Parental attitudes toward breastfeeding: their association with feeding outcome at hospital discharge

Predictors of breastfeeding duration among women in Kuwait: results of a prospective cohort study

The purposes of this paper are to report the prevalence of breastfeeding to six months among women in Kuwait and to determine the factors that are associated with the duration of breastfeeding. A cohort of 373 women recruited from maternity wards in four hospitals in Kuwait city were followed from birth to 26 weeks postpartum. The association of any and full breastfeeding duration and predictor variables were explored using multivariate Cox's proportional hazards models. At six months, 39% of all infants were receiving some breast milk and only 2% of infants had been fully breastfed to 26 weeks. Women born in other Arab countries were less likely to discontinue breastfeeding than women born in Kuwait. Other factors positively associated with breastfeeding duration were level of maternal education, higher parity, infant being demand fed in hospital and a preference for breastfeeding on the part of the infant's father and maternal grandmother. The introduction of a pacifier before four weeks of age and the mother intending to return to work by six months were negatively associated with duration. These findings present a number of opportunities for prolonging breastfeeding duration in Kuwait.

Infant Feeding Attitudes and Breastfeeding Intentions of Black College Students

Breastfeeding rates are lowest among Black women than women of other races. An understanding of infant feeding attitudes may help improve breastfeeding rates among Black women. The theory of planned behavior guided this study to explore infant feeding attitudes of Black college students and the contribution of attitudes to breastfeeding intentions after controlling for age, gender, income, and education level. A sample of 348 Black college students below 45 years old with no children and no history of pregnancies were recruited for this study. The Iowa Infant Feeding Attitude Scale and a Demographic Questionnaire were used to collect data. Participants agreed that breast milk is the ideal food for infants and 48% indicated high probability of breastfeeding intentions. Infant feeding attitudes also explained approximately 30% (Nagelkerke R2) of the variance in breastfeeding intentions. Therefore, breastfeeding interventions targeting Black women should focus on improving breastfeeding attitudes.

Engaging and supporting fathers to promote breast feeding: a concept analysis

OBJECTIVE

Empirical evidence demonstrates that fathers have a strong influence on a mother's decision to initiate and continue breast feeding. However, no clear delineation of what behaviours and attributes constitute father support or differentiate it from other kinds of support is provided in the current literature. The purpose of this study was to analyse the concept of 'father support' in relation to maternity services and broader health settings, thereby clarifying meaning to enable comprehension and application in practice, education, and research.

DESIGN

A concept analysis combining the evolutionary model of concept development with the inter-related theoretical, fieldwork and analytical phases of the hybrid model of concept development.

SETTING

Children's Centres in East and West Sussex in Southern England.

PARTICIPANTS

Repeated qualitative research over two phases with 16 parents of breast fed infants through seven focus groups and five telephone interviews.

MEASUREMENTS AND FINDINGS

CINAHL, PsycINFO, AMED, MEDLINE, OVID and EMBASE databases were searched for articles published in English between 1999 and 2013 using the keywords breast feeding, father, and support. Seven same-sex focus groups and five individual interviews were also conducted over two research phases with the parents of breast fed infants to expand and exemplify, and then validate the analysis of the literature search. Five main attributes of father support in relation to breast feeding were identified: (1) knowledge about breast feeding; (2) positive attitude to breast feeding; (3) involvement in the decision-making process; (4) practical support; and (5) emotional support. Multiple antecedents and consequences to these attributes were also identified.

KEY CONCLUSION

This study has contributed to clarifying the meaning of father support in relation to breast feeding and provides an important starting point for the development of a theoretical and practical model of optimal breast feeding that takes into account father support.

IMPLICATIONS FOR PRACTICE

Identification of attributes, antecedents, and consequences of father support may assist practitioners to reflect on current working practices and service delivery models, and offer important educational opportunities for the training of student midwives and other health professionals.

Prediction of initiation and cessation of breastfeeding from late pregnancy to 16 weeks: the Feeding Your Baby (FYB) cohort study

OBJECTIVE

To derive prediction models for both initiation and cessation of breastfeeding using demographic, psychological and obstetric variables.

DESIGN

A prospective cohort study.

SETTING

Women delivering at Ninewells Hospital, Dundee, UK.

DATA SOURCES

Demographic data and psychological measures were obtained during pregnancy by questionnaire. Birth details, feeding method at birth and at hospital discharge were obtained from the Ninewells hospital database, Dundee, UK. Breastfeeding women were followed up by text messages every 2 weeks until 16 weeks or until breastfeeding was discontinued to ascertain feeding method and feeding intentions.

PARTICIPANTS

Pregnant women over 30 weeks gestation aged 16 years and above, living in Dundee, booked to deliver at Ninewells Hospital, Dundee, and able to speak English.

MAIN OUTCOME MEASURE

Initiation and cessation of breastfeeding.

RESULTS

From the total cohort of women at delivery (n=344) 68% (95% CI 63% to 73%) of women had started breastfeeding at discharge. Significant predictors of initiating breastfeeding were older age, parity, greater intention to breastfeed from a Theory of Planned Behaviour (TPB)-based questionnaire, higher Iowa Infant Feeding Assessment Scale (IIFAS) score as well as living with a husband or partner. For the final model, the AUROC was 0.967. For those who initiated breastfeeding (n=233), the strongest predictors of stopping were low intention to breastfeed from TPB, low IIFAS score and non-managerial/professional occupations.

CONCLUSIONS

The findings from this study will be used to inform the protocol for an intervention study to encourage and support prolonged breastfeeding as intentions appear to be a key intervention focus for initiation. The predictive models could be used to identify women at high risk of not initiating and also women at high risk of stopping for interventions to improve the longevity of breastfeeding.

