Breast-feeding practices among adolescent and adult mothers in the Missouri WIC population

Factors Associated with Infant Feeding Choices in the Adolescent Population

BACKGROUND

Strong recommendations have been made for exclusive breastfeeding of infants for the first 6 months of life, with continuation throughout the first year. In an attempt to optimize support for breastfeeding, particular barriers in populations with decreased rates need to be analyzed.

OBJECTIVE

This study aimed to determine if participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food voucher program, involvement of the infant's father, involvement of the adolescent mother's parents or other caregivers, and participation in early skin-to-skin contact after birth are associated with the decision to breastfeed or bottle feed among this adolescent population.

METHODS

A retrospective chart review of 457 adolescent patients who delivered January 2010 through May 2013 at the University of Louisville Hospital was conducted. Nursing documentation was used to determine the patient's intention to breastfeed or bottle feed, participation in WIC, involvement of the infant's father, involvement of the patient's parents, and participation in early skin-to-skin contact after delivery. These factors were compared using Fisher exact test.

RESULTS

Three hundred one adolescents reported a plan to breastfeed (65.9%) and 156 reported a plan to bottle feed (34.1%) when questioned pre-delivery. There was no significant difference between the groups with respect to WIC participation or involvement of the infant's father. The bottle-feeding group had a significantly higher percentage who reported parental involvement (80.1% vs 67.8%, P = .0059). The breastfeeding group had a significantly higher percentage who participated in early skin-to-skin contact after birth (74.5% vs 58.1%, P = .0064).

CONCLUSION

Involvement of the adolescent mothers' parents or caregivers was associated with the decision to bottle feed. Participation in early skin-to-skin contact after birth was associated with the decision to breastfeed.

Factors Associated With Exclusive Breastfeeding Through Four Weeks Postpartum in Thai Adolescent Mothers

Breastfeeding initiation and duration are decreased in adolescent mothers compared to older mothers. A prospective descriptive cohort design was used to explore personal, social, cultural, and infant factors that explain and predict breastfeeding initiation and maintenance at 4 weeks postpartum. Adolescent mothers (N = 120) were recruited at prenatal clinics in Thailand. Data were collected at enrollment, during birth hospitalization (N = 102), and at 4 weeks postpartum (N = 96). Findings revealed breastfeeding attitudes, social support, and cultural beliefs about "being a good mother" were positively correlated with breastfeeding initiation. Furthermore, breastfeeding attitudes and social support were significant positive predictors of exclusive breastfeeding (both p ≥ .01) continuation through 4 weeks, whereas infant temperament was a significant negative predictor (p ≥ .04). Maternal competence at 4 weeks postpartum was also positively correlated with exclusive breastfeeding continuation.

Counselling sessions increased duration of exclusive breastfeeding: a randomized clinical trial with adolescent mothers and grandmothers

Background

Considering that adolescent mothers may be more vulnerable to discontinuing exclusive breastfeeding (EBF) before 6 months and that their mothers may exert a negative influence on this practice, this study was conducted with the objective of evaluating the efficacy of breastfeeding counselling for adolescent mothers and their mothers in increasing EBF duration.

Methods

A clinical trial was performed in 323 adolescent mothers with newborns and their mothers randomized in four groups: (1) not living with mother, without intervention; (2) not living with mother, with intervention; (3) living with mother, without intervention, (4) living with mother, with intervention. The intervention consisted of five counselling sessions directed to mother and grandmother, in the maternity hospital and on follow-up. Information about feeding practices during the newborn’s first six months of life was collected monthly by telephone. Intervention’s efficacy was measured through Cox regression and comparison of exclusive breastfeeding medians and survival curves for the different groups.

Results

The intervention increased the duration of EBF by67 days for the group which included grandmothers (HR = 0.64; CI 95% = 0.46-0.90) and 46 days for the group which did not include grandmothers (HR = 0.52; CI 95% = 0.36-0.76).

Conclusions

Counselling sessions in the first four months of children’s lives proved to be effective in increasing EBF duration among adolescent mothers.

Trial registration

ClinicalTrials.gov NCT00910377.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design

OBJECTIVE

The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed.

DESIGN

A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools.

METHODS

The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data.

RESULTS

Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools.

CONCLUSION

The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Evaluation of the supportive needs of adolescents during childbirth intrapartum nursing intervention on adolescents' childbirth satisfaction and breastfeeding rates

OBJECTIVE

To evaluate the effect of the Supportive Needs of Adolescents during Childbirth (SNAC) intrapartum nursing intervention on adolescents' childbirth satisfaction and breastfeeding rates.

DESIGN

Separate sample posttest quasi-experimental.

SETTING

A tertiary hospital intrapartum unit.

PARTICIPANTS

A convenience sample of 106 parturient adolescents.

METHODS

During Phase 1 the control group received current standard of intrapartum care. During Phase 2, the interventionist nurses provided the SNAC intervention and standard of care to the intervention group.

RESULTS

The t test indicated higher childbirth satisfaction in the intervention group. Chi-square analysis indicated that the intervention group was more likely to breastfeed within the first hour after birth. There was no significant relationship between childbirth satisfaction and breastfeeding at three months and no differences between the groups in breastfeeding rates at hospital discharge and three months.

