Breastfeeding Initiation and Birth Setting Practices: A Review of the Literature

Welcoming, supportive care in US birthing facilities and realization of breastfeeding goals

BACKGROUND

Emotional and physical support for birthing parents is positively associated with realization of their breastfeeding goals. However, few studies have investigated maternal descriptions of their postnatal unit experience of these domains.

RESEARCH AIM

The objective was to investigate maternal report of their birthing facility experiences and quantify the extent to which accounts of postpartum support were associated with meeting their breastfeeding goals.

METHODS

After IRB review, data were obtained through an online survey distributed from November 2016-May 2017. This analysis utilizes data from 2,771 birthing parents who were at least 18 years of age, experienced maternity care in the United States within five years, and reported that they had intended to breastfeed. Bivariate analysis was followed by logistic regression controlling for significant covariates.

RESULTS

In this sample of primarily non-Hispanic white birthing parents with intent to exclusively breastfeed, the following postnatal unit variables were associated with higher odds of meeting their breastfeeding goals, birthing parents feeling: welcomed (adjusted OR=1.36), that health care promoted their physical health (adjusted OR=1.41), that care promoted their emotional health (adjusted OR=1.38), that they were supported (adjusted OR=1.56), and that they were recognized by their health care team (adjusted OR=1.30). All the measured postnatal unit support variables were significantly correlated with each other, with correlation coefficients ranging from 0.15 to 0.81.

CONCLUSIONS

Before the COVID-19 pandemic, birthing parents' experiences on the postnatal unit were interrelated and associated with meeting their breastfeeding goals. As health care services are reviewed and prioritized during the COVID-19 pandemic and as part of ongoing strengthening of systems, qualitative and observational research can address the mechanisms underlying breastfeeding outcomes to inform the provision of more holistic and effective support.

Early initiation of breastfeeding and factors associated with its delay among mothers at discharge from a single hospital

BACKGROUND

According to the National Family Health Survey- 4, in India, 78.9% of deliveries occur in institutions, although only 42.6% of new mothers initiate breastfeeding within 1 hour of delivery.

PURPOSE

To estimate the proportion of early initiation of breastfeeding (EIBF) among new mothers at discharge from a tertiary care hospital and identify the determinants of delayed initiation of breastfeeding among them.

METHODS

This was a hospital-based analytical cross-sectional study of 108 new mothers. After obtaining Institutional Review Board approval and informed consent, we interviewed the new mothers on the day of discharge. Multivariate logistic regression was performed using IBM SPSS Statistics ver. 24.

RESULTS

The median breastfeeding initiation time was 90 minutes (interquartile range, 30-180 minutes). Overall, 43.5% of the mothers practiced EIBF, 77.4% practiced exclusive breastfeeding, and 43.5% were rooming in at discharge. Reasons for breastfeeding delays included extended recovery time from spinal anesthesia, maternal lassitude, and uncomfortable breastfeeding position due to post-cesarean pain. In the multivariate analysis, a birth weight less than 2,500 g (adjusted odds ratio [aOR], 4.33; 95% confidence interval [CI], 1.12-16.82; P=0.03), cesarean section delivery (aOR, 4.68; 95% CI, 1.57- 13.92; P=0.005), and mother's poor knowledge of breastfeeding (aOR, 4.61; 95% CI, 1.44-14.72; P=0.010) were more likely to delay the initiation of breastfeeding.

CONCLUSION

EIBF was practiced by less than half of the new mothers as determined by the cesarean section, baby's birth weight, and mothers' awareness of breastfeeding. Thus, it is vital to improve breastfeeding and nutritional counseling among mothers during the antenatal period and improve healthcare professionals' training to facilitate EIBF, even in circumstances such as cesarean section.

Delayed Initiation of Breastfeeding and Role of Mode and Place of Childbirth: Evidence from Health Surveys in 58 Low- and Middle- Income Countries (2012-2017)

Background: Timely initiation of breastfeeding is the first step towards achieving recommended breastfeeding behaviours. Delayed breastfeeding initiation harms neonatal health and survival, including infection associated neonatal mortality. Eighty percent of neonatal deaths occur in the low-and middle-income countries (LMICs), where delayed breastfeeding initiation is the highest. Place and mode of childbirth are important factors determining the time of initiation of breastfeeding. In this study, we report the prevalence of delayed breastfeeding initiation from 58 LMICs and investigate the relationship between place and mode of childbirth and delayed breastfeeding initiation in each country. Methods: We analysed data from the most recent Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) collected between 2012 and 2017 and reported by 2019. The study sample comprised all women who had a live birth in the 24 months preceding the survey. ‘Delayed’ initiation of breastfeeding was defined using WHO recommendations as starting breastfeeding after one hour of birth. We coded the stratifying variable for the place and mode of childbirth as “vaginal birth at a facility (VBF)”, “caesarean section birth (CSB) “, and “vaginal birth at home (VBH)”. We used respondent-level sampling weights to account for individual surveys and de-normalised the standard survey weights to ensure the appropriate contribution of data from each country. We report the prevalence and population attributable fractions with robust standard errors. The population attributable risk identifies the proportion of delayed initiation that we could avert among VBH and CSB if everyone had the same risk of delaying breastfeeding as in VBF. Results: The overall prevalence of delayed initiation of breastfeeding was 53.8% (95% CI 53.3, 54.3), ranging from 15.0% (95% CI 13.8, 16.2) in Burundi to 83.4% (95% CI 80.6, 86.0) in Guinea. The prevalence of delayed initiation of breastfeeding was consistently high among women who experienced caesarean section births; however, there was no direct association with each country’s national caesarean section rates. The prevalence of delayed initiation among women who experienced VBF was high in Sub-Saharan Africa and South Asia, even though the CSB rates were low. In some countries, women who give birth vaginally in health facilities were more likely to delay breastfeeding initiation than women who did not. In many places, women who give birth by caesarean section were less likely to delay breastfeeding initiation. Population attributable risk percent for VBH ranged from −28.5% in Ukraine to 22.9% in Moldova, and for CSB, from 10.3% in Guinea to 54.8% in Burundi. On average, across all 58 countries, 24.4% of delayed initiation could be prevented if all women had the same risk of delaying breastfeeding initiation as in VBF. Discussion: In general, women who give birth in a health facility were less likely to experience delayed initiation of breastfeeding. Programs could avert much of the delayed breastfeeding initiation in LMICs if the prevalence of delayed initiation amongst women who experience CSB were the same as amongst women who experience VBF. Crucial reforms of health facilities are required to ensure early breastfeeding practices and to create pro-breastfeeding supportive environments as recommended in intervention packages like the Baby-friendly hospital initiative and Early essential newborn care. The findings from this study will guide program managers to identify countries at varying levels of preparedness to establish and maintain a breastfeeding-friendly environment at health facilities. Thus, governments should prioritise intervention strategies to improve coverage and settings surrounding early initiation of breastfeeding while considering the complex role of place and mode of childbirth.

