Reasons For Breastfeeding Cessation Research Articles

Incidence and Factors Associated with Breastfeeding at Six Months in Very-Low-Birthweight Infants: A Single-Center Prospective Study

Objective: Primary objective was to determine success rate of breastfeeding (BF) at 6-month-postnatal age (PNA). Secondary objective was to explore factors associated with unsuccessful BF at 6-month-PNA in very-low-birthweight (VLBW) infants. Materials and Methods: Single-center, prospective, observational study was conducted. Inclusion criteria were discharged VLBW infants and maternal desire for BF. We conducted telephone interviews to assess feeding type and volume every 2 months until 12-month-PNA and reasons for BF cessation. Results: Eighty-nine VLBW infants were included. Mean (±standard deviation) maternal age was 31.4 ± 6.5 years. Median [P25, P75] gestational age was 29.0 [28.0, 31.5] weeks. At 6-month-PNA, 22 infants (24.7%) were exclusively breastfed, which decreased to 2 infants (2.2%) by 12 months. Rate of successful BF at 6 months was 55.1%. After controlling for potential confounders, factors associated with unsuccessful BF at 6 months were male [aOR (95% CI) 3.2 (1.1, 9.4), p = 0.04], longer hospitalization stays [aOR 1.0 (1.0, 1.1), p = 0.02], born via cesarean section [aOR 4.1 (1.1, 15.4), p = 0.04], maternal education below bachelor's degree [aOR 4.0 (1.1, 14.0), p = 0.03], and introduction of additional feeding types at hospital discharge [aOR 3.8 (1.2, 12.2), p = 0.03]. Main reason for unsuccessful breastfeeding at 6 months was inadequate milk supply (77.5%). Conclusion: Fifty-five percent of VLBW infants retained successful BF at 6 months. Main reason for unsuccessful BF was inadequate milk supply.

Breastfeeding practices and associations with pregnancy, maternal and infant characteristics in Australia: a cross-sectional study

BackgroundExclusive breastfeeding to six months of age is a major global public health priority. Several characteristics are known to be associated with early cessation of breastfeeding, however, limited evidence exists regarding whether women’s reported reasons for cessation are associated with maternal, pregnancy and infant characteristics. The aims of this study were to: i) describe women’s reported intention to breastfeed and their subsequent breastfeeding practices; ii) describe women’s reported reasons for breastfeeding cessation prior to the infant being five months of age; and iii) examine associations between these factors and maternal, pregnancy and infant characteristics.MethodsTelephone and online surveys were conducted between October 2019 and April 2020 with 536 women who had given birth in the previous eight to 21 weeks at four public maternity services in Australia.ResultsThe majority of women intended to (94%), and did, initiate (95%) breastfeeding. At the time the survey was conducted, 57% of women were exclusively breastfeeding. Women who: had less than University level education, had a pre-pregnancy BMI in the overweight or obese category, and who smoked tobacco at the time of the survey had lower odds of exclusively breastfeeding. The most common self-reported reasons for breastfeeding cessation were breastfeeding challenges (47%) and low milk supply (40%). Women aged 26–35 years and 36 + years had greater odds of reporting breastfeeding cessation due to low milk supply (OR = 2.92, 95% CI: 1.11, 7.66; OR = 5.57, 95% CI: 1.70, 18.29) compared to women aged 18–25 years. While women who had completed a TAFE certificate or diploma had lower odds of reporting this as a reason for breastfeeding cessation (OR = 0.28; 95% CI: 0.11, 0.73) compared to women who had University level education. There were no other significant associations found between characteristics and reasons for ceasing breastfeeding.ConclusionsThe most common reasons for breastfeeding cessation may be modifiable through the provision of breastfeeding support in the early postpartum period, with such support being tailored to women’s age and level of education. Such support should aim to increase women's self-efficacy in breastfeeding, and be provided from the antenatal period and throughout the first six months postpartum.

Exploring women\u2019s perceptions of pain when breastfeeding using online forums

BackgroundDespite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration.MethodsData was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: ‘painful breastfeeding’ and ‘sore breastfeeding’. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis.ResultsThe first theme identified was ‘variation in types of pain’, highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme ‘perceived causes and explanations for pain’ revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme ‘cessation of breastfeeding related to pain’ identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme ‘shared experiences and support’ identified women’s strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums.ConclusionsPain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.

Declared Reasons for Cessation of Breastfeeding during the First Year of Life: An Analysis Based on a Cohort Study in Northern Spain.

