Increased Breastfeeding Rates Research Articles

Characteristics of Patients Intending to Breastfeed in a Tertiary Obstetric Hospital in Louisiana [07O

INTRODUCTION: Increasing the rates of breastfed infants has become a national health objective. Louisiana's breastfeeding initiation and continuance rates remain below the national average, ranking 49th of 50. Our goal is to identify demographic predictors of initial and continued intent to breastfeed. METHODS: We conducted a retrospective cohort study of electronic health records from deliveries at Woman's Hospital, a tertiary hospital in South-Central Louisiana, between July 2015 and June 2016 (n=6689; approved and monitored by Woman's IRB). Patients were asked upon admission for delivery if they intended to breastfeed. Their feeding plan (breast, formula, combination) was reassessed at discharge. Logistic regression was used to describe the populations most likely to intend to breastfeed prior to delivery and those that were breastfeeding successfully at the time of discharge. RESULTS: Between July 2015 and June 2016, 6,689 patients met criteria for analysis. Patients reporting intent to breastfeed prior to delivery were more likely Caucasian (P<.0001), married (P<.001), nulliparous (P<.01), privately-insured (P<.0001), educated (P<.0001), and older (P<.01) compared to patients not intending to breastfeed. These characteristics were similar in those with continued breastfeeding at discharge, however the strongest predictor of breastfeeding at discharge was intent to breastfeed prior to delivery (P<.0001). African American race was the strongest predictor of non-breastfeeding intent (P<.0001). CONCLUSION: Intent to breastfeed prior to delivery was the strongest predictor of breastfeeding at discharge; thus, prenatal breastfeeding education within the at-risk population is crucial to increasing breastfeeding rates. Future studies should assess factors influencing breastfeeding discontinuation and breastfeeding rates through six months postpartum.

Baby-Friendly Hospital Initiative Is Associated with Lower Rates of Neonatal Hyperbilirubinemia.

Background: The Baby-Friendly Hospital Initiative (BFHI) advances practices that support exclusive breastfeeding. BFHI practices are associated with increased breastfeeding rates, however, other patient outcomes are not well described. This study examined the association of BFHI practices with hyperbilirubinemia and phototherapy between groups of newborns born before and after BFHI implementation at an urban, tertiary academic medical center in South Carolina. Materials and Methods: We conducted a retrospective study of healthy, term newborns born between July and September 2011 (n = 956), before BFHI implementation, and newborns born during the same period in 2013 (n = 1,131) after BFHI implementation. Primary outcomes were neonatal hyperbilirubinemia, phototherapy treatment, and hospital readmissions for hyperbilirubinemia within 30 days of discharge. We compared rates of outcomes between the study groups using unadjusted and adjusted odds ratios (OR). Results: Among newborns born before versus after BFHI implementation, 20.3% versus 6.98% were diagnosed with hyperbilirubinemia (p < 0.001), 5.75% versus 1.95% received phototherapy (p < 0.001), and 0.31% versus 0.35% were readmitted to the hospital for hyperbilirubinemia within 30 days (p = 0.88). In adjusted analyses, newborns born after BFHI implementation were significantly less likely to develop neonatal hyperbilirubinemia (OR 0.28 [95% confidence intervals; CI 0.20-0.37]) and receive phototherapy treatment (OR 0.27 [95% CI 0.15-0.49]) than newborns born before BFHI implementation. Conclusions: Implementation of BFHI practices is associated with significant decreases in neonatal hyperbilirubinemia and phototherapy without affecting readmission rates. Exclusive breastfeeding has traditionally been considered a risk factor for the development of neonatal jaundice. This study demonstrates that BFHI practices may mitigate that risk.

Historical Perspectives: Low Birthweight and Preterm Infants in Indonesia.

The incidence of infants with low birthweight (LBW), prematurity, and small for gestational age (SGA) in Indonesia remains high, and the morbidity and mortality in these infants are significant. To study these groups of infants in Indonesia, the author searched PubMed/Medline, the Cochrane Library, Google, Indonesian reports, local publications, and doctoral and master theses in English and Indonesian from 1987 to February 2019. In this review, the development of local reference growth charts of infants born in Indonesia is described, as well as the importance of these curves in defining the prevalence of SGA infants. Some of the risk factors associated with LBW, preterm, and SGA Indonesian infants are described. The author also discusses the effectiveness of specific interventions, such as kangaroo mother care, early initiation of enteral feedings, increased breastfeeding rates, and identifying the optimal timing of hospital discharge. Some of the morbidities associated with LBW infants born in Indonesia are described. Advances in hospital care and postdischarge follow-up of LBW, preterm, and SGA infants born in Indonesia are critical to decrease the morbidity and mortality rates associated with these populations.

