[Support of breastfeeding by health professionals: integrative review of the literature]

Validity and reliability of the Turkish version of the Self-Efficacy Tool for the Ability to Support Breastfeeding Mothers

AIM

The aim of the study is to investigate the validity and reliability of the Turkish version of the Self-Efficacy Tool for the Ability to Support Breastfeeding Mothers.

METHODS

In the current methodological study, research data were collected using a Descriptive Information Form and the Self-Efficacy Tool for the Ability to Support Breastfeeding Mothers. Validity analysis was conducted using the content validity index, exploratory factor analysis, and confirmatory factor analysis. The Pearson product-moment correlation and Cronbach alpha reliability coefficients were performed for reliability analysis. High scores indicate a higher ability to support breastfeeding mothers.

RESULTS

To evaluate the tool's invariance over time, test-retest measurements were made at an interval of at least two weeks and showed no difference in mean scores (p > 0.05). Corrected item-total score correlations varied between 0.43 and 0.77. The Cronbach alpha value was determined to be 0.97, which indicated high internal consistency.

CONCLUSION

The results of the present study show that the Turkish version of the Self-Efficacy Tool for the Ability to Support Breastfeeding Mothers is valid and reliable. It can be utilised as a measurement tool to determine the degree of self-efficacy in the ability to support breastfeeding mothers.

Developing an Instrument to Measure Public Health Nurses' Competence Related to Breastfeeding Beyond 12 Months

BACKGROUND

Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed.

RESEARCH AIM

To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families.

METHODS

This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel (N = 6). Public health nurses (N = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics.

RESULTS

According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level (α = 0.796) and met the requirements set for a new instrument.

CONCLUSION

The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months.

Effects of responsive breastfeeding intervention on breastfeeding and infant growth in China: A randomised controlled trial

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self-determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother-infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self-efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post-partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post-partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self-perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post-partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post-partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: -2.09; 95% CI: -2.88 to -1.31; p < 0.001), 6 weeks post-partum (MD: -4.35; 95% CI: -5.20 to -3.49; p < 0.001) and 3 months (MD: -4.89; 95% CI: -5.70 to -4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post-partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post-partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post-partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post-partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post-partum, the intervention group's infants showed slower weight (t = -0.90, p = 0.371) and length (t = -0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post-partum, there was a significant difference in both weight (t = -3.46, p = 0.001) and length (t = -2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self-confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow-up in future research.

Breastfeeding challenges and the impact of social support in Iranian Muslim mothers: A cross-sectional study

Breast milk is the perfect food during infancy. Adequate support from family and health systems can be helpful to continue breastfeeding. This study aimed to determine the status of breastfeeding challenges and its relationship with social support and socio-demographic factors. In this correlational-descriptive study, 348 breastfeeding mothers were recruited using cluster random sampling from health care centers in Tabriz, Iran in 2022. Socio-demographic, breastfeeding challenges and social support questionnaires were used for data collection. Data were analyzed for descriptive and inferential statistics (Pearson correlation tests, independent t-test, one-way ANOVA and general linear model) using SPSS version 16. Difficulty in completing household tasks and breastfeeding at the same time (32.5 percent) was the most common challenge reported by mothers. There was an inverse and significant correlation between perceived social support and experiencing challenges (r = -0.199؛ p = .001). Based on the adjusted general linear model, with increasing social support, the score of breastfeeding challenges decreased (B = -0.165; 95 percent CI: -0.07-0.25, p < .001). Considering the relationship between perceived social support and the challenges experienced during breastfeeding, it can be concluded that adequate support from family along with training and guidance from health care providers can lead women to have better breastfeeding experiences and overcome breastfeeding problems.

