From dyad to triad: a survey on fathers' knowledge and attitudes toward breastfeeding

First-time parents' perception of midwives' and other healthcare professionals' support behaviours: A qualitative study

PROBLEM

Parents often report not being satisfied with the support received from midwives and nurses during their postpartum hospital stay.

BACKGROUND

Social support is an important protective factor during the transition to parenthood. However, little is known on how first-time parents perceived the behaviours demonstrated by healthcare professionals to support them.

OBJECTIVE

To describe social support behaviours of midwives and nurses as perceived by first-time parents during the early postpartum period.

METHODS

This qualitative study used individual semi-structured interviews to collect data. A purposeful sample of first-time parents staying on the postpartum ward of a Swiss university hospital were included. Thematic analysis was performed to identify themes and sub-themes.

FINDINGS

A total of 26 parents (15 mothers and 11 fathers) were interviewed. Parents reported behaviours perceived either as positive or negative. These behaviours were summarized into five themes: "Welcoming parents on the postpartum ward", "Establishing a partnership with parents", "Guiding parents in acquiring their new parenting role", "Caring for parent's emotions", and "Creating a peaceful environment".

DISCUSSION AND CONCLUSION

This study reported a wide variety of professional support behaviours. Behaviours promoting individualised care and related to empowering parents in their infant care were perceived as helpful by parents. Midwives and nurses should be aware of the way they provide support, as this shapes the early postpartum experience of first-time parents. Being sufficiently staffed and being well-trained, especially in providing interpersonal support, could help midwives and nurses provide better sensitive individualised care.

Analysis of the duration of exclusive breastfeeding in premature infants and its influencing factors

PURPOSE

The purpose of this study was to investigate the duration of breastfeeding among preterm infants within the first 12 months after birth and analyzed factors influencing the duration of exclusive breastfeeding.

DESIGN AND METHODS

In this retrospective study, premature infants who were hospitalized in the Neonatal Intensive Care Unit (NICU) premature delivery area of a third-class maternal and child health hospital in Changsha City, Hunan Province, China from October 2020 to January 2021 were selected as the participants for this study. Relevant data of these infants during their hospitalization was obtained from the hospital information system, while the rate of exclusive breastfeeding among preterm infants at a corrected age of 12 months was tracked through telephone follow-up. Univariate analysis of the effects of breastfeeding duration in preterm infants was conducted based on Mann-Whitney U test and Kruskal-Wallis H test. Multiple linear regression was then applied to determine the factors influencing the duration of exclusive breastfeeding in preterm infants.

RESULTS

The median and interquartile range of breastfeeding duration for preterm infants in this study was 4.00 (1.00, 6.00) months. Multiple linear regression analysis showed that the duration of exclusive breastfeeding was affected by several factors including how much other family members support breastfeeding, whether the mother returns to work after maternal leave, and whether the infant is a twin (P < 0.05).

CONCLUSION

The duration of exclusive breastfeeding among preterm infants needs to be improved by strengthening health education regarding the benefits of breastfeeding for preterm infants. Medical staff should provide guidance, encourage continuous nursing after discharge, and work with the community to implement targeted intervention measures with the goal of increasing the duration of exclusive breastfeeding among premature infants.

IMPLICATIONS TO PRACTICE

Because breastfeeding is vitally important for premature infants, we should encourage longer breastfeeding duration for premature infants by increasing family support, removing barriers to workplace breastfeeding, enhancing people's confidence in breastfeeding and providing support to mothers with twins. Hopefully, these measure can promote breastfeeding for premature infants.

Exploring Successful Breastfeeding Behaviors Among Women Who Have High Body Mass Indices

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.

Breastfeeding experiences and women's self-concept: Negotiations and dilemmas in the transition to motherhood

Introduction

Breastfeeding is much more than a biological event. It is a social construction, full of cultural meanings and framed by social structures. Being, simultaneously, a natural event and a social practice, breastfeeding poses challenges to feminist approaches in the sense it may be acknowledged as an empowering practice for women and/or as a setback in the process of women's social emancipation. Often focused on the product, i.e., the milk and its beneficial properties for the infant's health, the dominant discourse on breastfeeding makes it a trait of good mothering, withdrawing the understanding of the particular (but also structural) contexts in which this practice occurs.

Methods

Based on results from a focus group with five mothers of a first child, this paper addresses first-person testimonies about breastfeeding and transition to motherhood, aiming to capture eventual self-concept dilemmas, impacts of social judgments, difficulties related to the work-family balance, as well as negotiation processes taking place within couples and early-parents.

