed initiation of breast feeding after 24 hours of giving birth, and those who did not get information on breast feeding during antenatal classes were at higher risk of stopping exclusive breast feeding before 6 months. Regional differences exist with Dammam city having greater awareness and better compliance to breast feeding practices. There is a need to strengthen the education facilities at ANC clinics in Riyadh regarding duration and benefits of breast feeding along with nationwide promotion of breast feeding practices as per guidelines.

891: Does a home-based lifestyle intervention improve breastfeeding rates in socioeconomically disadvantaged (SED) obese women?

SED, obese women are comparatively less likely to breastfeed. Prior studies suggest the highest increases in breastfeeding (BF) occur from individual-level BF education and support interventions available during pregnancy and after delivery. However, data remain limited on the effectiveness on these interventions among SED women. We aimed to test the efficacy of an antepartum and postpartum home-based lifestyle intervention on BF rates in this population. This prospective study was nested within a randomized control trial occurring at a single university-based tertiary care center from 2013-2016 as part of the LIFE-Moms consortium (NCT01768793). SED, obese women with singleton gestations were randomized by 15 weeks to Parents as Teachers (PAT)—a parenting support and child development intervention—or PAT+, PAT with behavior interventions to decrease excessive weight gain and increase BF rates. Consenting women completed a well-validated BF survey at 6-12 months postpartum. The primary outcome was BF initiation. Secondary outcomes were reasons for not initiating or stopping BF. 118 women completed the survey: 59 in PAT+ and 59 in PAT. BF initiation rates were similar in each group. On a 1-4 scale with higher scores denoting more importance, there were no statistically significant differences among reasons for not initiating BF. On the same scale, women in PAT+ and PAT similarly rated their difficulty latching, concern for low milk supply, or pain during BF as the most important reasons for BF cessation. Comparatively, those in PAT+ were less likely to rate their desire to leave their baby for several hours, their medication use, or their desire to return to prior diet as important reasons for BF cessation (1.49 vs 1.98, aOR 0.39 (95% CI 0.16-0.98); 1.40 vs 1.86; aOR 0.33 (95% CI 0.12-0.93); 1.29 vs 1.72, aOR 0.32 (95% CI 0.11-0.95), respectively). Among SED, obese women, a home-based lifestyle intervention did not improve BF initiation rates or impact views on BF initiation or common reasons for BF cessation. Other educational interventions are needed to improve BF rates in this at-risk population.

Interventions to Improve Breastfeeding Exclusivity in Low-And Middle-Income Countries: A Systematic Review and Meta-Analysis

Background: Exclusive breastfeeding (EBF) rates until six months in most low and middle income counties (LMICs) are well below the 90% WHO benchmark. This systematic review sought to provide evidence on effectiveness of various interventions on exclusive breastfeeding until six months in LMICs, compared with standard care. Methods: This systematic review included experimental and observational studies, with concurrent comparator, in which exclusive breastfeeding was promoted, in LMICs with high country rates of breastfeeding initiation. Studies were identified from a systematic review and PUBMED, Cochrane and CABI databases. Study selection, data abstraction, and quality assessment (using the Cochrane tools for risk of bias assessment) were carried out independently and in duplicate. Relative risks with 95% confidence intervals were calculated for individual studies and pooled. High heterogeneity was explored through pre-specified sub-group analyses for the primary outcome (exclusive breastfeeding until six months) by context and by intervention for the randomised controlled trials. Prediction intervals were calculated for each effect estimate. Findings: 67 studies with 79 comparisons from 30 LMICs were included. At six months, intervention group infants were more likely to be exclusively breastfed than controls (RR=2.19, 95%CI 1.73 to 2.77; I2 78.4%; 25 randomised controlled trials). Larger effects were obtained from interventions delivered by a combination of professional and lay persons (RR 3.90, 95%CI 1.25 to 12.21; I2 46.7%), in interventions spanning antenatal and postnatal periods (RR 2.40, 95%CI 1.70 to 3.38; I283.6%), and when the intensity was between four to eight contacts/sessions (RR 3.20, 95%CI 2.30 to 4.45; I2 53.8%). Interpretation: Almost every intervention conducted in LMICs increased exclusive breastfeeding rates. Choice of intervention should therefore be driven by feasibility of delivery in the local context to reduce infant mortality. Funding: Needs Assessment Intervention Fund of the University of Lagos, Nigeria Registration: PROSPERO International prospective register of systematic reviews of the University of York CRD42016037029 Funding: Needs Assessment Intervention Fund of the University of Lagos, Nigeria Declaration of Interest: We declare no competing interests. Ethical Approval: Ethical approval was not required for this systematic review.

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.

Infant Feeding Beliefs, Attitudes, Knowledge and Practices of Chinese Immigrant Mothers: An Integrative Review of the Literature.

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers’ beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.

