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Verea-Nuñez C, Novoa-Maciñeiras N, Suarez-Casal A, Vazquez-Lago JM. Factors Associated with Exclusive Breastfeeding during Admission to a Baby-Friendly Hospital Initiative Hospital: A Cross-Sectional Study in Spain. Nutrients 2024; 16:1679. [PMID: 38892611 PMCID: PMC11174580 DOI: 10.3390/nu16111679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Breastfeeding is the optimal nourishment for infants and it is recommended that children commence breastfeeding within the first hour of birth and be exclusively breastfed for the initial 6 months of life. Our objective was to determine which factors related to mothers could influence the degree of exclusive breastfeeding during hospitalization, as well as to assess breastfeeding mothers' attitudes towards breastfeeding. METHODS A multicenter cross-sectional study was undertaken in the healthcare area of Santiago de Compostela, Spain. The necessary variables were collected using a specially designed ad hoc questionnaire. The researcher responsible for recruitment conducted the interviews with the participants. The reduced Iowa Infant Feeding Attitude Scale (IIFAS-s) was employed to gauge maternal attitudes toward feeding their baby. RESULTS In total, 64 women were studied. The overall score of IIFAS-s (mean ± standard deviation) was 36.95 ± 5.17. A positive attitude towards breastfeeding was therefore observed in our sample. No use of a pacifier by the newborn was associated with a positive attitude for breastfeeding. Having previous children (Ora = 6.40; IC95% 1.26-32.51) and previous experience with breastfeeding (Ora = 6.70; IC95% 1.31-34.27) increased the likelihood of exclusive breastfeeding during admission. CONCLUSIONS In our study, exclusive breastfeeding during hospitalization is associated with having previous children and prior breastfeeding experience.
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Affiliation(s)
- Cristina Verea-Nuñez
- Resident Nurse in Pediatrics, Pediatric Service, University Hospital of Santiago de Compostela, Rua da Choupana s/n, 15705 Santiago de Compostela, Spain;
| | - Nuria Novoa-Maciñeiras
- Nurse Specialist in Pediatrics, Hospitalary Unit of Neonatology, University Hospital of Santiago de Compostela, Rua da Choupana s/n, 15705 Santiago de Compostela, Spain; (N.N.-M.); (A.S.-C.)
| | - Ana Suarez-Casal
- Nurse Specialist in Pediatrics, Hospitalary Unit of Neonatology, University Hospital of Santiago de Compostela, Rua da Choupana s/n, 15705 Santiago de Compostela, Spain; (N.N.-M.); (A.S.-C.)
| | - Juan Manuel Vazquez-Lago
- Preventive Medicine and Public Health Service, University Hospital of Santiago de Compostela, Rua da Choupana s/n, 15705 Santiago de Compostela, Spain
- UTAMI, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
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Corkery-Hayward M, Talaei M. Teleintervention's effects on breastfeeding in low-income women in high income countries: a systematic review and meta-analysis. Int Breastfeed J 2024; 19:26. [PMID: 38615079 PMCID: PMC11015560 DOI: 10.1186/s13006-024-00631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions. Teleinterventions are flexible and widely used following the global pandemic and increase maternal autonomy over intervention delivery. They show promise in improving other maternal conditions in LIW, including postpartum depression. Teleinterventions can increase breastfeeding rates in the wider maternal population, however their efficacy for this underserved population has not yet been systematically assessed. This meta-analysis aimed to identify if teleinterventions increase 'exclusive' or 'any' breastfeeding by LIW in HIC at 1-, 3-4, and 6-months postpartum. METHODS We searched five online databases for randomised controlled trials assessing breastfeeding teleinterventions for LIW in HIC. Risk ratios (RR) were used to calculate the average effect of teleinterventions on 'any' and 'exclusive' breastfeeding at at 1-, 3-4, and 6-months postpartum using random effects meta-analysis. Study bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), and outcome quality was evaluated against GRADE criteria. RESULTS Nine studies met inclusion criteria: six providing telephone calls, two text messages and one an online support group. All the studies were conducted in the United States, with small sample sizes and a high risk of bias. Pooled results indicate teleinterventions modestly increase 'any' and 'exclusive' breastfeeding at all time points, with a statistically significant increase in 'exclusive' breastfeeding after 3-4 months (RR 1.12, 95% CI [1.00,1.25]). At 3-4 months teleinterventions providing peer support were more effective than educational teleinterventions at promoting any and exclusive breastfeeding. Evidence for all outcomes were rated 'low' or 'very low' quality using the GRADE tool, mainly due to high attrition and low power. CONCLUSIONS Despite insufficient high-quality research into breastfeeding teleinterventions for LIW, our results suggest teleinterventions may improve exclusive and any breastfeeding. Given breastfeeding is particularly low in LIW population from HIC, our findings are promising and require further exploration by larger, methodologically sound trials in other HIC.
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Affiliation(s)
- Madeleine Corkery-Hayward
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Barts and The London Medical School, Queen Mary University of London, London, E1 2AD, UK.
| | - Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Subramani S. Beyond Public Health and Private Choice: Breastfeeding, Embodiment and Public Health Ethics. Asian Bioeth Rev 2024; 16:249-266. [PMID: 38586574 PMCID: PMC10994897 DOI: 10.1007/s41649-023-00259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 04/09/2024] Open
Abstract
The key objective of this paper is to emphasize the importance of acknowledging breastfeeding as an embodied social practice within interventions related to breastfeeding and lactation and illustrate how this recognition holds implications for public health ethics debates. Recent scholarship has shown that breastfeeding and lactation support interventions undermine women's autonomy. However, substantial discourse is required to determine how to align with public health goals while also recognizing the embodied experiences of breastfeeding and lactating individuals. Presently, interventions in this realm predominantly revolve around health-related messaging and the promotion of individual behaviors, often neglecting the systemic and structural factors that influence choices and practices. I closely examine breastfeeding interventions in India, in particular Mothers' Absolute Affection health promotion program, along with breastfeeding narratives. I argue that for such interventions to evolve, they must acknowledge the intrinsic embodied social nature of breastfeeding during their design and implementation. Furthermore, it is important to emphasize that achieving equity and justice objectives necessitates moving beyond the confines of both conventional public health frameworks and frameworks solely centered on private choices. Instead, a more encompassing approach that embraces the concept of embodiment should be adopted.
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Affiliation(s)
- Supriya Subramani
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Yang Y, Liu H, Cui X, Meng J. Mothers' experiences and perceptions of breastfeeding peer support: a qualitative systematic review. Int Breastfeed J 2024; 19:7. [PMID: 38243287 PMCID: PMC10797811 DOI: 10.1186/s13006-024-00614-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The global issue of low breastfeeding rates has been widely reported. Quantitative studies have shown the positive effects of peer support on breastfeeding. However, the experiences of mothers who receive breastfeeding peer support have been found to vary. To date, no systematic qualitative summary has been conducted to document the impact of peer support, nor to provide advice for its implementation from the perspective of breastfeeding mothers. This review aims to systematically synthesize qualitative findings on mothers' experiences of breastfeeding peer support to provide evidence for optimizing peer support services and ultimately enhancing their role in promoting breastfeeding. METHODS PubMed, Embase, Cochrane Library, Ovid, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Datebase, VIP Database and Chinese Biomedical Database (CBM) were searched from the inception of each database until January 2023, to collect qualitative studies and mixed methods studies that included qualitative findings on mothers' experiences with breastfeeding peer support. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to extract data and evaluate the quality of the included articles. The meta-integration method was used to explain and integrate the research findings. The review process was carried out by two authors independently, and the disagreements were resolved through consensus. RESULTS A total of 15 articles were included in the study, consisting of 13 qualitative studies and 2 mixed methods studies. The analysis identified four integrated themes: (1) obtaining psycho-emotional support; (2) acquiring knowledge and skills; (3) expectations for breastfeeding peer support; and (4) feeding perceptions and behavior change. It should be noted that the articles reviewed are in English and mostly originate from developed countries or regions. Therefore, the generalizability of the integrated findings to underdeveloped regions or non-English speaking countries may be limited. CONCLUSION Mothers perceived that peer support had a positive impact on breastfeeding. To improve the effectiveness of peer support in promoting breastfeeding, it is important to consider the individual needs of each mother. It is recommended that peer support services should be standardized in the future, including the accreditation, training, supervision, and management of peer supporters.
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Affiliation(s)
- Yuanyuan Yang
- Peking University School of Nursing, Beijing, China.
- Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China.
| | - Huijuan Liu
- Neonatal Disease Diagnosis and Treatment Center, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoyi Cui
- Peking University School of Nursing, Beijing, China
| | - Jingwen Meng
- Peking University First Hospital, Beijing, China
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Oyedele OK. Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey. BMJ Open 2023; 13:e072849. [PMID: 37798017 PMCID: PMC10565270 DOI: 10.1136/bmjopen-2023-072849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice. DESIGN AND SETTINGS A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria. PARTICIPANTS Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey. MAIN OUTCOME MEASURES TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics. METHODS Descriptive statistics were reported and graphically presented. Bivariate χ2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17. RESULTS 44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9). CONCLUSIONS CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice.