CONCLUSIONS

These results suggest that learning the SNAC intervention may help nurses positively influence adolescents' childbirth experience and timing of breastfeeding initiation. Replication of the study is needed to further explore whether the intervention can significantly influence breastfeeding duration.

Adolescent mothers' breastfeeding social support needs

OBJECTIVE

To define aspects of social support that adolescents need from nurses when initiating breastfeeding in the early postpartum.

DATA SOURCES

MEDLINE and CINAHL databases for years 2000 to 2009.

DATA EXTRACTION

Three searches were done using the following subject terms: adolescent mothers and breastfeeding (12 studies), adolescent mothers and breastfeeding and support (24 studies), and breastfeeding and adolescent mothers and attitudes (15 studies). The 18 studies that were chosen for this synthesized review illuminated the dimensions of social support identified by House.

DATA SYNTHESIS

The four types of supportive behavior categories identified by House were described in these studies (informational, instrumental, emotional, and appraisal). Esteem support as defined by Sarafino seemed to be synonymous with appraisal support. Many studies identified the importance of network support as a fifth category of supportive behavior in increased breastfeeding duration among adolescents; network support was included in this synthesis. These five types of social support provide a framework for defining supportive nurse behaviors.

CONCLUSIONS

Nurses in the early postpartum can promote the long-term health of adolescents and their children through the social support they offer adolescent mothers as they initiate breastfeeding. Network support appears to be essential to adolescents' breastfeeding experiences and needs to be included with informational, instrumental, emotional, and esteem/appraisal support when investigating support for this population. By integrating the five dimensions of social support into their care, nurses play an essential role in providing adolescents with the positive experiences that are so important to establishing breastfeeding.

Breastfeeding experiences of urban adolescent mothers

This qualitative descriptive study examined the breastfeeding experiences of urban adolescent mothers using a combination of focus groups and semi-structured interviews. Analysis of verbatim interview text, field, and debriefing notes was undertaken to discover categories, themes and an emerging conceptual framework. Twenty-three teens, between the ages of 14 and 18, enrolled from two postpartum clinics described the process of teens' breastfeeding decision-making, initiation, continuation, and termination of breastfeeding. Roughly half of the teens were currently breastfeeding and the other half had weaned their infant within the last six months. Adolescent mothers chose breastfeeding mainly for infant health reasons, closeness and bonding. Positive and negative events; barriers and facilitators to continued breastfeeding; and types of support received during breastfeeding illuminated the experience starting in the hospital and extending over time. Among those who weaned, a combination of primary and secondary obstacles or problems, such as perceptions of insufficient milk supply, nipple/breast pain, time demands of school or work, problems with pumping, and feeling overwhelmed and frustrated led to weaning. Many who weaned did not seek out available help and ultimately many reported regret about weaning earlier than intended. Those who continued breastfeeding beyond six weeks reported significant emotional, informational and instrumental support from family, friends, school, and their babies. Implications for nursing practice and research are discussed.

Experiences of infant-feeding decision-making among urban economically disadvantaged pregnant adolescents

AIM

The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices.

BACKGROUND

Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done.

METHODS

Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae.

FINDINGS

The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident.

CONCLUSIONS

Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.

Evaluation of a comprehensive loving support program among state Women, Infants, and Children (WIC) program breast-feeding coordinators

BACKGROUND

Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC) Breastfeeding Promotion Project Team developed a comprehensive program that included patient and family education, staff training, public awareness activities, health professional outreach, and partnerships with the community. The program also implemented a breastfeeding-friendly clinic environment project and a videotape project. This study was conducted to evaluate the impact of Mississippi's LSMBW activities among WIC breastfeeding coordinators in the United States.

METHOD

The cross-sectional study was performed with the use of a mailed, self-administered questionnaire.

RESULTS

Representatives of 50 state WIC agencies returned the survey. Of these 50 agencies, 36 (72%) had effectively used education materials created by the state of Mississippi. Breastfeeding coordinators reported that among the campaign activities, staff training, community outreach, and peer counseling were most beneficial. They also identified the videotape project developed by Mississippi as useful in addressing barriers to breastfeeding and in training support groups, staff, and health care professionals.

CONCLUSION

This study showed that Mississippi's outreach activities and motivational videotape had a positive impact on coordinators' promotion of breastfeeding.

A longitudinal study of breastfeeding and weaning practices during the first year of life in Dunedin, New Zealand

OBJECTIVE

To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand.

DESIGN

Prospective study of infants from birth to 12 months of age.

PARTICIPANTS

A self-selected sample of 74 white mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996. Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration.

RESULTS

Among mothers, 88% (n=65) initiated breastfeeding, 42% (n=31) were exclusively breastfeeding at 3 months, and 34% (n=25) were partially breastfeeding at 12 months. Intention to breastfeed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breastmilk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45% (n=33) were given nonmilk foods before 4 months of age, and 69% (n=51) were given unmodified cow's milk as a beverage before 12 months.

APPLICATIONS

Breastfeeding rates in this study, although higher than in many Western countries, were still lower than current recommendations. Our findings suggest that women should be taught how to increase their breastmilk supply. Parents should also be informed of the importance of delaying the introduction of nonmilk foods until their infant is 4 to 6 months of age and cow's milk until they are 12 months of age. Society also needs to address the social issue of embarrassment many mothers feel when breastfeeding in public.