The financing need for expanded maternity protection in Indonesia

BackgroundAlmost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia.MethodsThe potential cost implication of the current and increased maternity leave length (three and 6 months) as well as the potential budget impact to the government were estimated for 2020 to 2030. The cost of setting up lactation rooms in formal sector companies was estimated using the Alive & Thrive standards. Interviews were conducted in five different provinces to 29 respondents in 2016 to identify current and potential challenges in implementing both existing and improved maternity protection policies.ResultsThe costs of expanding paid maternity leave from three to 6 months and incorporating standardized lactation rooms in 80% of medium and large size firms in Indonesia was estimated at US$1.0 billion (US$616.4/mother per year) from 2020 to 2030, covering roughly 1.7 million females. The cost of setting up a basic lactation room in 80% of medium and large companies may reach US$18.1 million over 10 years. The three main barriers to increasing breastfeeding rates were: breastmilk substitutes marketing practices, the lack of lactation rooms in workplaces, and local customs that may hamper breastfeeding according to recommendations.ConclusionsThe cost of expanding paid maternity leave is lower than the potential cost savings of US$ 1.5 billion from decreased child mortality and morbidity, maternal cancer rates and cognitive loss. Sharing the cost of paid maternity leave between government and the private sector may provide a feasible economic solution. The main barriers to increasing breastfeeding need to be overcome to reap the benefits of recommended breastfeeding practices.

Quiet Time on the Postpartum Unit

Disruptions and noise during postpartum stays may cause decreased breastfeeding and patient satisfaction. This study sought to translate evidence by implementing a 2-hour quiet time with decreased disruptions on a postpartum unit. The objectives were to determine if quiet time on a postpartum unit would increase Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) via Press Ganey score of satisfaction with unit quietness, patient breastfeeding, and the implementation of nursing evidence-based practices. A quasi-experimental pre- and postdesign was used. The study was conducted at a 377-bed community hospital that has 400 births per month. A convenience sample of postpartum women with uncomplicated vaginal or cesarean births were included in the study during their postpartum stay. The intervention consisted of 2 hours of quiet time each afternoon with limited interruptions by staff and visitors. Observations of interuptions were recorded on random days outside of the patient room. Visitors and staff presence were limited but presence of the support person was not limited. Preintervention prospective HCAHPS via Press Ganey scores of satisfaction with unit quietness were collected, as they also were prospectively after the introduction of the intervention. Retrospective breastfeeding rates were also collected preintervention and were compared with prospective postintervention breastfeeding rates. Chi-square analysis was completed for both of these indicators, with p values below .05 indicating significance. The preintervention average breastfeeding rate was 38.71%, and postintervention, it was 45.0%. Th chi-square calculation was 7.0829. Probability of statistical significance was .3763 (not statistically significant). Preintervention HCAHPS via Press Ganey always score of satisfaction with unit quietness was 50.54. The postintervention score was 71.05. The chi-square calculation was 7.3197. Probability of statistical significance was .0068 (statistically significant). Quiet time in a postpartum unit was accepted by patients, staff, and families. Developing the structure may take some work, and education of all stakeholders is a critical step toward success. A significant positive difference was found in patient satisfaction scores, and, although not statistically significant, clinically significant increased breastfeeding rates should lead postpartum nurses toward implementation of evidence-based practices that will improve the postpartum women’s experience and lead to long-term positive outcomes.