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Affiliation(s)
- Oyewole K Oyedele
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Epidemiology and Medical Statistics, University of Ibadan, College of Medicine, Ibadan, Nigeria
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Modak A, Ronghe V, Gomase KP. The Psychological Benefits of Breastfeeding: Fostering Maternal Well-Being and Child Development. Cureus 2023; 15:e46730. [PMID: 38021634 PMCID: PMC10631302 DOI: 10.7759/cureus.46730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
The value of breastfeeding surpasses its utilitarian role in nourishing, encompassing profound psychological advantages for mothers and children. The orchestration of emotional bonds relies on the interplay of oxytocin and prolactin, fundamental hormones that underpin maternal attachment, mitigate postpartum depression, and cultivate self-confidence. Simultaneously, breastfeeding promotes infant development by fostering robust brain growth, bolstering immune defenses, and nurturing cognitive and emotional maturation - all of which are nurtured through maternal interactions. We must respond to the call for heightened advocacy of breastfeeding. This entails delivering education, easily accessible support, and creating an environment where breastfeeding is normalized. By dispelling misconceptions and eradicating stigmatization associated with breastfeeding, we can amplify awareness and empower mothers to make well-informed decisions for their newborns. These implications reverberate extensively. Enhanced maternal mental well-being and self-assurance form the bedrock of healthier family dynamics. At the same time, the dividends of cognitive, emotional, and immunological enrichment in children represent a more promising future. At a societal level, the embrace and promotion of breastfeeding cultivate an environment that places immense value on the health and happiness of both mothers and children. This journey is more profound than mere sustenance; it signifies a complex web of advantages. Elevating awareness and support for breastfeeding solidifies the global commitment to comprehensive maternal and child welfare and the flourishing of meaningful relationships.
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Affiliation(s)
- Anushree Modak
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vaishnavi Ronghe
- Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kavita P Gomase
- Obstetrics and Gynaecological Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Estafanous M, Lee A, Thomas A, Burns Thomas A, Hart S, Chong N, Marcellino G, Bello O, van Dyk J, Chang S, Sterris K, Kim L, Mason D, Hart E. Breastfeeding and Antepartum Breast Milk Expression ( BABE): A Randomized Control Trial Utilizing an Electric Breast Pump and its Effect on Postpartum Breastfeeding. Breastfeed Med 2023; 18:759-766. [PMID: 37782909 DOI: 10.1089/bfm.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Objective: To evaluate the effect of antenatal breast milk expression (ABE) on exclusive breastfeeding. Materials and Methods: A randomized control study was performed with the primary outcome being formula use during the postpartum hospital stay. Secondary outcomes were the exclusive breastfeeding rate at 6 months postpartum and peripartum safety outcomes. Participants included multiparous and nulliparous patients who planned to breastfeed. Exclusion criteria included exclusively breastfeeding in prior pregnancies for greater than 6 months, medical contraindications for breastfeeding, multiple gestation, history of preterm delivery, or any contraindication to vaginal delivery. ABE group participants were instructed to pump for 20 minutes, three times daily, starting at 37 weeks of gestation. Results: Three-hundred four participants from two clinics were enrolled. There was no significant difference in formula use during hospital admission (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.34-1.22) or in exclusive breastfeeding at 6 months postpartum (OR 0.66, 95% CI 0.34-1.29). Colostrum use was more prevalent in the ABE group (OR 5.31, 95% CI 2.63-10.76). ABE participants were more likely to present in spontaneous labor (OR 2.09, 95% CI 1.05-4.14). Conclusion: ABE did not significantly improve exclusive breastfeeding rates, but safely provides women opportunities to become familiar with breastfeeding before delivery and can provide readily available colostrum. There was no negative secondary safety outcome related to ABE identified. Prenatal care providers can consider recommending ABE to patients with minimal to no experience with breastfeeding.
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Affiliation(s)
- Merai Estafanous
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Alice Lee
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Alexander Thomas
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
| | - Abbey Burns Thomas
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
| | - Spencer Hart
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Nicole Chong
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | | | - Oluwatomisin Bello
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
| | - Jennifer van Dyk
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, New York, New York, USA
| | - Stephanie Chang
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
| | - Karah Sterris
- Loma Linda University Medical Center, Department of Psychiatry, Loma Linda, California, USA
| | - Lindsey Kim
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Danielle Mason
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
| | - Elaine Hart
- Loma Linda University Medical Center, Department of Gynecology and Obstetrics, Loma Linda, California, USA
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Zahir I, Asghar W, Khalid N. Recent trends and policy shifts on empowering breastfeeding in developing countries. Nutr Health 2023; 29:359-361. [PMID: 37707368 DOI: 10.1177/02601060231196994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Izma Zahir
- Department of Food Science and Technology, School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Waqas Asghar
- Department of Food Science and Technology, School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
| | - Nauman Khalid
- Department of Food Science and Technology, School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan; College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Chen S, Washio Y, Liu A, Acker C, Herrine G. Teaching antenatal hand expression: a feasibility study in an inner urban U.S. hospital. Int Breastfeed J 2023; 18:39. [PMID: 37563682 PMCID: PMC10416364 DOI: 10.1186/s13006-023-00578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Many women have low confidence in breastfeeding and have concerns regarding low milk volume or discomfort with breastfeeding. Antenatal hand expression may be an opportunity to help women feel more comfortable with breastfeeding and help promote exclusive breastfeeding. A study at a hospital in Philadelphia, Pennsylvania, U.S. assessed the feasibility of teaching antenatal hand expression at 39 weeks among socioeconomically disadvantaged populations, overall participant satisfaction and adoption of hand expression and breastfeeding. METHODS From March 2020 to June 2021, women recruited at 34-39 weeks were taught to hand express, collect, and store colostrum. Starting from 39 weeks, participants were asked to practice hand expression 1-3 times / day until delivery, log their experiences, and store colostrum expressed. Women were contacted to encourage continued hand expression and answer any questions. Postpartum, a survey assessed satisfaction with hand expression and issues encountered. The survey also inquired about breastfeeding plans and barriers, and whether women were exclusively breastfeeding (defined as infants who received only breastmilk from the time of birth). Chart review of postpartum or well-baby visit notes determined whether women continued breastfeeding. RESULTS Of the 29 participants, 72% (21/29) reported hand expressing at home, and no women reported contractions when hand expressing. Participants rated mean satisfaction of 8.1/10 (SD = 1.62) with antenatal hand expression, mean satisfaction of 9.4/10 (SD = 0.90) toward hand expression education, mean likelihood of 9.4/10 (SD = 1.24) recommending hand expression to others, and a mean score of 8.1/10 (SD = 1.69) on how helpful hand expression was in breastfeeding initiation. 90% (26/29) of women initiated breastfeeding after birth and 72% (21/29) exclusively breastfed on discharge, but only 11/29 (38%) continued exclusively breastfeeding when re-assessed 4-6 weeks postpartum. Barriers included maternal discomfort, low milk supply, and maternal or infant illness. CONCLUSIONS This study suggests that women in an urban setting would be willing to practice antenatal hand expression. A larger and adequately powered study could be feasible to determine associations between antenatal hand expression and breastfeeding rates and confidence.
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Affiliation(s)
- Sally Chen
- Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA USA
| | - Yukiko Washio
- Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA USA
- RTI International, Research Triangle Park, NC USA
| | - Angela Liu
- Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA USA
| | | | - Gail Herrine
- Obstetrics, Gynecology, and Reproductive Sciences, Temple University Hospital, Philadelphia, PA USA
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Grech AM, Kizirian N, Lal R, Zankl A, Birkner K, Nasir R, Muirhead R, Sau-Harvey R, Haghighi MM, Collins C, Holmes A, Skilton M, Simpson S, Gordon A. Cohort profile: the BABY1000 pilot prospective longitudinal birth cohort study based in Sydney, Australia. BMJ Open 2023; 13:e068275. [PMID: 37290940 PMCID: PMC10255277 DOI: 10.1136/bmjopen-2022-068275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE The health of parents prior to conception, a woman's health during pregnancy and the infant's environment across their first months and years collectively have profound effects on the child's health across the lifespan. Since there are very few cohort studies in early pregnancy, gaps remain in our understanding of the mechanisms underpinning these relationships, and how health may be optimised. 'BABY1000', a pilot prospective longitudinal birth cohort study, aims to (1) identify factors before and during pregnancy and early life that impact longer-term health and (2) assess the feasibility and acceptability of study design to inform future research. PARTICIPANTS Participants were based in Sydney, Australia. Women were recruited at preconception or 12 weeks' gestation, and data were collected from them throughout pregnancy and postpartum, their children until the age of 2 years, and dietary information from a partner (if able) at the last study visit. The pilot aimed to recruit 250 women. However, recruitment ceased earlier than planned secondary to limitations from the COVID-19 pandemic and the final number of subjects was 225. FINDINGS TO DATE Biosamples, clinical measurements and sociodemographic/psychosocial measures were collected using validated tools and questionnaires. Data analysis and 24-month follow-up assessments for children are ongoing. Key early findings presented include participant demographics and dietary adequacy during pregnancy. The COVID-19 pandemic and associated public health and research restrictions affected recruitment of participants, follow-up assessments and data completeness. FUTURE PLANS The BABY1000 study will provide further insight into the developmental origins of health and disease and inform design and implementation of future cohort and intervention studies in the field. Since the BABY1000 pilot was conducted across the COVID-19 pandemic, it also provides unique insight into the early impacts of the pandemic on families, which may have effects on health across the lifespan.