Impact of Nipple Shield Use on Milk Transfer and Maternal Nipple Pain

Background: Nipple pain is a common cause of early cessation of breastfeeding. A nipple shield (shield) is often used to improve breastfeeding comfort. There are concerns that shield use may limit milk transfer. The aims of this study were to determine whether shield use reduces milk transfer and maternal nipple pain. Methods: A within-subject study of two groups of breastfeeding dyads (infants <6 months) was conducted; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) shield used for nipple pain. There were two monitored sessions where shield use was randomized. Test weights and pain questionnaires were completed, and percentage of available milk removed (PAMR) was calculated. Results: Twenty-five PG (6 ± 4 postnatal weeks) and 34 CG (9 ± 6 postnatal weeks) had similar 24-hour milk production (PG: 676 ± 239 mL, CG: 775 ± 162 mL, p = 0.083). PG mean milk transfer volume and PAMR did not differ with shield use (no shield: 46 mL, 59%; shield: 40 mL, 53%, volume p = 0.38, PAMR p = 0.64). CG mean volume and PAMR were reduced with shield use (no shield: 65 mL, 64%; shield: 31 mL, 33%, volume p < 0.001, PAMR p < 0.001). PG pain scores were similar with and without shield use (Visual Analog Scale p = 0.44, McGill p = 0.97). Conclusions: Shield use did not impact either milk production or milk transfer in breastfeeding women experiencing nipple pain.

Factors influencing the early initiation of breast feeding in public primary healthcare facilities in Northeast Nigeria: a mixed-method study

INTRODUCTION

The early initiation of breast feeding is a high-impact intervention that gives newborns a better chance of survival. We assess the barriers and facilitators influencing the practice of early breast feeding of newborns in public primary healthcare facilities (PHCs) in Northeast Nigeria, to influence the planning of programmes targeted at improving newborn care in the region.

METHOD

We used an explanatory mixed-method approach. We conducted case observation of childbirths and newborn care for the quantitative arm, and interviewed mothers and birth attendants 1 hour after childbirth for the qualitative arm. The analysis for the quantitative arm was done with SPSS V.23. For the qualitative arm, we transcribed the audio files, coded the texts and categorised them using thematic analysis.

RESULT

We observed 393 and 27 mothers for the quantitative and qualitative arms of the study, respectively. The quantitative arm shows that 39% of mothers did not breastfeed their newborns within 1 hour of birth. The qualitative arm shows that 37% of mothers did not breastfeed within 1 hour of birth. Themes that describe the barriers to early breast feeding in public PHCs are: birth attendants' unwillingness or inability to accommodate mothers' safe traditional practices, ineffective rooming-in practices, staff shortages, lack of privacy in the lying-in ward and poor implementation of visiting-hour policy in public PHCs. The pregnant women denied safe traditional birth practices like chanting, praying or reading religious books during delivery are five times more likely not to breastfeed newborns within the first hour of birth (relative risk=4.5, 95% CI 1.2-17.1) compared with pregnant women allowed these practices.

CONCLUSION

Stakeholders must increase their focus on improving breastfeeding practices in public PHCs. Instituting policies that protect mothers' privacy and finding innovative ways to accommodate and promote safe traditional practices in the intrapartum and postpartum period in PHCs will improve the early breast feeding of newborns in these PHCs.

Factors affecting breast-feeding practice among a sample of Iranian women: a structural equation modeling approach

Background

Breastfeeding is one of the most sensitive stages in the development of children, having many benefits for the mother and the child. The present study aimed to determine factors associated with breastfeeding intention and behavior in mothers living in Taft County, Iran.

Methods

In this cross-sectional design, the statistical population consisted of 420 mothers with infants under 1 year of age living in Taft County of Yazd province, Iran. The research data were collected from health records of infants under one in health centers of the county as well as a researcher-made questionnaire including demographic information, knowledge and attitude towards breastfeeding, social support and perceived self-efficacy, and breastfeeding intention and behavior. Structural Equation Modeling (SEM) based on AMOS 18 were employed to analyze the relationship between research variables.

Results

The mean age of mothers was 28.04 ± 6.49 year and the children were 10 ± 6 months. Half of the mothers (50.3%) had cesarean sections and more than half (55.8%) of the children were males. Mothers’ attitude (β = 0.442; 95% CI: 0.284, 0.599), self-efficacy (β = 0.186; 95% CI: 0.047, 0.324) and perceived social support (β = 0.178; 95% CI: 0.035, 0.322) were respectively the strongest predictors of breastfeeding intention. Besides, the breastfeeding intention affected breastfeeding behavior with a high coefficient (0.857; 95% CI: 0.735, 0.979).

Conclusions

The study provided informative pathways on the association of maternal attitude, social support and self-efficacy with breast feeding behavior. These findings could be useful for designing health education and promotion programs about breast feeding among women.

Newborn physical condition and breastfeeding behaviours: Secondary outcomes of a cluster-randomized trial of prenatal lipid-based nutrient supplements in Bangladesh

Prenatal nutritional supplements may improve birth outcomes. This study aims to examine the effect of prenatal lipid-based nutrient supplements (LNS), compared with iron and folic acid (IFA), on general newborn physical condition and feeding behaviours. We conducted a cluster-randomized effectiveness trial that enrolled 4,011 pregnant women at ≤20 gestational weeks. LNS and IFA were provided to women in 48 and 16 clusters, respectively, for daily consumption until delivery. We collected data on household socio-economic, food insecurity, and maternal characteristics during early pregnancy and on newborn condition and feeding within 72 hr of delivery. We analysed intervention effects on these secondary outcomes using mixed models with analysis of covariance for continuous outcomes and logistic regression for dichotomous outcomes. Among 3,664 live births, intervention groups did not differ in newborn response, mother's rating of the general condition of her newborn, early initiation of breastfeeding (EIBF), suckling ability, or frequency and exclusivity of breastfeeding in the first 24 hr. If the mother perceived her infant to be healthy, EIBF was more likely (OR [95% CI]: 2.08 [1.46, 2.97]) and frequency of breastfeeding in the first 24 hr was greater (mean difference [95% CI]: 3.0 [1.91, 4.01]), but there was no difference in exclusive breastfeeding in the first 24 hr. Newborn condition and early breastfeeding practices were not affected by giving mothers prenatal LNS versus IFA. However, early breastfeeding practices were related to maternal perception of her newborn's condition. Thus, interventions to improve breastfeeding practices for newborns with poorer perceived health status may be useful.