Breastfeeding attitudes: association between maternal and male partner attitudes and breastfeeding intent

Breastfeeding is considered the best infant feeding method, yet initiation and duration rates in the United States are lower than recommended by medical and public health professionals. Positive attitudes toward breastfeeding of the male partner are important in a mother's success at initiating and maintaining breastfeeding. This study measured the infant feeding attitudes of low-income women and their male partners using the Iowa Infant Feeding Attitude Scale (IIFAS), investigated the reliability and validity of the measure in male partners, and examined the associations of the partner's attitudes with the mother's attitudes and intention to breastfeed. A convenience sample of 112 pregnant women and their male partners completed a survey including sociodemographic items, the IIFAS, and their intended infant feeding method in the hospital and in the first few weeks after the infant's birth (breastfeeding, formula feeding, mixed, and don't know). Mother's and partner's IIFAS scores were highly correlated, and higher scores of both mothers and partners were significantly associated with their intentions to breastfeed. With each increased point on mother's and partner's IIFAS scores, the odds that the mother and her partner intended to breastfeed in the first few weeks increased 12% and 20%, respectively. This is the first U.S. study to validate the IIFAS with male partners. Future research on breastfeeding attitudes and attitude-changing interventions is needed to see if improving partners' attitudes toward breastfeeding will also improve mothers' attitudes and if that increases initiation and duration of breastfeeding.

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study

BACKGROUND

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

METHODS

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

RESULTS

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

CONCLUSIONS

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.

Breastfeeding by Chinese mothers in Australia and China: the healthy migrant effect

BACKGROUND

Breastfeeding practices might be influenced by migration to another country. Although the "healthy migrant effect" is commonly reported in epidemiology, evidence for it in breastfeeding practices is weak.

OBJECTIVES

This study aimed to compare the initiation and duration of breastfeeding between Chinese Australian migrants and Chinese mothers in mainland China and test the healthy migrant effect in Chinese Australian migrants in Perth, Western Australia.

METHODS

A survey was undertaken of 239 Chinese mothers living in Perth and 1844 mothers living in Chengdu, Sichuan Province, PR China, with a response rate of 96.7% and 87.8%, respectively.

RESULTS

The breastfeeding initiation rate in Chinese Australian mothers (94.1%) was higher than in mothers in China (86.2%, P < .001). Chinese Australian mothers also had a longer breastfeeding duration, greater "full breastfeeding" rate at 6 months, and greater "any breastfeeding" rates at 6 and 12 months. After controlling for potential confounding variables, the results of the binary logistic regression analysis showed that the location of the mother (Australia or China) was associated with breastfeeding practices. Chinese mothers living in Chengdu were less likely to initiate breastfeeding (odds ratio = 0.47, 95% confidence interval, 0.25-0.89) and breastfeed their babies at 12 months (odds ratio = 0.48, 95% confidence interval, 0.33-0.69) than Chinese mothers in Perth.

CONCLUSION

The higher breastfeeding initiation and longer breastfeeding duration by Chinese migrant mothers in Perth than mothers in Chengdu suggest a "healthy migrant effect."

Is breastfeeding duration influenced by maternal attitude and knowledge? A longitudinal study during the first year of life

OBJECTIVE

To discuss the duration and types of breastfeeding and to identify the factors associated with the early introduction of formula milk.

MATERIALS AND METHODS

This longitudinal study was conducted in the largest birthing centre of Turin. 562 mother-infant pairs were selected randomly and enrolled from among all the births that occurred in our Hospital from January to December 2009. Data was collected by means of a questionnaire filled out by the researcher during a face-to-face interview at mother's bed side during her hospital stay. This questionnaire included data regarding maternal socio-demographic, biomedical and hospital-related characteristics and some questions regarding family support, maternal attitude and current knowledge on breastfeeding. Mothers were interviewed by telephone at 1, 3, 6 and 12 months postpartum using the 24-h recall technique and definitions recommended by the WHO to investigate the type of breastfeeding adopted.

RESULTS

At the age of 6 months only 8.9% of the infants involved were still exclusively breastfed and 44.3% had discontinued breastfeeding. By the age of 12 months 25.3% of infants were still receiving some breast milk. The main factors that had a negative impact on the duration of breastfeeding included maternal smoking habits, early pacifier introduction and the maternal infant feeding attitude.

CONCLUSIONS

The rate of initiation and overall duration of breastfeeding reached the WHO objectives, but exclusive breastfeeding duration has still not reached satisfactory levels at 6 months. Given that the maternal infant feeding attitude is the only factor independently related to breastfeeding duration for the whole first year of life, reliable measures of maternal attitude could be used as a first step in targeting and assessing interventions that promote and sustain breastfeeding.

Factors influencing initiation and duration of breast feeding in Ireland

The aim of this research was to identify factors associated with mothers breast feeding and to identify, for those who breast fed, factors associated with breast feeding for as long as planned.

BACKGROUND

breast feeding rates in Ireland are amongst the lowest in Europe. Research evidence indicates that in order for mothers to be successful at breast feeding, multiplicities of supports are necessary for both initiation and duration. The nature of these supports in tandem with other influencing factors requires analysis from an Irish perspective.

DESIGN

cross-sectional study involving public health nurses and mothers in Ireland. This paper presents the results of the mothers' evaluation.

METHOD

mothers (n=1715) with children less than three years were offered a choice of completing the self-report questionnaires online or by mail. Data were analysed and reported using descriptive and inferential statistics.

FINDINGS

four in every five participants breast fed their infant and two thirds of them breast fed as long as planned. The multivariate logistic regression analysis identified that third level education, being a first time mother or previously having breast fed, participating online, having more than two public health nurse visits, and having a positive infant feeding attitude were independently and statistically significantly associated with breast feeding. Among mothers who breast fed, being aged at least 35 years, participating online, having a positive infant feeding attitude and high breast feeding self-efficacy were independently and statistically significantly associated with breast feeding for as long as planned.

CONCLUSIONS

findings from this study reinforce health inequalities therefore there needs to be a renewed commitment to reducing health inequalities in relation to breast feeding.

RELEVANCE TO CLINICAL PRACTICE

this study has identified factors associated with initiation and duration of breast feeding that are potentially modifiable through public health interventions.

Prediction of duration of breastfeeding among migrant and Canadian-born women: results from a multi-center study

OBJECTIVE

To examine and compare predictors of breastfeeding duration among migrant and Canadian-born women.

STUDY DESIGN

As part of a longitudinal study, a sample of 1503 mothers was recruited from 12 hospitals in Canada who completed questionnaires at 1 and 16 weeks postpartum. Following bivariate analysis, multivariate logistic regression analyses were completed to examine and compare predictors of continued breastfeeding at 16 weeks postpartum among migrant and Canadian-born women.