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Affiliation(s)
- Allison Marie Grech
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Nathalie Kizirian
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Ravin Lal
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Angelika Zankl
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Karin Birkner
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Reeja Nasir
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Roslyn Muirhead
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Rachelle Sau-Harvey
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Marjan Mosalman Haghighi
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Clare Collins
- The University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, The University of Newcastle, New Lambton, New South Wales, Australia
| | - Andrew Holmes
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Skilton
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Stephen Simpson
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Adrienne Gordon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
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11
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López EP, González S, Sánchez M. Educational intervention for the main caregiver of primiparous women to promote breastfeeding and the association between prolactin and nutritional parameters. J Glob Health 2023; 13:04046. [PMID: 37083003 PMCID: PMC10119807 DOI: 10.7189/jogh.13.04046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Background In the last two years, breastfeeding rates have experienced a notable decline worldwide. Only 46% of women breastfeed their children, the figure being much lower in primiparous women. Breastfed milk is the ideal food for babies; its benefits for the health of mothers and babies are scientifically proven. Several studies show that babies who are not breastfed have a higher risk of getting sick. This fact gives rise to an important public health problem. The aim of this paper is to describe the association between presence of the caregiver in health education and increasing rates of breastfeeding. Methods We conducted an observational study (cohort) in a population of primiparous pregnant women (n = 88), and their main caregivers belonging to a region of central Spain. The development, content and implementation of the intervention consisted of: 1) obtaining the blood levels of pregnant women (prolactin, folic acid, vitamin B12 and transferrin) before health education (13-26 weeks of pregnancy), 2) carry out health education with two groups: A (44 pregnant women with caregivers) and B (44 without caregivers), 3) obtain the same blood levels as in the first intervention, 15 days after delivery, and finally the evaluation of the intervention with breastfeeding rates. Results The levels of prolactin (288.57 ± 107.46 nanogrammes per millilitre (ng / ml)), folic acid (16.93 ± 4.09 ng / ml), vitamin B12 (505.05 ± 213.97 picogrammes (pg) / ml) and transferrin (296.82 ± 67.61 milligrammmes per decilitre (mg / dl)) were higher in pregnant women who attended the health education program with a caregiver than in pregnant women who attended alone: prolcoactin (103.61 ± 45.48 ng / ml), folic acid (7.16 ± 5.88 ng / ml), vitamin B12 (160.59 ± 36.92 pg / ml) and transferrin (223.86 ± 44.14 mg / dl). Of the sample size of 44 primiparous people who attended the talks with caregivers, 35 (79.54%) breastfed their babies, while the other 44 primiparous women who attended alone, only seven (15.91%) established breastfeeding successfully. Conclusions The implications for public health research are that the presence of a caregiver in health education programs modifies levels of prolactin, folic acid, vitamin B12, and transferrin, as well as increasing breastfeeding rates.
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Affiliation(s)
- Eva Pilar López
- Doctoral School in translational Medicine San Pablo CEU University, Madrid, Spain
| | - Sergio González
- Department of Nursing, Santa Teresa de Jesus, Catholic University, Avila, Spain
| | - Mercedes Sánchez
- Department of Preventive Medicine and Public Health, Santa Teresa de Jesus, Catholic University, Avila, Spain
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12
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Strong G, Gober M, Walker M. Speaking the Same Language: A Call for Standardized Lactation Terminology in the United States. J Hum Lact 2023; 39:121-131. [PMID: 36511175 DOI: 10.1177/08903344221131041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Genae Strong
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, USA
| | - Merrilee Gober
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
| | - Marsha Walker
- National Lactation Consultant Alliance, Inc, Atlanta, GA, USA
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13
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O'Reilly SL, Conway MC, O'Brien EC, Molloy E, Walker H, O'Carroll E, McAuliffe FM. Exploring Successful Breastfeeding Behaviors Among Women Who Have High Body Mass Indices. J Hum Lact 2023; 39:82-92. [PMID: 35708019 PMCID: PMC9929695 DOI: 10.1177/08903344221102839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with high body mass indices are at risk of lower breastfeeding rates but the drivers of successful breastfeeding in this population are unclear. RESEARCH AIM We aimed to (a) explore the barriers and enablers to breastfeeding among women with high body mass indices and (b) map specific behaviors suitable for intervention across the antenatal to postpartum periods. METHODS This was a prospective, cross-sectional qualitative study. We conducted semi-structured interviews with women with high body mass indices who successfully breastfed for 6 months or more (n =20), partners (n = 22), and healthcare professionals (n =19) in Ireland during 2018. Interviews were audio recorded, and transcribed verbatim. Data were inductively coded using reflexive thematic analysis and deductively mapped within the Capability, Opportunity, Motivation-Behavior model. RESULTS The three themes developed were knowledge, support, and self-efficacy. Knowledge supported a participant's psychological and physical capability to engage in breastfeeding. Support was related to the social and physical opportunity to enable performance of breastfeeding behaviors. Self-efficacy influenced reflective and automatic motivation to perform breastfeeding behaviors. A multifactorial intervention design is needed to support successful breastfeeding. CONCLUSION The barriers and enablers identified for participants with high body mass indices were similar to those for the broader population; however, the physicality and associated social bias of high body mass indices mean that additional support is warranted. Antenatal and postpartum breastfeeding services need a multifaceted, inclusive, and high-quality program to provide the necessary support to women with higher body mass indices.
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Affiliation(s)
- Sharleen L O'Reilly
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Marie C Conway
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eva Molloy
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Hannah Walker
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Eimear O'Carroll
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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14
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DeYoreo M, Kapinos K, Lawrence R, Alvarado G, Waymouth M, Demirci JR, Uscher-Pines L. Changes in Breastfeeding and Lactation Support Experiences During COVID. J Womens Health (Larchmt) 2023; 32:150-160. [PMID: 36576992 PMCID: PMC9940799 DOI: 10.1089/jwh.2022.0146] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: We surveyed parents who gave birth from 2019 to 2021 to examine changes in breastfeeding experiences and professional and lay breastfeeding support services due to the coronavirus disease 2019 (COVID-19) pandemic. We also examined racial and ethnic disparities in breastfeeding support. Materials and Methods: A cross-sectional opt-in survey of 1,617 parents was administered on Ovia's parenting app in January 2022. Respondents were 18-45 years of age and delivered in one of three birth cohorts: August-December 2019, March-May 2020, or June-August 2021. We fit linear and logistic regression models wherein the outcomes were six breastfeeding support and experience measures, adjusting for birth cohort and respondent demographics. Results: Parents who gave birth in the early pandemic versus those in the prepandemic had reduced odds of interacting with lactation consultants (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.44-0.90), attending breastfeeding classes (OR: 0.71; 95% CI: 0.54-0.94), meeting breastfeeding goals (OR: 0.65; 95% CI: 0.46-0.92), and reporting it was easy to get breastfeeding help (estimate: -0.36; 95% CI: -0.55 to -0.17). Birth cohort was not associated with use of donor milk or receipt of in-hospital help. The later pandemic cohort differed from the prepandemic cohort for one outcome: they were less likely to meet their breastfeeding goals (OR: 0.67; 95% CI: 0.48-0.95). There were racial and ethnic disparities in the use of multiple types of breastfeeding support. Although one-third of respondents felt that the pandemic facilitated breastfeeding because of more time at home, 18% felt the pandemic posed additional challenges including disruptions to lactation support. Conclusions: Parents who gave birth in the later pandemic did not report significant disruptions to professional breastfeeding support, likely as a result of the growth of virtual services. However, disparities in receipt of support require policy attention and action.
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Affiliation(s)
| | - Kandice Kapinos
- RAND Corporation, Arlington, Virginia, USA.,Department of Population and Data Sciences, UTSW, Dallas, Texas, USA
| | | | | | | | | | - Lori Uscher-Pines
- RAND Corporation, Arlington, Virginia, USA.,Address correspondence to: Lori Uscher-Pines, PhD, RAND Corporation, 1200 S Hayes Street, Arlington, VA 22202, USA
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15
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Song JT, Kinshella MLW, Kawaza K, Goldfarb DM. Neonatal Intensive Care Unit Interventions to Improve Breastfeeding Rates at Discharge Among Preterm and Low Birth Weight Infants: A Systematic Review and Meta-Analysis. Breastfeed Med 2023; 18:97-106. [PMID: 36595356 DOI: 10.1089/bfm.2022.0151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: While breast milk is widely accepted as the best source of nutrients for almost all newborns, breastfeeding can be especially challenging for preterm and low birth weight (LBW) infants. With increased risk of admission to neonatal intensive care units (NICUs) and separation from parents, this population experiences significant barriers to successful breastfeeding. Thus, it is crucial to identify interventions that can optimize breastfeeding for preterm and LBW infants that is continued from birth and admission, through to hospital discharge and beyond. Objectives: To identify and analyze evidence-based interventions that promote any and exclusive breastfeeding among preterm and LBW neonates at discharge and/or postdischarge from hospital. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Searches were performed in the following databases: MEDLINE Ovid, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health (CINAHL). Results: From the 42 studies included, 6 groups of intervention types were identified: educational and breastfeeding support programs, early discharge, oral stimulation, artificial teats and cups, kangaroo mother care (KMC), and supportive policies within NICUs. All groupings of interventions were associated with significantly increased rates of any breastfeeding at discharge. All types of interventions except artificial teats/cups and oral stimulation showed statistically significant increases in exclusive breastfeeding at discharge. KMC demonstrated the highest increased odds of breastfeeding at discharge among preterm and LBW infants. Conclusions: A variety of effective interventions exist to promote breastfeeding among hospitalized preterm and LBW infants. Hospital settings hold unique opportunities for successful breastfeeding promotion. PROSPERO registration: CRD42021252610.
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Affiliation(s)
- Jia Tong Song
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
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16
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Khatib MN, Gaidhane A, Upadhyay S, Telrandhe S, Saxena D, Simkhada PP, Sawleshwarkar S, Quazi SZ. Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review. Front Public Health 2023; 11:984876. [PMID: 36761137 PMCID: PMC9904444 DOI: 10.3389/fpubh.2023.984876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Background Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding. Methods We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs. Result We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty. Conclusion Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020174998, PROSPERO [CRD42020174998].