Nutritive and non-nutritive sucking patterns associated with pacifier use and bottle-feeding in full-term infants

BACKGROUND

The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants.

AIMS

We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

429 full-term infants/mothers.

OUTCOME MEASURES

Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes.

RESULTS

There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern.

CONCLUSION

The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding.

The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: a systematic review and meta-analysis

In the new millennium, exclusive breastfeeding plays an important role in national and international policies. The effects of mother-infant skin-to-skin contact (SSC) after birth has been investigated in several studies. Given that there has been no overall estimate of this effects, the present study was conducted with the aim of investigating the effects of mother-infant SSC on the rate of exclusive breastfeeding through a systematic review and meta-analysis of randomized controlled trials. In the present study, the databases of Scopus, PubMed, Cochrane, SID, Magiran, IranDoc, and Google Scholar were searched to identify randomized controlled trials that evaluated the effects of mother-infant SSC immediately after birth on the rate of exclusive breastfeeding. The risk of bias and strength of evidence were examined according to the Cochrane Collaboration’s tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach, respectively. The data analysis was performed using Stata software. To assess the publication bias and heterogeneity, Egger’s and Begg’s tests and I2 were used, respectively. In addition, the fixed effects model was employed to perform the meta-analysis. The heterogeneity of the factor of effects in the studies was determined as 16.2% (p<0.303). There was no publication bias among the studies included; the p values of Egger’s and Begg’s tests were 0.168 and 0.386, respectively. The effects of mother-infant SSC on exclusive breastfeeding was statistically significant [odds raito (OR)=2.19; 95% confidence interval (CI): (1.66-2); p<0.001]. The subgroup analysis results in the normal vaginal delivery group included OR=2.45 [95% CI: (1.76-3.35); p<0.001], for the cesarean delivery group the results were OR=1.44 [95% CI: (0.78-2.65); p=0.24], the results for the duration of exclusive breastfeeding as of the discharge time up to 3 months were OR=2.47 [95% CI: (1.76-3.48); p<0.001], and the results for the 3 to 6 months of exclusive breastfeeding were OR=1.71 [95% CI: (1.05-2.78); p=0.030]. The study results showed that mother-infant SSC increased the rate of exclusive breastfeeding. Therefore, this finding could be used by maternal and infant health care providers to develop evidence-based intervention programs.

Effect of Kangaroo Mother Care on Successful Breastfeeding: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

BACKGROUND & AIMS

Evaluating the effect of Kangaroo Mother Care (KMC) on breastfeeding success shows conflicting results. Regarding the importance of breastfeeding and uncertainties about its effect, this study intended to conduct a systematic review and meta-analysis of randomised controlled trials on the effect of KMC on success of breastfeeding.

METHODS

In this systematic review and meta-analysis study, required data were collected by searching the following keywords: breastfeeding, Breast-Feeding, "skin-to-skin", "Kangaroo Mother Care", randomized clinical trial. The following databases were searched: Google Scholar, PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Two authors independently extracted the data. To estimate the Breast-Feeding outcome variables, CMA2 software was used. The risk of bias of studies was assessed with the criteria developed in the Cochrane Handbook.

RESULTS

Twenty articles were included. In the KMC and CNC groups, 1,432 and 1,410 neonates were examined. Breastfeeding success rate was higher in the KMC group within different time slots, however this difference was not statistically significant (RR=1.11(95CI, 0.93-1.34) and RR=1.13(95%CI, 0.92-1.34) based on the time slot and birth weight, respectively). The inter-groups differences in the mean scores of Infant Breast-Feeding Assessment Tool (IBFAT) were statistically significant (P<0.05). Breastfeeding was initiated very sooner in the KMC group, suggesting a statistically significant inter-groups difference -0.72(95%CI, from -0.92 to -0.53) (P<0.05). Majority of the studies had a high risk of bias.

CONCLUSION

Findings indicated a superiority of KMC over CNC in terms of breastfeeding success. Assessment of the complications and costs of KMC implementation is recommended.

Prenatal breastfeeding self efficacy scale: validity and reliability study

AIM

To determine the validity and the reliability of the Prenatal Breastfeeding Self-Efficacy Scale.

MATERIAL AND METHODS

This was a methodologic study. The sample of the research comprised 200 pregnant women who presented to the outpatient clinic of Gynecology between April and June 2015. An introductory information form and the Prenatal Breast Self-Efficacy Scale were used to collect the data. In the analysis of the data, descriptive statistics, content validity index for coverage validity, exploratory factor analysis, and confirmatory factor analysis for construct validity, and Cronbach-alfa α for reliability were used.

RESULTS

In the explanatory factor analysis of the scale, the Kaiser-Meyer-Olkin floor number was 0.84 and the Barlett's sphericity test results were χ2=1812.608; df=171; p<0.001. The contribution of the factors to total variance was 59.06%. According to confirmatory factor analysis of the scale, the Chi-square test result was as follows: χ2=254.23 (p<0.001, SD=146). The model fit indices were as follows: χ2/SD=1.74, Root Mean Square Error of Approximation=0.06, Comparative Fit Index=0.96, Normed Fit Index=0.92, Non-Normed Fit Index=0.96, Goodness of Fit Index=0.88 and Adjusted Goodness of Fit Index=0.85. The internal consistency reliability coefficient of Prenatal Breastfeeding Self-Efficacy Scale was 0.86.

CONCLUSION

The Prental Breastfeeding Self-Efficacy Scale is a valid and reliable scale which is applicable to Turkish culture and an appropriate tool which can be used by all healthcare workers who wish to design and evaluate interventions to support breastfeeding in the prenatal period.

Maternal Factors Associated with the Initiation of Exclusive Breastfeeding among Mothers at One Week after Delivery in Two Selected Hospitals in Kelantan, Malaysia

Background

The first week following delivery usually coincides with the initiation of exclusive breastfeeding. This study aimed to determine the prevalence of and the associated factors regarding the initiation of exclusive breastfeeding among mothers at one week after delivery in two selected hospitals in the state of Kelantan, Malaysia.