Background: Breastfeeding is the gold standard of infant feeding due to the many advantages it offers to both the child and the mother. Objective: To identity the main reasons for cessation of breastfeeding reported by mothers during the first year of life. Design: A prospective cohort study was conducted, recruiting 970 infants from a university hospital in Spain. The main maternal variables studied were maternal age, parity, educational level, work occupation, smoking habit, weeks of gestation at birth, birth weight, feeding type, and duration of breastfeeding. All participants were followed for one year to determinate the duration of breastfeeding and to gather reasons for abandoning breastfeeding. Results: At six months, the percentage of breastfeeding experienced a decline of 50%, and only 24.5% of these mothers maintained breastfeeding. Up to 15.8% of the mothers decided to give up exclusive breastfeeding by their own choice, whereas 15.4% did so because they suspected low milk production. Work-related causes represent the third reason of abandonment. Conclusions: Our results highlight the need to improve the health policies for the promotion, protection, and support for the initiation and maintenance of breastfeeding. In particular, our results highlight the importance of researching women’s low milk production and work-related factors, with particular emphasis on improving conciliation measures.

Consumption of Breast Milk Is Associated With Decreased Prevalence of Autism in Fragile X Syndrome

ObjectivesBreastfeeding is associated with numerous health benefits in infants, but early life nutrition has not been specifically studied in the neurodevelopmental disorder fragile X syndrome (FXS). Herein, we evaluate associations between the consumption of breast milk during infancy and the prevalence of autism, allergies, diabetes, gastrointestinal (GI) problems and seizures in participants with FXS. MethodsThe study design was a retrospective survey of families enrolled in the Fragile X Online Registry and Accessible Research Database (FORWARD). ResultsThere was a 73% rate of breastfeeding in the enrolled participants with an 81% rate for at least 3 months, 73% for 6 months and 41% for 12 months of age or longer. There was a 1.7-fold reduction in the prevalence of autism in participants with FXS who were fed breast milk for 12 months or longer and a 1.9-fold decrease in autism in participants reporting no use of any infant formula (P < 0.05). The most common reasons for cessation of breastfeeding were reduced milk production and age of the child. There were strong negative correlations between increased time the infant with FXS was fed breast milk and the prevalence of autism and seizures and moderate negative correlations with the prevalence of GI problems and allergies. However, participants reporting GI problems or allergies commenced these comorbidities significantly earlier than participants that were not fed breast milk. Parsing the data by sex indicated that males exclusively fed breast milk exhibited decreased prevalence of GI problems and allergies. ConclusionsThese data suggest that long-term or exclusive use of breast milk is associated with reduced prevalence of key comorbidities in FXS including autism, GI problems and allergies, although breast milk is associated with the earlier development of GI problems and allergies. Funding SourcesNICHD.

Medication Use During Lactation: Either a Potential Contributor to Premature Weaning or Evidence-based Support of the Mother/Child Couplet

It is well established that breastfeeding improves the health of women, children, and populations. According to the 2018 Centers for Disease Control and Prevention Report Card, 83% of women initiated breastfeeding, but only 58% maintained breastfeeding at the 6-month mark, and 36% continued to 12 months. Reasons for cessation of breastfeeding are multifactorial and include issues surrounding safe use of medications while breastfeeding for acute or chronic conditions. There are a wide variety of resources that clinicians may consult to help decide if medications are compatible with breastfeeding. The resources have varying data and recommendations, which can make counseling challenging for the clinician. There are some resources that are updated regularly with the most current information about drug safety in lactation, as well as call centers that can answer questions from clinicians and patients. A case scenario is presented to help illustrate the many facets of how medication use can affect breastfeeding. Very few medications are absolutely contraindicated during lactation. Involving the woman and her family in a shared decision-making approach regarding medication use may help women feel more confident in the medication recommendations given and ultimately help women achieve their breastfeeding goals. (Clin Ther. 2020; 42:XXX–XXX)© 2020 Elsevier HS Journals, Inc.