RESULTS

Among migrant women, factors predictive of breastfeeding duration included maternal age ≥ 35 years, primiparity, and breast engorgement pain at 1 week postpartum. Factors predictive of discontinued breastfeeding in this group included maternal age <20 years, higher gender-related development index of country of origin, no previous breastfeeding experience, breastfeeding duration of peers <6 months, planned duration of exclusive breastfeeding <6 months, and not exclusively breastfeeding at 1 week postpartum. Among Canadian-born women, factors predictive of breastfeeding duration included residence in Vancouver and maternal age ≥ 35 years. Factors predictive of discontinued breastfeeding included residence in Toronto, maternal age <20 years, smoking at 16 weeks postpartum, primiparity, planned duration of exclusive breastfeeding <6 months, and not exclusively breastfeeding at 1 week postpartum.

CONCLUSIONS

Although certain predictors for breastfeeding duration were similar between migrant and Canadian-born women, several were dissimilar, suggesting that these groups might benefit from different strategies to optimize breastfeeding outcomes.

Infant feeding attitudes of women in the United Kingdom during pregnancy and after birth

BACKGROUND

To address the recognized low rates of breastfeeding in the United Kingdom (UK), a change in fundamental attitudes toward infant feeding might be required. This paper reports an exploration of women's attitudes toward breastfeeding at different time points in the perinatal period, undertaken as part of a larger breastfeeding evaluation study.

OBJECTIVES

To measure women's infant feeding attitudes at 3 stages during the perinatal period to see whether, on average, they differed over time.

METHODS

Using the 17-item Iowa Infant Feeding Attitudes Scale (IIFAS), this cross-sectional study measured the infant feeding attitudes of 866 UK women at 3 perinatal stages (20 and 35 weeks antenatally and 6 weeks postpartum).

RESULTS

Mean IIFAS scores were very similar, which shows that discrete groups of women at different time points in pregnancy and postpartum appear to have the same attitudes toward infant feeding. The predominance of scores lay in the mid-range at each of the time points, which may indicate women's indecision or ambivalent feelings about infant feeding during pregnancy and the postpartum period.

CONCLUSIONS

Action must be undertaken to target the majority of women with mid-range scores whose ambivalence may respond positively to intervention programs. The challenge is to understand what would be appropriate and acceptable to this vulnerable group of women.

Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study

The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian-born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post-partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post-partum. Among migrant women, factors predictive of breastfeeding exclusivity included non-refugee immigrant or asylum-seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender-related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post-partum. Among Canadian-born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post-partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian-born women was not exclusively breastfeeding at 1 week post-partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.

Predicting breastfeeding duration related to maternal attitudes in a taiwanese sample

The purpose of this study was to examine maternal attitudes and sociodemographic variables associated with Taiwanese mothers' continuation of breastfeeding at 6 weeks postpartum. A sample of 140 in-hospital breastfeeding mothers was recruited in Taiwan. Participants completed the Iowa Infant Feeding Attitude Scale (IIFAS) in the hospital prior to discharge. Postdischarge participants were contacted by telephone at 3 and 6 weeks postpartum to obtain information regarding their feeding method and duration. Findings revealed that in-hospital maternal breastfeeding attitudes are predictive of breastfeeding duration. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Women's husband/partner was found to be the main source of breastfeeding support. We recommend health-care professionals add the IIFAS to their assessment to identify mothers at high risk for discontinuing breastfeeding and to develop and better evaluate breastfeeding promotion programs.

Breastfeeding attitudes among couples planning exclusive breastfeeding or mixed feeding

OBJECTIVES

The goals of the study were to describe maternal and paternal attitudes toward breastfeeding among couples planning exclusive breastfeeding and those planning mixed feeding and to compare maternal predictions of paternal attitudes with actual paternal attitudes.

METHODS

Expectant parents with the intention to breastfeed were recruited from outpatient clinics. During the third trimester of pregnancy, mothers and fathers independently completed a demographic questionnaire and a breastfeeding attitude survey. In addition, mothers were asked to predict fathers' attitudes.

RESULTS

Seventy-one subjects completed all study requirements: 56 planned to exclusively breastfeed, and 15 planned to mix feed. The majority of subjects were white, educated beyond high school, and married. Expectant parents planning to exclusively breastfeed were significantly more likely to report higher paternal age (p=0.019), higher maternal age (p=0.006), and higher maternal education (p=0.023) than those planning to mix feed. Among fathers, those planning exclusive breastfeeding expressed more favorable attitudes related to naturalness (p=0.009) and closeness (p=0.036) than their mixed-feeding peers. Compared with mothers planning mixed feeding, those planning exclusive breastfeeding indicated more favorable attitudes related to naturalness (p=0.006) and respect for breastfeeding women (p=0.005). Overall, mothers reported more favorable attitudes toward breastfeeding than fathers in several areas, including disease protection (p=0.004), respect for breastfeeding women (p=0.043), and naturalness (p=0.011). The mother's predictions were less favorable than the father's actual attitudes in the areas of purpose of breasts (p=0.007), respect (p=0.049), and closeness (p=0.024).

CONCLUSIONS

Results suggest expectant parents who plan to mix feed may be fundamentally different from those planning to exclusively breastfeed. There is a continued need to identify factors that influence the prenatal decision to mix feed and to develop strategies that promote exclusive breastfeeding in this population.

[Prenatal breastfeeding information: survey in Pays de Loire, France]

OBJECTIVES

The main aim of this study was to evaluate how well expectant mothers were informed on breastfeeding by healthcare professionals. The secondary objective was to determine the factors associated with the initiation of breastfeeding.

POPULATION AND METHODS

The survey was conducted in a group of 500 women who had delivered at the Angers Hospital (France), based on a questionnaire filled out by the postpartum women during their hospital stay.

RESULTS

The rate of breastfeeding was 61.2%. More than a quarter (26.9%) of the women did not receive any prenatal breastfeeding information. The survey showed that 77.8% of the women had been informed of breastfeeding advantages for infants and 51.5% of breastfeeding advantages for themselves. Only 27.5% had received the advice of exclusive breastfeeding for 6months. Only 5.2% had been informed of the uselessness of breast preparation during pregnancy and a minority had been informed of correct and incorrect breastfeeding contraindications. Only 15.4% of fathers had been involved in a discussion on infant feeding practices during prenatal consultations. Only 4.8% of the women had come to prenatal classes on breastfeeding with a relative. The maternal factors positively associated with breastfeeding initiation were age between 25 and 34 years, non-French origin, a high socioeconomic status, being married, having been breastfed, and having previous experience with breastfeeding. Breastfeeding initiation was negatively associated with maternal smoking. All the factors concerning prenatal breastfeeding information in women were associated with the choice of breastfeeding.

CONCLUSION

This study pointed out the populations at risk of not breastfeeding. Breastfeeding information given to pregnant women by healthcare professionals may influence them on whether or not they choose to breastfeed their newborn. However, this survey showed that women are insufficiently informed on prenatal breastfeeding. Therefore, prenatal breastfeeding information should be improved.

Breastfeeding attitudes of Finnish parents during pregnancy

BACKGROUND

Breastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents' prenatal breastfeeding attitudes and their relationships with demographic characteristics.

METHODS

The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.

RESULTS

Breastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18-26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.

CONCLUSIONS

Both mothers and fathers found breastfeeding important. A father's eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.

An exploration of the knowledge and attitudes towards breastfeeding among a sample of Chinese mothers in Ireland

Background

Psychological factors are important in influencing breastfeeding practices. This retrospective study explored knowledge and attitudes related to breastfeeding of Chinese mothers living in Ireland.

Methods

A cross-sectional self-administrated survey written in Chinese was distributed to a convenience sample of 322 immigrant Chinese mothers mainly via Chinese supermarkets and Chinese language schools in Dublin, with the involvement of the snowball method to increase sample size. Maternal breastfeeding knowledge and attitudes were described, their associations with socio-demographic variables were explored by Chi-square analysis, and their independent associations with breastfeeding behaviours were estimated by binary logistic regression analyses.

Results

In spite of considerable awareness of the advantages of breastfeeding (mean score = 4.03 ± 0.73), some misconceptions (e.g. 'mother should stop breastfeeding if she catches a cold') and negative attitudes (e.g. breastfeeding inconvenient, embarrassing, and adverse to mothers' figure) existed, especially among the less educated mothers. Cultural beliefs concerning the traditional Chinese postpartum diet were prevalent, particularly among those who had lived in Ireland for a shorter duration (P = 0.004). Psychological parameters had strong independent associations with breastfeeding practices in this study. Those who had lower awareness score (OR = 2.98, 95% CI: 1.87-4.73), more misconceptions and negative attitudes (P < 0.05), and weaker cultural beliefs (P < 0.05) were less likely to breastfeed.

Conclusions

Findings highlight a need to focus resources and education on correcting the misconceptions identified and reversing the negative attitudes towards breastfeeding among Chinese mothers in Ireland, in particular those with primary/secondary level of education. Mothers' cultural beliefs should also be acknowledged and understood by healthcare providers.

Effectiveness of the UNICEF/WHO 20-hour course in improving health professionals' knowledge, practices, and attitudes to breastfeeding: before/after study of 5 maternity facilities in Croatia

AIM

To evaluate knowledge, practices, and attitudes to breastfeeding among Croatian health professionals before and after the United Nations International Children's Emergency Fund/World Health Organization (UNICEF/WHO) 20-hour course.

METHODS

Study included 5 of 9 maternity hospitals in southern Croatia, which had completed the UNICEF/WHO 20-hour breastfeeding training course between December 2007 and February 2009. An anonymous questionnaire testing knowledge and practices, and attitudes was distributed to 424 health professionals before training and to 308 health professionals afterwards. Health professionals' attitudes were assessed using the validated Iowa Infant Feeding Attitude Scale.

RESULTS

The pre-training response rate was >90%, but only 53% of data were analyzed; the post-training response rate was 69%. Only one-fifth of health professionals prior to training knew that breast preparation in pregnancy was unnecessary, but this increased to 57% after training (P<0.001). The proportion of health professionals who recognized hospital practices that support breastfeeding and signs of poor positioning when breastfeeding nearly doubled after training (P<0.001). The proportion of health professionals correctly recommending immediate "skin-to-skin" contact post-Cesarean section under local anesthesia did not improve significantly, and stratification analyses showed that younger respondents (<36 years) were more likely to support this practice. Although the proportion of health professionals who correctly managed mastitis improved significantly as a result of the training, the proportion of those who after training inappropriately recommended partial or complete cessation of breastfeeding remained high at 47%. The number of staff with positive attitudes toward breastfeeding increased from 65% to 79%, whereas the number of staff with neutral attitudes dropped from 26.6% to 9.9% (P<0.001). Even after training, a substantial proportion of health professionals showed uncertainty in their attitude toward alcohol consumption and breastfeeding.

CONCLUSION

The UNICEF/WHO 20-hour course appears to be an effective tool for improving health professionals' breastfeeding knowledge, attitudes, and practices.

Breast-feeding attitudes and behavior among WIC mothers in Texas

OBJECTIVE

This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas.

DESIGN

This study used a cross-sectional design.

SETTING

Participants completed questionnaires at WIC clinic sites across Texas.

PARTICIPANTS

Mothers of young children who were receiving WIC benefits.

MAIN OUTCOME MEASURE(S)

Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice.

ANALYSIS

Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression.

RESULTS

A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk.

CONCLUSIONS AND IMPLICATIONS

Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs.

Factors that positively influence breastfeeding duration to 6 months: a literature review

QUESTION

What modifiable factors positively influence breastfeeding duration to 6 months postpartum?

AIM

This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding.

METHOD

An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified.

RESULTS

Modifiable factors that influence women's breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy.

CONCLUSION

The modifiable factors that are positively associated with breastfeeding duration are the woman's breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously.

Predictors of the early introduction of solid foods in infants: results of a cohort study

BACKGROUND

The early introduction of solid foods before 4 months of age has been associated with an increased risk of diarrhoea in infancy and a greater risk of wheeze and increased percentage body fat and weight in childhood. The purpose of this study was to identify the level of compliance with national recommendations related to the timing of the introduction of solid foods and to describe the maternal and infant characteristics associated with the timing of the introduction of solids.

METHODS

Subjects were 519 participants in the second longitudinal Perth Infant Feeding Study (PIFS II) recruited from two maternity hospitals in Perth, Western Australia in 2002/3. Data collected prior to, or shortly after discharge from hospital, and at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum included timing of the introduction of solid foods and a variety of maternal and infant characteristics associated with the introduction of solid foods. Multivariate logistic regression was used to identify those factors associated with the risk of introducing solid foods early, which for the purposes of this study was defined as being before 17 weeks.

RESULTS

The median age of introduction of solid foods was 17.6 weeks. In total, 44% of infants had received solids before 17 weeks and 93% of infants had received their first solids before 26 weeks of age. The strongest independent predictors of the early introduction of solids were young maternal age, mother smoking prior to pregnancy and not fully breastfeeding at 4 weeks postpartum. In general, mothers introduced solids earlier than recommended because they perceived their baby to either need them or be ready for them.

CONCLUSION

This study showed a high level of non-compliance among Australian mothers with the infant feeding recommendation related to the timing of solids that was current at the time. In order to improve compliance health professionals need to be aware of those groups least likely to comply with recommendations and their reasons for non-compliance. Infant feeding recommendations need to be evidence-based, uniformly supported by professionals and widely, clearly and consistently articulated if higher rates of compliance are to be achieved in the future.

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

OBJECTIVE

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers.

DESIGN

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

SETTING

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

SUBJECTS

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

RESULTS

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

CONCLUSIONS

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars

In conjunction with other health professionals, doctors believe they play an important role in promoting breastfeeding to women. Although many have positive breastfeeding attitudes, significant knowledge deficits often limit their capacity to effectively encourage, support and assist breastfeeding women and their infants. Personal breastfeeding experience (of self or partner) may be the main source of breastfeeding knowledge and skill development and is related to improved knowledge, more positive attitudes and greater confidence. This paper describes the relationship between the cumulative length of personal breastfeeding experience and the breastfeeding knowledge and attitudes of a cohort of Australian general practice (GP) registrars, as well as their confidence and perceived effectiveness assisting breastfeeding women. The Australian Breastfeeding Knowledge and Attitude Questionnaire containing demographic items, a 20-item attitude scale and a 40-item knowledge scale was distributed between February and May 2007 to Australian GP registrars in their final year of training. Participants with more than 52-week cumulative personal (self or partner) breastfeeding experience had the highest mean knowledge score, had more positive attitudes, and were more confident and effective than all other participants. Parents with limited personal experience (<or=26 weeks) had the poorest breastfeeding attitudes and their knowledge base was similar to participants with no personal experience. Confidence and perceived effectiveness when assisting breastfeeding women rose with increasing cumulative breastfeeding experience. Personal breastfeeding experience per se does not guarantee better breastfeeding knowledge or attitudes although increasing length of experience is related to higher knowledge, attitude, confidence and perceived effectiveness scores.

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge

AIM

To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS-R). The original instrument has well-established psychometrics for use in English-speaking countries.

METHODS

Questionnaires including demographics and items about prior pregnancy and opinions about breastfeeding in public were administered to women in Cluj-Napoca, Romania, attending antenatal clinic (n = 336) and to a separate cohort of mothers within 24 h of delivery (n = 276). Postpartum follow-up was conducted with a sample of maternity cohort subjects who initiated breastfeeding in the hospital (n = 52).

RESULTS

Internal consistency was adequate in both cohorts (antenatal alpha= 0.50; maternity alpha= 0.63), with improved reliability for antenatal multigravid (alpha= 0.60) and university-educated women (alpha= 0.57). Score distributions were comparable and item means were approximately central across cohorts. Among pregnant women, higher scores (more positive towards breastfeeding) were associated with longer planned maternity leave (chi2= 17.8; p = 0.02). Higher maternity cohort scores were associated with age (r = 0.31, p = 0.003), urban residence (chi2= 10.2, p = 0.04), breastfeeding a prior infant for at least 6 weeks (chi2= 6.4, p = 0.04), and with intending to breastfeed for at least 6 weeks (chi2= 4.7, p = 0.03). Postpartum women still breastfeeding at follow-up also scored higher (chi2= 9.3, p = 0.009).

CONCLUSION

This is the first study to report on use of the IIFAS in Eastern Europe. The IIFAS-R is easy to administer, reliable and valid in Romania. The IIFAS-R can support data collection to promote and assess breastfeeding initiatives consistent with World Health Organization recommendations.

Session 1: Public health nutrition Breast-feeding practices in Ireland

Breast-feeding is the superior infant feeding method from birth, with research consistently demonstrating its numerous short- and long-term health benefits for both mother and infant. As a global recommendation the WHO advises that mothers should exclusively breast-feed for the first 6-months of life, thus delaying the introduction of solids during this time. Historically, Irish breast-feeding initiation rates have remained strikingly low in comparison with international data and there has been little improvement in breast-feeding duration rates. There is wide geographical variation in terms of breast-feeding initiation both internationally and in Ireland. Some of these differences in breast-feeding rates may be associated with differing socio-economic characteristics. A recent cross-sectional prospective study of 561 pregnant women attending a Dublin hospital and followed from the antenatal period to 6 months post partum has found that 47% of the Irish-national mothers initiated breast-feeding, while only 24% were still offering ‘any’ breast milk to their infants at 6 weeks. Mothers' positive antenatal feeding intention to breast-feed is indicated as one of the most important independent determinants of initiation and ‘any’ breast-feeding at 6 weeks, suggesting that the antenatal period should be targeted as an effective time to influence and affect mothers' attitudes and beliefs pertaining to breast-feeding. These results suggest that the ‘cultural’ barrier towards breast-feeding appears to still prevail in Ireland and consequently an environment that enables women to breast-feed is far from being achieved. Undoubtedly, a shift towards a more positive and accepting breast-feeding culture is required if national breast-feeding rates are to improve.

Maternal breastfeeding attitudes: association with breastfeeding intent and socio-demographics among urban primiparas

Breastfeeding is associated with improved developmental and social outcomes for an infant. Despite these health benefits, only 54% of women breastfeed in the early postpartum period. Although an understanding of socio-demographic characteristics, breastfeeding intent, and breastfeeding attitudes can facilitate breastfeeding initiatives, these factors have not been characterized particularly for urban and immigrant mothers. The objectives of this study are to provide a descriptive analysis of the socio-demographic characteristics, breastfeeding intent, and breastfeeding attitudes of primiparas presenting to an inner city prenatal clinic and determine if breastfeeding attitudes are associated with breastfeeding intent and socio-demographic variables. Of 100 primiparas, 79 reported the intent to breastfeed. Breastfeeding intent was associated with 1) positive breastfeeding attitudes, 2) higher household incomes, 3) being born outside the US, 4) being Afro-Caribbean as opposed to African American, 5) having family, peer, and partner support for breastfeeding, 6) attending breastfeeding classes, and 7) greater years of education. These findings suggest that targeting breastfeeding initiatives towards low-income, less educated, US born mothers who lack breastfeeding support from their loved ones may improve breastfeeding rates among urban primiparas.

The effect of alcohol intake on breastfeeding duration in Australian women

AIM

This study investigated the relationships between alcohol consumption and breastfeeding initiation and duration.

METHODS

DESIGN AND SETTING

A 12-month longitudinal study was conducted in two public hospitals in Perth, Australia between September 2002 and July 2003.

INTERVENTION

Participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks.

MAIN OUTCOME MEASURES

Association of the relationships between alcohol consumption and breastfeeding initiation and duration.

RESULTS

After 6 months of follow-up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0).

CONCLUSION

Consuming alcohol in excess of two standard drinks per day during lactation was found to be independently associated with shorter breastfeeding duration, even after consideration of previously identified predictors of breastfeeding duration. Guidelines that provide direction on safe alcohol consumption for lactating mothers may help support extended breastfeeding duration.

Which mothers smoke before, during and after pregnancy?

OBJECTIVE

To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy.

STUDY DESIGN

A 12-month longitudinal study.

METHOD

All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding.

RESULTS

A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum.

CONCLUSIONS

Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally.

Identifying predictors of the reasons women give for choosing to breastfeed

The aims of this article are to outline the reasons Australian women give for initiating breastfeeding, identify unique predictors for these reasons, and use principal components factor analysis to determine factors that influence a woman's decision to breastfeed. Data were collected as part of a large longitudinal study investigating the breastfeeding behaviors and supports of women in Southern Queensland, Australia. The most common reason women (N = 562) gave for deciding to breastfeed was breast milk is better for my baby (95.5%). Reasons related to the mother such as breastfeeding is more convenient (84.3%) were also popular. Four significant components-mother-related reasons, health effects for the infant, moral and family influences, and advice from others-were determined after principal components factor analysis. As well as health benefits for the infant, convenience and other reasons related to the mother appear to be important factors in an Australian woman's decision to breastfeed.

Infants who drink cows milk: a cohort study

AIM

The aim of this study was to document current practice in an Australia city regarding the introduction of whole cows milk to children under the age of 12 months.

METHODS

A cohort study of mothers and infants, recruited at birth was undertaken in Perth, Australia. A total of 587 mothers were interviewed on seven occasions over a period of 12 months using a structured questionnaire. At each interview infant feeding methods were recorded in detail. At 12 months 453 mothers (78%) remained in the study.

RESULTS

In this study the median age of introduction of cows milk was 41.5 weeks, a behaviour that has not changed in the past 8 years. Infants who were given solids earlier than 4 months were more likely to be introduced to cows milk before 12 months (odds ratio (OR) 2.06, confidence interval (CI) 1.4-3.1). Mothers who had a lower score on the IOWA Infant Feeding Attitudes Scale were more likely to give cows milk earlier (OR 1.83, CI 1.21-1.77). Where fathers did not support breastfeeding or were ambivalent infants were more likely to be given cows milk (OR 1.70, CI 1.23-2.58)

CONCLUSIONS

Despite recommendations that cows milk should not be given before 12 months of age, the majority of infants were given cows milk before this age. This suggests the need for further education programs.

Mother-Infant Breastfeeding Progress Tool: a guide for education and support of the breastfeeding dyad

OBJECTIVE

To describe the development of the Mother-Infant Breastfeeding Progress Tool to be used at the bedside by nurses to guide ongoing support and education for the mother-baby dyad.

DESIGN

Cross-sectional study.

SETTING

Community hospital in a Midwestern city.

PARTICIPANTS

Sixty-two English-speaking mother-infant dyads.

METHODS

Three nurse raters (two per session) independently scored the eight characteristics on the Mother-Infant Breastfeeding Progress Tool during 81 breastfeeding sessions.

MAIN OUTCOME MEASURE

Percent agreement between raters and suggested modifications for the Mother-Infant Breastfeeding Progress Tool.

RESULTS

The results support the use of the tool as a checklist for assessment of the breastfeeding mother-infant dyad to guide education and support.

CONCLUSIONS

The interrater agreement was high for individual items of the Mother-Infant Breastfeeding Progress Tool. The Mother-Infant Breastfeeding Progress Tool is useful as a checklist for assessing maternal and infant breastfeeding progress, though additional research is needed to support the validity of the tool.

Infant feeding attitudes and knowledge among socioeconomically disadvantaged women in Glasgow

OBJECTIVES

This study: (1) investigated infant feeding attitudes and knowledge among socioeconomically disadvantaged mothers in an urban community with historically low breastfeeding rates, (2) examined the influence of women's social networks on infant feeding attitudes and decisions, and (3) validated a measure of infant feeding attitudes and knowledge in this population (Iowa Infant Feeding Attitude Scale, IIFAS).

METHODS

Women attending a prenatal clinic (n=49) reported on: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) feeding intent, (4) opinions about breastfeeding in public, and (5) social networks. Feeding method at discharge was abstracted from hospital charts. Social network members (n=47) identified by the prenatal sample completed interviews covering: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) prior infant feeding methods and recommendations, and (4) opinions about breastfeeding in public.

RESULTS

Mean IIFAS scores were low in both groups, indicating neutral to negative breastfeeding attitudes; mothers' scores were lower than social network members. Higher maternal IIFAS score was significantly associated with intended and actual breastfeeding. A social network positive towards breastfeeding was significantly associated with mothers' positive attitude towards breastfeeding. Both mothers and social network members support breastfeeding in public. IIFAS internal consistency was robust for both mothers and social network members. Predictive validity was demonstrated by significant positive association between score and intended and actual feeding methods.

CONCLUSIONS

Knowledge and attitude predict breastfeeding initiation in this population. Social network members may influence mothers' feeding choices. This research is important because attitudes and knowledge derived from the IIFAS can be used to develop and evaluate breastfeeding promotion programs.

Predictors of delayed onset of lactation

The objective of this study was to identify biomedical and hospital-related factors associated with the delayed onset of lactation (>72 h postpartum) in a population of Australian women. Subjects were 453 women participating in the second Perth Infant Feeding Study. Information on mothers' perception of the timing of the onset of lactation and associated explanatory factors was collected in a questionnaire completed by women prior to or shortly after discharge from hospital. Multivariate logistic regression was used to identify those factors independently associated with delayed lactation. Risk factors for delayed lactation were being primiparous (adjusted OR 3.16, 95% CI 1.58-6.33) and having delivered by caesarean section (adjusted OR 2.40, 95% CI 1.28-4.51). We failed to find a negative association with maternal body mass index reported in previous studies. While a greater proportion of women who experienced delayed lactation were overweight or obese compared with those who did not experience delayed lactation (40.8% vs. 32.1%), this difference was not statistically significant.

Research priorities of NSW midwives

PURPOSE

Research is vital to achieve optimum health outcomes for pregnant women, children and families. Recently, the benefit of setting research priorities to effectively utilize limited resources has been identified. Currently there is a lack of published Australian research data relevant to the practice of midwifery. Consultation with current practitioners is important to fulfill the National Health and Medical Research Council (NHMRC) key priority for a healthy start to life, ensure limited resources are expended appropriately and promote evidence-based midwifery practice. The aim of this study was to ascertain the perceived research priorities and the research experience of midwives in NSW, Australia.

PROCEDURES

Postal questionnaire sent to the 1000 subscribers of Australian Midwifery, of whom 90% (900) are midwives, in March 2005 with key open-ended questions to ascertain midwifery research priorities and research experience of participants.

FINDINGS

Respondents were all midwives with 95% indicating they were currently practising as a midwife. They identified six priority areas: professional practice; clinical issues; education and support; breastfeeding; psychosocial factors; rural/indigenous issues.

PRINCIPLE CONCLUSIONS

Priorities for research were identified and the need for a link between research and professional midwifery practice was highlighted. Midwives were positive about the possibility of becoming more actively involved in research and/or advocates for evidence based practice. The opportunity exists to take the broad priority areas from this study and develop research questions of relevance for the midwifery profession.

Factors associated with breastfeeding at six months postpartum in a group of Australian women

BACKGROUND

Despite high levels of breastfeeding initiation in Australia, only 47 percent of women are breastfeeding (exclusively or partially) six months later, with marked differences between social groups. It is important to identify women who are at increased risk of early cessation of breastfeeding.

METHODS

Data from the three arms of a randomised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum. The original trial included 981 primiparous women attending a public, tertiary, women's hospital in Melbourne, Australia in 1999-2001. The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration. In the 889 women with six month outcomes available, neither intervention increased breastfeeding initiation nor duration compared to standard care. Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable (any breastfeeding at six months).

RESULTS

Thirty-three independent variables of interest were identified, of which 25 qualified for inclusion in the preliminary regression model; 764 observations had complete data available. Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were: a very strong desire to breastfeed; having been breastfed oneself as a baby; being born in an Asian country; and older maternal age. There was an increasing association with increasing age. Factors negatively associated with feeding any breast milk at six months were: a woman having no intention to breastfeed six months or more; smoking 20 or more cigarettes per day pre-pregnancy; not attending childbirth education; maternal obesity; having self-reported depression in the six months after birth; and the baby receiving infant formula while in hospital.

CONCLUSION

In addition to the factors commonly reported as being associated with breastfeeding in previous work, this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital, a high maternal body mass index, and self-reported maternal depression or anxiety in the six months after the baby was born. Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation.

Which women stop smoking during pregnancy and the effect on breastfeeding duration

BACKGROUND

Cigarette smoking during pregnancy increases the risk of adverse pregnancy outcomes and women who quit smoking at this time are able to reduce the risk of low birth weight, preterm labour, spontaneous abortion and perinatal death. This study investigates the socio-demographic characteristics of pregnant women who stop smoking during pregnancy and the association between stopping smoking and breastfeeding duration.

METHODS

A 12 month longitudinal study was conducted in two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks.

RESULTS

A total of 587 (55%) mothers participated in the study. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Women who were pregnant for the first time were twice as likely (OR = 2.05; 95% CI 1.047 - 4.03; p < 0.05) to quit smoking as multiparous women. Women who smoked more than 10 cigarettes per day were significantly less likely to quit smoking during pregnancy (OR = 0.36; 95% CI 0.18 - 0.69; p < 0.05). Women who consumed alcohol before pregnancy were three times more likely to quit smoking (OR = 2.58; 95% CI 1.00 - 6.66; p < 0.05). Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70; 95% CI 1.55 - 8.83; p < 0.05).

CONCLUSION

Pregnancy is a time when many women are motivated to quit smoking and providing targeted smoking cessation interventions at this time, which take into account factors predictive of quitting smoking, are more likely to be successful.

The effect of health visitors on breastfeeding in Glasgow

BACKGROUND

The UNICEF Baby Friendly Initiative includes a community component to help women who want to breastfeed. This study aimed to document the health visitor role in promoting and supporting breastfeeding in Glasgow during 2000 and the effect it had on breastfeeding rates.

METHODS

Glasgow, UK, has a population of 906,000, with approximately 10,000 births per year. Glasgow has high levels of material deprivation and traditionally low breastfeeding rates. This was a cross-sectional study in January 2000 which used a postal questionnaire to document individual health visitors' interventions, activities and attitude towards breastfeeding. Infant's breastfeeding data collected routinely by the Child Health Surveillance programme from 1 August 1998 to 28 February 1999 was directly matched with interventions, activities and attitudes reported by their own health visitor.

RESULTS

146/216 (68%) health visitors completed and returned the questionnaire. 5401 child health records were eligible and 3,294 (58.2%) could be matched with health visitors who returned questionnaires. 2145 infants had the first visit from 8 to 20 days of age and the second 3 to 7 weeks later. At the first postnatal visit 835 of 2145 (39%) infants were breastfed (median age of 13 days) and 646 (30%) continued to breastfeed at the second visit (median age 35 days). Infants being breastfed at the first visit were significantly more likely to be fed infant formula at the second visit if their health visitors had had no breastfeeding training in the previous two years (OR1.74 95%CI 1.13, 2.68).

CONCLUSION

It is essential that Health Visitors are specially trained to support breastfeeding postnatally.

Breastfeeding and family life

The problems faced by breastfeeding mothers are well documented. However, the influence of social networks has mainly received attention solely through the eyes of the women. Therefore, we explored the views of the family as a whole. This exploratory study utilizes semi-structured interviews, diaries and questionnaires. A purposive sample of 24 women and their families, from a hospital in the north-west of England were invited to participate. Questionnaire data were analysed descriptively. Diaries and interviews were analysed using an open coding mechanism to identify emergent themes. Twenty-three women and 27 of their family members participated. Questionnaire data showed that the majority of women (n = 17) expected to breastfeed for more than 3 months; 12 actually did this. Women anticipated that family members would provide the main source of breastfeeding support. Three main themes emerged from the interviews and diaries: "moving with the times", "marketable commodity" and "disparate communications". The authors conclude that multi-layered approach to breastfeeding promotion and support should be considered. Society needs to proactively encourage a positive breastfeeding culture, family members need direction on how to support a woman to breastfeed and women need to be able to articulate their individual requirements. Midwives could be instrumental in supporting such needs and facilitating change.

Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados

Maternal feeding attitudes, maternal moods and infant feeding practices during the first 6 months postpartum were assessed in 226 healthy, well-nourished Barbadian mother-infant dyads. Factor analysis of the feeding attitudes questionnaire resulted in six independent factors. The belief that breastfeeding was better than bottle-feeding was associated with higher family income, more information seeking behavior and older maternal age at the time of her first pregnancy. Women who believed that breastfeeding was better at 7 weeks postpartum were also more likely to breastfeed at concurrent and later ages, up to 6 months postpartum. This belief was also associated with less maternal depression at 7 weeks and 6 months. The association between feeding attitudes and actual feeding practices was significant even after correcting for maternal moods and other background variables. Conversely, after controlling for feeding attitudes, maternal mood at 7 weeks was still significantly associated with infant feeding practices at 6 months. Thus, feeding attitudes and maternal moods were closely linked, but each contributed independently and uniquely to different aspects of breastfeeding, especially at 6 months. These findings suggest that early intervention addressing maternal feeding attitudes, may improve the extent of breastfeeding and the health of children in this setting.

Predictors of breastfeeding duration: evidence from a cohort study

OBJECTIVE

To report the duration of breastfeeding among a population of Australian women and to identify factors that are associated with the duration of full breastfeeding to 6 months and any breastfeeding to 12 months.

METHODS

Participants were 587 women who were recruited from 2 maternity hospitals in Perth and completed a baseline questionnaire just before or shortly after discharge from the hospital. Women were followed up by telephone interview at 4, 10, 16, 22, 32, 40, and 52 weeks postpartum. Data collected included sociodemographic, biomedical, hospital-related, and psychosocial factors associated with the initiation and the duration of breastfeeding. Cox's proportional hazards model was used to identify factors that were associated with the risk for discontinuing full breastfeeding before 6 months and any breastfeeding before 12 months.

RESULTS

At 6 months of age, fewer than one half of infants were receiving any breast milk (45.9%), and only 12% were being fully breastfed. By 12 months, only 19.2% of infants were still receiving any breast milk. Breastfeeding duration was independently, positively associated with maternal infant feeding attitudes and negatively associated with breastfeeding difficulties in the first 4 weeks, maternal smoking, introduction of a pacifier, and early return to work.

CONCLUSIONS

Relatively few women achieved the international recommendations for duration of full and overall breastfeeding. Women should receive anticipatory guidance while still in the hospital on how to prevent or manage common breastfeeding difficulties and should be discouraged from introducing a pacifier before 10 weeks, if at all. Improved maternity leave provisions and more flexible working conditions may help women to remain at home with their infants longer and/or to combine successfully breastfeeding with employment outside the home.

Temporal changes in the determinants of breastfeeding initiation

BACKGROUND

Regular identification of factors that predict a woman's infant feeding choice is important so that breastfeeding promotion interventions can be targeted at those women least likely to breastfeed. The objective of this study was to compare determinants of breastfeeding at discharge from hospital in 2002/2003 with those reported for 1992/1993.

METHODS

Women participating in two longitudinal infant feeding studies in Perth, Australia, completed a baseline questionnaire just before, or shortly after, discharge from hospital. Data collected included infant feeding method and socio-demographic, biomedical, and psychosocial factors known, or suspected, to be related to the initiation of breastfeeding. Multivariate logistic regression was used to identify independent predictors of "any" and "exclusive" breastfeeding at hospital discharge in both studies.

RESULTS

Although maternal age, level of education, and family income were independent predictors of breastfeeding at hospital discharge in the first study, no association was found between these factors and breastfeeding at hospital discharge in the second study. In both studies, a woman who perceived her husband to prefer breastfeeding was significantly more likely to leave hospital breastfeeding, and to be exclusively breastfeeding, than a woman who perceived her husband to prefer formula feeding. The strongest predictor in both studies for a woman to not be exclusively breastfeeding at hospital discharge was having an infant who had been admitted to the special care nursery after delivery.

CONCLUSIONS

Given the importance of psychosocial factors to breastfeeding initiation, interventions that aim to increase breastfeeding initiation rates should be targeted on the basis of parental attitudes to breastfeeding rather than on sociodemographic factors. Similarly, interventions that aim to increase exclusive breastfeeding should address biomedical factors that hinder a woman's ability to establish exclusive breastfeeding.

Position of the American Dietetic Association: Promoting and supporting breastfeeding

It is the position of the American Dietetic Association (ADA) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life, and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Breastfeeding is also a public health strategy for improving infant and child health survival, improving maternal morbidity, controlling health care costs, and conserving natural resources. ADA emphasizes the essential role of dietetics professionals in promoting and supporting breastfeeding by providing up-to-date, practical information to pregnant and postpartum women, involving family and friends in breastfeeding education and counseling, removing institutional barriers to breastfeeding, collaborating with community organizations and others who promote and support breastfeeding, and advocating for policies that position breastfeeding as the norm for infant feeding. ADA also emphasizes its own role by providing up-to-date information to the public, encouraging empirical research, providing continuing education opportunities, providing cultural sensitivity and cultural competence training to dietetics professionals, and encouraging universities to review and update undergraduate and graduate training programs.