Methods

A cross-sectional study was conducted from March to August 2015 among post-partum mothers, who were selected through systematic sampling. A newly developed and validated questionnaire on the participants’ data, knowledge and attitude items and a breastfeeding practice checklist were used. The mothers were interviewed in the post-natal ward, and their breastfeeding practices were determined through a phone call at one week following delivery. Descriptive statistics and simple and multiple logistic regressions were used for the data analysis.

Results

A total of 335 participants were included. The prevalence of exclusive breastfeeding at one week post-partum was 77.9% (95% CI: 73.0%, 82.2%), with significant associated factors being previous exclusive breastfeeding experience [adjusted odds ratio (AOR) 2.48; 95% CI: 1.37, 4.49; P-value = 0.003] and the mean total score of knowledge [AOR 1.06; 95% CI: 1.01, 1.11; P-value = 0.011].

Conclusion

Every mother should receive breastfeeding education, with special emphasis on those with no previous experience. The weak areas of knowledge identified herein should be strengthened during health education.

Initiation of breastfeeding within one hour of birth and its determinants among normal vaginal deliveries at primary and secondary health facilities in Bangladesh: A case-observation study

BACKGROUND

Initiation of breastfeeding within one hour of birth can avert 22% of newborn mortality. Several factors influence breastfeeding practice including mothers' socio-demographic and obstetric characteristics, and factors related to time around child birth. This study explores breastfeeding initiation practices and associated influencing factors for initiating breastfeeding within one hour of birth in public health facilities of Bangladesh.

METHODS

In this study, normal deliveries were observed in 15 public health facilities from 3 districts in Bangladesh. Study participants were selected by convenient sampling i.e. delivery cases attending health facilities during the study period were selected excluding caesarean section deliveries. Among 249 mothers, time of initiation of breastfeeding was observed and its association was measured with type of health facility, privacy in delivery room, presence of separate staff for newborn, spontaneous breathing, skin-to-skin contact and postnatal contact of mother or newborn with health care providers within one hour after delivery. Data was collected during August-September, 2016. Kruskal-Wallis test was used to measure equality of median duration of breastfeeding initiation time among two or more categories of independent variables. Series of simple logistic regressions were conducted followed by multiple logistic regression to identify the determinants for breastfeeding initiation within one hour.

RESULTS

Among 249 mothers observed, 67% initiated breastfeeding within one hour of birth at health facilities and median time to initiate breastfeeding was 38 minutes (Inter-quartile range: 20-56 minutes). After controlling for maternal age as potential confounder, the odds of initiating breastfeeding within one hour of birth was significantly higher if mothers gave birth in district hospitals (AOR 3.5: 95% CI 1.5, 6.4), visual privacy was well-maintained in delivery room (AOR 2.6: 95% CI 1.2, 4.8), newborns cried spontaneously (AOR 4.9: 95% CI 3.4, 17.2), were put to skin-to-skin contact with mothers (AOR 3.4: 95% CI 1.9, 10.4) or were examined by health care providers in the facilities (AOR 2.4: 95% CI 1.3, 12.9).

CONCLUSIONS

In health facilities, initiation of breastfeeding within one hour is associated with some critical practices and events around the time of birth. With the global push toward facility-based deliveries, it is very important to identify those key factors, within the landscape of maternal and newborn care, which significantly enable health care providers and parents to engage in the evidence-based newborn care activities including early initiation of breastfeeding that will, in turn, reduce global rates of newborn mortality.

Effective Communication Strategies for Nurses to Discuss Infant Feeding with New Mothers During Postpartum Hospitalization

During prenatal care and postpartum hospitalization, nurses have an important role in assisting new mothers to make informed decisions about feeding their newborn infants. There is overwhelming evidence that breastfeeding is beneficial for most new mothers and babies; therefore, perinatal nurses encourage breastfeeding. Newborn infant feeding conversations with women who have chosen to formula feed may be complicated and may cause tension in the nurse-patient relationship. Despite this potential difficulty, these conversations are essential to establish a feeding plan for the newborn infant and to promote healthy outcomes for mothers and babies. Tools are offered for nurses to guide conversations about infant feeding choices and to help to ensure that all mothers receive support and encouragement on their feeding choice.

Factors related to health services determine breastfeeding within one hour of birth in the Federal District of Brazil, 2011

Objective:

To identify factors associated with breastfeeding in the first hour of life.

Methods:

A cross-sectional study conducted among mothers and children under one year of age, who attended the second stage of the polio vaccination campaign in the Federal District, Brazil, in 2011. The sample was composed of 1,027 pairs of mothers and children. Breastfeeding in the first hour of life was considered as the dependent variable; and the independent variables were: socio-demographic characteristics of the mother, prenatal, delivery and postpartum care, reference to physical or verbal violence/neglect during delivery, and children health. Unadjusted and adjusted prevalence ratios (PR) were used as measures of association, calculated by Poisson regression.

Results:

The prevalence of breastfeeding in the first hour of life was 77.3%. Inadequate prenatal care (PR = 0.72), cesarean section (PR = 0.88) and no access to rooming-in after birth (PR = 0.28) were factors that interfered negatively in breastfeeding in the first hour of life. No factor was associated with breastfeeding in the first hour of life for mother and children.

Conclusions:

Factors related to health services such as prenatal care, type of delivery and postpartum rooming-in interfered with breastfeeding in the first hour of life, indicating that health services, as well health professional practices were major determinants the breastfeeding in the first hour of life.

Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO Global Survey

Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors hampering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding >1 hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI <24 hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section.

The Effect of Message-Framing on Breastfeeding Self-Efficacy Among Nulliparous Women in Shushtar, Iran

Introduction

Exclusive breastfeeding for 6 months and continuing it for 2 years, along with complementary feeding, are the primary objectives of public health plans and nutrition around the world. Self-efficacy is a theoretical framework that could be a strong predictive for breastfeeding. This study aimed to determine the effect of message-framing on self-efficacy of breastfeeding in nulliparous women in Shushtar.

Methods

This quasi-experimental study was conducted in 2015 on 210 nulliparous women in Shushtar (Iran). The participants were randomly allocated into intervention and control groups. The study tool was the short form of breastfeeding self-efficacy scale that was completed on arrival of the study (days 3–5), at the end of week four and at the end of week eight. Data were analyzed by SPSS 19, using Chi-square, ANOVA, and repeated measurements.