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Upadhyay
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Padam Prasad Simkhada
- Global Consortium of Public Health Research, School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Shailendra Sawleshwarkar
- Postgraduate Coursework Programs, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Camperdown, NSW, Australia
| | - Syed Zahiruddin Quazi
- South Asia Infant Feeding Research Network (SAIFRN), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
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17
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Skoracka K, Hryhorowicz S, Rychter AM, Ratajczak AE, Szymczak-Tomczak A, Zawada A, Słomski R, Dobrowolska A, Krela-Kaźmierczak I. Why are western diet and western lifestyle pro-inflammatory risk factors of celiac disease? Front Nutr 2023; 9:1054089. [PMID: 36742009 PMCID: PMC9895111 DOI: 10.3389/fnut.2022.1054089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/31/2022] [Indexed: 01/21/2023] Open
Abstract
The prevalence of celiac disease increased in recent years. In addition to the genetic and immunological factors, it appears that environmental determinants are also involved in the pathophysiology of celiac disease. Gastrointestinal infections impact the development of celiac disease. Current research does not directly confirm the protective effect of natural childbirth and breastfeeding on celiac disease. However, it seems that in genetically predisposed children, the amount of gluten introduced into the diet may have an impact on celiac disease development. Also western lifestyle, including western dietary patterns high in fat, sugar, and gliadin, potentially may increase the risk of celiac disease due to changes in intestinal microbiota, intestinal permeability, or mucosal inflammation. Further research is needed to expand the knowledge of the relationship between environmental factors and the development of celiac disease to define evidence-based preventive interventions against the development of celiac disease. The manuscript summarizes current knowledge on factors predisposing to the development of celiac disease including factors associated with the western lifestyle.
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Affiliation(s)
- Kinga Skoracka
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland,Doctoral School, Poznan University of Medical Sciences, Poznań, Poland,*Correspondence: Kinga Skoracka ✉
| | | | - Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland,Doctoral School, Poznan University of Medical Sciences, Poznań, Poland
| | - Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland,Doctoral School, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksandra Szymczak-Tomczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Agnieszka Zawada
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Ryszard Słomski
- Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Iwona Krela-Kaźmierczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
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18
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Flax VL, Fagbemi M, Schnefke CH, Kawu AA, Edwards S, Unangst J, Bose S. Impacts of a social and behavior change communication program implemented at scale on infant and young feeding practices in Nigeria: Results of a cluster-randomized evaluation. PLoS One 2022; 17:e0277137. [PMID: 36480569 PMCID: PMC9731440 DOI: 10.1371/journal.pone.0277137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Infant and young child feeding (IYCF) practices are important for child survival and healthy growth, but IYCF practices remain suboptimal in Nigeria. The objective of this study was to measure the impact of Alive & Thrive's IYCF social and behavior change communication intervention on early initiation of breastfeeding, exclusive breastfeeding, and minimum dietary diversity in Kaduna and Lagos States. METHODS Local government areas were randomly allocated to intervention or comparison. Cross-sectional surveys of households with children aged 0-23 months were conducted [N = 6,266 baseline (2017), N = 7,320 endline (2020)]. Logistic regression was used to calculate difference-in-differences estimates (DDEs) of impact on IYCF practices and to assess within group changes from baseline to endline. Associations between intervention exposures and IYCF practices were tested in both study groups combined. RESULTS In Kaduna, a positive differential effect of the intervention was found for exclusive breastfeeding (adjusted DDE 8.9 pp, P<0.099). Increases in both study groups from baseline to endline were observed in Kaduna for early initiation of breastfeeding (intervention 12.2 pp, P = 0.010; comparison 6.4 pp, P = 0.118) and minimum dietary diversity (intervention 20.0 pp, P<0.001; comparison 19.7 pp, P<0.001), which eliminated differential effects. In Lagos, no differential intervention impacts were found on IYCF practices because changes in early initiation of breastfeeding from baseline to endline were small in both study groups and increases in both study groups from baseline to endline were observed for exclusive breastfeeding (intervention 8.9 pp, P = 0.05; comparison 6.6 pp, P<0.001) and minimum dietary diversity (intervention 18.9 pp, P<0.001; comparison 24.3 pp, P<0.001). Odds of all three IYCF practices increased with exposure to facility-based interpersonal communication in both states and with community mobilization or mass media exposure in Kaduna. CONCLUSIONS This evaluation found weak impacts of the Alive & Thrive intervention on IYCF practices in the difference-in-differences analysis because of suspected intervention spillover to the comparison group. Substantial within group increases in IYCF practices from baseline to endline are likely attributable to the intervention, which was the major IYCF promotion activity in both states. This is supported by the association between intervention exposures and IYCF practices. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT02975063).
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Affiliation(s)
- Valerie L. Flax
- RTI International, Research Triangle Park, North Carolina, United States of America
- * E-mail:
| | | | - Courtney H. Schnefke
- RTI International, Research Triangle Park, North Carolina, United States of America
| | | | - Susan Edwards
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jennifer Unangst
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Sujata Bose
- Alive & Thrive, FHI Solutions, Washington, District of Columbia, United States of America
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19
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1194-1248. [PMID: 36339632 PMCID: PMC9633230 DOI: 10.1055/a-1904-6769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Korrespondenzadresse Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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20
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Pommeret-de Villepin B, Barasinski C, Rigourd V. Initiating and Supporting Breastfeeding: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S56-S73. [PMID: 36480673 DOI: 10.1111/jmwh.13420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Exclusive breastfeeding is recommended for children for the first 4 to 6 months of life, with complementary foods added thereafter. It is the most ecological way of protecting the child's and mother's health. Training of health professionals is required to avoid transmitting inconsistent information in 3 areas: 1) implementing these 3 predictors: safe skin-to-skin, first breastfeed, and rooming-in 24/7; 2) teaching and monitoring: i) early signs of waking and feeding rhythms, ii) positioning and latching, and iii) signs of effective transfer; and 3) referring women to specialized support services if difficulties arise (eg, inadequate milk production, pain, cracked nipples, engorgement). Breastfeeding should continue during mastitis or an abscess. Ultrasound-guided needle aspiration is beneficial in treating an abscess. Précis: Information is provided to enable health professionals to better support breastfeeding and help women with the most common difficulties, thus promoting breastfeeding initiation and duration.
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Affiliation(s)
- Brune Pommeret-de Villepin
- Service gynécologie-obstétrique, Centre hospitalier de Tourcoing, 155 rue du Président-René-Coty, Tourcoing, 59200, France
| | - Chloé Barasinski
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Axe TGI-DecisipH, Clermont-Ferrand, F-63000, France
| | - Virginie Rigourd
- Pédiatre en néonatalogie médecin responsable du lactarium régional d'Ile de France Hopital, Necker Enfants malades, Paris, France
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Chuisano SA, Anderson OS, Weirauch K, Roper R, Phillips J, McCabe C, Sadovnikova A. An Application of Kane's Validity Framework to Evaluate Formative and Summative Assessment Instruments for Telesimulations in Clinical Lactation. Simul Healthc 2022; 17:313-321. [PMID: 35322800 DOI: 10.1097/sih.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Health professional learners have limited exposure to breastfeeding patients from diverse backgrounds in clinical rotations. Instead, simulation-based training is used for lactation skills training. There are no validated or standardized simulations and assessment rubrics for lactation. In this pilot, breastfeeding telesimulations with standardized patients (SPs) wearing a high-fidelity breast model matching their skin tone were developed. The validity of Formative and Summative Assessment Rubrics (FAR, SAR) were assessed following Kane's validity framework. The objective was to provide initial evidence for the validity of the FAR and SAR as constructs of competence in lactation support at the entry to practice or practice level. METHODS Three breastfeeding case scenarios, FAR, and SAR were developed and evaluated with clinical lactation specialists (evaluators, n = 17) and SPs. The FAR was used in practice telesimulations where SPs' (n = 14) performance and telesimulation feasibility were assessed. The FAR was updated in preparation for a pilot study where medical students (n = 13) completed the 3 telesimulations. In the pilot, the updated FAR was used by SPs (n = 6) to assess medical students' performance of clinical skills. After the pilot, rubrics were updated after focus groups with SPs and discussions with evaluators. Evaluators (n = 3) graded students' posttelesimulation documentations using the SAR. Cronbach ɑ level and the intraclass correlation coefficient were assessed iteratively to collect evidence for the scoring, generalizability, and extrapolation of the FAR and SAR according to Kane's framework. RESULTS The FAR and SAR were found to have acceptable internal consistency and moderate to high interrater reliability (intraclass correlation coefficient, 0.55-0.94), which provided evidence for scoring and generalizability of the instruments. Evaluators agreed that SPs' performances were realistic (5.6/6), and SPs' feedback was organized (5.5/6) and helpful (5.6/6), which provided evidence for extrapolation. CONCLUSIONS Initial evidence for validity of scoring, generalization, and extrapolation FAR and SAR (according to Kane's framework) in assessing health professional learner's performance of clinical lactation skills has been presented. These results from a pilot study suggest that the FAR and SAR are reliable instruments for assessing learners' clinical performance in a breastfeeding-focused telesimulation where the SP wears a high-fidelity breast model matching their skin tone. Additional studies will be required to collect evidence according to all 4 categories of Kane's framework for the validity of the FAR and SAR.