Results and discussion

Despite being subject to tensions and sometimes stressful adaptation processes, motherhood and breastfeeding tend to be ultimately described by women as experiences that enhance welcome changes in personal trajectories, life priorities and identities.

The Role of Fathers in Promoting Exclusive Breastfeeding

The cornerstone of a newborn's nutrition is breastfeeding. Due to its well-known benefits for mothers, children, and society in the short and long term, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend it as the best way of feeding the baby during the first six months of life. The family, particularly the spouse, may significantly influence the baby's quality of nursing. On a global scale, previous studies have demonstrated that family members (such as a mother's spouse, partner, or grandmother) not only affect her choice to start and endure breastfeeding but also significantly contribute to the early postnatal period's cessation of appropriate breastfeeding. A father's knowledge and attitude are fundamental in this regard, as he has the most critical role in helping women with parenting and feeding their babies. Furthermore, because the father's role is considered important in a family, the partner's or wife's perception of the father's attitude may alter her subjective criteria about exclusive breastfeeding (EBF). Future initiatives should target new mothers and their spouses to see how they may provide the most beneficial assistance to new mothers. The main focus should be on targeting newly married couples. The father's lack of involvement may be due to the hierarchical structure of power within households. Because of this hierarchical aspect, partners or fathers may significantly influence a mother's choice to nurse their child correctly. Household chores, childcare for grown-up children, guaranteeing the well-being of their spouse, preparing meals, recognizing a newborn's hunger cues, burping, and changing the infant's diaper after feedings, all these factors indirectly support the mother in initiating and enduring the nursing of a child.

Effect of IMB Model Combined with Spousal Support Breastfeeding Intervention on PBSES Score and Breastfeeding Rate of Primipara with Chronic Hepatitis B Virus Infection

Objective

To analyze the effects of the info-motivation-behavior skills (IMB) model combined with spousal support breastfeeding intervention on breastfeeding Self-Efficacy Scale (PBSES) scores and breastfeeding rate of primiparas with chronic hepatitis B virus (HBV) infection.

Methods

Seventy-four first-term pregnant women and 74 of their spouses were selected as the traditional control group by the convenience sampling method from July to September 2021 in obstetrics department of Shenzhen Third People's Hospital. 74 pregnant women with their first child and 74 spouses who had their first child checked during October to December 2021 were classified as the IMB model group. The traditional control group was applied with conventional intervention management mode, and the IMB model group was applied with intervention management mode based on IMB theory on the basis of the traditional control group. The self-efficacy scores of breastfeeding before and after intervention during pregnancy and during hospitalization were compared between the two groups, and the self-efficacy scores of paternal support for breastfeeding were compared. The exclusive breastfeeding rate of infants within 6 months and the maternal breastfeeding knowledge level of the two groups were compared, and the correlation between maternal breastfeeding self-efficacy score and feeding knowledge level was analyzed.

Results

After pregnancy intervention, PBSES and FBSES-SF scores were significantly increased in both groups, and scores of scales in the IMB model group increased significantly than the traditional control group (all P < 0.05). The BSES-SF and FBSES-SF scores of the IMB model group increased significantly than the traditional control group at 3 days after delivery and at discharge (P < 0.05), and the scores of each scale at discharge in both groups increased significantly than those at 3 days after delivery (P < 0.05). The rate of exclusive breastfeeding in the IMB model group was 94.59% (70/74), and that in the traditional control group was 78.38% (58/74). There was a significant difference (χ2 = 8.325, P = 0.004). At discharge, the score of maternal breastfeeding knowledge increased significantly in both groups, and the score of the IMB model group increased significantly than that of the traditional control group (all P < 0.05). Pearson correlation coefficient was used to analyze the correlation between PBSES score, FBSES-SF score, and maternal feeding knowledge level, which showed positive correlation (all P < 0.05).

Conclusion

The self-efficacy of prenatal breastfeeding in pregnant women with HBV is low, and the application of the IMB model combined with the intervention mode of spy-supported breastfeeding has positive effects on the improvement of maternal breastfeeding efficiency, breastfeeding health knowledge level, and postpartum breastfeeding rate, which is worthy of clinical promotion and application.

Postnatal Unit Experiences Associated With Exclusive Breastfeeding During the Inpatient Stay: A Cross-Sectional Online Survey

BACKGROUND

Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization.