Role of Health Care Providers in Encouraging Formula Feeding in Mosul City

Unacceptable advertisements and deceptive promotion of formula feeding undermine breastfeeding and threaten infant and maternal health worldwide. The purpose of this study was to estimate the role of healthcare providers and other sources in promoting the use of formula feeding among attendants at healthcare facilities in Mosul, Iraq. This one-year cross-sectional study was conducted at three healthcare facilities in Mosul, Iraq. Mothers of formula-fed infants under the age of one year were surveyed with a prepared questionnaire. Data analysis was performed using descriptive and inferential statistics. Of the 400 women who participated, 73% stated that healthcare professionals encouraged the use of formula feeding without a convenient reason, of which more than 80% were pediatricians and nursery nurses. Only 27% percent of the women chose to formula-feed their infants based on other factors. An extensive analysis of this attitude is warranted.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

The Influence of Participation in Pregnancy Courses and Breastfeeding Support Groups on Attitudes and Knowledge of Health Professionals about Breastfeeding

Numerous factors affect the behavior, attitudes, and knowledge of health professionals about breastfeeding. The aim of this paper is to determine the impact of participation in pregnancy courses and breastfeeding support groups on the attitudes and knowledge of health professionals about breastfeeding. The study compares two groups of health professionals according to the results they achieved on a validated questionnaire of behavior, attitudes, and knowledge about breastfeeding. The authors did not make personal contact with the respondents, as the questionnaires were filled out online. The two groups of respondents differed according to the frequency of participation in pregnancy courses, that is, groups for breastfeeding support. The results are presented tabularly and graphically (frequencies and percentages), while differences in the results between the infrequent and regular participants are shown with the Mann–Whitney U test (asymmetric distribution). Better results on the questionnaire were achieved by those who regularly attended breastfeeding support groups (Mdn = 149, IQR = 11) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The same is found for regular visitors of pregnancy courses (Mdn = 149, IQR = 15.75) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The differences are statistically significant (p < 0.00). Partial correlation confirms a more significant influence of breastfeeding support groups (<0.00) than pregnancy courses (p = 0.34). Working in breastfeeding support groups had a statistically significant positive effect on the attitudes and knowledge of health professionals about breastfeeding. The topic of breastfeeding should be given more space and importance during pregnancy courses as well. Personal experience working in breastfeeding support groups and pregnancy courses should be incorporated into the training of medical students.

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

BACKGROUND

Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0-5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers.

METHODS

We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017-2018 retrospective online survey on social support and infant feeding.

RESULTS

Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive.

CONCLUSIONS

Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK.

Breastfeeding mothers' experiences with community physicians in Israel: a qualitative study

BACKGROUND

The guidelines of all leading professional organizations recommend providing adequate support and education regarding breastfeeding; yet many mothers feel that they receive inadequate information from their health care providers in the primary care setting. This is in line with studies that demonstrate that physicians' knowledge about breastfeeding is lacking. The aim of this study was to expand our understanding of the breastfeeding-related experiences of mothers with primary care physicians (PCPs).

METHODS

In this qualitative study, we interviewed breastfeeding mothers in Israel in the first six months after delivery. The interviews were conducted between December 2020 and May 2021. We used thematic analysis to explore women's attitudes and experiences with their PCPs regarding breastfeeding concerns. All authors read the transcribed interviews and independently marked statements regarding breastfeeding. Then, in a joint process, codes, subthemes and themes were defined. Each subtheme was backed up with a quote from the interviews.

RESULTS

We interviewed 13 women aged 24 to 37. We identified four main themes. The first of these was physicians' inconsistent attitudes toward breastfeeding. Some were indifferent, while others related to breastfeeding solely in the context of infant development. Some were supportive, while others opposed breastfeeding. Several women revealed physicians' inappropriate and disturbing attitudes to breastfeeding. The second theme was physicians' lack of knowledge regarding medical treatment for breastfeeding issues. This theme included lack of knowledge, incorrect treatment of breastfeeding problems, and contradictions among HCPs. The third was mothers' preference for alternative resources, including individualized breastfeeding counselling, maternity and childcare nurses, mothers' groups (in person or online), and family and friends over medical treatment for breastfeeding problems. The fourth theme involved mothers' suggestions for PCPs, which highlighted the importance of communication, prenatal physician-initiated dialogue on breastfeeding, expanding professional knowledge on breastfeeding, and increasing the availability of treatment for breastfeeding problems.

CONCLUSION

The women in this study reported unsatisfactory breastfeeding support by PCPs and incorrect or inadequate treatment of medical problems related to breastfeeding. They also felt they had no medical experts to approach with breastfeeding-related problems. We believe that physicians should expand their knowledge on breastfeeding medicine so that they can provide comprehensive patient-centered treatment to both mothers and infants. Education programs for improving knowledge and skills in breastfeeding issues should be implemented throughout the medical training.