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Affiliation(s)
- Samantha A Chuisano
- From LiquidGoldConcept, Inc. (S.A.C., A.S.), Ypsilanti; Department of Nutritional Sciences (O.S.A., C.M.), University of Michigan School of Public Health, Ann Arbor, MI; Sparrow-MSU Family Medicine Residency Program (K.W., R.R.), Lansing, MI; Department of Family Medicine (J.P.), College of Human Medicine, Michigan State University, East Lansing, MI; and Physician Scientist Training Program (A.S.), University of California, Davis, Davis, CA
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Bengough T, Dawson S, Cheng H, McFadden A, Gavine A, Rees R, Sacks E, Hannes K. Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis. MATERNAL & CHILD NUTRITION 2022; 18:e13405. [PMID: 36006012 PMCID: PMC9480951 DOI: 10.1111/mcn.13405] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/05/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022]
Abstract
Breastfeeding is an integral part of early childhood interventions as it can prevent serious childhood and maternal illnesses. For breastfeeding support programmes to be effective, a better understanding of contextual factors that influence women's engagement and satisfaction with these programmes is needed. The aim of this synthesis is to suggest strategies to increase the level of satisfaction with support programmes and to better match the expectations and needs of women. We systematically searched for studies that used qualitative methods for data collection and analysis and that focused on women's experiences and perceptions regarding breastfeeding support programmes. We applied a maximum variation purposive sampling strategy and used thematic analysis. We assessed the methodological quality of the studies using a modified version of the CASP tool and assessed our confidence in the findings using the GRADE-CERQual approach. We included 51 studies of which we sampled 22 for in-depth analysis. Our sampled studies described the experiences of women with formal breastfeeding support by health care professionals in a hospital setting and informal support as for instance from community support groups. Our findings illustrate that the current models of breastfeeding support are dependent on a variety of contextual factors encouraging and supporting women to initiate and continue breastfeeding. They further highlight the relevance of providing different forms of support based on socio-cultural norms and personal backgrounds of women, especially if the support is one-on-one. Feeding decisions of women are situated within a woman's personal situation and may require diverse forms of support.
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Affiliation(s)
- Theresa Bengough
- Research Group SoMeTHin'K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social SciencesKU LeuvenLeuvenBelgium
- National Centre for Early Childhood InterventionThe Austrian Public Health InstituteViennaAustria
| | - Shoba Dawson
- Faculty of Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Hui‐Lin Cheng
- School of NursingThe Hong Kong Polytechnic UniversityKowloonHong Kong
| | - Alison McFadden
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Anna Gavine
- School of Health SciencesUniversity of DundeeDundeeScotlandUK
| | - Rebecca Rees
- EPPI‐Centre, Social Science Research Unit, UCL Institute of EducationUniversity College LondonLondonUK
| | - Emma Sacks
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Karin Hannes
- Research Group SoMeTHin'K (Social, Methodological and Theoretical Innovation/Kreative), Faculty of Social SciencesKU LeuvenLeuvenBelgium
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Foong SC, Foong WC, Tan ML, Ho JJ, Omer-Salim A. A Participatory, Needs-Based Approach to Breastfeeding Training for Confinement Centres. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10914. [PMID: 36078639 PMCID: PMC9517788 DOI: 10.3390/ijerph191710914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
With a focus on traditional practices rather than evidence-based practices, breastfeeding support is sub-optimal in confinement centres (CCs). We used a participatory, needs-based approach to develop a training module for CC staff adopting Kern's six-step approach as our conceptual framework. Of 46 identified CCs, 25 accepted our invitation to a dialogue aimed at establishing relationships and understanding their needs. An interactive training workshop was developed from the dialogue's findings. The workshop, attended by 32 CCs (101 participants), was conducted four times over a four-month period. Questions raised by the participants reflected deficits in understanding breastfeeding concepts and erroneous cultural beliefs. Correct answers rose from 20% pre-test to 51% post-test. Post-workshop feedback showed that participants appreciated the safe environment to ask questions, raise concerns and correct misconceptions. An interview conducted 14 months later showed that while some CCs improved breastfeeding support, others made no change due to conflict between breastfeeding and traditional postnatal practices, which was aggravated by a lack of support due to the COVID-19 pandemic. A participatory approach established a trustful learning environment, helping CCs appreciate the value of learning and adopting new concepts. However, cultural perceptions take time to change, hence continuous training and support are vital for sustained changes.
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Affiliation(s)
- Siew Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (Formerly Penang Medical College), George Town 10450, Malaysia
| | - Wai Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (Formerly Penang Medical College), George Town 10450, Malaysia
| | - May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (Formerly Penang Medical College), George Town 10450, Malaysia
| | - Jacqueline J. Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (Formerly Penang Medical College), George Town 10450, Malaysia
| | - Amal Omer-Salim
- World Alliance for Breastfeeding Action, George Town 10850, Malaysia
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Yip KH, Yip YC, Tsui WK. The Lived Experiences of Women without COVID-19 in Breastfeeding Their Infants during the Pandemic: A Descriptive Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159511. [PMID: 35954868 PMCID: PMC9368050 DOI: 10.3390/ijerph19159511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak in 2020 has led to several changes and disturbances in the daily lives of the general public. Particularly for new (first-time) mothers, there has been a significant impact on the practices of raising and feeding their babies. Social distancing measures everywhere have made mothers hesitant to breastfeed their babies anywhere else but at home. Combined with the fear of being infected with COVID-19, the present situation has created unprecedented barriers for breastfeeding mothers to accessing various types of support: emotional, instrumental, informational, and appraisal. There has been no research on the influence of the pandemic on social support regarding breastfeeding in Hong Kong. This study aimed to explore the social support and impact of COVID-19 on mothers breastfeeding their babies. Semi-structured interviews were conducted with 20 currently breastfeeding women in Hong Kong. Colaizzi’s seven-step method was used for data analysis. Two key themes emerged from the interview data: (1) positive influences on breastfeeding support during COVID-19 and (2) negative influences on breastfeeding support during COVID-19. Our findings may help mothers prepare to breastfeed their babies in places other than their homes.
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What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study. J Perinatol 2022; 42:1083-1090. [PMID: 34725448 DOI: 10.1038/s41372-021-01259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To explore LGBTQI+ parental experiences regarding their interactions with healthcare professionals as a resource for feeding options during the prenatal-to-neonatal period. STUDY DESIGN This single-center, interview-based qualitative study of LGBTQI+ parents utilized grounded theory to identify and verify emergent themes and subthemes. We developed a conceptual framework to illustrate relationships among themes and subthemes, as well as opportunities for healthcare professionals and families to improve LGBTQI+ parental support. RESULTS Thematic saturation was attained after interviewing 21 parents from 12 families. Analyses revealed four main themes representing opportunities for improvement: education, continuity of care, parental engagement and open communication. Personal and interpersonal factors influenced parental experiences and decisions, which shaped ultimate feeding outcomes. CONCLUSIONS LGBTQI+ parents revealed challenges of establishing feeding practices that best aligned with their values and goals. Recognizing these factors can help healthcare professionals improve their counseling, engagement and support of LGBTQI+ parents.
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Birhan TY, Alene M, Seretew WS, Taddese AA. Magnitude and determinants of breastfeeding initiation within one hour among reproductive women in Sub-Saharan Africa; evidence from demographic and health survey data: a multilevel study. BMC Public Health 2022; 22:1062. [PMID: 35624450 PMCID: PMC9145512 DOI: 10.1186/s12889-022-13114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Early initiation of breastfeeding is one of the most simple and essential intervention for child development and survival in the world. World Health Organization recommended to begin breast milk with one hour after delivery. The objective of this study was to determine the magnitude of early initiation of breastfeeding in Sub-Saharan Africa using DHS data set. Methods This study was carried out within 32 Sub-Saharan African countries from 2010–2020, a pooled study of early initiation of breastfeeding was performed. For assessing model fitness and contrast, intra-class correlation coefficient, median odds ratio, proportional change in variance, and deviance were used. In order to identify possible covariates associated with early initiation of breastfeeding in the study area, the multilevel multivariable logistic regression model was adapted. Adjusted Odds Ratio was used with 95% confidence interval to declare major breastfeeding factors. Result The pooled prevalence of early initiation of breastfeeding in Sub-Saharan Africa countries was 57% (95% CI; 56%—61%), the highest prevalence rate of early initiation of breastfeeding was found in Malawi while the lowest prevalence was found in Congo Brazzaville (24%). In multilevel multivariable logistic regression model; wealth index (AOR = 1.20; 95% CI 1.16 – 1.26), place of delivery (AOR = 1.97; 95% CI 1.89 – 2.05), skin-to-skin contact (AOR = 1.51; 95% CI 1.47 – 1.57), mode of delivery (AOR = 0.27; 95% CI 0.25 – 0.29), media exposure (AOR = 1.36; 95% CI 1.31 – 1.41) were significantly correlated with early initiation of breastfeeding in Sub-Saharan Africa. Conclusion The magnitude of early initiation of breastfeeding rate was low in Sub-Saharan Africa. Covariates significantly associated with early initiation of breastfeeding was wealth index, place of delivery, mode of delivery, women educational status, and media exposure. Structural improvements are required for women with caesarean births to achieve optimal breastfeeding practice in Sub-Saharan Africa.
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Affiliation(s)
- Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Muluneh Alene
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wullo Sisay Seretew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asefa Adimasu Taddese
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Nagendla P, Manju A, Somasekhara Aradhya A, Shebannavar RN, Venkatagiri P. Sustaining immediate newborn care processes (delayed cord clamping and early breastfeeding initiation) in the delivery room: a quality improvement study. BMJ Open Qual 2022; 11:bmjoq-2021-001705. [PMID: 35584842 PMCID: PMC9119176 DOI: 10.1136/bmjoq-2021-001705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/08/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Immediate newborn care processes like delayed cord clamping (DCC) and early breastfeeding initiation (EBFI) in the delivery room have several benefits including survival. Despite the evidence, the practices have not been widely adopted. We used a point-of-care quality improvement (QI) to implement and sustain these two immediate newborn care processes in our delivery room over a period of 2 years through a series of plan-do-study-act (PDSA) cycles. METHODS All neonates above 30 weeks of gestation irrespective of the need for resuscitation except Rh-isoimmunisation were eligible for DCC. Neonates >35 weeks not requiring respiratory support or resuscitation were eligible for EBFI. The root causes of gaps in the quality were analysed by fishbone analysis. The key quantitative outcome measure was the percentage of eligible deliveries in which DCC and EBFI were done. Duration of DCC was also recorded in the sustenance phase. This implementation was done through three PDSA cycles and the practices were sustained for 2 years. RESULTS A total of 770 deliveries were part of this QI study from October 2018 to December 2020. There was a significant improvement in DCC (median) from a baseline of 25% to 96% over a 2-year period. Sensitisation, making DCC part of pre-birth checklist and recording outcomes on a dashboard daily helped to implement and sustain the processes over 2 years. As a co-process, EBFI improved (median) from a baseline of 50% to 97% without any major intervention in the system. CONCLUSIONS Immediate newborn care processes could be sustained by making them part of pre-birth preparation and dashboard recording by a QI initiative without any additional resources.