Nurses’ attitudes towards the implementation of the Mother-Baby Friendly Initiative in selected primary healthcare facilities at Makhuduthamaga Municipality, Limpopo province

BackgroundThe implementation of the Mother-Baby Friendly Initiative (MBFI) strategy demonstrated its capabilities to improve global children’s health and maternal survival. However, its implementation in primary healthcare (PHC) facilities remains a challenge as many nurses are reluctant to adopt it for the improvement of child and maternal healthcare services in their respective clinics.ObjectivesThe primary objective of this study was to determine the attitudes of nurses towards the implementation of the MBFI in selected PHC facilities in the Makhuduthamaga Municipality, Limpopo province.MethodThis study used a quantitative, descriptive design, and all respondents were conveniently sampled. A self-administered questionnaire was used to collect data. One-hundred and seventy-seven questionnaires were distributed, and 153 nurses responded and completed the questionnaire. The Statistical Package for Social Sciences version 23 was used to analyse data.ResultsResults show that the majority of nurses (professional nurses [PNs] = 65, 78%; enrolled nurses [ENs] = 18, 72%; enrolled nursing auxiliaries [ENAs] = 23, 51%) had a positive attitude towards the MBFI strategy implementation as they agreed that it increased breastfeeding rates. Most PNs (n = 58, 70%) and ENs (n = 15, 60%) showed positive attitudes towards exclusive breastfeeding (EBF) as they agreed that it was the ideal feeding option for any child, and most ENAs (n = 38, 84%) showed a negative attitude as they disagreed that EBF was the ideal feeding option for any child.ConclusionIn this study, most PNs and ENs had a positive attitude in all the aspects that determined their attitudes towards MBFI strategy implementation. A concern is the fact that most ENAs showed negative attitudes in almost all the statements that were in line with the principles of MBFI, as they disagreed in most aspects. Therefore, this study recommends that on-going orientation and trainings should be offered to all nurses including ENAs to equip them with information that can assist in changing their attitudes towards MBFI implementation in PHC facilities.

Nurses' attitudes towards the implementation of the Mother-Baby Friendly Initiative in selected primary healthcare facilities at Makhuduthamaga Municipality, Limpopo province.

The implementation of the Mother-Baby Friendly Initiative (MBFI) strategy demonstrated its capabilities to improve global children's health and maternal survival. However, its implementation in primary healthcare (PHC) facilities remains a challenge as many nurses are reluctant to adopt it for the improvement of child and maternal healthcare services in their respective clinics. The primary objective of this study was to determine the attitudes of nurses towards the implementation of the MBFI in selected PHC facilities in the Makhuduthamaga Municipality, Limpopo province. This study used a quantitative, descriptive design, and all respondents were conveniently sampled. A self-administered questionnaire was used to collect data. One-hundred and seventy-seven questionnaires were distributed, and 153 nurses responded and completed the questionnaire. The Statistical Package for Social Sciences version 23 was used to analyse data. Results show that the majority of nurses (professional nurses [PNs] = 65, 78%; enrolled nurses [ENs] = 18, 72%; enrolled nursing auxiliaries [ENAs] = 23, 51%) had a positive attitude towards the MBFI strategy implementation as they agreed that it increased breastfeeding rates. Most PNs (n= 58, 70%) and ENs (n= 15, 60%) showed positive attitudes towards exclusive breastfeeding (EBF) as they agreed that it was the ideal feeding option for any child, and most ENAs (n= 38, 84%) showed a negative attitude as they disagreed that EBF was the ideal feeding option for any child. In this study, most PNs and ENs had a positive attitude in all the aspects that determined their attitudes towards MBFI strategy implementation. A concern is the fact that most ENAs showed negative attitudes in almost all the statements that were in line with the principles of MBFI, as they disagreed in most aspects. Therefore, this study recommends that on-going orientation and trainings should be offered to all nurses including ENAs to equip them with information that can assist in changing their attitudes towards MBFI implementation in PHC facilities.

Breastmilk feeding for mothers and infants with opioid exposure: What is best?

With rare exception, breastfeeding is the optimal way to feed infants, and has special benefits for women and infants with perinatal opioid exposure. Infants breastfed and/or fed their mother's own breastmilk experience less severe opioid withdrawal symptoms, have shorter hospital stays, and are less likely to be treated with medication for withdrawal. The specific impact of mothers' milk feeding on opioid withdrawal may be related to the act of breastfeeding and associated skin-to-skin contact, qualities of breastmilk, healthier microbiome, small amounts of opioid drug in breastmilk, or a combination of these. Women with opioid use disorder face significant breastfeeding obstacles, including psychosocial, behavioral, concomitant medications, and tobacco use and thus may require high levels of support to achieve their breastfeeding goals. They often don't receive information to make informed infant feeding decisions. Hospital practices such as prenatal education, rooming-in and having a policy that minimizes barriers to breastfeeding are associated with increased breastfeeding rates.