Behaviour, Attitudes and Knowledge of Healthcare Workers on Breastfeeding

The aim of this paper is to determine the current state of behavior, attitudes, and knowledge of health professionals about breastfeeding in Croatia. Data were collected via a breastfeeding behavior, attitudes, and knowledge questionnaire, which has already been validated and used in Croatia. The secondary aim is to identify differences in outcomes of respondents by occupation (nurses versus others health professionals). In the study, 374 health professionals participated (37 males and 337 females). Respondents completed the questionnaire online. Respondents were rarely involved in breastfeeding education. On the behavior scale, the worst answer was given to the question of advising mothers on breastfeeding after 24 months. On the attitude scale, the worst result was achieved in terms of public breastfeeding and the support of the child's father for the breastfeeding mother. Respondents demonstrated the worst knowledge of The International Code of Marketing of Breast-milk Substitutes and the use of medications while breastfeeding. There was no statistically significant difference between the results of respondents in relation to the occupation of the respondents. In the preparation of future breastfeeding education for health professionals in Croatia, particular attention should be given to these issues.

Effectiveness of breastfeeding education compared to standard hospital information on exclusive breastfeeding among mothers: A systematic review

Breastfeeding is the single intervention with the largest impact on the health of a new-born baby. Evidence has to be generated to convince the mother as well as policy-makers for the promotion of exclusive breastfeeding (EBF) for 6 months. This study aimed to assess the evidence for the effectiveness of breastfeeding education compared with standard hospital information among mothers on the rate of EBF. The study design is systematic review. Trials which are randomized or cluster randomized which studied the effect of educational interventions for mothers on EBF were searched for. Two databases were searched, namely PubMed and Cochrane. Manual search of reference lists of all included studies in Google scholar and Clinical Trial Registry was done. Two reviewers independently assessed the quality of the included studies. Data were extracted using a table format set by the reviewers referring the previously reported high-quality systematic reviews. Out of the 12 comparisons of nine studies included for review, eight studies report that breastfeeding education has added advantage on increasing the rate of EBF. We conclude that there is evidence to support breastfeeding education versus standard hospital information across diverse settings.

Healthcare worker perspectives on mother's insufficient milk supply in Malawi

Background

Human milk insufficiency is a significant barrier to implementing breastfeeding, and it is identified as a prevalent concern in 60–90% of mothers in low-and-middle-income countries. Breastmilk insufficiency can lead to hypoglycemia, hypernatremia, nutritional deficiencies, and failure to thrive in newborns and infants. Studies investigating the impact of breastfeeding interventions to improve milk production highlight inconsistencies between healthcare workers and mothers perceived support, as well as gaps in practical knowledge and training. The aim of this study was to determine perceptions surrounding human milk insufficiency from Malawian healthcare workers.

Methods

This study is a secondary analysis of 39 interviews with healthcare workers from one tertiary and three district hospitals in Malawi employing content analysis. Interviewed healthcare workers included nurses, clinical officers, midwives, and medical doctors. An inclusive coding framework was developed to identify themes related to human milk insufficiency, which were analyzed using an iterative process with NVivo12 software. Researchers focused on themes emerging from perceptions and reasons given by healthcare workers for human milk insufficiency.

Results

Inability to produce adequate breastmilk was identified as a prevalent obstacle mothers face in the early postpartum period in both district and tertiary facilities in Malawi. The main reasons given by participants for human milk insufficiency were mothers’ perceived normalcy of milk insufficiency, maternal stress, maternal malnutrition, and traditional beliefs around food and eating. Three focused solutions were offered by participants to improve mother’s milk production – improving education for mothers and training for healthcare providers on interventions to improve mother’s milk production, increasing breastfeeding frequency, and ensuring adequate maternal nutrition pre- and post-partum.

Conclusion

Health care workers perspectives shed light on the complexity of causes and solutions for human milk insufficiency in Malawi. This research highlights that a respectful professional relationship between health care workers and mothers is an essential bridge to improving communication, detecting human milk insufficiency early, and implementing appropriate interventions. The results of this study may help to inform research, clinical practice, and education in Malawi to improve human milk production.

Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits

Gestational diabetes mellitus (GDM) is a multifaceted disease and is associated with complications for newborns and mothers. The aim of the study was to assess Polish women’s knowledge concerning GDM and their attitude to breastfeeding. As a research tool, an anonymous online survey that included 33 questions, grouped into three main sections—sociodemographic and obstetric variables, risk factors for GDM and neonatal adverse outcomes, and knowledge about breastfeeding—was used and administered online. A total of 410 women aged from 18 to 45 participated in this study. Based on the survey, it was demonstrated that the women had moderate knowledge concerning the maternal risk factors and adverse neonatal outcomes associated with GDM and, additionally, the short- and long-term effects of breastfeeding. Significantly deeper knowledge about GDM, including breastfeeding by GDM mothers, was observed among hyperglycemic mothers in comparison to normoglycemic mothers. However, knowledge concerning the health benefits of breastfeeding was not related to the mothers’ glycemic status. In conclusion, educational programs must include pre-pregnancy education of women and place emphasis on explaining the mechanism of development of GDM and the transformation of GDM to type 2 diabetes. This is crucial for changing the public’s perception of GDM as a temporary, reversible clinical entity.

The Social Value of Implementing the Ten Steps to Successful Breastfeeding in an Indonesian Hospital: A Case Study

Background: Despite the known importance of breastfeeding for women's and children's health, global exclusive prevalence among infants under 6 months old is estimated at only 41%. In 2018, Indonesia had a lower exclusive breastfeeding rate of 37% at 6 months postpartum; ranging from 20% to 56%, showing unequal breastfeeding support throughout the country. The World Health Organization (WHO) launched the Ten Steps to Successful Breastfeeding (Ten Steps) in 1989, later embedded in UNICEF's Baby-Friendly Hospital Initiative (BFHI) program in 1991. The BFHI aims to encourage maternity facilities worldwide to ensure adequate education and support for breastfeeding mothers by adhering to the Ten Steps and complying with the International Code of Marketing of Breastmilk Substitutes. An Indonesian survey in 2011 found that less than one in 10 government hospitals implemented the Ten Steps. It has been common for Indonesian health services to collaborate with infant formula companies. While no Indonesian hospitals are currently BFHI-accredited, the WHO/UNICEF Ten Steps (updated in 2018) have been adopted in Indonesia's national regulation of maternity facilities since 2012. Internationally, implementation of the Ten Steps individually and as a package has been associated with benefits to breastfeeding rates and maternal and infant health. However, to date, few studies have examined the impact of implementing the Ten Steps in economic terms. This study aims to measure the economic benefit of Ten Steps implementation in an Indonesian hospital. Methods: The study was conducted in January 2020 in Airlangga University Hospital, Surabaya, Indonesia, which has implemented the Ten Steps since it was established in 2012. To understand and generate evidence on the social value of the Ten Steps, we conducted a "Social Return on Investment (SROI)" study of implementing the Ten Steps in this maternity facility. To estimate the costs relating to the Ten Steps we interviewed the financial and nursing managers, a senior pediatrician, and senior midwife due to their detailed understanding of the implementation of the Ten Steps in the hospital. The interview was guided by a questionnaire which we developed based on the 2018 WHO/UNICEF Ten Steps to Successful Breastfeeding. The analysis was supported with peer-reviewed literature on the benefits of Ten Steps breastfeeding outcomes. Results: The total per annum value of investment (cost) required to implement Ten Steps in Airlangga University Hospital was US$ 972,303. The estimate yearly benefit was US$ 22,642,661. The social return on the investment in implementing Ten Steps in this facility was calculated to be US$ 49 (sensitivity analysis: US$ 18-65). Thus, for every US$ 1 invested in Ten Steps implementation by Airlangga Hospital could be expected to generate approximately US$ 49 of benefit. Conclusions: Investment in the Ten Steps implementation in this Surabaya maternity facility produced a social value 49 times greater than the cost of investment. This provides novel evidence of breastfeeding as a public health tool, demonstrating the value of the investment, in terms of social impact for mothers, babies, families, communities, and countries. Breastfeeding has the potential to help address inequity throughout the lifetime by providing the equal best start to all infants regardless of their background. Indonesia's initial moves towards implementing the WHO/UNICEF Ten Steps can be strengthened by integrating all elements into the national regulation and health care system.