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Affiliation(s)
- Pranavi Nagendla
- Obstetrics & Gynaecology, Ovum Hospitals, Bangalore, Karnataka, India
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Barta KR. Ethical Considerations for Hospital-Based Infant Feeding Support. J Obstet Gynecol Neonatal Nurs 2022; 51:243-256. [PMID: 35460604 DOI: 10.1016/j.jogn.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
I applied a systematic ethical decision-making approach to evaluate how health care professionals in hospital settings should provide infant feeding support after childbirth. Human milk is recommended as the optimal source of nutrition for infants because of the health benefits it provides for infants and their lactating parents. However, health consequences of insufficient oral intake in infants and psychological distress in the lactating parent may occur when infant feeding does not go according to plan. Infant feeding support should be provided in a way that is objective, sensitive, individualized, equitable, and supportive of autonomy and avoids harm. I provide recommendations for ethical infant feeding support that can be applied by individual health care professionals and on postpartum units in hospitals.
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McCarter D, Law AA, Cabullo H, Pinto K. Scoping Review of Postpartum Discharge Education Provided by Nurses. J Obstet Gynecol Neonatal Nurs 2022; 51:377-387. [PMID: 35483423 DOI: 10.1016/j.jogn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding. DATA SOURCES We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020. STUDY SELECTION We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria. DATA EXTRACTION We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results. DATA SYNTHESIS Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information. CONCLUSION Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.
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Philemon RN, Mmbaga BT, Bartlett J, Renju J, Mtuy TB, Mboya IB, Msuya SE. Adherence to Optimal Breastfeeding Practices Among HIV-Positive Mothers in Kilimanjaro, Tanzania. Patient Prefer Adherence 2022; 16:841-852. [PMID: 35387257 PMCID: PMC8977531 DOI: 10.2147/ppa.s343213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose We sought to assess how HIV-positive mothers enrolled in the PMTCT program adhere to breastfeeding recommendations concerning early initiation of breastfeeding (EIBF), ie, within one hour of birth, pre-lacteal feeds, exclusive breastfeeding until six months (EBF), and continued breastfeeding to one year of age. This study was designed to assess the practices in response to changing recommendations for breastfeeding in HIV, which have differed drastically over the years. Patients and Methods We recruited 524 mother-child pairs from 37 PMTCT clinics across Kilimanjaro, Tanzania. The 5 clinics with the highest patient load in each of the 7 districts of Kilimanjaro were chosen, plus the zonal and municipal referral hospitals. The children were below two years of age and currently in the PMTCT program. We administered a questionnaire to assess the mother's practices in feeding the child. We used multiple logistic regression models to determine factors associated with EIBF, EBF, and continued breastfeeding. Results EIBF was achieved for 73.1% of babies. Cesarean delivery, low birth weight, and partner disclosure of HIV status were significant risk factors for not achieving EIBF. About 19% of children did not breastfeed exclusively. Of the 247 children ≥12 months old, 43.3% had stopped breastfeeding before 12 months. Counseling on ARV, having had >2 pregnancies while HIV-positive and EBF were associated with breastfeeding until 12 months old. Using ART for more than two years decreased the odds of EBF and continued breastfeeding to 12 months of age. Conclusion Adherence to breastfeeding recommendations for HIV-positive women is suboptimal, particularly in aspects of recent changes in recommendations such as continuing breastfeeding for one year. There is a missed opportunity for interventions such as counseling, which has shown to favor adherence. Health education and counseling are needed for providers and mothers to keep them abreast with the frequently changing recommendations.
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Affiliation(s)
- Rune Nathaniel Philemon
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College (KCMUCo) & Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
- Department of Research, Kilimanjaro Clinical Research Institute (KCRI), Moshi, Kilimanjaro, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jenny Renju
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Population Studies, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Tara B Mtuy
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Faculty of Public Health and Policy and the Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Innocent B Mboya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- School of Mathematics, Statistics & Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Sia E Msuya
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Kilimanjaro, Tanzania
- Department of Community Health, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Kilimanjaro, Tanzania
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What Works to Improve Nutrition and Food Sustainability across the First 2000 Days of Life: A Rapid Review. Nutrients 2022; 14:nu14040731. [PMID: 35215381 PMCID: PMC8878998 DOI: 10.3390/nu14040731] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Informed by the Innocenti framework, this rapid review of systematic reviews (n = 60) and sentinel grey literature (n = 27) synthesises the evidence of what works to improve nutrition and food sustainability across the first 2000 days. Most systematic reviews focused on interventions targeting the behaviour of parents and caregivers (n = 49), with fewer reviews focusing on the personal (n = 7) and external (n = 4) food environments. No reviews focused on food supply-chain activities. Most reviews were rated as critically low (n = 28, 47%) or low (n = 21, 35%) quality using AMSTAR 2. Evidence supports the effectiveness of multi-component breastfeeding interventions, interventions delivered in home and child-care settings, particularly when involving parents, interactive skill building and repeated exposure to vegetables. Food vouchers and access to local farmers markets and community gardens have potential for improving access and availability to healthier foods, while evidence supports interventions improving the external food environment, including fiscal strategies such as the SSB tax, restrictions on marketing and advertising of discretionary products and improved food labelling. Overall, this review highlights the importance of action across a range of settings and sectors at the international, national and local levels to improve young children’s diets.
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Pontoppidan M, Nygaard L, Thorsager M, Friis-Hansen M, Davis D, Nohr EA. The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood. Trials 2022; 23:73. [PMID: 35073975 PMCID: PMC8785506 DOI: 10.1186/s13063-022-06022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child. METHODS The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child. DISCUSSION The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.
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Affiliation(s)
- Maiken Pontoppidan
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Lene Nygaard
- University of Canberra and ACT Health, Bruce, Australia
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Thorsager
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Mette Friis-Hansen
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Deborah Davis
- University of Canberra and ACT Health, Bruce, Australia
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
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van Goudoever JB, Spatz DL, Hoban R, Dumitriu D, Gyamfi-Bannerman C, Berns M, McKechnie L, Davanzo R. Updating Clinical Practices to Promote and Protect Human Milk and Breastfeeding in a COVID-19 Era. Front Pediatr 2022; 10:867540. [PMID: 35558372 PMCID: PMC9086708 DOI: 10.3389/fped.2022.867540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/30/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to deliver breastfeeding information and education to parents-to-be will be critical. In addition, the establishment of a hospital culture that values breastfeeding and prioritizes the use of human milk will be integral for the motivation of health care professionals. That culture will also support active management of the initiation of lactation and the development of a 'back-up plan' toolkit to support the mother experiencing lactation difficulties. Post-discharge support will also be crucial with the development of both in-person and virtual lactation support programs, in particular for the immediate post-discharge period to benefit mothers who experience an early discharge process. These measures will allow for a new, adapted framework of practice that acknowledges the current COVID-19 paradigm and maintains the emphasis on the need to protect and support breastfeeding and the use of human milk.
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Affiliation(s)
| | - Diane L Spatz
- University of Pennsylvania School of Nursing & Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Rebecca Hoban
- The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, Canada
| | - Dani Dumitriu
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - Monika Berns
- Charité - Universitätsmedizin, Klink für Neonatologie, Berlin, Germany
| | - Liz McKechnie
- Leeds Centre for Newborn Care, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Riccardo Davanzo
- Institute for Maternal and Child Health Institute, IRCCS "Burlo Garofolo", Trieste, Italy
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Women's experiences of initiating feeding shortly after birth in Ireland: A secondary analysis of quantitative and qualitative data from the National Maternity Experience Survey. Midwifery 2022; 107:103263. [DOI: 10.1016/j.midw.2022.103263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
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Jenkins V, Everett BG, Steadman M, Mollborn S. Breastfeeding Initiation and Continuation Among Sexual Minority Women. Matern Child Health J 2021; 25:1757-1765. [PMID: 34417684 PMCID: PMC10317205 DOI: 10.1007/s10995-021-03218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed disparities. METHODS We used data from the 2006 to 2017 National Survey of Family Growth female pregnancy questionnaire. We measured sexual orientation using self-reported sexual identity and histories of same-sex sexual experiences reported by women (heterosexual-WSM [women who only reported sex with men]; heterosexual-WSW [women who reported sex with women]; bisexual, and lesbian. In total, we had 18,696 births that occurred within the last 10 years and used logistic and multinomial regression models to assess sexual orientation disparities in breastfeeding initiation and duration that clustered on women to account for potential multiple births to a woman. RESULTS Compared to heterosexual-WSM, infants born to lesbian-identified women had decreased odds of ever being breastfed (OR 0.55, 95% CI 0.30, 0.99) and a decreased relative risk of being breastfed more than 6 months (RRR 0.46, 95% CI 0.22, 0.97). Infants of heterosexual-WSW had an increased odds of ever breastfeeding (OR 1.40, 95% CI 1.12, 1.74) and increased relative risk of breastfeeding more than 6 months (RRR 1.32, 95% CI 1.02, 1.69). CONCLUSIONS Our results show that infants born to lesbian-identified women were less likely to be breastfed than those born to their heterosexual counterparts, even after adjusting for several factors associated with breastfeeding behaviors. We found no differences in breastfeeding between bisexual women and heterosexual-WSM. Understanding and addressing the barriers sexual minority women face for breastfeeding is critical for ensuring maternal and child health equity.
