Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System

Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach

OBJECTIVE

To determine factors associated with breastfeeding in rural communities.

METHODS

We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N=1292) of infants born September 2003-2004 and (2) a parallel ethnographic study (N=30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding.

RESULTS

Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance.

CONCLUSIONS

Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.

Attitudes, knowledge, and intentions related to breastfeeding among university undergraduate women and men

The purpose of the current study was to examine university undergraduate women's and men's attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population.

Recognizing and treating delayed or failed lactogenesis II

Delayed or failed achievement of lactogenesis II--the onset of copious milk volume--occurs as a result of various maternal and/or infant factors. Early recognition of these risk factors is critical for clinicians who interact with breastfeeding women so that intervention and achievement of full or partial breastfeeding can be preserved. This article describes the maternal and infant conditions that contribute to the unsuccessful establishment of a full lactation. Treatment modalities that can maximize maternal lactation capacity and infant growth rates are offered.

Breastfeeding attitudes and reported problems in a national sample of WIC participants

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed.

Hospital practices that increase breastfeeding duration: results from a population-based study

BACKGROUND

A high percentage (83%) of mothers in Colorado initiate breastfeeding; but in keeping with national breastfeeding trends, many of them discontinue breastfeeding within the first few months. The objective of this study was to determine the effects of hospital practices on breastfeeding duration and whether the effects differed based on maternal socioeconomic status.

METHODS

Pregnancy Risk Assessment Monitoring System data were used to calculate breastfeeding duration rates for all Colorado mothers in 2002 to 2003. Breastfeeding duration rates were determined for recipients of each of nine hospital practices included in the survey compared with rates for nonrecipients. Practices that significantly increased breastfeeding duration rates were combined and then stratified by socioeconomic status.

RESULTS

Breastfeeding duration was significantly improved when mothers experienced all five specific hospital practices: breastfeeding within the first hour, breastmilk only, infant rooming-in, no pacifier use, and receipt of a telephone number for use after discharge. Two-thirds (68%; 95% CI: 61-75) of mothers who experienced all five successful practices were still breastfeeding at 16 weeks compared with one-half (53%; 95% CI: 49-56) of those who did not. Breastfeeding duration was improved independent of maternal socioeconomic status. Only one in five mothers (18.7%) experienced all five supportive hospital practices. Mothers who experienced the five supportive hospital practices were significantly less likely to stop breastfeeding due to any of the top reasons given for stopping (p < 0.001).

CONCLUSIONS

Implementation of the five hospital practices supportive of breastfeeding significantly increased breastfeeding duration rates regardless of maternal socioeconomic status.

A qualitative evaluation of a breastfeeding peer counselor program

The Breastfeeding Initiative program is a collaboration between the Michigan Department of Community Health (Women, Infants, and Children Division) and Michigan State University Extension. It aims to increase breastfeeding rates among low-income women through the use of peer counselors. The study's purpose was to identify the program's strengths, operation procedures, and improvement areas from participants' and peer counselors' perspectives. Six focus groups were conducted: 3 of peer counselors and 3 of program participants. Findings revealed that peer counselors and participants were satisfied with the quality of services due to emotional and practical assistance and breast pumps provided by peer counselors. Peer counselors' job satisfaction was explained positively by the intrinsic rewards of helping others and negatively by perceived inadequate resources and recognition. Operating procedures varied greatly. Possible improvements include expanding services, providing peer counselors with additional support, and standardizing peer counselor operating procedures. The peer counselor model can effectively support low-income breastfeeding women.

Breast-feeding: good starts, good outcomes

Meeting national breast-feeding objectives and mothers' personal breast-feeding goals depends on a number of factors, including the provision of current, consistent, and timely help with breast-feeding. Nurses are in a prime position to guide mothers during their hospital stay and provide community follow-up postdischarge. Mothers and infants need to acquire a set of breast-feeding skills prior to hospital discharge so that a mother goes home confident that she can adequately nourish her infant, initiate and maintain an abundant milk supply, avoid problems, and address them if they occur. This article describes strategies for optimizing breast-feeding during the first 48 hours and delineates what mothers need to know before they leave the hospital.

Challenges faced by new mothers in the early postpartum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey

OBJECTIVE

To identify challenges that women face 2-9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS).

METHODS

PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders.

RESULTS

We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery.

CONCLUSION

The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.

Midwives in the UK: an exploratory study of providing newborn feeding support for postpartum mothers in the hospital

Our objective was to explore English midwives' views and experiences of supporting mothers with feeding their newborn baby. Grounded theory methodology was used. Data were collected using in-depth interviews from 30 midwives in the North of England. Data were analyzed using constant comparison techniques. Midwives were theoretically sampled for interview from a pool of volunteers recruited from a poster promoting the study in the clinical areas. Overall, hospital midwives felt that they did not have enough time to support mothers with feeding their neonate. To cope with these time constraints, midwives developed practices of rationing the time that they spent with mothers, and the rationing of resources available to mothers, to help them process mothers through the hospital services. These practices have important implications for the success of breastfeeding in hospitals as the practices by providers who are assigned to help breastfeeding initiation described here may inhibit the breastfeeding process.

Therapeutic Tears and Postpartum Blues

A qualitative study of 9 American women explored personal experiences with postpartum blues in relation to crying, breastfeeding, lactation suppression, and prior pregnancy loss. A greater understanding of postpartum rituals and cultural aspects benefits the nursing profession in order to better educate women in childbearing years.

The effect of training nursery staff in breastfeeding guidance on the duration of breastfeeding in healthy term infants

BACKGROUND

Promoting breastfeeding is a central aim of child health care. It is critical to develop approaches that are inexpensive, effective, and suitable across cultural and socioeconomic groups.

OBJECTIVE

To study the effect of training perinatal-neonatal nursing and medical staff in breastfeeding guidance on the duration of breastfeeding in a middle-income urban population.

METHODS

This was an interventional study with data collection before and after. The intervention was an intensive course on breastfeeding guidance provided to all of the neonatal nurses and midwives in a local general hospital (2001-2002). Data were collected on two cohorts of mothers and infants (before -1999 [n = 471], after -2003 [n = 364]) regarding the duration of breastfeeding and factors influencing its discontinuation.

RESULTS

The rate of breastfeeding initiation rose from 84% to 93% (p = 0.0001) and the mean duration of breastfeeding rose from 3.7 +/- 3.7 to 5.6 +/- 4.3 months (p = 0.0001). The rate of breastfeeding in the delivery room rose from 3% to 37% (p = 0.0001). Satisfaction with breastfeeding guidance in the hospital rose from 43% to 79% (p = 0.0001). However, there was no change in the proportion of mothers who planned to breastfeed this infant (88% in both cohorts) and no significant differences in the reasons given by the mothers for stopping breastfeeding.

CONCLUSION

Training hospital nursery staff in breastfeeding guidance is a potential, cost-effective intervention even in settings with relatively high rates of breastfeeding.