Combining breastfeeding and work: findings from the Epifane population-based birth cohort

BackgroundReturn to work is often cited as a reason for early cessation of breastfeeding (BF). Our objectives were to study the time span during which women employed prior to pregnancy returned to work according to BF duration category, and to identify sociodemographic, behavioral and pregnancy characteristics of women who continued BF after returning to work.MethodsInformation on BF mode and work status was prospectively collected in a French nation-wide birth cohort up to 1 year after delivery. Time of return to work according to BF category was addressed using Kaplan-Meier curves and Poisson regression adjusted on co-variates. Multiple logistic regression enabled to identify characteristics associated with the combination of BF with work.ResultsAmong 2480 women holding jobs prior to pregnancy, 82.0% returned to work within a year postpartum. Women who breastfed > 4 months returned at median of 6.5 months, whereas those who did not breastfeed at all returned to their jobs at 4.0 months, those who had breastfed for less than 1 month returned at 4.5 months, and those who had breastfed for 1 to 4 months returned at 4.0 months. Around one-third of women (34.5%) combined BF and work, and breastfed for a longer duration (median: 213 days, vs. 61 days for women who stopped BF before returning to work). Women born outside of France or who were self-employed were more likely to combine BF and work, while intermediate employees, manual workers, women who quitted smoking during pregnancy, who had smoked before and during pregnancy, or who had given birth by cesarean section were less likely to combine BF and work.ConclusionWomen who had breastfed for less than 4 months, or not at all, returned to their jobs at comparable times. This suggests that working women should be encouraged to breastfeed, even for a short duration. Moreover, only one-third of working women succeeded in combining BF and work, highlighting the need for a support system that would encourage flexibility.

Pragmatic Effectiveness of the Loving Support Peer Counseling Program to Increase Breastfeeding Duration Among Nevada WIC Participants

Peer counseling programs are increasingly popular, and intervention trials have established efficacy. However, pragmatic, real-world effectiveness of peer counseling programs are limited, but necessary, to justify funding. This study examined the effectiveness of the Loving Support Peer Counseling (LSPC) program to increase breastfeeding duration and reasons for cessation among Women, Infants, and Children (WIC) participants. In a sample of 178 WIC participants, new mothers who received LSPC breastfed for an average of 8.6 weeks longer relative to mothers who did not receive LSPC (p &lt; .001). Although all mothers cited concerns about infants'’ nutritional uptake, WIC mothers who did not receive LSPC reported frustration as the reason for breastfeeding cessation. This study supports the pragmatic, real-world effectiveness of LSPC among WIC mothers.

Got milk? Workplace factors related to breastfeeding among working mothers

SummaryThe American Academy of Pediatrics recommends that women breastfeed because of improved health outcomes for mothers and children. Because maternal employment during the first year of the child's life has been identified as a reason for breastfeeding cessation, we develop and test a role‐theory‐based framework to explain women's continuation of breastfeeding after return to work (Study 1) and report results of an exploratory study linking breastfeeding at work with job attitudes and well‐being (Study 2). Applying survival analysis to a longitudinal dataset gathered by the Centers for Disease Control (Study 1), we identify pregnant women's perceived employer support for breastfeeding as a predictor of women's breastfeeding goal intentions. Supervisors' negative workplace remarks about breastfeeding related to an eightfold increase of women's likelihood to discontinue exclusive breastfeeding and perceived support for breastfeeding after return to work predicted exclusive breastfeeding continuation. Results of Study 2 suggest that women who return to work and continue breastfeeding experience more family‐to‐work conflict and overload than women who do not reconcile work and breastfeeding. Further, results of Study 2 provide preliminary evidence suggesting that perceptions of supervisor and coworker support for breastfeeding relate positively to general perceptions of organizational support and negatively to depressive symptoms. Copyright © 2015 John Wiley &amp; Sons, Ltd.

G203(P) Breastfeeding practices of paediatrician mothers: Do we practice what we preach?

AimsTo study the personal breastfeeding practices of paediatrician mothers and determine initiation rates and duration of breastfeeding. The survey also studied the availability of work place facilities and support for...

Urine NMR metabolomics analysis of breastfeeding biomarkers during and after pregnancy in a large prospective cohort study

Background. Modern metabolomic profiling has not yet been applied to human breastfeeding research. A common reason for breastfeeding cessation is perceived insufficient milk production. We investigated broad biochemical profiles in maternal urine collected during and after pregnancy to identify biomarkers related to reduced reported breastfeeding. Methods. Fasting urine was collected at three consultations (visit V1: gestational week 8–20; V2: week 28 ± 2; V3: 10–16 weeks postpartum) in the STORK Groruddalen program, a prospective, multiethnic cohort study of gestational diabetes involving healthy, pregnant women in Oslo, Norway, and analyzed using NMR spectroscopy. Breastfeeding at V3 was recorded in three categories: Exclusively breastfeeding (n = 326), partially breastfeeding (n = 156) and formula feeding (n = 67). Results. Five metabolites were relevant to breastfeeding. Lactose was detected at V1 and increased to 0.1 mM/mM creatinine at V2. Postpartum excretion at V3 was significantly higher in exclusively breastfeeding women than partially or non-breastfeeding (median = 0.29, 0.23 and 0.04 mM/mM creatine, respectively; ANOVA p-value = 2e–70). Glycine excretion at V3 (0.12, 0.10 and 0.06, respectively; p = 2e–5) and at V2 were associated with breastfeeding (0.34, 0.33 and 0.26, respectively; p = 4e–5). Creatine and two unidentified substances also correlated with breastfeeding. NMR metabolomics found no other metabolites differing between categories during pregnancy (V1, V2), and did not predict individual breastfeeding postpartum (V3). Conclusion. Decreased glycine excretion at V2 may indicate difficulties meeting the metabolic demands of the growing fetus, but urine profiles contained otherwise little indication of early adaptations during pregnancy towards reduced biological potential to breastfeed.