The experiences of trained breastfeeding support providers that influence how breastfeeding support is practised: A protocol for a qualitative evidence synthesis

BACKGROUND

Many women stop breastfeeding before they intend to as they cannot overcome breastfeeding difficulties. Breastfeeding support, as an evidence-based intervention by trained lay or professional breastfeeding support providers, can prevent early unintended cessation. Yet some women report dissatisfaction with support and reluctantly stop breastfeeding despite receiving this intervention. Understanding the experiences which shape how support is provided can inform effective implementation of breastfeeding support interventions. This review aims to synthesise experiences of trained breastfeeding support providers in high income settings and how these may influence their breastfeeding support practices.

METHODS

A qualitative systematic review of trained breastfeeding supporters' experiences of supporting women to breastfeed, as part of a generic healthcare role or focused breastfeeding support role, will be conducted. A systematic search will be performed of the databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL +), MEDLINE ALL, Maternity and Infant Care, EMBASE, APA PsycINFO, Web of Science and Scopus. Title and abstract screening using eligibility criteria will be conducted using Covidence software. Eligible papers will be agreed by the review team following full text screening and reported using PRISMA guidelines. CASP and COREQ tools will assess study methodological quality and quality of reporting. Data will be extracted using a bespoke form and coded, using Excel software for data management. Analysis will involve the three stages of thematic synthesis: initial free coding, development of descriptive and subsequent analytical themes. Confidence in findings will be assessed using the CERQual framework.

DISCUSSION

This review is the first to date to synthesise qualitative evidence on experiences which influence how trained lay and professional providers support women with breastfeeding. Findings will enable deeper understanding of the underpinning mechanisms of breastfeeding support provision and inform the development of tailored interventions to improve breastfeeding rates.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020207380.

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects

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.

Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: 'underprepared and ineffectively supported', 'morality and perceived judgement' (breastfeeding), 'frustration with infant feeding care' and 'failures, fears and forbidden practice' (formula feeding). Both guilt and shame were associated with self-perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon

Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding.Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case.Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior.Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice.Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice.

New mothers and their understanding about breast milk donation

Abstract Objective: to analyze the understanding of mothers about the donation of human milk. Methods: a qualitative and quantitative study with 13 potential milk donors who answered a sociodemographic and obstetric background questionnaire, as well as a semi-structured interview guide on milk donation. Mothers were approached in the hospital environment, after delivery and the visit of the milk bank. Data were analyzed in Statistical Package for Social Sciences 20.0 and NVivo 11 Starter. Results: the mean age was 24.62 ± 3.95 years; 84.6% had more than eleven years of formal education; 38.5% declared themselves housewives; 46.2% were in a stable union and 76.9% had an income of up to two minimum wages. Most of the mothers (69.2%) experienced previous pregnancy; 76.9% had 6 or more prenatal consultations and 62.5% had previously breastfed. The motivating factors of the donation were altruism; empathy with other mothers; recognition of the primacy of breast milk; the child's understanding of breast milk need; excess milk production and family support. Unawareness of the process, limited time available, and lack of transportation and collection points can make donation difficult. Conclusions: there was a desire for information and support for breastfeeding and donation, which made the donation act complex and distant from reality.

Care during Breastfeeding: Perceptions of Mothers and Health Professionals

OBJECTIVES

To know the perceptions of mothers and health professionals in relation to the care provided and received during breastfeeding at primary health care level.

METHODS

A qualitative exploratory study was conducted with breastfeeding mothers (10) and primary health care professionals (24). Data was gathered through in-depth interviews and focus groups. Data analysis was performed through thematic content analysis. The rigor of the study was ensured by the Guba and Lincoln criteria for qualitative research. Ethical aspects were addressed through the informed consent process, confidentiality, and methodological rigor.

RESULTS

The experience of providing/receiving breastfeeding support was revealed as a dynamic, multidimensional care and support process, through three central themes: 1. Influence of previous care and support experiences during the breastfeeding process; 2. Importance of the context within which care is framed; and 3. Addressing emotions to establish trust between professionals and mothers.

CONCLUSIONS

The study findings contribute to further understanding a complex phenomenon, such as breastfeeding support and care for mothers/families, from the experience of the actors involved, deepening the experiences of both in integrated manner. In addition, the relational, organizational, and contextual dimensions that influence support, and that should guide care, are also highlighted.

