High Breastfeeding Initiation Rates Research Articles

Breastfeeding Initiation in People With Hepatitis C Virus Infection in the United States.

To evaluate breastfeeding initiation rates among people living with and without hepatitis C virus (HCV) infection during pregnancy and to identify characteristics associated with breastfeeding initiation. We conducted a cross-sectional analysis of individuals who had a live birth in the United States from 2016 to 2021 using the National Center for Health Statistics birth certificate data. We grouped participants by whether they had HCV infection during pregnancy. Using propensity-score matching, we assessed the association between breastfeeding initiation before hospital discharge , defined as neonates receiving any parental breast milk or colostrum, and HCV infection during pregnancy in a logistic regression model. We also assessed factors associated with breastfeeding initiation among those with HCV infection. There were 96,896 reported cases (0.5%) of HCV infection among 19.0 million births that met inclusion criteria during the study period. Using propensity-score matching, we matched 87,761 individuals with HCV infection during pregnancy with 87,761 individuals without HCV infection. People with HCV infection during pregnancy were less likely to initiate breastfeeding compared with those without HCV infection (51.5% vs 64.2%, respectively; odds ratio 0.59, 95% CI, 0.58-0.60, P <.001). Characteristics associated with higher rates of breastfeeding initiation among individuals with HCV infection included a college degree (adjusted odds ratio [aOR] 1.22, 95% CI, 1.21-1.24); self-identified race or ethnicity as Native Hawaiian or Pacific Islander (aOR 1.22, 95% CI, 1.06-1.40), Asian (aOR 1.09, 95% CI, 1.06-1.13), or Hispanic (aOR 1.09, 95% CI, 1.08-1.11); private insurance (aOR 1.07, 95% CI, 1.06-1.08); nulliparity (aOR 1.09, 95% CI, 1.08-1.10), and being married (aOR 1.08, 95% CI, 1.07-1.09). Characteristics associated with not breastfeeding before hospital discharge included receiving no prenatal care (aOR 0.81, 95% CI, 0.79-0.82), smoking during pregnancy (aOR 0.88, 95% CI, 0.88-0.89), and neonatal intensive care unit admission (aOR 0.92, 95% CI, 0.91-0.93). Despite leading health organizations' support for people living with HCV infection to breastfeed, our study demonstrates low breastfeeding initiation rates in this population. Our findings highlight the need for tailored breastfeeding support for people with HCV infection and for understanding the additional effects of human immunodeficiency virus (HIV) co-infection, HCV treatment, and concurrent substance use disorders on breastfeeding initiation.

Birth Center Breastfeeding Rates: A Literature Review.

Breastfeeding rates in the United States fall short of national targets and are marked by racial and ethnic disparities. Birth centers are associated with high rates of breastfeeding initiation and duration, yet no systematic review has compiled reported birth center breastfeeding data. A PRISMA-guided literature review was conducted in CINAHL, PubMed, and Web of Science to retrieve quantitative studies that reported breastfeeding data in birth centers. Inclusion criteria focused on English language studies published since 2011 with breastfeeding outcomes from birth centers in the United States. Ten studies were included for analysis. Breastfeeding rates that exceeded actual and target national breastfeeding rates were reported among all 10 studies. Characteristics about breastfeeding outcomes were reported heterogeneously across the studies, which included a range of breastfeeding timepoints (immediately postpartum up to 6 weeks postpartum) and definitions of breastfeeding. Although breastfeeding rates reported in birth centers are higher than national breastfeeding rates and targets, authors of the included studies did not explore or analyze these rates in-depth. Developing standard definitions and data collection may enhance research about breastfeeding outcomes in birth centers. Giving birth in a birth center is associated with higher than national breastfeeding rates.

Breastfeeding, Community Vulnerability, Resilience, and Disasters: A Snapshot of the United States Gulf Coast.