The IBLCE exam: candidate experience, motivation, study strategies used and predictors of success

BackgroundOptimising breastfeeding rates is a public health priority. Studies have shown that all forms of extra breastfeeding support increase breastfeeding rates, including support provided by trained health professionals. International Board Certified Lactation Consultants (IBCLCs) are trained healthcare professionals in the clinical management of breastfeeding and human lactation. The IBCLC certification is a sought-after credential and can only be obtained after passing the exam administered by the International Board of Lactation Consultant Examiners (IBLCE). In Slovenia and Croatia, the IBLCE exam has been offered since 2006 and 2009, respectively. In this study, our aim was to 1) determine which candidate characteristics are associated with a passing grade on the IBLCE exam; and 2) analyse differences between candidates from Slovenia and Croatia, given Slovenians’ higher achievements in the past.MethodsIn February, 2017, a 4-page, 36-question survey was sent via Survey Monkey to the available email addresses of all past IBLCE exam candidates in Croatia and Slovenia. Questions covered sociodemographic data, breastfeeding education, exam preparation, motivation and experience taking the IBLCE exam.ResultsNinety-two participants completed the online survey: 36 from Croatia and 55 from Slovenia, giving a response of 47 and 52%, respectively. No significant difference was found in pass rates between the two countries, despite Slovenians being younger and spending more time observing normal breastfeeding dyads. Variables found to be significantly more common among respondents who passed the IBLCE exam included: attending breastfeeding conferences/symposiums, using a breastfeeding atlas and studying with others. Statistical predictors of IBLCE exam success were: number of hours of bedside teaching, perceived clarity of photographs and breastfeeding conference/symposium attendance. Respondents who reported that they had attended a breastfeeding conference/symposium, had less hours of bedside teaching and perceived exam photographs as completely clear, were 7.49 (95% CI 2.26, 24.84), 0.48 (95% CI 0.28, 0.82), and 3.49 (95% CI 1.17, 10.41) times more likely to pass the exam, respectively.ConclusionBreastfeeding conference attendance, less bedside teaching and perceived clarity of exam photographs may be predictors of IBLCE exam success. Further studies on larger samples of exam candidates are required to confirm our findings and determine other factors associated with passing the IBLCE exam.

Relationship among Breastfeeding Exposure, Knowledge, and Attitudes in Collegiate Males Residing in East Texas.

Researchers exploring breastfeeding attitudes and knowledge among women suggest the decision to breastfeed is influenced by the male partner, yet few studies address males. Because collegiate males will soon enter fatherhood, assessment of their attitudes and knowledge may inform interventions aimed at increasing intention to breastfeed. This study aimed to describe collegiate males' exposure to, attitude toward, and knowledge about breastfeeding. A cross-sectional online survey was used with males ≥ 18 years of age enrolled at a Texas public university. Attitude indices measured included social limitations, public displays of breastfeeding, and employer accommodations. Descriptive statistics, correlational and regression analyses were employed. The participants' (N = 949) average age was 25.48 years; > 80% reported not being fathers. Exposure to breastfeeding was high; > 80% witnessed breastfeeding and/or had someone close breastfeed. High attitude scores indicated social acceptability of breastfeeding. Knowledge appeared limited: only 16% identified the recommendation of exclusive breastfeeding for the first 6 months of life; > 50% overlooked the reduced risk for overweight/obesity, ear infections, diarrhea, or food allergies. Correlations between knowledge, exposure, total attitude, and index scores were positive (p < .01) except for the public displays index. Stepwise multiple regression determined that breastfeeding exposure, knowledge scores, and father's educational level predicted total attitude score, (R2 = 0.13, F (3,851) = 44.02, p < .01). The positive attitudes outcome among this male population is promising for breastfeeding support and advocacy. Education efforts improving knowledge will likely increase behavioral intention, resulting in increased breastfeeding rates and duration.

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.

Impact of family integrated care on infants\u2019 clinical outcomes in two children\u2019s hospitals in China: a pre-post intervention study

BackgroundMost Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD).MethodsA pre-post intervention study was conducted at NICUs in two Chinese children’s hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants’ outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses.ResultsCompared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391).ConclusionThe results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant.

A Pilot Study of a Culturally Grounded Breastfeeding Intervention for Pregnant, Low-Income African American Women.