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Affiliation(s)
- Virginia Jenkins
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT, 84112, USA.
| | - Bethany G Everett
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT, 84112, USA
| | - Mindy Steadman
- Department of Sociology, The University of Utah, 390 1530 E #301, Salt Lake City, UT, 84112, USA
| | - Stefanie Mollborn
- Department of Sociology, Stockholm University and University of Colorado Boulder, Stockholm, Sweden
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The Effect of a Structured Individualized Educational Intervention on Breastfeeding Rates in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111359. [PMID: 34769876 PMCID: PMC8582789 DOI: 10.3390/ijerph182111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Breastfeeding rates remain extremely low in Greece and women with gestational diabetes mellitus and hypothyroidism may experience additional difficulties. The aim of the study was to investigate the effect of a structured individualized lactation educational intervention by a midwife on increasing breastfeeding rates in women with endocrine disorders and low-risk women compared to women receiving standard care, 24 months after delivery. Two-hundred women made up the study population. Half of them were experiencing endocrine pregnancy disorders and 100 women constituted the low-risk pregnancy standard care control group. Women who were breastfeeding exclusively were significantly higher in the midwifery intervention group with endocrine disorders, namely breastfeeding continued at four months (breastfeeding: 20% vs. 12%, exclusive breastfeeding: 50% vs. 26%, p = 0.0228), and at six months after childbirth (breastfeeding: 54% vs. 28%, exclusive breastfeeding: 32% vs. 12%, p = 0.0011), compared to the standard care control group with endocrine disorder. The low-risk midwifery intervention group breastfed at four months (22% vs. 14%, p = 0.0428) and at six months (52% vs. 26%, p = 0.0018) at higher rates compared to the standard care control group. In addition, exclusive breastfeeding was significantly higher in the low-risk midwifery intervention group at four months (46% vs. 20%, p = 0.0102) and six months (38% vs. 4%, p < 0.0001) compared to the standard care control group. This study was the first attempt of a structured midwifery breastfeeding education in Greece and its major contribution reflects a significant positive impact on breastfeeding rates in terms of duration and exclusivity in women with gestational endocrine disorders as well as in low-risk women, and could possibly be applied and instituted in everyday clinical practice to increase the low breastfeeding rates in Greece.
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Guyatt S, Ferguson M, Beckmann M, Wilkinson SA. Using the Consolidated Framework for Implementation Research to design and implement a perinatal education program in a large maternity hospital. BMC Health Serv Res 2021; 21:1077. [PMID: 34635125 PMCID: PMC8507156 DOI: 10.1186/s12913-021-07024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation science aims to embed evidence-based practice as 'usual care' using theoretical underpinnings to guide these processes. Conceptualising the complementary purpose and application of theoretical approaches through all stages of an implementation project is not well understood and is not routinely reported in implementation research, despite call for this. This paper presents the synthesis and a collective approach to application of a co-design model, a model for understanding need, theories of behaviour change with frameworks and tools to guide implementation and evaluation brought together with the Consolidated Framework for Implementation Research (CFIR). METHOD Using a determinant framework such as the CFIR provides a lens for understanding, influencing, and explaining the complex and multidimensional variables at play within a health service that contribute to planning for and delivering effective patient care. Complementary theories, models, frameworks, and tools support the research process by providing a theoretical and practical structure to understanding the local context and guiding successful local implementation. RESULTS This paper provides a rationale for conceptualising the multidimensional approach for implementation using the worked example of a pregnancy, birth, postnatal and early parenting education intervention for expectant and new parents at a large maternity hospital. CONCLUSION This multidimensional theoretical approach provides useful, practical guidance to health service researchers and clinicians to develop project specific rationale for their theoretical approach to implementation projects.
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Affiliation(s)
- Sheridan Guyatt
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia.
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia.
| | - Megan Ferguson
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4072, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, 0810, Australia
| | - Michael Beckmann
- Physiotherapy Department, Mater Misericordiae Ltd, Level 2 Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
| | - Shelley A Wilkinson
- Mater Research, The University of Queensland, Brisbane, Queensland, 4101, Australia
- School of Human Movements and Nutrition Science, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia
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Impact of early-onset sepsis guidelines on breastfeeding. J Perinatol 2021; 41:2499-2504. [PMID: 34362994 DOI: 10.1038/s41372-021-01154-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of changes to neonatal early-onset sepsis (EOS) guidelines on in-hospital breastfeeding. STUDY DESIGN Asymptomatic neonates admitted to the Neonatal Intensive Care Unit (NICU) for sepsis evaluations over a 2-year period were identified. A retrospective chart review was conducted as part of a larger quality initiative on antibiotic stewardship. RESULT In Epoch 1, Epoch 2, and Epoch 3, there were 268 babies, 138 babies and 138 babies admitted to the NICU based on sepsis protocol, respectively. When comparing Epoch 1 to Epoch 3, there was a 14% increase in total breast milk consumption rates (p < 0.0001) and a 15% increase in exclusive breastfeeding at discharge (p < 0.002). CONCLUSION By implementing new EOS protocols, we have decreased NICU length of stay. We suggest that the decrease in mother-infant separation time leads to an improvement in breastfeeding.
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Ossai CR, McDonnell J, Behairy M, Schelzig C, Larkin L, Jones J, Liu W, Das A. Association of Parental Use of Patient Portals with Breastfeeding Rates in Infants. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2021.1943635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chionye R. Ossai
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - John McDonnell
- Department of Allergy and Immunology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Mohga Behairy
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Colleen Schelzig
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Lauren Larkin
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Jessica Jones
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirudha Das
- Department of Neonatology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
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[S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]. Anaesthesist 2021; 70:1031-1039. [PMID: 34487216 DOI: 10.1007/s00101-021-01024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.
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Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.
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Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Saniel OP, Pepito VCF, Amit AML. Effectiveness of peer counseling and membership in breastfeeding support groups in promoting optimal breastfeeding behaviors in the Philippines. Int Breastfeed J 2021; 16:53. [PMID: 34247624 PMCID: PMC8274007 DOI: 10.1186/s13006-021-00400-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of early initiation of breastfeeding and exclusive breastfeeding (EBF) at 6 months remain low in the Philippines. To help meet the 90% early initiation of breastfeeding target and to improve infant and young child feeding practices in the Philippines, the Millennium Development Goals - Fund 2030 Joint Programme (JP) on Ensuring Food Security and Nutrition for Children 0–24 months old was implemented. We aimed to determine the effectiveness of visits by peer counselors during pregnancy and after delivery, and membership in breastfeeding support groups in promoting these optimal breastfeeding practices. Methods We used data from the Endline Survey of the JP to study the effects of prenatal and postnatal peer counselor visits, and membership in breastfeeding support groups, and their possible interactions with initiation of breastfeeding within 1 hour of birth among children aged 0 to 24 months and EBF at 6 months among children aged 6 to 24 months, while adjusting for confounding. We used logistic regression methods for survey data to assess these associations. Results Of the 2343 mother-infant pairs, only 1500 (63.1%) practiced early initiation of breastfeeding. Of the 1865 children aged 6 months or older, only 621 (34.7%) were exclusively breastfed at 6 months. After adjusting for confounding variables, there was no strong evidence that peer counselor visits were associated with early initiation or EBF at 6 months. However, members of breastfeeding support groups had 1.49 times higher odds of early initiation of breastfeeding (95% CI [Confidence Interval] 1.12, 1.98) and 1.65 times higher odds of EBF (95% CI 1.20, 2.24) compared to those who were not members of breastfeeding support groups. There was no interaction between the different exposure variables and early initiation and EBF at 6 months. Conclusions Our findings suggest breastfeeding support groups may be institutionalized to promote both early initiation of breastfeeding and EBF in the Philippines, while the role of peer counselors in promoting optimal breastfeeding behaviors should be further reviewed. Our suggestion to integrate non-healthcare professionals to promote early initiation of breastfeeding and EBF could be tested in future intervention studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-021-00400-5.
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Affiliation(s)
- Ofelia P Saniel
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines. .,Symmetrix Research Consultancy Company, Manila, Philippines.
| | - Veincent Christian F Pepito
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City, Philippines
| | - Arianna Maever L Amit
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St., Ermita, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Ortigas Ave., Pasig City, Philippines
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Moon H, Woo K. An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects. MATERNAL & CHILD NUTRITION 2021; 17:e13200. [PMID: 33960665 PMCID: PMC8189189 DOI: 10.1111/mcn.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/27/2021] [Accepted: 04/13/2021] [Indexed: 12/02/2022]
Abstract
Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face-to-face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.
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Affiliation(s)
- Hyojeong Moon
- College of NursingSeoul National UniversitySeoulSouth Korea
| | - Kyungmi Woo
- The Research Institute of Nursing Science, College of NursingSeoul National UniversitySeoulSouth Korea
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Perez MR, de Castro LS, Chang YS, Sañudo A, Marcacine KO, Amir LH, Ross MG, Coca KP. Breastfeeding Practices and Problems Among Obese Women Compared with Nonobese Women in a Brazilian Hospital. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:219-226. [PMID: 34235509 PMCID: PMC8243705 DOI: 10.1089/whr.2021.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum. Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2). Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29-6.10) compared with the nonobese group on the third day. Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.