Climate change-induced disasters are increasing in intensity and frequency in the United States. Infant feeding in the aftermath of an extreme event is particularly challenging, especially given large variations in community vulnerability and resilience. The aim of this study was to identify the physical, social, and spatial vulnerabilities of communities along the Gulf Coast and highlight locations where high (or low) breastfeeding initiation rates have the potential to offset (or exacerbate) infant feeding challenges in the wake of a disaster. We structured this study as a retrospective, spatial data analysis of breastfeeding initiation, the risk for extreme events, social vulnerability, and community resilience to uncover locations that may need post-disaster intervention. The results suggested that significant gaps in the geographic distribution of community risk, vulnerability, resilience, and breastfeeding initiation existed. While many metropolitan areas benefitted from high breastfeeding initiation rates, they were also the most “at risk” for disasters. Conversely, many rural communities faced less risk for extreme events but exhibited more social vulnerability and less resilience should a disaster strike. Prioritizing emergency response resources to support infant feeding after a disaster is critically important, but urban and rural communities have divergent profiles that will require variable strategies to ensure recovery. Our results highlight this variability and provide prescriptive guidance regarding where to potentially allocate emergency resources.

Clinical predictors for breastfeeding initiation among women with epilepsy

PurposeTo study breastfeeding initiation and continuation rates and identify clinical predictors of breastfeeding initiation related to maternal epilepsy and the newborn's condition among women with epilepsy (WWE). MethodsData on a cohort of 1195 pregnant WWE from an epilepsy center in Poland from 2000 to 2019 were prospectively collected. Mann-Whitney U and ch2 tests -based comparisons between lactating and non-lactating WWE according to age, week of delivery, Apgar score, birth weight, type of epilepsy, seizure control, major congenital malformation (MCM), mode of delivery, type and dose of antiseizure medication (ASM) were performed. A logistic regression model was constructed to identify predictors of breastfeeding initiation. ResultsAmong 921 WWE, who gave birth to a living child, 709 (77%) initiated breastfeeding. The annual rate did not significantly change over the study period. Higher breastfeeding initiation rates were associated with vaginal birth (OR = 0.66) and lack of MCM (OR = 0.23). Breastfeeding initiation was less frequent with old-generation ASM monotherapy (OR = 0.36) or polytherapy (OR = 0.33) compared to no ASM treatment. The rate of breastfeeding initiation was positively associated with gestational week and the newborn's condition. At 6 months, about 1/3 of WWE maintained lactation. ConclusionApproximately ¾ of the WWE cohort initiated breastfeeding. Breastfeeding initiation was associated with delivery mode, treatment type, and the newborn's condition but was not associated with seizures during pregnancy or the individual ASM dose. Further studies are needed to identify additional factors that may negatively affect breastfeeding.

Lockdown-Associated Hunger May Be Affecting Breastfeeding: Findings from a Large SMS Survey in South Africa.

The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; p = 0.045). This result also holds in a multivariate framework, including covariates such as depressive symptoms, attendance of a PHC facility, and whether the infant was older than 3 months. Support for breastfeeding must include support, such as economic support, for breastfeeding mothers, to enable them to access nutritious diets. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed and should be encouraged to continue to attend the health clinic regularly.

Factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women: a multi-centre study.

To identify factors associated with breast-feeding initiation and continuation in Canadian-born and non-Canadian-born women. Prospective cohort of mothers and infants born from 2008 to 2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. General community setting in four Canadian provinces. In total, 3455 pregnant women from Vancouver, Edmonton, Winnipeg and Toronto between 2008 and 2012. Of 3010 participants included in the current study, the majority were Canadian-born (75·5 %). Breast-feeding initiation rates were high in both non-Canadian-born (95·5 %) and Canadian-born participants (92·7 %). The median breast-feeding duration was 10 months in Canadian-born participants and 11 months in non-Canadian-born participants. Among Canadian-born participants, factors associated with breast-feeding initiation and continuation were older maternal age, higher maternal education, living with their partner and recruitment site. Rooming-in during the hospital stay was also associated with higher rates of breast-feeding initiation, but not continuation at 6-month postpartum. Factors associated with non-initiation of breast-feeding and cessation at 6-month postpartum were maternal smoking, living with a current smoker, caesarean birth and early-term birth. Among non-Canadian-born participants, maternal smoking during pregnancy was associated with lower odds of breast-feeding initiation and lower odds of breast-feeding continuation at 6 months, and older maternal age and recruitment site were associated with breast-feeding continuation at 6 months. Although Canadian-born and non-Canadian-born women in the CHILD cohort have similar breast-feeding initiation rates, breast-feeding initiation and continuation are more strongly associated with socio-demographic characteristics in Canadian-born participants. Recruitment site was strongly associated with breast-feeding continuation in both groups and may indicate geographic disparities in breast-feeding rates nationally.