Neonatal Head Cooling: Implications for Community Hospital Nurses

Methods Selected components of the Interaction Model of Client Health Behavior guided the inclusion of potential predictors related to the reason for discontinuing breastfeeding. The authors used descriptive statistics and logistic regression to analyze how maternal and infant characteristics (demographic, social, health-related, environmental, motivational, cognitive, and affective) influenced the reason for breastfeeding cessation. Results The duration of breastfeeding was low, with an estimated 31% continuing to breastfeed at 6 months and 6% continuing to breastfeed at 12 months. Of the 239 women in this sample who provided a reason for discontinuing breastfeeding, 43% (n = 111) reported perception of insufficient milk as the reason. The majority of women who reported perception of insufficient milk did so within the first 3 months of breastfeeding (55%). Women who reported perception of insufficient milk were more likely to be of Hispanic descent. Additional analysis is on-going.

Breast feeding initiation and duration: comparison of French and German mothers

Backgroundapproximately 56% of babies in France are breast fed at birth compared with approximately 91% in Germany. Few studies have compared these neighbouring countries despite the similarities in their social systems. Objectivesto compare breast-feeding initiation and duration from birth to 3 months post partum between French and German mothers, as well as reasons for breast-feeding cessation in the first 3 months. Designmothers were contacted twice during the study: immediately after childbirth and at 3 months post partum. Participants126 French mothers were recruited during their maternity stay in hospital, and 80 German women were recruited by their midwives and contacted via regular mail. All women were primiparous. Methodsbreast-feeding rates at birth and 3 months post partum were collected and compared. In addition, reasons for breast-feeding cessation in the first 3 months were explored and analysed. Results96% of German women initiated breast feeding at birth and 83% were still breast feeding at 3 months post partum. In comparison, 67% of French women initiated breast feeding at birth and 34% were still breast feeding at 3 months post partum. Conclusionthere is a need for postnatal follow-up care for French mothers who breast feed. Follow-up care available for German mothers shows encouraging results.

The yeast connection - is candida linked to breastfeeding-associated pain?

The American Academy of Pediatrics recommends breastfeeding of infants for at least the first 12 months of age. Breast pain is second only to insufficient milk supply as a reason for cessation of breastfeeding. Although some believe Candida to be a significant cause of this breastfeeding-associated pain, the published data is conflicting. The objective of this study was to determine whether isolation of Candida from cultures of breast milk, areolae and/or infant oropharynx was associated with breastfeeding-associated pain.

Early Breastfeeding Cessation in Rural Senegal: Causes, Modes, and Consequences

We studied reasons for cessation of breastfeeding before the age of 15 months, replacement feeding modes, and child mortality in West Africa. Data were gathered for 12208 children born between 1987 and 1997 in a rural area of Senegal. Interviews were conducted with caregivers of early-weaned children, and child mortality risks were assessed. Fewer than 1% of children had been weaned early. The main reasons for early weaning were maternal death and new pregnancy (in 41% and 27% of cases, respectively). Twenty percent of children had been relactated by a wet nurse, and 16% had received formula. Many early-weaned children died before the age of 2 years (26%), particularly those weaned early as a result of the mother's death (hazard ratio = 5.1; 95% confidence interval [CI] = 1.74, 15.0). Girls had a lower hazard ratio than boys (0.16; 95% CI=0.05, 0.41). Our results showed that early cessation of breastfeeding was rare but that associated mortality was high, especially when the mother had died.

Explanation for Cessation of Breastfeeding in Mothers of Twins

This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother's role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants' behaviors, challenges presented by growth and development, and time commitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise.