Impact of structured programs on breastfeeding initiation rates in preterm neonates in a socioeconomically deprived area in France: A 10-year population-based study

Structured programs have a positive impact on breastfeeding (BF) but have rarely been evaluated for preterm neonates, frequently combining prematurity and socioeconomic deprivation as risk factors of a low BF rate. We aimed to assess BF initiation rates in very preterm (<33 weeks’ gestational age), moderately preterm (33–36 weeks), and term neonates from 2002 to 2011 in a French administrative district characterized by socioeconomic deprivation. Structured activities to promote and support BF have been implemented in this area since 2002; they all started in neonatal units. This retrospective population-based study analyzed 302,102 first health certificates. Overall, the BF initiation rate significantly increased, from 52.9% [95% CI: (52.3; 53.4)] in 2002 to 61.0% [95% CI: (60.4; 61.6)] in 2011. In 2002, BF initiation rates did not differ between groups, but in 2011, it was higher for very preterm than for term and moderately preterm neonates [74.7% (69.7; 79.6)] vs. 60.9% (60.3; 61.5) and 59.9% (57.6; 62.2), respectively, both P<0.001. In 2011, however, no difference was observed between moderately preterm children and term-born children (P=0.40). The 2.2% yearly increase observed in very preterm neonates significantly differed from the 0.9% yearly increase in the French general population (P<0.001). ConclusionStructured BF programs initiated in neonatal care units may have a positive impact on BF initiation rates in very preterm neonates, but not in moderately preterm neonates, whose specific needs should be further evaluated.

Lactation Advice through Texting Can Help: An Analysis of Intensity of Engagement via Two-Way Text Messaging

Rates of breastfeeding initiation and duration among women who attend the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are dramatically lower than nonparticipants. Innovative solutions are needed to improve breastfeeding rates in this population. The Lactation Advice through Texting Can Help (LATCH) study was one such approach, designed to augment and reinforce the WIC breastfeeding peer counseling process. The purpose of the present study was to examine engagement via two-way text messaging in a sample of women attending the WIC breastfeeding peer counseling program and enrolled in LATCH. The objectives were to: (1) describe text message engagement in the context of LATCH; and (2) assess the association between engagement variables and exclusive breastfeeding status. Text messaging data were first coded qualitatively by two independent researchers and engagement variables created. An analysis of engagement was conducted using descriptive statistics for normally distributed data and binary logistic regression. In the multivariable model, intensity of engagement during the first 2 weeks post partum was the single strongest predictor of exclusive breastfeeding status. LATCH is an innovative intervention designed to enhance the capacity of breastfeeding peer counselors and holds much potential for improving exclusive breastfeeding rates in this population.

A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study.

In total, 81% of women in the UK start breastfeeding, but fewer than half continue beyond 6 weeks. Peer support in the early postnatal period may encourage women to breastfeed for longer. To develop a breastfeeding peer-support intervention based on motivational interviewing (MI) for breastfeeding maintenance and to test the feasibility of delivering it to mothers in areas with high levels of social deprivation. Intervention development and a non-randomised multisite feasibility study. Community maternity services in three areas with high levels of social deprivation and low breastfeeding initiation rates in England and Wales. Pregnant women considering breastfeeding. Women who did not plan to breastfeed, who had a clinical reason that precluded breastfeeding continuation or who were unable to consent were excluded. The intervention Mam-Kind was informed by a survey of infant feeding co-ordinators, rapid literature review, focus groups with service users and peer supporters and interviews with health-care professionals and a Stakeholder Advisory Group. It consisted of face-to-face contact at 48 hours after birth and proactive one-to-one peer support from the Mam-Kind buddy for 2 weeks, followed by mother-led contact for a further 2-6 weeks. Recruitment and retention of Mam-Kind buddies, uptake of Mam-Kind by participants, feasibility of delivering Mam-Kind as specified and of data collection methods, and acceptability of Mam-Kind to mothers, buddies and health-care professionals. Nine buddies were recruited to deliver Mam-Kind to 70 participants (61% of eligible women who expressed an interest in taking part in the study). Participants were aged between 19 and 41 years and 94% of participants were white. Intervention uptake was 75% and did not vary according to age or parity. Most contacts (79%) were initiated by the buddy, demonstrating the intended proactive nature of the intervention and 73% (n = 51) of participants received a contact within 48 hours. Follow-up data were available for 78% of participants at 10 days and 64% at 8 weeks. Data collection methods were judged feasible and acceptable. Data completeness was > 80% for almost all variables. Interviews with participants, buddies and health service professionals showed that the intervention was acceptable. Buddies delivered the intervention content with fidelity (93% of intervention objectives were met), and, in some cases, developed certain MI skills to a competency level. However, they reported difficulties in changing from an information-giving role to a collaborative approach. These findings were used to refine the training and intervention specification to emphasise the focus of the intervention on providing mother-centric support. Health-care professionals were satisfied that the intervention could be integrated with existing services. The Mam-Kind intervention was acceptable and feasible to deliver within NHS maternity services and should be tested for effectiveness in a multicentre randomised controlled trial. The feasibility study highlighted the need to strengthen strategies for birth notification and retention of participants, and provided some insights on how this could be achieved in a full trial. The response rate to the survey of infant feeding co-ordinators was low (19.5%). In addition, the women who were recruited may not be representative of the study sites. The National Institute for Health Research Health Technology Assessment programme.

Trends and Factors Associated with Breastfeeding and Infant Sleep Practices in Georgia.

Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004-2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding