The influence of psychosocial factors on the duration of breastfeeding

Systematic review and meta-analysis of randomized controlled trials evaluating primary care-based interventions to promote breastfeeding in low-income women

BACKGROUND

Given the benefits of breastfeeding (BF), health care institutions recommend that a child should be breastfed for the first 6 months of its life. However, differences between social groups as regards BF behaviour are very prevalent.

OBJECTIVES

To identify effective programmes that can be implemented by GPs to promote BF in low-income women.

METHODS

A review of the literature was based on the Medline, Cochrane and Public Health databases (1985-2009), using index terms relating to BF, general medicine and social inequalities in health. Randomized controlled trials were included in our analysis. Two people independently selected which studies would be used by rating the quality of the articles. The results of these studies were presented in raw form and in terms of a pooled relative risk.

RESULTS

We analysed 10 studies (of the 343 articles originally selected) involving a population of 1445 'mother and child' pairs. The studies that assessed ways of encouraging the initiation of any form of BF showed that educational programmes are effective [relative risk (RR) for starting BF, 1.46, 95% confidence interval (CI): 1.03-2.08]. As regards the studies that involved ways to encourage mothers to continue BF, the programmes used showed significant success rates after 3-month postpartum (RR: 1.15, 95% CI: 1.01-1.30). The successful programmes usually involved multiple 'short' follow-up appointments (<20 to 30 minutes).

CONCLUSIONS

Educational programmes delivered in the context of ongoing personal contact with a health professional are effective in promoting BF in low-income women.

Severe breastfeeding difficulties: Existential lostness as a mother-Women's lived experiences of initiating breastfeeding under severe difficulties

A majority of women in Sweden initiate breastfeeding but almost a quarter stop or wean the infant in the first few weeks after birth because of difficulties. In order to develop care that facilitates initiation of breastfeeding and enables mothers to realize their expectations concerning breastfeeding, it is necessary to understand what having severe breastfeeding difficulties means for women who experience them. The aim of this study is to describe the lived experiences of initiating breastfeeding under severe difficulties. A reflective lifeworld research design was used. Eight women, seven primiparous and one multipara, were interviewed within 2 months of giving birth. The essential meaning of the phenomenon is described as "Existential lostness as a mother forcing oneself into a constant fight". This pattern is further explicated through its constituents; shattered expectations, a lost time for closeness, being of no use to the infant, being forced to expose oneself, and gaining strength through sharing. The results show that mothers with severe breastfeeding difficulties feel alone and exposed because of their suffering and are lost in motherhood. Thus, adequate care for mothers should enhance the forming of a caring relationship through sharing rather than exposing.

Development of a postnatal educational program for breastfeeding mothers in community settings: intervention mapping as a useful guide

Inconsistency in how professionals can best support the breastfeeding mother after discharge call on further investigation. The authors describe how intervention mapping was used to develop a postnatal breastfeeding support intervention for mothers in community settings. Breastfeeding cessation most often occurred in the first weeks among mothers with low self-efficacy, low confidence, or limited previous breastfeeding experience. Besides learning effective breastfeeding techniques, mothers needed to learn how to recognize their baby's cues, let the baby regulate meals, gain confidence in producing enough milk, and handle breastfeeding problems. Theory-based methods-such as individualization, skills training with guided practice, reattribution, planning coping responses, and mobilizing social support-were built into a health visitor-delivered program. An 18-hour training course addressed determinants for implementation. Finally, process and effect evaluations were planned. Support of the breastfeeding mother in community settings should address the psychosocial and practical aspects of breastfeeding to prevent premature cessation.

Psychometric testing of the breastfeeding self-efficacy scale-short form among adolescents

PURPOSE

This study aimed to (a) psychometrically assess the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) antenatally and postnatally among adolescents, and (b) examine the relationship between breast-feeding self-efficacy and adolescent demographic variables. The BSES-SF is used internationally but has not been psychometrically tested with an adolescent population.

METHODS

A methodological study was conducted in which 103 pregnant adolescents were recruited from two prenatal clinics at a tertiary care setting in western Canada. The BSES-SF was administered at 34 weeks' gestation and again at 1 and 4 weeks postpartum.

RESULTS

The Cronbach's alpha coefficient was .84 for the antenatal assessment and .93 for the postnatal assessment. Antenatal BSES-SF scores significantly predicted breast-feeding initiation, whereas antenatal and postnatal scores predicted duration and exclusivity to 4 weeks postpartum. Other reliability and validity results are consistent with previous research with adult samples. Study findings indicate prenatal classes and professional support may be particularly important sources of information to increase adolescent breast-feeding self-efficacy.

CONCLUSIONS

Results provide evidence that the scale may be a valid and reliable measure of breast-feeding self-efficacy among adolescents, predicting breast-feeding initiation, duration, and exclusivity.

Breastfeeding and risk of epilepsy in childhood: a birth cohort study

OBJECTIVE

We asked whether breastfeeding reduces the risk of epilepsy in childhood.

STUDY DESIGN

We included 69 750 singletons born between September 1997 and June 2003 in the Danish National Birth Cohort and observed them to August 2008. Information on breastfeeding was reported by mothers in two computer-assisted telephone interviews at 6 and 18 months after birth. Information on epilepsy (inpatients and outpatients) was retrieved from the Danish National Hospital Register. Cox proportional hazards regression models were used to estimate incidence rate ratios and 95% CIs.

RESULTS

Breastfeeding was associated with a decreased risk of epilepsy, with a dose-response like pattern. For example, children breastfed for 3 to 5, 6 to 8, 9 to 12, and ≥ 13 months had a 26%, 39%, 50%, and 59% lower risk of epilepsy after the first year of life, respectively, compared with children who were breastfed for <1 month. The association remained when we excluded children who had adverse neonatal conditions or children who were exposed to adverse maternal conditions during pregnancy.

CONCLUSIONS

The observed protective effect of breastfeeding may be causal. Breastfeeding may decrease epilepsy in childhood, thereby adding another reason for breastfeeding.

Larger infant size at birth reduces the negative association between maternal prepregnancy body mass index and breastfeeding duration

Women who are overweight or obese prepregnancy have shorter durations of producing milk (PM) and feeding breast milk exclusively (FBM-ex) than normal-weight women. We proposed that infant size at birth may reduce the negative associations between prepregnancy BMI and the durations of PM and FBM-ex. We used data from 2798 participants in the Infant Feeding Practices Study II and characterized infant size at birth as weight-for-gestational age (WGA). To assess possible mediation of the associations between maternal BMI and the durations of PM and FBM-ex by infant size at birth, Baron and Kenny's methods, the Sobel test, and bootstrapping were used. As expected, prepregnancy BMI was negatively associated (P < 0.0001) with the durations of PM and FBM-ex; it also was positively associated (P < 0.0001) with infant size at birth. However, infant WGA was positively associated (P < 0.0003) with the durations of PM and FBM-ex after adjustment for BMI. Thus, the negative associations between BMI and the durations of PM and FBM-ex were reduced by infant WGA; i.e. the statistical removal of infant size at birth increased the magnitude of the negative associations between BMI and the durations of PM and FBM-ex. Thus, the tendency of heavier mothers to deliver heavier infants reduces the true magnitude of the association between maternal prepregnancy BMI and shortened breastfeeding duration.

A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns

This paper reports on current initiation and prevalence rates, in Western Australia, differentiating 'any' breastfeeding with 'exclusive' breastfeeding whilst exploring patterns and reasons for stopping breastfeeding. The results presented are part of a larger study examining women's perceptions of care and wellbeing in the early postnatal period. A cross sectional survey was used to examine infant feeding practices during the hospital stay and at 9 weeks post birth from Western Australian women with a registered live birth between February and June 2006. Data obtained from 2,669 women revealed a 93% (n = 2,472) initiation rate of any breastfeeding. More multiparous women (73.5%) were exclusively breastfeeding in hospital compared to primiparous women (65.2%), which decreased to 57.1 and 49.2%, respectively at 9 weeks. Of those who had ceased by 9 weeks, more multiparous women (71.1%) ceased before 3 weeks. Reasons cited for ceasing in order of frequency were insufficient milk supply, infant related reasons, pain and discomfort and emotional reasons. Younger maternal age, primiparous women, lower maternal education levels, offering a combination of breast milk and formula in hospital and caesarean birth were significant independent predictors of early cessation. Although initiation rates including "any" breast milk are meeting NHMRC dietary guidelines of 90%, the 60% target of exclusive breastfeeding is not being achieved for 3 months or in fact at 9 weeks. Targeted support for at risk groups such as younger, less well-educated, primiparous women must continue. Evidence based policies to protect breastfeeding must address the practice of offering formula to breastfed infants in hospital and the impact of increasing interventions such as caesarean births.

Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding

BACKGROUND

To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.

OBJECTIVES

To assess the effect of pacifier use versus no pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

MAIN RESULTS

We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

AUTHORS' CONCLUSIONS

Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Breastfeeding: An existential challenge-women's lived experiences of initiating breastfeeding within the context of early home discharge in Sweden

For most Swedish women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women's perspective is scantily explored. Therefore, the aim of this study is to describe women's lived experiences of initiating breastfeeding within the context of early home discharge. Eight women, two primiparous, and six multiparous were interviewed within 2 months after birth. A reflective lifeworld research design based on phenomenological philosophy was used during the data gathering and data analysis. The results show that the phenomenon, initiating breastfeeding, in spite of good conditions, i.e., early home discharge, is complex and entails an existential challenge. The essential meaning of the phenomenon is conceptualized as, "A movement from a bodily performance to an embodied relation with the infant and oneself as a mother." This pattern is further described in its five constituents: "Fascination in the first encounter," "Balancing the unknown," "Devoting oneself and enduring the situation," "Seeking confirmation in the unique," and "Having the entire responsibility." Caring for women initiating breastfeeding entails, from a caring science perspective, to help the mother meet insecurity and strengthen confidence to trust her ability to breastfeed the newborn infant. According to these findings, it is suggested in the discussion that it is time for health care professionals to reject the idea of breastfeeding merely as meals or eating for the infant. Instead, they ought to embrace its origin, namely as a way to closeness between mother and infant.

A multilevel model for the study of breastfeeding determinants in Brazil

The benefits of breastfeeding for the children's health have been highlighted in many studies. The innovative aspect of the present study lies in its use of a multilevel model, a technique that has rarely been applied to studies on breastfeeding. The data reported were collected from a larger study, the Family Budget Survey-Pesquisa de Orçamentos Familiares, carried out between 2002 and 2003 in Brazil that involved a sample of 48 470 households. A representative national sample of 1477 infants aged 0-6 months was used. The statistical analysis was performed using a multilevel model, with two levels grouped by region. In Brazil, breastfeeding prevalence was 58%. The factors that bore a negative influence on breastfeeding were over four residents living in the same household [odds ratio (OR) = 0.68, 90% confidence interval (CI) = 0.51-0.89] and mothers aged 30 years or more (OR = 0.68, 90% CI = 0.53-0.89). The factors that positively influenced breastfeeding were the following: higher socio-economic levels (OR = 1.37, 90% CI = 1.01-1.88), families with over two infants under 5 years (OR = 1.25, 90% CI = 1.00-1.58) and being a resident in rural areas (OR = 1.25, 90% CI = 1.00-1.58). Although majority of the mothers was aware of the value of maternal milk and breastfed their babies, the prevalence of breastfeeding remains lower than the rate advised by the World Health Organization, and the number of residents living in the same household along with mothers aged 30 years or older were both factors associated with early cessation of infant breastfeeding before 6 months.

[Factors affecting mother's adaptation to breastfeeding]

PURPOSE

The aim of this study was to identify factors which influence breastfeeding adaptation from among the following: parity and feeding behavior, social support, psychological, and demographic factors.

METHODS

The respondents were 179 breastfeeding mothers. Data were collected from June 2 to 19, 2009 at two community health centers and one pediatric outpatient department. Data were analyzed using the SPSS program and included descriptive statistics, t-test, ANOVA, correlation, and multiple regression.

RESULTS

The major findings of this study were: 1) Significant differences in the level of breastfeeding adaptation were related to number of children, current problems related to breastfeeding, and lay supporters. 2) Level of breastfeeding adaptation was significantly related to marriage satisfaction, proportion of breastfeeding, length of previous breastfeeding, planned length of breastfeeding, parenting stress, and encouragement to breastfeed given by medical personnel. 3) Regression analysis showed that parenting stress, marriage satisfaction, current problems related to breastfeeding, and proportion of breastfeeding explained 44.3% of variance for breastfeeding adaptation. Length of previous breastfeeding also explained 9.7% of breastfeeding adaptation among mothers who had breastfed an elder child.

CONCLUSION

Mothers with lower marriage satisfaction, breastfeeding problems, and higher parenting stress require more help from their family and nurses for breastfeeding adaptation. Future research should include variables, such as mother's and baby's behavior related to breastfeeding, knowledge about breastfeeding, and attitude toward breastfeeding.

Exclusive breastfeeding in southern Brazil: prevalence and associated factors

BACKGROUND

Worldwide strategies have been conducted in order to guarantee longer periods of exclusive breastfeeding for most children, especially those from developing countries. The evaluation of infant feeding practices and the identification of weaning risk factors are essential for public health policy planning.

METHODS

This cross-sectional study was carried out in Joinville, the biggest city of Santa Catarina State in the southern Brazilian region. The caregivers of children under 1 year of age were systematically selected for interview in previously drawn immunization units during the 2005 National Vaccination Campaign. A structured questionnaire was applied for collection of infant, maternal, and healthcare variables. A 24-hour food recall survey was included in order to evaluate infant feeding practices. Descriptive statistic analysis on breastfeeding prevalence and Poisson regression analysis of risk factors for discontinuing exclusive breastfeeding for infants up to 6 months of age were performed.

RESULTS

Caregivers of 1,470 infants were interviewed. The feeding inquiry showed an overall rate of breastfeeding of 72.5% and a frequency of exclusive breastfeeding of 43.7% and 53.9% among infants younger than 6 and 4 months of age, respectively. The findings associated with the interruption of exclusive breastfeeding for infants up to 6 months were: higher infant age (P < 0.001), pacifier use (P < 0.001), and lower maternal educational level (P = 0.013).

CONCLUSIONS

In developing countries, specific strategies must be created for the delivery of information about breastfeeding and the effect of pacifier use, especially for less educated women.

Salt preference of nursing mothers is associated with earlier cessation of exclusive breastfeeding

Successful breastfeeding is predicated on its initial success. Salt appetite during lactation may be relevant to breastfeeding success because sodium is essential for development of foetus and neonate. Here we examined whether maternal salt preference might facilitate breastfeeding. Nursing mothers (n=327) were categorized as high, medium or low salt preferring, and the relationship to persistence of exclusive breastfeeding during the first 25 days postnatal was evaluated. Contrary to expectation, we find that mothers with low salt preference persisted in breastfeeding beyond day 7 postnatal in comparison to mothers with high salt preference, and mothers with high salt preference had the shortest exclusive breastfeeding duration up to postnatal day 25. Awareness of this among health workers and nursing mothers could contribute to successful breastfeeding.

Variables associated with breastfeeding duration

OBJECTIVE

To identify the variables associated with breastfeeding duration.

DATA SOURCES

The health science reference databases of CINAHL, PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION

Meta-analyses, Cochrane reviews, literature reviews, and quantitative and qualitative studies published in English from 1998 through 2008.

DATA EXTRACTION

Data included all variables, both positive and negative, that were found to influence the outcome of breastfeeding duration.

DATA SYNTHESIS

Demographic factors that influence breastfeeding duration are race, age, marital status, education, socioeconomics, and Special Supplemental Nutrition Program for Women, Infants, and Children status. Biological variables consisted of insufficient milk supply, infant health problems, maternal obesity, and the physical challenges of breastfeeding, maternal smoking, parity, and method of delivery. Social variables included paid work, family support, and professional support. Maternal intention, interest, and confidence in breastfeeding were psychological variables.

CONCLUSION

Human lactation is a complex phenomena and the duration of breastfeeding is influenced by many demographic, physical, social, and psychological variables.

Breastfeeding changes for VLBW infants in the NICU following staff education

PURPOSE

To assess the effectiveness of an educational intervention aimed at staff and parents in changing breastfeeding practices in the NICU.

DESIGN

The breastfeeding education initiative consisted of three parts: breastfeeding training for NICU staff, issuance of complementary breastfeeding materials to mothers of infants in the NICU, and addition of a breastfeeding pathway to the individualized care plan. Infants admitted before and after the initiative were compared to evaluate for changes in breastfeeding practices.

SAMPLE

The study sample included very low birth weight (VLBW) infants hospitalized in the NICU for more than seven days and born weighing <1,500 g. Infants were grouped based on whether they were admitted before (pre-intervention) or after (post-intervention) implementation of the education initiative.

MAIN OUTCOME VARIABLES

Health care professional (HCP) knowledge of breastfeeding interventions in the NICU was measured using a posttest following training. Breast milk feeding initiation rates, breastfeeding rates, and rates of breast milk feeding at discharge were measured via retrospective chart review among pre- and post-intervention infant groups.

RESULTS

The post-intervention group demonstrated significant improvement in rates of breastfeeding (infants being put directly to the breast) in the NICU compared with the pre-intervention group. General positive trends in breast milk feeding initiation (up 11 percent) and breast milk feeding at discharge (up 5 percent) were observed, but these increases failed to reach significance.

Maternal years of schooling but not academic skills is independently associated with infant-feeding practices in a cohort of rural Guatemalan women

The effects of maternal academic skills on infant-feeding practices are not clear. From 1996 to 1999, the authors collected information on infant-feeding practices from birth on infants born to 279 mothers from 4 rural villages in Guatemala. They examined associations between maternal academic skills and indicators for the initiation of exclusive breastfeeding (EBF) and timely introduction of complementary foods (CF). Mothers in the highest category of academic skills had greater odds of initiating EBF, but this association failed to remain significant after adjusting for schooling. Compared with mothers with < 1 year of school, mothers with > 3 to <or= 6 years had greater odds of initiating EBF; mothers with > 6 years of school had greater odds of introducing CF early, while mothers with >or= 1 to <or= 3 years had greater odds of introducing CF late. Unmeasured schooling-related factors influenced infant-feeding practices to a greater extent than academic skills.

How are effective breastfeeding technique and pacifier use related to breastfeeding problems and breastfeeding duration?

BACKGROUND

Inconsistent findings leave uncertainty about the impact of pacifier use on effective breastfeeding technique. The purpose of this study was to investigate how breastfeeding technique and pacifier use were related to breastfeeding problems and duration of breastfeeding.

METHODS

Data were collected from the intervention group of a randomized trial in which health visitors followed up with mothers for 6 months after childbirth. The health visitors classified the breastfeeding technique at approximately 1 week after birth and repeated the observation if a correction was necessary. Effective technique included positioning, latch, sucking, and milk transfer. Data on breastfeeding problems and pacifier use were obtained from self-reported questionnaires. The study population included 570 mother-baby pairs with complete information on breastfeeding technique and pacifier use. The primary outcome was duration of exclusive breastfeeding.

RESULTS

One-half of the mothers showed ineffective breastfeeding technique at the first\ observation, most frequently ineffective position (61%) and latch (52%). In the unadjusted analysis, only sucking and milk transfer were associated with breastfeeding duration. In the adjusted analysis, ineffective technique was significantly associated with mothers reporting early breastfeeding problems, which thereby influenced the breastfeeding duration. Pacifier use had an independent negative impact on duration of breastfeeding. A single correction of the breastfeeding technique was not associated with duration or occurrence of problems.

CONCLUSIONS

Observation of breastfeeding technique may help mothers in the stage of when they are establishing breastfeeding to avoid early and later problems, but breastfeeding technique is less useful in predicting breastfeeding duration. Use of a pacifier should be avoided in the first weeks after birth.

Shattered expectations: when mothers' confidence in breastfeeding is undermined--a metasynthesis

OBJECTIVES

Why do mothers give up breastfeeding, even though breastfeeding has great importance to them? This study examines what has affected mother's confidence in breastfeeding when she gives up breastfeeding.

METHOD

A metasynthesis of seven studies on mothers' experiences with breastfeeding was conducted using Noblit and Hare's methodological approach.

RESULTS

The metasynthesis shows that confidence in breastfeeding is shaped by shattered expectations and is affected on an immediate level by mothers' expectations, the network and the breastfeeding experts and on a discourse level by the discourses: breastfeeding as nature, the female body as a machine and the note of caution. Foucault's concept of discourse is used to discuss how these discourses affect mothers' confidence in breastfeeding by giving the right to speak about breastfeeding to the breastfeeding experts, by isolating the mothers who do not breastfeed and by organizing knowledge about breastfeeding in a certain way.

CONCLUSIONS

The individual mother is responsible for the success of breastfeeding and the discourses are hiding that general perceptions of breastfeeding undermines the mothers' confidence in breastfeeding and leads to shattered expectations.

The influence of psychological factors on breastfeeding duration

AIM

This paper reports on a study examining the relationship between women's psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors.

BACKGROUND

The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design.

METHOD

Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview.

FINDINGS

Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy.

CONCLUSION

This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

Translation and psychometric assessment of the Breast-feeding Self-Efficacy Scale-Short Form among pregnant and postnatal women in Turkey

BACKGROUND

most women stop breast feeding before the recommended 6 months post partum. If health professionals are to improve low breast-feeding duration and exclusivity rates, they need to assess high-risk women reliably and identify predisposing factors amenable to intervention. One possible modifiable variable is breast-feeding confidence. The Breast-feeding Self-Efficacy Scale-Short Form (BSES-SF) is a 14-item measure designed to assess a mother's confidence in her ability to breast feed her baby.

OBJECTIVES

to translate the BSES-SF into Turkish and assess its psychometric properties among women in the antenatal and postnatal periods.

DESIGN

a methodological study to assess the reliability, validity and predictive value of the BSES-SF.

SETTING

two private and two public hospitals and their outpatient health clinics in Izmir, Turkey.

PARTICIPANTS

144 pregnant women and 150 postnatal breast-feeding mothers were recruited using convenience sampling.

METHODS

following back-translation procedures, questionnaires were completed in the third trimester by pregnant women and in the hospital by postnatal women. All mothers were telephoned at approximately 12 weeks after the birth to determine how they were feeding their babies.

RESULTS

Cronbach's alpha coefficient for internal consistency was 0.87 antenatally and 0.86 postnatally. Antenatal and postnatal BSES-SF scores were significant predictors of breast-feeding duration and exclusivity at 12 weeks after the birth. Differences were found between antenatal and postnatal BSES-SF scores for mothers with previous breast-feeding experience compared with scores for mothers with no breast-feeding experience. Demographic response patterns suggest that the BSES-SF is a unique tool to identify pregnant women and new mothers at risk of early cessation of breast feeding.

CONCLUSIONS

this study provides evidence that the translated version of the BSES-SF may be a valid and reliable measure of breast-feeding self-efficacy among a perinatal sample in Turkey.

Intake of water, herbal teas and non-breast milks during the first month of life: associated factors and impact on breastfeeding duration

BACKGROUND

The use of non-breast milks seems to cause more harm to the child's health than the isolated introduction of water/herbal teas.

AIMS

Study the factors associated with introduction of water/herbal teas or non-breast milks during the first month of life and determine the impact of this supplementation on breastfeeding duration.

STUDY DESIGN

Nested cross-sectional study.

SUBJECTS

220 mother-infant pairs contacted in the maternity ward, at 7 days and at the end of 1, 2, 4, and 6 months.

OUTCOME MEASURES

Introduction of water/herbal teas or non-breast milks in the first month of life based on data collected during a home visit 30 days after delivery.

RESULTS

Introduction of water/herbal teas was associated with maternal age <20 years (prevalence ratio=1.55; 95%CI 1.14-2.09), <6 prenatal consultations (1.48; 1.09-2.01), cohabitation with maternal grandmother (1.51; 1.10-2.10), and poor latch-on at 30 days (1.87; 1.35-2.58). Introduction of non-breast milks was associated with breastfeeding of previous children for <6 months (3.18; 1.18-8.58), cesarean (1.92; 1.07-3.44), poor latch-on at 30 days (2.82; 1.55-5.11), use of pacifier at 7 days (2.75; 1.38-5.48), introduction of herbal teas in the first 7 days (2.75; 1.15-4.15) and breast engorgement at 7 days (2.19; 1.01-3.16). Introduction of non-breast milks negatively influenced breastfeeding duration (p<0.001); this was not observed with water/herbal teas (p=0.277).

CONCLUSION

Priority should be given to preventing the early introduction on non-breast milks, especially in mother-infant pairs with associated risk factors.

Psychosocial Determinants of the Early Introduction of Complementary Foods

Infant feeding guidelines recommend exclusive breast-feeding to the age of 6 months; complementary foods should not be introduced before this age. This study examined parent and infant psychosocial determinants of the early introduction of complementary foods. Analyses were conducted on a representative sample of children born in Québec (Canada) in 1998 ( n = 2,223), surveyed through the Québec Longitudinal Study of Child Development. Of the children, 61% received complementary foods prior to the age of 4 months. A multiple logistic regression analysis revealed the early introduction of complementary foods was more likely when mothers were younger, less educated, of lower socioeconomic class, and when they felt they had little influence on their child's development. Higher parental confidence in caring for the infant was also associated with the early introduction of complementary foods ( p ≤ .05). Future research must carefully consider the psychosocial aspects involved in adhering to infant feeding guidelines.

The reliability and validity of the Polish version of the Breastfeeding Self-Efficacy Scale-Short Form: Translation and psychometric assessment

BACKGROUND

The majority of women discontinue breastfeeding before the recommended 6 months postpartum. If health professionals are to improve low breastfeeding duration and exclusivity rates, they need to reliably assess high-risk women and identify predisposing factors that are amenable to intervention. One possible modifiable variable is breastfeeding confidence. The Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) is a 14-item measure designed to assess a mother's confidence in her ability to breastfeed her baby.

OBJECTIVES

To translate the BSES-SF into Polish and assess its psychometric properties among breastfeeding mothers.

DESIGN

Methodological study.

SETTING

Five hospitals in Lodz Poland.

PARTICIPANTS

Using convenience sampling, 105 in-hospital breastfeeding mothers were recruited.

METHODS

Following back-translation procedures, mothers completed questionnaires in-hospital and at 8 and 16 weeks postpartum.

RESULTS

The Cronbach's alpha coefficient for internal consistency was 0.89. In-hospital BSES-SF scores significantly predicted breastfeeding duration and exclusivity at 8 and 16 weeks postpartum. Demographic response patterns suggested the BSES-SF is a unique tool to identify breastfeeding mothers at risk of prematurely discontinuing.

CONCLUSIONS

This study provides evidence that the translated version of the BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among a sample of mothers in Lodz Poland.

Effect of early postnatal breastfeeding support: a cluster-randomized community based trial

AIM

To assess the impact of a supportive intervention on the duration of breastfeeding.

DESIGN AND SETTING

A community based cluster-randomized trial in Western Denmark.

SUBJECTS

Fifty-two health visitors and 781 mothers in the intervention group, and 57 health visitors and 816 mothers in the comparison group.

INTERVENTION

Health visitors in the intervention group received an 18-h course. The intervention addressed maternal psychosocial factors and consisted of 1-3 home visits during the first 5 weeks post-partum. Health visitors in the comparison group offered their usual practice.

MAIN OUTCOME MEASURE

Duration of exclusive breastfeeding during 6 months of follow-up.

RESULTS

Mothers in the intervention group had a 14% lower cessation rate (HR = 0.86 CI: 0.75-0.99). Similar results were seen for primipara, and multipara with previously short breastfeeding experience. Mothers in the intervention group received their first home visit earlier, had more visits and practical breastfeeding training within the first 5 weeks. Babies in the intervention group were breastfed more frequently, fewer used pacifiers, and their mothers reported more confidence in not knowing the exact amount of milk their babies had received when being breastfed.

CONCLUSION

Home visits in the first 5 weeks following birth may prolong the duration of exclusive breastfeeding. Postnatal support should focus on both psychosocial and practical aspects of breastfeeding. Mothers with no or little previous breastfeeding experience require special attention.

Whom can I rely on? Mothers’ approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania

OBJECTIVE

to explore and describe mothers' perceptions of baby feeding and approaches to support for baby feeding.

DESIGN

individual qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis.

SETTING

suburban Dar es Salaam, Tanzania.

PARTICIPANTS

8 mothers with babies under 6 months of age.

FINDINGS

the study revealed four categories of mothers' perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.

Early breastfeeding cessation: validation of a prognostic breastfeeding score

AIM

To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth.

METHODS

Two independent cohorts of Danish mothers in 1999 and 2004 with 4 months of follow-up on breastfeeding duration were used. The breastfeeding score was developed from 471 mothers' responses to a questionnaire in 1999 and based on duration of schooling, previous breastfeeding experience, self-efficacy, and mother's confidence in ability to produce milk. The 2004 cohort consisting of 723 mothers was used to validate the score.

RESULTS

A breastfeeding score of 7 or higher classified 45% of the mothers in the 2004 cohort as being at risk of breastfeeding cessation. With this cut-point the sensitivity was 70% and the specificity 71%. Among primipara the cut-point gave a sensitivity of 76% and a specificity of 54% and classified 60% to be in the risk group. Among multipara the corresponding figures were 66%, 81% and 34%, respectively. The area under the ROC curve was 0.78.

CONCLUSION

The breastfeeding score based on a simple scoring system derived from four risk factors was capable of predicting the breastfeeding duration in an independent sample. It may help health professionals to identify mothers at risk of breastfeeding cessation before 4 months.

Working mothers breastfeed babies more than housewives

AIM

To examine the prevalence and determinants of breastfeeding and to identify perinatal, sociodemographic, psychosocial and environmental factors associated with maternal infant feeding intention.

METHODS

A sample of 3734 Greek mothers that delivered their infants in 2000 was recruited in a longitudinal cohort study. Data on duration of breastfeeding was based on a questionnaire answered by 76.6% of the participants at 8-12 months postpartum.

RESULTS

The rates of any breastfeeding at 3 and 6 months were 52% and 24%, respectively. The corresponding rates of exclusive breastfeeding were 37% and 17%. From Cox regression analysis mother's intention to breastfeed for a short time and upbringing in the area of Athens were significantly associated with early termination of any breastfeeding and exclusive breastfeeding. A positive intention to breastfeed was influenced by maternal entitlement more than 6 months, delivery in autumn or winter, mother's upbringing abroad and previous breastfeeding experience.

CONCLUSIONS

The rates of any breastfeeding and exclusive breastfeeding during the first year of life were fairly satisfactory. Programs to support breastfeeding are necessary and should encourage women to feel positive to breastfeed, focusing particularly on non-working mothers, mothers with a maternity entitlement less than 6 months and mothers who lack previous breastfeeding experience.

Maternal distress and intended breastfeeding duration

AIM

To evaluate the associations between maternal psychological status and intended breastfeeding duration.

METHODS

A total of 852 pregnant women who attended antenatal care between September 1997 and August 2000 in 12 health units and five hospitals in Jundiaí city, Brazil, were included in the study. Psychological measures (stress and distress) were obtained at a gestational age from 30 to 36 weeks, using standardized scales, questionnaires and inventories. Psychological factors specifically related to breastfeeding assessed their worries, concerns, and support when breastfeeding. Multiple linear regression analysis identified the associations between the outcome "intended duration of breastfeeding" and psychological status of the mothers, controlling for toxic exposure, socioeconomic, demographic, obstetric and nutritional factors.

RESULTS

There were negative associations between the outcome and distress, "concerned about body's changes", and work outside home, and a positive association between the outcome and marital status (p < or = 0.03).

CONCLUSION

Early identification of distress in pregnant women and a more attentive encouragement to breastfeed is probably one of the steps to improve intended breastfeeding duration.

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.

Randomized Controlled Trial to Determine Effects of Prenatal Breastfeeding Workshop on Maternal Breastfeeding Self‐Efficacy and Breastfeeding Duration

OBJECTIVE

To determine the effects of a prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration.

DESIGN

Randomized controlled trial.

SETTING

Large tertiary hospital in Ontario, Canada.

PARTICIPANTS

110 primiparous women expecting a single child, an uncomplicated birth, and planning to breastfeed.

INTERVENTION

2.5-hour prenatal breastfeeding workshop based on adult learning principles and self-efficacy theory.

MAIN OUTCOME MEASURE

Maternal breastfeeding self-efficacy and the numbers of days and amount of breastfeeding were measured at four and eight weeks postpartum. RESULTS/DATA ANALYSIS: Over time, maternal breastfeeding self-efficacy scores increased in both groups. Women who attended the workshop had higher self-efficacy scores and a higher proportion were exclusively breastfeeding compared to women who did not attend the workshop. There was little difference in the average number of days of breastfeeding, but the intervention group had less weaning.

CONCLUSIONS

The workshop increased maternal breastfeeding self-efficacy and exclusive breastfeeding.

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period

Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.

Clinical lactation practice: 20 years of evidence

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.

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.