Doula Programs Improve Cesarean Section Rate, Breastfeeding Initiation, Maternal and Perinatal Outcomes [11P

INTRODUCTION: Doula support for socially disadvantaged women during pregnancy, childbirth and postpartum period is associated with improved outcomes, including lower rates of cesarean section, higher rates of breastfeeding initiation, and decreased maternal and perinatal complications. The purpose of our study is to report rates of primary cesarean section rate, breastfeeding initiation, and maternal and perinatal complications among socially or economically disadvantaged pregnant patients enrolled in a doula program in a large inner city setting. METHODS: Retrospective chart review of birth outcomes included primary cesarean section rate, breast feeding initiations, maternal and perinatal complications of patients enrolled in a certified doula support program in a large inner city setting. Outcomes were compared to local states percentages. RESULTS: Three hundred twenty two patients enrolled in the doula support program, 248 delivered vaginally and 74 required a cesarean section (cesarean section rate 22%), breast feeding initiation was reported in 269 patient (83% rate breast feeding initiations) and no maternal or perinatal loss was reported. CONCLUSION: Patients enrolled in a certified doula support programs in an inner city setting have improved cesarean section rates (22% vs 27%), breast feeding initiation rate (83% vs 80%) and improved maternal and perinatal outcomes compared to local state percentages. Our study confirms that pregnancy support by doulas are associated with improved outcomes in socially disadvantaged mothers because of racial disparities and psychosocial factors. Given these benefits certified doula support programs should be an available option during prenatal and postpartum care.

Historical-qualitative analysis of breastfeeding trends in three OECD countries

BackgroundBreastfeeding rates among high income, western countries vary considerably. This research examines three countries, Sweden, Ireland, and the United States, with respect to both public health initiatives and policy initiatives.MethodsThis article uses a historical qualitative analysis of breastfeeding rates over time. It uses the welfare state structure as a framework for understanding the variation in breastfeeding outcomes among these three countries.ResultsWith its strong family policies and early adherence to international public health recommendations, Sweden was able to build high rates of breastfeeding initiation and duration. However, Sweden’s breastfeeding rates have been declining, which may be a result of increasing encouragement for fathers to take equal leave, and because Sweden is no longer prioritizing breastfeeding in its public health goals. Ireland has experienced rapid growth of both breastfeeding initiation and participation in the Baby-Friendly Hospital Initiative, though its rates still lag behind much of the Western world. The United States has seen increases in participation with the Baby-Friendly Hospital Initiative, but lacks state support in public health and labor policies.ConclusionThis analysis suggests that in a country with a strong welfare state and early adoption of internationally recommended public policy, breastfeeding is able to flourish. It also suggests that the Baby-Friendly hospital Initiative is a predictor of breastfeeding success.

Maternal and child health nurses’ experiences of implementing two community-based breastfeeding interventions in Victoria, Australia: A mixed methods process evaluation

Despite high rates of breastfeeding initiation in Australia, there is a significant drop in breastfeeding rates in the early postpartum period, and Australian government breastfeeding targets are not being met. The Supporting breastfeeding In Local Communities (SILC) trial was a three-arm cluster randomised trial implemented in 10 Victorian local government areas (LGAs). It aimed to determine whether early home-based breastfeeding support by a maternal and child health nurse (MCH nurse) with or without access to a community-based breastfeeding drop-in centre increased the proportion of infants receiving ‘any’ breast milk at four months. Focus groups, a written questionnaire and semi-structured interviews were undertaken to explore the interventions from the perspective of the SILC-MCH nurses (n=13) and coordinators (n=6), who established and implemented the interventions. Inductive thematic analysis was used to identify themes, then findings further examined using Diffusion of Innovations Theory as a framework. SILC-MCH nurses and coordinators reported high levels of satisfaction, valuing the opportunity to improve breastfeeding in our community; and having focused breastfeeding time with women in their own homes. They felt the SILC interventions offered benefits to women, nurses and the MCH service. Implementing new interventions into existing, complex community health services presented unforeseen challenges, which were different in each LGA and were in part due to the complexity of the individual LGAs and not the interventions themselves. These findings will help inform the planning and development of future programs aimed at improving breastfeeding and other interventions in MCH.

Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital.

To determine infant feeding practices of low-income women at a Baby-Friendly Hospital and to ascertain breastfeeding interventions they believe would increase exclusive breastfeeding. This cross-sectional study occurred at a tertiary care Baby-Friendly Hospital. Low-income women without breastfeeding contraindications were recruited at scheduled obstetrician/gynecologist appointments within 6 to 9 months of delivering a term, nonanomalous infant. Participants completed a survey. Outcomes included infant feeding patterns and perceived usefulness of proposed breastfeeding interventions. Of 149 participants, 129 (86.6%) initiated breastfeeding; by postpartum day 2 (PPD2), 47 (31.5%) exclusively breastfed, 51 (34.2%) breastfed with formula, and 51 (34.2%) exclusively formula fed. On a scale of 1 ("strongly agree") to 5 ("strongly disagree"), women who supplemented with formula on PPD2 were significantly more likely than those who exclusively formula fed to agree education on neonatal behavior, 1 (interquartile range [IQR] 1, 2) versus 2 (IQR 1, 3); p = 0.026 and on-demand access to breastfeeding videos on latch or positioning, 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.043; 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.021, respectively, would have helped them exclusively breastfeed. Though low-income women at a Baby-Friendly Hospital had high breastfeeding initiation rates, the majority used formula by PPD2. To increase breastfeeding rates among low-income women, future interventions should provide appropriate and effective breastfeeding interventions.

Infant Feeding Practices in China and Ireland: Ireland Chinese Mother Survey.

Introduction: Migration to another country may induce changes in infant feeding practices especially where such practices differ considerably between the two countries. This study was undertaken to compare the infant feeding practices between Chinese mothers who gave birth in Ireland (CMI) with immigrant Chinese mothers who gave birth in China (CMC), and to examine the factors that influence these practices.Methods: A cross-sectional self-administrated survey was conducted among a convenience sample of 322 Chinese mothers living in Ireland. Data were obtained from mailed questionnaires. Infant feeding practices between CMC and CMI were compared by Chi-square or independent sample t-test. Binary logistic regression analyses were further performed to test the differences in infant feeding practices between two groups, after controlling for potential socio-demographic confounders.Results: High breastfeeding initiation rates were found in both groups (CMC: 87.2%; CMI: 75.6%); however sharp reductions in breastfeeding rates at 3 months (49.1%) and 6 months (28.4%) were found among CMI but not CMC (P < 0.05). Introduction of water within 1 week after childbirth was common for CMC in comparison with CMI. CMI were more likely than CMC to introduce infant formula to their child within the first 4 months after childbirth. The timing of introduction of rice porridge, vegetables, fruits and meats did not differ between CMC and CMI.Conclusions: Cultural and perceptional factors, and changes caused by migration contribute to the decline in breastfeeding duration among CMI. Language-specific breastfeeding support and education among Chinese mothers in Ireland is needed, in particular to encourage mothers to breastfeed for 6 months or more.

SEX DIFFERENCES IN THE SOCIAL ECOLOGY OF BREASTFEEDING: A MIXED METHODS ANALYSIS OF THE BREASTFEEDING VIEWS OF EXPECTANT MOTHERS AND FATHERS IN THE US EXPOSED TO ADVERSITY.

Despite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant's health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.

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.

The Impact of Federal Policy Changes and Initiatives on Breastfeeding Initiation Rates and Attitudes Toward Breastfeeding Among WIC Participants

To explore the effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on participants' breastfeeding (BF) practices, studies that use large national samples are warranted. The US Department of Agriculture's Food and Nutrition Service funded several studies that leveraged national samples of WIC agencies, sites, and participants to evaluate how WIC affects BF outcomes among its participants. This report integrates findings across multiple Food and Nutrition Service–funded studies to describe important program benefits and how the program and its benefits supported positive attitudes and beliefs toward BF, as well as higher rates of BF initiation. The report concludes with policy implications and suggestions for future research.

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study.