Online participatory intervention to promote and support exclusive breastfeeding: Randomized clinical trial

The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother-child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.

A case study on breastfeeding education in Lebanon's public medical school: exploring the potential role of social networks in medical education

BACKGROUND

Limited knowledge, negative beliefs, and lack of sufficient breastfeeding promotion and support by physicians contribute to global suboptimal breastfeeding rates. Formal medical education is well-known to influence future physicians' knowledge, beliefs, and medical practice. However, less understood is the influence of social networks and processes on the exchange and diffusion of knowledge and practices related to breastfeeding.

OBJECTIVES

We selected the underserved and under-supported public medical school in Lebanon to examine the social side of medical education. Our objectives were to assess knowledge, beliefs, and self-efficacy related to breastfeeding promotion and support among interns and residents. We also examined the social ecosystem surrounding these students concerning the exchange of breastfeeding knowledge.

DESIGN

All data were collected during one study visit per participant. First, an interview-administered structured survey was used to assess beliefs, perceived knowledge, basic breastfeeding knowledge, and self-efficacy related to breastfeeding among n = 70 medical interns and residents. Then, social network data were collected during a semi-structured interview and analyzed using an ego-network approach. All interviews were voice-recorded, transcribed, coded, and thematically analyzed. Descriptive statistics were used to analyze quantitative survey and social network results.

RESULTS

Although interns and residents had positive beliefs about breastfeeding benefits, they had limited knowledge and low self-efficacy related to the psychosocial and clinical aspects of breastfeeding promotion and support. They did not seem to have a well-connected professional network around breastfeeding knowledge and practices. Several tended to rely on their informal/non-professional network, such as their mothers, partners, and sisters, for knowledge and practice.

CONCLUSIONS

Our work using breastfeeding as an exemplary case suggests there is a role for better attending to the beliefs of medical students as well as to the social side of medical education. Future studies can use social network theory to help identify and address influences on medical education outcomes.

Evaluation of breastfeeding self-efficacy of puerperal women in shared rooming units

Purpose

To evaluate the perception of breastfeeding self-efficacy in puerperal women and to verify the association between Breastfeeding Self-Efficacy Scale-Brazilian Version (BSES-VB) scores and sociodemographic and obstetric variables. The practice of breastfeeding is of extreme importance, not only because of its affective value but also because the nutritional composition of human milk is essential nutrients for the adequate growth and development of the newborn.

Design and methods

This is a quantitative and cross-sectional study. The sample consisted of 100 puerperal women. The research instruments used were form with demographic, economic, obstetric and breastfeeding data and the BSES-VB.

Results

40% of the mothers obtained scores compatible with average breastfeeding self-efficacy, 35% of them presented high efficacy and 25% low efficacy. There was no significant relationship between sociodemographic and obstetric variables with the BSES-VB mean scores in the puerperal period. In the association between some variables and items of the breastfeeding self-efficacy scale, it was observed that breastfeeding guidance in the prenatal period and marital status were statistically significant with the mean scores of each item on the scale.

Conclusion

Only 35% of the puerperal women presented high breastfeeding efficacy. Breastfeeding guidance variables in prenatal care and marital status were statistically significant.

Practice implications

the work of the professionals who work in the care of puerperal women becomes of great importance to provide information on the breastfeeding theme and determining the adherence to the practice of breastfeeding.

Fatores relacionados ao desmame precoce do aleitamento materno

Objetivos: Investigar os fatores relacionados ao desmame precoce antes dos seis meses de vida. Métodos: Trata-se de uma pesquisa exploratória, descritiva de abordagem quantitativa, baseada em questionário semiestruturado, com amostra de 52 mulheres com filhos de 0 a 6 meses de vida que não estavam mais em aleitamento materno exclusivo (AME), pertencentes às Estratégias de Saúde da Família urbanas do município de Santo Antônio do Monte, centro-oeste de Minas Gerais. Resultados: Apontaram mães jovens, casadas, primíparas, inseguras, com gravidez não planejada, realização das consultas de pré-natal periodicamente, desmame do AME entre o quarto e quinto mês de vida da criança. Conclusão: As atividades laborais, as crenças quanto ao leite materno ser fraco ou insuficiente para o bebê e a má interpretação do choro do recém-nascido estão entre as causas encontradas para o desmame precoce. Salienta-se a implementação de estratégias e ações educativas que priorizem a resolutividade quanto aos fatores destacados, e que, especialmente, busquem melhorar o vínculo com esse público.