Increasing breastfeeding rates among low-income African American women may work toward the achievement of health equity. The dynamic breastfeeding assessment process (D-BAP) is a community-grounded, equity-focused intervention designed to increase prenatal breastfeeding self-efficacy. Research aim: The aims of the pilot study were (a) to determine the effect of the D-BAP on breastfeeding self-efficacy among pregnant, low-income African American women, (b) to examine the findings among women with no previous breastfeeding experience, and (c) to compare the findings between women with prior breastfeeding experience and those without it. A pre/post, paired-samples design was utilized. Convenience sampling was used to recruit pregnant, low-income African American women ( N = 25). Participants completed the Breastfeeding Self-Efficacy Scale-Short Form prior to and following the D-BAP. The Wilcoxon signed rank test indicated that participation in the D-BAP had a statistically significant influence on breastfeeding self-efficacy ( z = -2.01, p = .04). Among a subsample of participants with no previous breastfeeding experience ( n = 12), completion of the D-BAP resulted in a statistically significant increase in breastfeeding self-efficacy ( z = -2.36, p = .02). There was no statistically significant difference between those with prior breastfeeding experience and those without it. Breastfeeding among low-income African American women is a health equity issue for which culturally responsive, effective breastfeeding interventions are needed. This research demonstrates an association between completion of the D-BAP and an increase in prenatal breastfeeding self-efficacy.

Centering Pregnancy Does Not Affect Rates of Breastfeeding at Postpartum Discharge [25N

INTRODUCTION: Centering Pregnancy, a group prenatal care model, has been shown to have many benefits including increased breastfeeding rates in postpartum adolescents. We examined if our Centering Pregnancy program demonstrated increased breastfeeding rates overall. METHODS: A retrospective chart review was performed on all patients who delivered at our inner city tertiary care hospital from June 2016 to June 2017. This included 267 Centering patients and 2289 patients who received routine office based prenatal care. Patients who participated in our Centering Pregnancy program did so secondary to schedule availability and patient preferences. Center Pregnancy promoted breastfeeding through educational materials and lactation consultant educational sessions. Data on breastfeeding vs. bottle feeding choice was obtained on all patients via EMR abstraction at the time of postpartum discharge. Statistical analysis was performed using Chi-squared test for independence. RESULTS: Of the 267 Centering Pregnancy patients, 147 (55%) were breastfeeding at time of discharge, 120 (45%) were not. Of the routine prenatal care patients, 1278 (56%) were breastfeeding at time of discharge, 1011 (44%) were not. No statistical difference was noted in breastfeeding between the two groups. A subanalysis on patients with government assistance insurance similarly showed no difference in the rate of breastfeeding. CONCLUSION: Centering Pregnancy did not increase breastfeeding rates at the time of postpartum discharge. It may be useful to investigate breastfeeding rates at 3 and 6 months postpartum to look at continued adherence.

Women’s preferences for alternative financial incentive schemes for breastfeeding: A discrete choice experiment

BackgroundIncreasing breastfeeding rates have been associated with reductions in disease in babies and mothers as well as in related costs. ‘Nourishing Start for Health (NoSH)’, a financial incentive scheme has been proposed as a potentially effective way to increase both the number of mothers breastfeeding and duration of breastfeeding.AimsTo establish women’s relative preferences for different aspects of a financial incentive scheme for breastfeeding and to identify importance of scheme characteristics on probability on participation in an incentive scheme.MethodsA discrete choice experiment (DCE) obtained information on alternative specifications of the NoSH scheme designed to promote continued breastfeeding duration until at least 6 weeks after birth. Four attributes framed alternative scheme designs: value of the incentive; minimum breastfeeding duration required to receive incentive; method of verifying breastfeeding; type of incentive. Three versions of the DCE questionnaire, each containing 8 different choice sets, provided 24 choice sets for analysis. The questionnaire was mailed to 2,531 women in the South Yorkshire Cohort (SYC) aged 16–45 years in IMD quintiles 3–5. The analytic approach considered conditional and mixed effects logistic models to account for preference heterogeneity that may be associated with a variation in effects mediated by respondents’ characteristics.Results564 women completed the questionnaire and a response rate of 22% was achieved. Most of the included attributes were found to affect utility and therefore the probability to participate in the incentive scheme. Higher rewards were preferred, although the type of incentive significantly affected women’s preferences on average. We found evidence for preference heterogeneity based on individual characteristics that mediated preferences for an incentive scheme.ConclusionsAlthough participants’ opinion in our sample was mixed, financial incentives for breastfeeding may be an acceptable and effective instrument to change behaviour. However, individual characteristics could mediate the effect and should therefore be considered when developing and targeting future interventions.