RESEARCH AIMS

To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed.

METHODS

This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics.

RESULTS

Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood.

CONCLUSION

Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand.

Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial

Background

Fathers’ involvement is crucial for promoting breastfeeding. There are a few studies on the effectiveness of fathers’ educational programs to promote exclusive breastfeeding. This study aims to assess the effectiveness of a fathers’ educational program on their support for breastfeeding, mothers’ breastfeeding practice, and exclusive breastfeeding status.

Methods

This was a randomized controlled trial on 76 fathers who were randomly assigned to two groups of intervention and control, in a selected health center in Iran, 2018.

The tools for data collection were: 1) a questionnaire for “Demographic and Maternal-Infant Information”; 2) a questionnaire to assess “Fathers’ support for Breastfeeding”, and 3) an observational checklist to assess “Mothers’ Breastfeeding Practice”; and 4) a questionnaire to assess “Exclusive Breastfeeding Status”. The questionnaires were filled up through an interview. The checklist was completed through observation by the researcher. The fathers (with the mothers) of the intervention group were educated using individual face-to-face education and counseling, in two sessions, with the duration of about 40 min and one-week interval, whereas, the fathers of the control group did not receive any education and only mothers were educated with the same instruction. The content of the education was: fathers’ education about “benefits of breast milk” and “the supporting ways for breastfeeding including the women encouragement”. Then, the scores of “father’s support for breastfeeding”, “mothers’ breastfeeding practice” and “exclusive breastfeeding status” were compared before and after 4 months of intervention in each group, and also between groups. Data were analyzed using SPPS-23, and t- and paired-tests, Chi-square, and Generalized-Estimating-Equations (GEE) tests.

Results

The results showed two groups were not significantly different regarding the demographic and any other possible confounding variables before the intervention (P < 0.05). The before and after comparisons also demonstrated significant improvements in the two variables including “father’s support for breastfeeding”, and “mothers’ breastfeeding practice after 4 months, in the intervention group (Paired t-test: P<0.001 and P<0.0001, respectively) however, there was a significant decrease in “father’s support for breastfeeding” and no improvement in “mothers’ breastfeeding practice” after 4 months in the control group (Paired t-test: P < 0.001 and P = 0.07, respectively). Between groups comparison showed also significant higher scores for “father’s support for breastfeeding”, “mothers’ breastfeeding practice” and “exclusive breastfeeding status” in the intervention group comparing to the control group, after 4 months (T-test: P < 0.001 and P < 0.0001; Chi2: P < 0.001, respectively). The interaction effects of time and group were significant in the GEE test for the fathers’ support for breastfeeding (B-group = 31.93, B-time = 22.15, p < 0.001) and mothers’ breastfeeding practice (B-group = 26.32, B-time = 12.86, p < 0.0).

Conclusion

The results showed that the father’s education improves mothers’ breastfeeding practice and increases the rate and continuity of exclusive breastfeeding.

Trial registration

IRCT201508248801N10. “31/08/2016”.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07966-8.

Determinants and Factors Associated with the Maintenance of Exclusive Breastfeeding after Hospital Discharge after Birth

The benefits of exclusive breastfeeding are well known for both mother and baby. Despite this, rates of exclusive breastfeeding remain low. The present study aimed to determine the factors associated with the maintenance of this type of feeding after being discharged from the hospital after childbirth. A cross-sectional study was carried out with 1200 postpartum women in Spain. Sociodemographic, obstetric, and neonatal data were collected. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were calculated. Early breastfeeding initiation was identified as a factor that favors breastfeeding after hospital discharge (aOR: 2.47; 95%CI: 1.77, 3.45). Other factors that favor breastfeeding after discharge included the woman feeling very supported by her partner during pregnancy, childbirth, and the puerperium (aOR: 2.54; 95%CI:1.30, 5.00) and having previously breastfed other children (aOR: 1.97; 95%CI: 1.40, 2.76). Among the factors that hindered exclusive breastfeeding after discharge were multiple or twin pregnancies (aOR: 0.31; 95%CI 0.12, 0.83), induction of labor (aOR: 0.73; 95%CI: 0.53, 0.99), admission of the newborn to the neonatal intensive care unit (NICU) (aOR: 0.31; 95%CI 0.19, 0.52), using epidural pain relief during labor (aOR: 0.41; 95%CI: 0.27, 0.64), or a preterm newborn (aOR: 0.38; 95%CI: 0.21, 0.69). For all these reasons, it is essential to promote certain practices such as the early start of breastfeeding or the induced onset of labor, among others, in order to promote the maintenance of exclusive breastfeeding beyond hospital discharge after childbirth.