Results

Mean age of participants was 24.52 years old with standard deviation of 95.4. Mean score of breastfeeding self-efficacy in gain-framed group at days 3–5, week four and week eight was 47.94, 57.43 and 52.8 respectively; in loss-framed group it was 47.76, 56.11 and 52.64 respectively; and in control group it was 45.16, 48.68 and 45.31 respectively. No significant difference was observed between the score of average self-efficacy of days 3–5 and week eight in control group (p=0.93). However, in gain-framed group (p=0.001) and loss-framed group (p=0.004), a significant difference was observed.

Conclusion

Results of this study showed that message-framing promotes breastfeeding self-efficacy in nulliparous women and in this regard, there is no difference between gain-framed and loss-framed messages.

Fatores associados ao início tardio da amamentação em hospitais do Sistema Único de Saúde no Município do Rio de Janeiro, Brasil, 2009

Resumo O objetivo do trabalho foi analisar os fatores associados com o início tardio da amamentação (não amamentar na primeira hora de vida). Estudo transversal conduzido em 2009 com 673 puérperas internadas em hospitais do Sistema Único de Saúde (SUS) do Município do Rio de Janeiro, Brasil. Um modelo de regressão logística multinível com dois níveis (individual e hospitalar) foi utilizado nas análises estatísticas. A prevalência de início tardio da amamentação foi de 49,2%. O parto em Hospital Amigo da Criança (HAC) teve um efeito protetor contra o atraso no início da amamentação (OR = 0,17; IC95%: 0,05-0,55), enquanto a cesariana (OR = 5,95; IC95%: 3,88-9,12) e o desconhecimento do resultado do exame anti-HIV até o parto (OR = 2,16; IC95%: 1,04-4,50) aumentaram a chance de atraso. Redução das taxas de cesariana, adesão aos protocolos de atenção pré-natal e ampliação do credenciamento dos hospitais como HAC são estratégias importantes para promover o aleitamento materno na primeira hora de vida.

Maternal and Hospital Factors Associated with First-Time Mothers' Breastfeeding Practice: A Prospective Study

Continuity of breastfeeding is infrequent and indeterminate. Evidence is lacking regarding factors associated with breastfeeding at different postpartum time points. This prospective study investigated the change in, and correlates of, breastfeeding practices after delivery at a hospital and at 1, 3, and 6 months postpartum among first-time mothers. We followed a cohort of 300 primiparous mothers of Taiwan who gave birth at two hospitals during 2010-2011. Logistic and Cox regression analyses were performed to determine factors that were correlated with breastfeeding practices. In the study sample, the rate of exclusive breastfeeding during the hospital stay was 66%; it declined to 37.5% at 1 month and 30.2% at 3 months postpartum. Only 17.1% of women reported continuing breastfeeding at 6 months. Early initiation of breastfeeding, rooming-in practice, and self-efficacy were significantly related to exclusive breastfeeding during the hospital stay. After discharge, health literacy, knowledge, intention, and self-efficacy were positively and significantly associated with breastfeeding exclusivity. Later initiation (hazard ratio=1.53; 95% confidence interval, 1.05, 1.97), shorter intention (hazard ratio=1.42; 95% confidence interval, 1.13, 1.68), and self-efficacy (hazard ratio=0.98; 95% confidence interval, 0.96, 0.99) were important predictors of breastfeeding cessation within 6 months of delivery. Continuous breastfeeding practice for 6 months is challenging and difficult for new mothers. Results showed that factors related to breastfeeding varied over time after delivery. Interventions seeking to sustain breastfeeding should consider new mothers' needs and barriers at different times.

Epidural analgesia, neonatal care and breastfeeding

The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.

Factors associated with exclusive breastfeeding at hospital discharge in rural Western Australia

BACKGROUND

Breastfeeding is accepted as the best way of feeding infants, and health authorities recommend exclusive breastfeeding to around 6 months of age, but despite the evidence of its benefits, few mothers meet this goal. Infants who are exclusively breastfed in the early postpartum period are more likely to continue breastfeeding at 6 and 12 months, reinforcing the role that Baby-Friendly hospital practices play in supporting exclusive breastfeeding.

OBJECTIVES

This study aimed to determine the rate of breastfeeding initiation and identify the factors associated with exclusive breastfeeding at discharge from hospital for rural mothers.

METHODS

The prospective cohort study recruited 489 women from hospitals in regional Western Australia following the birth of their infant. Breastfeeding exclusivity at discharge was assessed based on mothers' self-reported infant feeding behavior during her hospital stay. The self-administered baseline questionnaire was completed by 427 mothers.

RESULTS

Breastfeeding was initiated by 97.7% of the mothers in this cohort, with 82.7% exclusively breastfeeding at hospital discharge. The odds of exclusive breastfeeding at discharge were more than 4 times higher for women whose infants did not require admission to the special care nursery (adjusted odds ratio [aOR] = 4.43; 95% confidence interval [CI], 1.98-9.99). Demand feeding (aOR = 3.33; 95% CI, 1.59-6.95) and 24-hour rooming-in (aOR = 2.31; 95% CI, 1.15-4.62) were also significant positive factors.

CONCLUSION

The findings suggest that hospital practices are strong predictors of exclusive breastfeeding. Greater emphasis on Baby-Friendly hospital practices in the early postpartum period may help the establishment of exclusive breastfeeding, assisting rural mothers to reach established international breastfeeding recommendations.

Knowledge and beliefs about breastfeeding are not determinants for successful breastfeeding

A cross-sectional prospective study was performed to assess knowledge and attitude toward breastfeeding among mothers in a tertiary hospital in Malaysia and its influence on their breastfeeding practices. Two hundred thirteen women who had delivered healthy babies at term were enrolled. A structured questionnaire containing demographic data and the Iowa Infant Feeding Attitude Score were used, followed by a telephone interview after 8 weeks to determine the feeding outcome. Women of Malay ethnicity with higher education level who had received breastfeeding counseling had a significantly more favorable attitude toward breastfeeding. Ethnicity was found to be a significant determinant in the success of breastfeeding, whereas returning to work was a major reason for discontinuing breastfeeding. In ensuring a successful breastfeeding practice, apart from knowledge and attitude, issues surrounding culture and traditions as well as improving deliverance of readily available support should be addressed.

Multiparous mothers: Breastfeeding support provided by nurses

The study aimed to identify the informational, practical and emotional support that multiparous mothers had received from nurses in the early postpartum period.This is a descriptive and cross-sectional study on 278 multiparous mothers who took part in the research prior to their discharge from a maternity hospital in Ankara, Turkey. The instrument used was a 38-item questionnaire. Experiencing breastfeeding problems was the only statistically significant predictor of in-hospital supplementation (P < 0.01, OR 0.028, 95% CI 0.005-0.159). There were no statistically significant association between some predictor variables with regard to breastfeeding support and breastfeeding outcomes including in-hospital formula supplementation and breastfeeding problems. No significant associations are indicative for the need of more effective implementation of informational, practical and emotional breastfeeding support for multiparous mothers in easing their adjustment to breastfeeding. Nurses can encourage multiparous mothers to maintain breastfeeding through individual teaching, giving mothers a sense of security, providing understanding care and telling about what to do with regard to breastfeeding problems. Antenatal education and support could be more likely to make a difference.

The continued care of pregnant women receiving opiate substitution treatment by midwives

BACKGROUND

The care of pregnant women receiving opiate substitution treatment (OST) is generally provided by a variety of health care professionals. Midwives working in prenatal consultations take part in this continued care and may meet with their patients several times throughout the pregnancy, which can have a tremendous impact on monitoring. The purpose of the study was to determine whether midwives are used to accompanying women taking OST and to determine their level of knowledge and investment in this area.

METHODS

One hundred fifty-nine midwives working in prenatal consultations in Lille, Roubaix, and Tourcoing received a questionnaire with 21 questions.

RESULTS

One hundred ten surveys were collected and analyzed. The majority (103) of the midwives were attending pregnant women taking OST. They were familiar with the effects of heroin on pregnancy but were not familiar with the management of OST.

CONCLUSIONS

The training of these professionals is important in risk reduction, and they should know the management of OST. All of the midwives requested specific training.

Mothers' expectations and other factors affecting breastfeeding at six months in Greece

The objective of this study is to determine the factors influencing breastfeeding duration in Greece. A total of 145 women were interviewed, on the third day post-partum. Women were followed up by telephone interviews at three and six months post-partum. Chi-square test and binomial sequential logistic regression analysis were used for statistical analysis. Results from this study show that baby-friendly hospital, antenatal courses, mother's perception of her capability to successfully breastfeed her infant, mother's intention to breastfeed for a duration of six months or more, mother's and father's education level, introduction of complementary foods or fluids, caesarean delivery, smoking and ethnicity were significantly associated with the duration of breastfeeding. In conclusion, additional antenatal and postnatal framework is necessary. Mothers' prediction of the duration of breastfeeding is an additional tool for identification of women with a high probability for early weaning.

Breastfeeding: a holistic concept analysis

Breastfeeding is a critical public health intervention. Nurses play a vital role in promoting and supporting optimal breastfeeding practices in infants and young children. An analysis following the eight-part Walker & Avant method provides clarity and context to the concept of breastfeeding. The antecedents of the concept of breastfeeding indicate nurse interventions to facilitate and the consequences provide key points for education related to the benefits of breastfeeding.

Doula care supports near-universal breastfeeding initiation among diverse, low-income women

INTRODUCTION

Breastfeeding initiation rates in the United States have risen in recent years. However, there are notable disparities by socioeconomic status and race/ethnicity. Previous research has suggested that care from a doula (a trained professional who provides nonmedical support during the perinatal period) may increase breastfeeding initiation. The goal of this analysis was to study whether doula support may be associated with breastfeeding initiation among low-income, diverse women.

METHODS

We compared breastfeeding initiation rates (means and 95% confidence intervals) for 1069 women who received doula care from Everyday Miracles, a Minnesota-based organization that employs a diverse group of certified doulas, to a state-based sample of women with Medicaid coverage who gave birth in 2009 or 2010 and participated in the Minnesota Pregnancy Risk Assessment Monitoring System survey (weighted n = 51,721).

RESULTS

Women who had doula-supported births had near-universal breastfeeding initiation (97.9%), compared with 80.8% of the general Medicaid population. Among African American women, 92.7% of those with doula support initiated breastfeeding, compared with 70.3% of the general Medicaid population.

DISCUSSION

These results suggest that access to culturally appropriate doula care may facilitate higher rates of breastfeeding initiation. When supported in their nonmedical needs by birth doulas, the diverse, low-income patients of midwives and other maternity care providers may have a greater likelihood of initiating breastfeeding and experiencing the maternal and infant health benefits associated with breastfeeding.

Baby-friendly hospital accreditation, in-hospital care practices, and breastfeeding

OBJECTIVES

To investigate the effect of Baby-Friendly Hospital Initiative (BFHI) accreditation and hospital care practices on breastfeeding rates at 1 and 4 months.

METHODS

All women who birthed in Queensland, Australia, from February 1 to May 31, 2010, received a survey 4 months postpartum. Maternal, infant, and hospital characteristics; pregnancy and birth complications; and infant feeding outcomes were measured.

RESULTS

Sample size was 6752 women. Breastfeeding initiation rates were high (96%) and similar in BFHI-accredited and nonaccredited hospitals. After adjustment for significant maternal, infant, clinical, and hospital variables, women who birthed in BFHI-accredited hospitals had significantly lower odds of breastfeeding at 1 month (adjusted odds ratio 0.72, 95% confidence interval 0.58-0.90) than those who birthed in non-BFHI-accredited hospitals. BFHI accreditation did not affect the odds of breastfeeding at 4 months or exclusive breastfeeding at 1 or 4 months. Four in-hospital practices (early skin-to-skin contact, attempted breastfeeding within the first hour, rooming-in, and no in-hospital supplementation) were experienced by 70% to 80% of mothers, with 50.3% experiencing all 4. Women who experienced all 4 hospital practices had higher odds of breastfeeding at 1 month (adjusted odds ratio 2.20, 95% confidence interval 1.78-2.71) and 4 months (adjusted odds ratio 2.93, 95% confidence interval 2.40-3.60) than women who experienced fewer than 4.

CONCLUSIONS

When breastfeeding-initiation rates are high and evidence-based practices that support breastfeeding are common within the hospital environment, BFHI accreditation per se has little effect on both exclusive or any breastfeeding rates.

Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth

BACKGROUND

Prefeeding cues are oral-motor neurobehaviors that communicate feeding readiness, and the ability to self-comfort and regulate behavioral state. Intrapartum and newborn procedures have been associated with altered frequency and emergence of prefeeding cues soon after birth. Intrapartum synthetic oxytocin is commonly used for labor induction/augmentation in the US, yet there is little research on potential effects on infant neurobehavioral cues.

AIMS

To explore whether fetal exposure to synthetic oxytocin was associated with the infant's level of prefeeding organization shortly after birth.

STUDY DESIGN

Cohort.

SUBJECTS

A convenience sample of 47 healthy full-term infants (36 exposed and 11 unexposed to intrapartum synthetic oxytocin) was studied.

EXCLUSION CRITERIA

Fetal distress, vacuum/forceps, cesarean, and low Apgar.

OUTCOME MEASURES

Videotapes of infants (45-50min postbirth) were coded for frequency of eight prefeeding cues, and analyzed by level of prefeeding organization.

RESULTS

In general, fewer prefeeding cues were observed in infants exposed versus unexposed to synOT and differences were significant for brief and sustained hand to mouth cues [incidence rate ratio (95% CI)=0.6 (0.4, 0.9) and 0.5 (0.2, 0.9), respectively]. Forty-four percent of exposed infants demonstrated a low level of prefeeding organization, compared to 0% from the unexposed group. In contrast, 25% of exposed versus 64% of unexposed infants demonstrated high prefeeding organization. After adjusting for covariates, exposed infants were at 11.5 times (95% CI=1.8-73.3) the odds of demonstrating low/medium versus high levels of prefeeding organization compared to unexposed infants.

CONCLUSIONS

Newborn neurobehavioral cues may be sensitive to intrapartum synthetic oxytocin.

High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study

Background

Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children’s Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling.

Methods

Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling.

Results

Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.

During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is “good”. Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits.

Conclusions

In a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted.

Infant feeding knowledge and practices of mothers with 6-24-month-old babies in the "Baby-Friendly City" of Diyarbakir

OBJECTIVE

This study examined factors related to breastfeeding behavior of mothers in the "Baby-Friendly City" of Diyarbakir, Turkey.

SUBJECTS AND METHODS

The study was cross-sectional. The cluster sample technique was used in which 992 mothers from 50 clusters were contacted. Data were collected by face-to-face interview. The breastfeeding behavior of the mothers and the demographic variables affecting such behavior were recorded and collected. Analysis was performed by χ(2) test, and logistic regression used to estimate relative risks and 95% confidence intervals (CIs).

RESULTS

We found that 78.3% of the mothers breastfed their babies for the first 6 months and that 92.4% gave their babies colostrum. The risk of not giving colostrum increased 2.7-fold (95% CI=1.25-5.75) in mothers giving birth at home compared with those giving birth in a hospital (p=0.011). The same risk increased 3.99-fold (95% CI=2.00-7.93) in mothers with no knowledge of breastfeeding compared with mothers instructed on the subject by health professionals (p<0.0001).

CONCLUSION

The breastfeeding behavior on the part of mothers giving birth with the help of healthcare personnel and receiving information on the subject is positive.

Maternal request for in-hospital supplementation of healthy breastfed infants among low-income women

BACKGROUND

While hospital policies and medical issues are important factors in determining exclusive breastfeeding rates, medically unnecessary supplementation of infants is likely to be due, in part, to maternal request for formula.

OBJECTIVES

The goal of this project was to gain an understanding of the facilitating factors and decision-making processes surrounding maternal request for formula in the early postpartum period.

METHODS

A series of 12 focus groups were conducted among 97 English- and Spanish-speaking low-income participants in California's Supplementary Nutrition Program for Women, Infants, and Children (WIC). Mothers were asked to share their in-hospital infant-feeding experiences.

RESULTS

The overarching theme that emerged was "lack of preparation" for what the early postpartum period would be like. Specifically, the decisions to formula feed fell into the following categories: inadequate preparation for newborn care (the need for rest and unrealistic expectations about infant behavior), lack of preparation for the process of breastfeeding, and formula as a solution to breastfeeding problems. Cultural factors were not mentioned as reasons for supplementation.

CONCLUSION

Interventions to promote in-hospital exclusive breastfeeding must address mothers' real and perceived barriers, specifically mothers' expectations related to breastfeeding and infant behavior.

Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding

BACKGROUND

The effect of epidural analgesia on labor and effective breastfeeding is still being debated. The aim of this study is to define its impact on the trend of labor, the newborns' well-being, and early breastfeeding.

METHODS

We considered first-term physiologic pregnant women who delivered by the vaginal route. We divided them into two groups: group A received epidural analgesia during labor, whereas group B received no analgesia. We recorded maternal age, gestational age, modality of delivery, length of labor, and length of active labor. All newborns received skin-to-skin contact; early breastfeeding was encouraged. We recorded data on birth weight and length, Apgar score at minutes 1 and 5, type of crying, neonatal reactivity, and time between birth and exposure to the breast. Statistical significance was considered for p<0.05.

RESULTS

Of 934 pregnant women who delivered by the vaginal route, 317 patients required labor analgesia, and 245 patients agreed to participate in our study. Only 128 patients met inclusion criteria. We randomized them in 64 women in group A and 64 women in group B. Data on maternal age, gestational age, type of delivery, neonatal birth weight and length, and Apgar score showed no significant differences. Total length of labor was 363.58±62.20 minutes in Group A versus 292.30±64.75 minutes in group B (p<0.001). The length of active labor showed no significant difference. Among neonatal parameters we found a statistically significant difference only for length of first breastfeeding, with a mean duration of <30 minutes in 62.2% in group A versus 29.3% in Group B (p<0.001).

CONCLUSIONS

Epidural analgesia has little effect on trend of labor and duration of first breastfeed and none on neonatal outcome. A new protocol of epidural analgesia may solve these side effects.

What do Kramer's Baby-Friendly Hospital Initiative PROBIT studies tell us? A review of a decade of research

BACKGROUND

Kramer et al's PROBIT (Promotion of Breastfeeding Intervention Trial) research in Belarus studied effects of the Baby-Friendly Hospital Initiative (BFHI) training on breastfeeding duration, exclusivity, and health outcomes.

AIMS

To critique inclusion criteria, context, approaches to data analysis, and health outcome results.

METHOD

Twenty-two articles were retrieved from PubMed and the PROBIT Website for 2001-2010; 6 were excluded as not focusing on breastfeeding and health outcomes.

RESULTS

PROBIT data from the cluster randomized hospital comparisons included only breastfed babies since all non-breastfed babies were excluded from the research. Context may affect outcomes, knowing that Belarus has good basic health services, 3-year maternity leaves with little use of daycare, 95% breastfeeding initiation rate, and a well-educated population. PROBIT data were analyzed in 2 ways: (a) intent-to-treat analyses of breastfeeding and health differences by cluster randomized intervention and control site mother/baby pairs; and (b) as an observational cohort study of health outcomes for all mother/baby pairs, analyzed by various breastfeeding categorizations and controlling for biases. PROBIT demonstrated links between BFHI and longer breastfeeding duration (19.7% vs 11.4% at 12 months, P < .001) and exclusivity (43.3% vs 6.4% at 3 months, P < .001), reductions in gastrointestinal episodes and rashes, higher verbal IQ scores, and longer exclusive breastfeeding rates for subsequent children but no statistically significant differences in the child's body mass index, blood pressure, or dental health.

CONCLUSION

PROBIT provides foundational evidence for BFHI policy and follow-up care. Knowing that non-breastfed babies were excluded, caution must be exercised for health comparisons.

Avaliação da promoção do aleitamento materno em Hospitais Amigos da Criança

OBJETIVO: Avaliar o cumprimento dos Passos 4 a 10 dentre os Dez Passos para o Sucesso do Aleitamento Materno, preconizados pela Iniciativa Hospital Amigo da Criança (IHAC), criada pela Organização Mundial da Saúde (OMS). MÉTODOS: Estudo descritivo de corte transversal. Foram realizadas entrevistas com 100 puérperas nos dois hospitais credenciados pela IHAC em Salvador. Não foram incluídas mães ou recém-nascidos que não poderiam oferecer ou receber aleitamento materno exclusivo, respectivamente.Questionou-se sobre história obstétrica, aleitamento materno anterior, atendimento pré-natal e aspectos relacionados aos Passos Para o Sucesso do Aleitamento Materno. As questões foram elaboradas de acordo com os Critérios Globais para a IHAC. No mínimo 80% das mães deveriam responder de forma satisfatória às perguntas correspondentes a cada passo para que ele fosse considerado como cumprido. Foi feita descrição de frequências para avaliar as respostas. RESULTADOS: O cumprimento foi insatisfatório para o Passo 4 (suporte ao aleitamento materno após o parto - 58%), Passo 5 (aleitamento exclusivo durante a internação - 77%) e Passo 10 (encaminhamento para grupo de suporte ao aleitamento materno - 5%). Outros passos demonstraram bons resultados: Passo 6 (oferta de substitutos do leite materno - 19%), Passo 7 (prática do alojamento conjunto - 91%) e Passo 9 (não uso de chupetas e mamadeiras - 100%). CONCLUSÕES: Houve boa aderência a alguns aspectos dos Critérios Globais da IHAC. Evidencia-se, no entanto, a necessidade de se ampliarem as discussões sobre os critérios para manter o título de "Hospital Amigo da Criança", uma vez que os resultados foram insatisfatórios em relação aos Passos 4, 5 e 10.

Types of Breastfeeding and its Predictors of Mothers in Twenty-four Months after Birth

PURPOSE

This study was done to investigate the types of breastfeeding visits by mothers twenty-four months after birth and to identify the factors that increased breast feeding rates.

METHODS

The subjects of this study totaled seven hundred and seventy-four mothers with infants aged 2 years or less who had visited national medical institutions including Sanhujori service facilities, breastfeeding care service facilities, and community health centers. Data was collected from June 22 to July 31, 2009. Data was analyzed using descriptive statistics, chi2 test, ANOVA with a post hoc Scheffe test, and multiple logistic regression.

RESULTS

Major findings of this study were significant differences of planned length of breastfeeding and breastfeeding self-efficacy in relation to the differing types of breast feeding community visits by mothers. In multivariate logistic regression, baby's age, exclusive breastfeeding at hospital, utilization of breastfeeding care service facility, planned length of breastfeeding, and breastfeeding self-efficacy were independent predictors of the feeding type.

CONCLUSION

In order to increase breastfeeding rates, programs provided by public health care services and medical facilities should start education on breast feeding in the hospital before mothers are discharged and then continue through the use of Sanhujori service facilities and workplace at 3 month and 6 month postpartum.

Addressing the midwifery workforce crisis: evaluating an employment model for undergraduate midwifery students at a tertiary maternity hospital in Melbourne, Australia

BACKGROUND AND AIMS

In Victoria, maternity services are under significant strain due to increased numbers of women giving birth and critical workforce shortages. Hospitals have experienced challenges in adequately staffing maternity units, particularly on postnatal wards. In 2008, a tertiary maternity hospital in Melbourne introduced a model where undergraduate midwifery students were employed as Division 2 nurses (SMW_Div2) (enrolled nurses), to work in the postnatal area only. This study explored the pilot employment model from the perspective of the SMW_Div2 and hospital midwives.

METHODS

A web-based survey was administered to hospital midwives and the SMW_Div2s in the employment model in January 2010. The survey explored the views of midwives and SMW_Div2s regarding the perceived impact of the model on workforce readiness, recruitment and retention, and clinical competence and confidence.

FINDINGS

Forty-seven of 158 midwives (30%) and five of nine SMW_Div2s employed in the model responded to the survey. Both groups considered the model to have benefits for the organisation, including increased: student workforce readiness; clinical confidence and competence; and organisational loyalty. Both groups also considered that the model would facilitate: workforce recruitment; a teaching and learning culture within the organisation; and enhanced partnerships between students, hospitals and universities. Caution was expressed regarding workload and the need for ongoing support for SMW_Div2s working in the model.

DISCUSSION AND CONCLUSION

SMW_Div2s and midwives were positive about the introduction of the paid employment model at the Women's. The findings are consistent with evaluations of similar programs in the nursing setting. The employment model has potential short and long term individual and organisational advantages, which is important in the context of increasing births and workforce shortages. Progression of such models will be contingent on the collaboration and cooperation of the various stakeholders involved in maternity workforce and education.

Fear of Home Birth in Doctors and Obstetric Iatrogenesis

Home births are physiological births and form part of the social model of birth. Doctors, traditionally, have been very fearful of out-of-hospital birth, and physiological births happen less frequently in obstetric units. Normal/physiological birth contributes to improving public health, and doctors are often not aware of the extent of this benefit. Normal birth leads to adaptive physiological function in the baby (endocrine, immune system, thyroid function, respiration, neurology, temperature regulation), more mother and baby bonding, and promotes higher breastfeeding rates, which in turn lead to better lifelong emotional and physical health in babies. Normal birth affirms health, promotes empowerment in mothers, and is a societal event that has been linked to promoting positive emotional qualities in society via the birthing hormone, oxytocin. Training within the medical model constrains doctors’ appreciation of normal birth. Experience of complications, a lack of awareness of the evidence surrounding home birth, compounded by failure to understand the concept of iatrogenesis, perpetuates fear of home birth among doctors.