Examination of Hospital, Maternal, and Infant Characteristics Associated with Breastfeeding Initiation and Continuation Among Opioid-Exposed Mother-Infant Dyads.

Among opioid-exposed newborns, breastfeeding is associated with less severe withdrawal signs, yet breastfeeding rates remain low. We determined the extent to which hospital, maternal, and infant characteristics are associated with breastfeeding initiation and continuation among opioid-exposed dyads. We examined breastfeeding initiation and continuation until infants' discharge among opioid-exposed dyads from 2006 to 2016. Among dyads meeting hospital breastfeeding guidelines, we assessed hospital (changes in breastfeeding guidelines and improvement initiatives [using delivery year as a proxy]), maternal (demographics, comorbid conditions, methadone versus buprenorphine treatment, and delivery mode), and infant (gestational age and birth weight) characteristics. We used multivariable logistic regression to examine independent associations of characteristics with breastfeeding initiation and continuation. Among 924 opioid-exposed dyads, 61% (564) met breastfeeding criteria. Overall, 50% (283/564) of dyads initiated and 33% (187/564) continued breastfeeding until discharge. Breastfeeding initiation and continuation rates increased from 38% and 8% in 2006, to 56% and 34% in 2016, respectively. In adjusted models, infants born after reducing restrictions in hospital breastfeeding guidelines and prenatal breastfeeding education (adjusted odds ratio, aOR 2.6 [95% confidence interval, CI 1.5-4.5]) had increased odds of receiving any maternal breast milk versus infants born with earlier hospital policies. Cesarean versus vaginal delivery (aOR 0.3 [95% CI 0.2-0.6]) and length of infant hospitalization (aOR 0.94 [95% CI 0.92-0.97]) were negatively associated with breastfeeding continuation. Despite increasing breastfeeding rates among opioid-exposed dyads, rates remain suboptimal. Hospital-level factors were the greatest predictor of breastfeeding initiation. The findings suggest that changes in hospital guidelines and initiatives can impact breastfeeding initiation among this vulnerable population.

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.

Fathers and breastfeeding: Attitudes, involvement and support

Background Fathers are recognised as a major source of social support for breastfeeding mothers. Mothers repeatedly identify their infant's father as an important part of the decision to breastfeed, yet limited research has focused on fathers and breastfeeding. Aims To review existing literature on the attitudes of fathers towards breastfeeding and their involvement in supporting mothers. Methods Studies were initially grouped according to research design, then each appraised against quality standards for respective designs. The selected studies were then re-grouped under themes and a narrative synthesising approach to findings was undertaken to develop the discussion. Data sources included a library and electronic search, conducted between January 2014 and June 2015, of the literature published between 1992 and 2015. Findings Fathers' positive attitude, involvement and support greatly influenced breastfeeding decision and commitment among mothers and was associated with increased breastfeeding rates and duration. The exclusion of fathers from breastfeeding support and preparation may result in decreased quality of life and self-efficacy among fathers. There is, however, a lack of clear evidence regarding what exactly constitutes the nature of fathers' support. Conclusions Taken collectively, the review findings demonstrate that focusing on fathers as a major part of the breastfeeding family and engaging them in the preparation and support process would certainly impact positively on breastfeeding rates.

Lactation Skills Workshop: A Collaboration of the City of Dallas WIC and Local Hospitals

The Baby-Friendly Hospital Initiative, a global endeavor of the World Health Organization and the United Nations Children's Fund, is an evidence-based program identifying 10 interventions that when hospitals implement them, breastfeeding (BF) rates improve. It recognizes the powerful role that health care workers have in successful BF and the need for competent hands-on skills to support lactation. The City of Dallas, TX, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program collaborated with 3 urban hospitals and developed a training of practical techniques and information for staff to use while working with BF patients. Since implementation, 1,600 workers were trained, 1 hospital achieved Baby-Friendly designation, and all have increased BF rates by 10%.