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Affiliation(s)
- Marina Rico Perez
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucíola Sant'Anna de Castro
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Adriana Sañudo
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Victoria, Australia
- Breastfeeding Service, Royal Women's Hospital, Victoria, Australia
| | - Michael G. Ross
- Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kelly Pereira Coca
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
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Navarro I, Soriano JM, Laredo S. Applying systematic review search methods to the grey literature: a review of education and training courses on breastfeeding support for health professionals. Int Breastfeed J 2021; 16:31. [PMID: 33823895 PMCID: PMC8025331 DOI: 10.1186/s13006-021-00373-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, lactation training courses aimed at health professionals are important for informing and supporting mothers who are breastfeeding. In this review, we seek to analyze similarities and/or variations in course content, modes of delivery, costs, teaching style and learning strategies among courses. To our knowledge, a review of lactation training courses available worldwide is lacking. Thus, the aim of this review is to describe course models aimed at training health professionals in lactation support for mothers. METHODS Through searching grey literature, training courses were obtained from several directories, including the Alaska Breastfeeding Coalition, International Board of Lactation Consultant Examiners (IBLCE), International Lactation Consultant Association (ILCA), Lactation Education Accreditation Association and Approval Review Committee (LEAARC), World Alliance for Breastfeeding Action (WABA), World Health Organization (WHO), and United Nations Children's Fund (UNICEF). RESULTS Descriptions of ten training programs were included in the final review. Our group found variations in costs, modes of delivery and duration among courses. CONCLUSIONS Certified training for health professionals in lactation is a promising approach for increasing and protecting breastfeeding. Breastfeeding mothers might also benefit from specifically trained health professionals, yet, well-conducted research on such training courses is still required. The variability in the mode of teaching, tuition costs and course content in breastfeeding education programs around the globe must be kept in mind when considering providing training on the optimal competency for health professionals.
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Affiliation(s)
- Ivette Navarro
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, Valencia, Spain.,Food & Health Lab, Institute of Materials Science, University of Valencia, Paterna, Valencia, Spain
| | - Jose M Soriano
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, University of Valencia-Health Research Institute La Fe, Valencia, Spain. .,Food & Health Lab, Institute of Materials Science, University of Valencia, Paterna, Valencia, Spain.
| | - Salomé Laredo
- Amamanta. Breastfeeding Support Group, Valencia, Spain.,Atomic Spectroscopy Section, Central Service for Experimental Research, University of Valencia, Burjassot, Spain
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Dagla M, Mrvoljak-Theodoropoulou I, Vogiatzoglou M, Giamalidou A, Tsolaridou E, Mavrou M, Dagla C, Antoniou E. Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041988. [PMID: 33670797 PMCID: PMC7922856 DOI: 10.3390/ijerph18041988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: ; Tel.: +30-210-932-4415
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Marilena Vogiatzoglou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Anastasia Giamalidou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Eleni Tsolaridou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Marianna Mavrou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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Pinzón-Villate GY, Alzate-Posada ML, Olaya-Vega GA. ¿Consejería para la madre lactante o para la técnica de lactancia materna? REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n1.82181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En Colombia, pese a la implementación de iniciativas como la consejería en lactancia materna (CLM), las tasas de lactancia materna exclusiva (LME) son bajas.
Objetivo. Comprender la experiencia de un grupo de madres lactantes respecto a la consejería en lactancia materna exclusiva (CLME) recibida en Instituciones Amigas de la Mujer y la Infancia (IAMI) en Bogotá D.C., Colombia.
Materiales y métodos. Investigación cualitativa con enfoque fenomenológico. Se aplicaron entrevistas a profundidad a 19 madres lactantes que recibieron CLME en 3 IAMI entre agosto de 2016 y enero de 2017. Las unidades de significado (US) se identificaron mediante un análisis comprensivo realizado en el programa N-Vivo versión 10 y basado en la lectura de las transcripciones textuales de las entrevistas y la identificación de estructuras esenciales en los relatos relacionadas con la experiencia que tuvieron durante la CLME en tres momentos (gestación, parto/posparto inmediato y puerperio).
Resultados. La edad promedio fue de 23 años. Solo el 37% lactó exclusivamente hasta los 4 meses. Se identificaron 9 US. Durante la gestación y el posparto inmediato las madres recibieron indicaciones sobre como lactar, pero no recibieron CLME por parte del personal de salud. En el puerperio, la familia y la red de apoyo de las madres les brindaron ayuda y acompañamiento respecto a la lactancia materna.
Conclusión. Es posible que en el país no se estén cumpliendo las disposiciones legales sobre la CLM e iniciativas como las IAMI, ya que se evidencian dificultades para su correcta realización, por lo que es necesario plantear y desarrollar estrategias efectivas para la formación de consejeros en lactancia materna entre el personal de salud.
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Gyamfi A, O'Neill B, Henderson WA, Lucas R. Black/African American Breastfeeding Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens. Breastfeed Med 2021; 16:103-111. [PMID: 33591226 PMCID: PMC7891224 DOI: 10.1089/bfm.2020.0312] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Disparities in breastfeeding (BF) continue to be a public health challenge, as currently only 42% of infants in the world and 25.6% of infants in the United States are exclusively breastfed for the first 6 months of life. In 2019, the infants least likely to be exclusively breastfed at 6 months are African Americans (AA) (17.2%). Materials and Methods: A scoping review of the literature was undertaken by using Arksey and O'Malley's six-stage framework to determine key themes of AA women's experience BF through an equity lens. Electronic databases of CINAHL and PubMed were searched for peer-reviewed, full-text articles written in the English language within the past 5 years by using the terms BF, AA, Black, sociological, cultural, equity, health, attitude, exposure, initiation, continuation, barriers, and facilitators. Results: Initially, 497 articles were identified, and 26 peer-reviewed articles met the eligibility criteria. Through an equity lens, three main themes emerged, which summarized AA women's BF experience: cultural (family, peers and community support; misconceptions; personal factors), sociological (prejudices, racism, home environment; financial status; sexuality issues; BF role models; employment policies), and health dimensions (family involvement; timely and honest information from staff; baby-friendly hospital initiatives; postnatal follow-up; special supplemental nutrition program for women, infants, and children). Conclusion: For AA women, exclusively BF is beset with diverse cultural, health, and sociological challenges. Multifaceted approaches are needed for successful resolution of BF challenges to bridge the racial gap in BF in the United States. Future studies may explore interventions targeted to modifiable barriers to improve BF outcomes.
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Affiliation(s)
- Adwoa Gyamfi
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Barbara O'Neill
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Wendy A Henderson
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
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Gómez L, Verd S, de-la-Banda G, Cardo E, Servera M, Filgueira A, Ponce-Taylor J, Mulet M. Perinatal psychological interventions to promote breastfeeding: a narrative review. Int Breastfeed J 2021; 16:8. [PMID: 33407656 PMCID: PMC7789781 DOI: 10.1186/s13006-020-00348-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Emotional distress in mothers inhibits the let-down reflex, thus affecting breastfeeding self-efficacy. A breastfeeding mother may have to cope with both physical discomfort and psychological distress. However, literature on initiatives to improve breastfeeding rates has focused mainly on providing community-based peer support, or social policies. The aim of this review is to assess evidence on the effectiveness of a broad range of psychological interventions to facilitate breastfeeding for mothers facing difficulties around the time of delivery. Methods The review of the literature is derived from a search on Cochrane Library, PubMed, EBSCOhost, and PsycINFO for papers published since 1980. The approach was to explore quantitative and qualitative parameters. Quantitative parameters included breastfeeding initiation, duration, and composition. Qualitative parameters recorded the evaluation of maternal perceptions on breastfeeding success. The high heterogeneity of the studies led to a narrative review; 20 selected papers that report on breastfeeding outcomes and psychological programs met the inclusion criteria. Results The evidence on breastfeeding support through psychotherapy is heterogeneous and scant. Out of the included studies, 11 were randomized controlled trials, two were non-randomised trials, and two used a quasi-experimental design. None of the studies reported an increase in adverse breastfeeding outcomes. Three studies failed to report an association between psychological procedures and improved breastfeeding outcomes. A literature review showed that 17 (85%) analyses support stress-releasing techniques to facilitate breastfeeding. Conclusions This review suggests that relaxation interventions carefully tailored to address perinatal emotional distress may lead to important health benefits, including improvement in breastfeeding outcomes. There is also some indication that psychotherapy support while breastfeeding may have more impact than routine counselling. Conversely, this review did not find an association between self-hypnosis and breastfeeding outcomes. Data from this study can be used in designing prevention programs and future research with appropriate theoretical underpinning.
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Affiliation(s)
- Lidia Gómez
- Department of Child Psychiatry, Son Espases Hospital, Valldemossa road, 07120, Palma de Mallorca, Spain.,Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain
| | - Sergio Verd
- Baleares Medical Research Council (IdISBa), Valldemossa road, 07120, Palma de Mallorca, Spain. .,Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.
| | - Gloria de-la-Banda
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Esther Cardo
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Matamusinos street, 07013, Palma de Mallorca, Spain.,Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Mateu Servera
- Department of Psychology, Baleares Islands University, Valldemossa road, 07122, Palma de Mallorca, Spain
| | - Ana Filgueira
- Department of Paediatrics, Hospital Son Llatzer, Manacor road, 07128, Palma de Mallorca, Spain
| | - Jaume Ponce-Taylor
- Accidents & Emergency Unit, Department of Primary Care, Illes Balears street., 07014, Palma de Mallorca, Spain
| | - Margarita Mulet
- Mental Health Unit, Department of Primary Care, Simo Tort street, 07500, Mallorca, Manacor, Spain
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