Reluctance to continue breastfeeding in The Netherlands

A prospective cohort study of breastfeeding practice (0–4 mo) was carried out in well‐baby clinics. The cohort included 4438 newborns brought to a clinic for the first time between 1 April and 1 July 1998. The odds ratios of demographic and gestational variables connected with the start and duration of breastfeeding were measured. The frequency of the reasons why breastfeeding was interrupted was determined. At birth 71% of the infants included in this study were exclusively breastfed. After 4 mo the percentage had dropped to 21%. Breast milk was replaced directly by formula (23%) or by a mixture of breast milk and formula (77%). Exclusive breastfeeding was given irrespective of the mother's cultural background. Higher education appeared to be the most decisive factor for the initiation of exclusive breastfeeding; higher parity was found to be the most decisive factor for continuation. In 46% of cases the infant's health and behaviour caused mothers to stop exclusive breastfeeding; in 38% the reasons were mother related; in 17% both mother‐ and infant‐related motives were mentioned. Conclusion: Mothers' perception of hunger and crying colics were the main infant‐related reasons for cessation of breastfeeding, whereas physical problems, return to work, doubt about the sufficiency of breast milk and the feeling of being restricted by breastfeeding were the main mother‐related reasons. The decision to abandon exclusive breastfeeding was made primarily by mothers (71%). In The Netherlands more babies are breastfed at birth than was the case 10 y ago, but the duration of the breastfeeding period has become shorter.

Reluctance to continue breastfeeding in The Netherlands.

A prospective cohort study of breastfeeding practice (0-4 mo) was carried out in well-baby clinics. The cohort included 4438 newborns brought to a clinic for the first time between 1 April and 1 July 1998. The odds ratios of demographic and gestational variables connected with the start and duration of breastfeeding were measured. The frequency of the reasons why breastfeeding was interrupted was determined. At birth 71% of the infants included in this study were exclusively breastfed. After 4 mo the percentage had dropped to 21%. Breast milk was replaced directly by formula (23%) or by a mixture of breast milk and formula (77%). Exclusive breastfeeding was given irrespective of the mother's cultural background. Higher education appeared to be the most decisive factor for the initiation of exclusive breastfeeding; higher parity was found to be the most decisive factor for continuation. In 46% of cases the infant's health and behaviour caused mothers to stop exclusive breastfeeding; in 38% the reasons were mother related; in 17% both mother- and infant-related motives were mentioned. Mothers' perception of hunger and crying colics were the main infant-related reasons for cessation of breastfeeding, whereas physical problems, return to work, doubt about the sufficiency of breast milk and the feeling of being restricted by breastfeeding were the main mother-related reasons. The decision to abandon exclusive breastfeeding was made primarily by mothers (71%). In The Netherlands more babies are breastfed at birth than was the case 10 y ago, but the duration of the breastfeeding period has become shorter.

Breast-Feeding Practices of Former Soviet Women in Their Homelands and After Immigration

LEARNING OUTCOME:To identify five practices regarding breast-feeding before and after immigration of former Soviet women. A trend from breast-feeding to commercial infant formula has been described for most immigrant groups studied. However, since the breakup of the former Union of Soviet Socialist Republics (USSR), immigrants from the newly independent republics are arriving in the United States (US) and there is very little information about this population. This study examined the incidence and duration of breast-feeding before and after immigration of former Soviet immigrants. Forty-five former Soviet women who delivered babies in both the former USSR and the US were recruited from Women, Infant, Children Supplemental Food Program (WIC) clinics in Washington State. They answered a pre-tested Russian questionnaire about infant feeding practices and beliefs. There were no significant differences in breast-feeding initiation or duration between the USSR and US. In the USSR, 98% initiated breast-feeding compared to 100% in the US. Mean duration of exclusive breast-feeding in the USSR was 22.8 ± 22.4 weeks, compared with 25.8 ± 22.7 weeks in the US. Their primary reason for breast-feeding was that it is “healthier for the baby,” with 93% listing it as the healthiest way to feed a baby. “Not enough breast-milk” received the highest score as the reason for cessation of breast-feeding. The majority of mothers had household help after the birth of the child in both countries, with the father and grandmother providing most of the help in the USSR. However, grandmothers were not as available in the US, so fathers provided more support in the US than in the USSR. Although former Soviet women perceive that breast-feeding is more embarrassing and less popular in the US than in their homelands, they continue their traditional practices after immigration. These results indicate that former Soviet women do not follow the trend of other immigrant groups away from breast feeding. This may be due to that fact that the participants came from cultural and/or religious backgrounds that value breast-feeding, and they strongly believe that breast-feeding is healthy for the baby.