The role of breastfeeding promotion in German hospitals for exclusive breastfeeding duration

Breastfeeding promotion and support in hospitals is expected to have a positive impact on maternal breastfeeding outcomes. The objective of this study is to examine the association between breastfeeding promotion in maternity hospitals in Germany and exclusive breastfeeding (EBF) rates during the first 4 months. Thus, a nationwide cross‐sectional web‐based survey of breastfeeding promotion was conducted in 103 hospitals. Mother–infant pairs (n = 962) were recruited at these hospitals for a prospective web‐based survey of breastfeeding status at five‐time points, that is, during a hospital stay, at discharge as well as after 0.5, 2, and 4 months. The hospital analysis was based on the “10 Steps to Successful Breastfeeding” of the World Health Organization and the United Nations Children's Fund, adapted for Germany. Their degree of implementation was stratified by a breastfeeding promotion index (BPI) as low (≤5 steps), medium (6–8 steps), and high (≥9 steps). The association between the BPI and the odds of EBF at each of the five‐time points was estimated by multivariable regression models, adjusting for various maternal factors. At all time points, the proportion of EBF among mothers from high BPI hospitals exceeded the proportion of those from medium or low BPI hospitals. A high BPI was associated with higher odds of EBF during the hospital stay and at discharge, while maternal factors for EBF such as breastfeeding experience and no early use of a pacifier persisted beyond. The high commitment of hospitals and tailored support of mothers is essential for EBF.

A high breastfeeding promotion index (BPI) favours exclusive breastfeeding (EBF) in the hospital environment, while maternal factors persisted beyond.

Even in a country with a high level of maternal and child care, breastfeeding promotion in hospitals plays a significant role in the successful start of breastfeeding.

Maternal factors, primarily breastfeeding experience and no early use of a pacifier, were persistent and stronger predictors of EBF than the BPI.

The steps that need to be improved most refer to breastfeeding information, early breastfeeding initiation, and alternative feeding methods.

High hospital commitment complemented by tailored, individualised postdischarge support of mothers are critical components for sustained breastfeeding success.

Effects of a WeChat Mini-Program on Human Milk Feeding Rates in a Neonatal Intensive Care Unit During the COVID-19 Pandemic

OBJECTIVE

We investigated changes in maternal daily milk pumping frequency and milk volume per expression and their derived lactation indicators, as well as human milk (HM) feeding status with a focus on amount and rates in preterm infants admitted to the neonatal intensive care unit (NICU) after using a WeChat mini-program during the 2019 coronavirus (COVID-19) pandemic.

METHODS

The study was conducted with 482 mothers and their 544 babies. We prospectively enrolled mothers and infants with birth weight <1,500 g or gestational age <32 weeks born in 2020, and retrospectively included the same population in 2019. All study subjects were classified into three subgroups: pre-pandemic (PP, 2019), early pandemic (EP, January to April 2020), and late pandemic (LP, May to December 2020). From 1 January 2020, mothers recorded in an online pumping diary using the WeChat mini-program. We obtained the infants' feeding information from an online database for analysis.

RESULTS

Maternal lactation indicators did not change significantly. However, 56.7% (139/245) of mothers achieved milk volume ≥500 ml/day (CTV) in PP, 58.9% (33/156) in EP, and a slight increase to 60.7% (91/150) in LP. Maternal pumping frequency remained about eight times/day. In LP, daily milk volume was higher than the other two periods from day 4, and mothers achieved CTV by day 12, which was achieved in the other two groups by 13-14 days. There were several statistical differences in the amount and rates of feeding between the groups, particularly about HM and donor milk feeding, with the vast majority being decreased during EP, while during LP they returned to PP levels. Pleasingly, the median average daily dose of HM at 1-28 days was highest in LP (LP, 87.8 vs. PP, 75.5 or EP, 52.6 ml/kg/day, P _corrected < 0.001). In addition, most categorical feeding indicators decreased in EP and recovered in LP.

CONCLUSION

An education model based on the WeChat program could aid lactation education and management in mothers of preterm infants to maintain healthy lactation. The model, together with optimized management strategies, can ensure that the HM feeding rate is not compromised in vulnerable high-risk infants during NICU hospitalization in a public health emergency, like the COVID-19 pandemic.