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Where there is no weighing scale: Newborn nourishment and care in Pakistani Punjab

A third of babies in South Asia are born low birthweight, more than in sub-Saharan Africa. This epidemiological enigma has been linked to gender and generational inequalities and to poor health and nutrition over the whole of women's lives. High rates of breastfeeding initiation are accompanied by high rates of colostrum avoidance, the giving of prelacteal feeds and early supplementation with formula or animal milks as well as other substances. Meanwhile, in Pakistan – despite the extensive presence of public community maternal and child health workers – very few babies are weighed at birth. This paper draws on an ethnographic study conducted in 2014–16 in rural and urban Punjab, to shed light on the interpretation, nourishment and care of newborns who are identified to be kamzoor (weak), and to comment on the extent to which carers' efforts are influenced by community health workers, who are charged with spreading modern biomedical knowledge and practices. Kamzoori is understood to be caused by maternal depletion and is managed at home by augmenting breastfeeding and giving supplementary milks, and by keeping the baby warm and massaged. In cases where weak newborns do not recover weight, spiritual explanations are invoked and treated through a variety of home remedies/methods. There are often similarities between the interpretations of mothers, grandmothers, and health workers. The paper considers health workers to be engaged in complex cultural mediations.

“Be positive as well as realistic”: a qualitative description analysis of information gaps experienced by breastfeeding mothers

BackgroundEarly breastfeeding cessation is common in many regions of the world despite high breastfeeding initiation rates and strong evidence of the health benefits to both mother and infant. This research investigated mothers’ perceived breastfeeding information needs in order to increase our understanding of this phenomenon.MethodsSurveys were distributed by public health nurses in a health region in Western Canada to mothers who had initiated breastfeeding and whose infants were six to eleven months old to learn more about their infant feeding experiences during the birth to six month period. Two open-ended survey questions asked: (1) What support or advice did you receive that helped you with feeding your baby?” and (2) “What support or information on feeding your baby would you have found helpful but did not receive?” A total of 191 eligible mothers submitted a survey (response rate 35%) between January and October 2012. Qualitative description was used in analyzing the responses of the women who provided comments for the open-ended questions.ResultsWhile many mothers felt their information needs were met, others outlined important content areas where more information and guidance was desired. These areas included milk supply management, frequency/duration of feeds, proper latch and feeding positions, nipple care, expression/pumping, other nutrition sources, and realistic information regarding common breastfeeding concerns.ConclusionsThe results suggest that several of the information gaps highlighted by respondents in this study closely align with commonly cited reasons for breastfeeding cessation including perceived insufficient milk supply, latching difficulties and nipple discomfort. The findings emphasize the need for lactation support with systematic measures to ensure breastfeeding mothers are universally provided with information on these key content areas. Lactation supports should reinforce critical information and seek feedback to ascertain that mothers have clearly understood the information provided. Ensuring mothers receive and understand key breastfeeding information is a modifiable factor in efforts to increase breastfeeding duration rates.

Factors influencing exclusive breastfeeding at 4 months postpartum in a sample of urban Hispanic mothers in Kentucky.

Although Hispanic mothers in the United States have slightly higher rates of breastfeeding initiation than the national average, they are more likely to supplement with formula. To describe infant feeding decisions in a sample of 72 urban Hispanic mothers and assess whether demographic and personal factors influence exclusive breastfeeding (EBF) status at 4 months postpartum. The study was longitudinal and included assessments during pregnancy, in the hospital following childbirth, and monthly up to 4 months following birth. Nearly all of the 72 mothers were breastfeeding at discharge after the birth of their infant (94%); half of these were EBF. By 2 months postpartum, the rate of EBF had declined to 26%, dropping to 22% by 4 months. Significant predictors of EBF status at 4 months included the baseline indicator for mother's partner as the most important person in life (adjusted odds ratio [AOR], 5.42; 95% confidence interval [CI], 1.03-28.66) and breastfeeding self-efficacy score at 1 month (AOR, 1.20; 95% CI, 1.07-1.34). These findings have particular relevance in this population, given the high rate of breastfeeding initiation coupled with breastfeeding self-efficacy being a modifiable factor. Support during pregnancy and postpartum, including consultation with a lactation consultant, may increase the self-efficacy of EBF in this low-income population, leading to higher rates of extended EBF among Hispanics.

Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates.

Background and AimMany preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding.MethodsThe study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks.ResultsOf the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding.ConclusionBreastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.

Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community.

Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community. Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks. We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)]. Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.