Avaliação do crescimento e desenvolvimento infantil na consulta de enfermagem

Objetivo: Analizar la evaluación del crecimiento y desarrollo infantil en la consulta de enfermería.Metodología: Estudio descriptivo con enfoque cualitativo. Los participantes del estudio fueron cuatro enfermeros que realizaban la consulta de enfermería a los niños de manera programática en unidades de salud de familia en Cuiabá, Mato Grosso, Brasil. La recolección de los datos se llevó a cabo mediante la observación participante de 21 consultas de enfermería entre enero y febrero de 2012. Los datos se analizaron con la técnica de análisis de contenido.Resultados: A partir del análisis de los datos, surgieron las siguientes dos categorías: Evaluación del crecimiento infantil en la consulta de enfermería y Evaluación del desarrollo infantil en la consulta de enfermería. Los enfermeros evaluaron el crecimiento infantil en todas las consultas, utilizando las curvas contenidas en la libreta personal de registro médico del niño. Sin embargo, el desarrollo infantil sólo fue evaluado parcialmente en la mayoría de las consultas observadas.Conclusión: Entre los aspectos más significativos de las consultas de enfermería se destacan la evaluación del crecimiento y desarrollo en todas ellas; y el uso de la libreta personal de registro médico del niño como instrumento de orientación para las madres y como estrategia de seguimiento del crecimiento y desarrollo infantil.

Promotion of breastfeeding in Poland: the current situation

Objective

Exclusive breastfeeding is safe and beneficial for healthy infants; it is the optimal feeding method during the first 6 months of life. Infants should be complementary fed in conjunction with breastfeeding until 12 months of age or longer. The aim of the present study was to analyse the duration of breastfeeding through 12 months of age.

Methods

Participants were 1679 women from 42 randomly selected hospitals in Poland. The data were obtained from surveys, including a paper and pencil interview that was conducted after mothers delivered in the hospital and before discharge. Computer aided telephone interviews were administered at 2, 4, 6 and 12 months.

Results

There was a high rate of initiating breastfeeding after birth (97%), a rapid abandonment of exclusive breastfeeding (43.5% at 2 months, 28.9% at 4 months and 4% at 6 months) and an onset of formula feeding during the first days of life, which is contrary to current recommendations.

Conclusions

It is necessary re-educate mothers, medical staff who care for mothers and children during the perinatal period, and other specialists.

Silêncios nos discursos pró-aleitamento materno: uma análise na perspectiva de gênero

Resumo: Este artigo aborda os discursos da atual Política Nacional de Aleitamento Materno brasileira, enfocando sentidos pouco explorados em seus materiais educativos. As perspectivas teórico-metodológicas adotadas foram a Semiologia dos Discursos Sociais, que entende o discurso como constitutivo e constituinte das relações sociais de poder, e os Estudos de Gênero, que questionam a naturalização da dualidade feminino/masculino como estruturante de uma essência fixa do ser. A análise identificou como, em geral, os materiais continuam a enfatizar a importância do aleitamento materno para a saúde da criança, omitindo ou tratando de forma estereotipada as perspectivas das mulheres sobre a prática. A complexidade da amamentação é pouco abordada, e o desmame como transição subjetiva na relação entre mãe, criança e mundo social, silenciado.

[Breastfeeding and complications that contribute to early weaning]

OBJECTIVE

To obtain knowledge on the experience of mothers about breastfeeding and events that contribute to early weaning.

METHOD

Research descriptive and exploratory kind with a qualitative approach carried out in a unit of the Family Health Strategy in the city of Cáceres-MT, through semi-structured interviews with 21 women who gave birth from January / 2012 to January / 2014.

RESULTS

The data showed that at six months only 19.1% of the children were still being exclusively breastfed and the main explanations for this were: Lack of knowledge, inexperience / insecurity; Underestimation of maternal distress; Complications of puerperal breast; Family interference; Weak / inadequate milk; maternal employment.

CONCLUSION

The study reinforced the need for adjustments in the current care model, surpassing applicability of predefined techniques, encouraging critical judgment and perception of health professionals regarding the the construction of new knowledge and behaviors.