Why invest, and what it will take to improve breastfeeding practices?

Father support breastfeeding self-efficacy positively affects exclusive breastfeeding at 6 weeks postpartum and its influencing factors in Southeast China: a multi-centre, cross-sectional study

BACKGROUND

The exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy.

METHODS

This research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data.

RESULTS

Results indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017-4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time.

CONCLUSIONS

High-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding.

Effects of Exclusive Breastfeeding Duration on Pneumonia Occurrence and Course in Infants Up to 6 Months of Age: A Case-Control Study

We aimed to analyze the effects of exclusive breastfeeding duration on the occurrence and course of pneumonia in infants aged up to 6 months. Prospective case-control study. This study was conducted from August 2020 to August 2022 at a maternity and child health hospital in China. A total of 218 infants up to 6 months of age with pneumonia were included in the analyses. Health data were obtained using a hospitalization information system or an interview-based questionnaire. Univariate and multivariate logistic regression analyses were performed to analyze the data. The incidence of pneumonia, hospitalization duration, and costs to participants were significantly affected by the duration of exclusive breastfeeding (p < 0.01). The incidence of pneumonia among participants with different exclusive breastfeeding durations also differed significantly (p < 0.01). The shorter the duration of exclusive breastfeeding, the higher the incidence of pneumonia among infants. We found that the longer the exclusive breastfeeding duration in infants up to 6 months of age, the lower the recurrence of pneumonia, the shorter the hospital stay, and the lower the hospital costs. The rate of exclusive breastfeeding for infants up to 6 months of age should be increased as much as possible to reduce the occurrence of pneumonia and hospital costs.

Dietary Intake and Exposure Assessment of Trace Elements in Infants' Diets: A Case Study in Kuwait

Different types of infant foods categorized as formulas, cereals, and purees imported from seven different countries and available on the Kuwaiti retail market were collected to determine the elemental content, including essential trace elements namely chromium (Cr), manganese (Mn), iron (Fe), copper (Cu), zinc (Zn), selenium (Se), and molybdenum (Mo); potentially toxic trace elements such as aluminum (Al), nickel (Ni), tin (Sn), antimony (Sb), and uranium (U); and toxic trace elements including arsenic (As), lead (Pb), cadmium (Cd), and mercury (Hg). The samples were analyzed using ICP-MS. An extensive literature search illustrated the uniqueness of this study since seven different essential elements, five different potentially toxic elements, and four different toxic trace elements were measured in a variety of infant foods; in addition, the different trace etlemental levels measured in the investigated infant foods were compared to the ones associated with the different infant foods types reported in the literature. The essential trace element concentrations detected in this study were implemented to calculate their total daily intake, where the calculated daily intake values were compared to their recommended dietary allowance (RDA) to assess the percentage total daily intake for the essential trace elements. Further, the calculated potentially toxic and toxic trace elements daily intake values were used to assess the potential health risks to infants incurred by consuming different infant foods by calculating the hazard quotient (HQ), while the margin of exposure (MOE) was calculated for the toxic ones only. It was concluded that infant formulas and foods should be added to the infant diet in addition to breast milk to meet specific nutritional needs. This study confirms that infants are exposed to toxic trace elements via diet, warranting careful attention to diet choices both to limit this exposure and to avert potentially hazardous adverse health effects to the infants. However, based on the calculated hazard quotients (HQs) and margin of exposures (MOEs), consuming breast milk in addition to almost all different types of infant foods is considered safe and unlikely to contribute to infants' non-cancerous health hazards.

Infant formula feeding and associated factors in Debre Berhan City: A community based cross-sectional study

Introduction

Globally, there is rising concern over the growing reliance on breast milk substitutes (BMSs). However, limited studies have been conducted to explore this issue in Ethiopia.

Objective

To assess infant formula feeding and associated factors among mothers of infants aged 0-6 months in Debre Berhan City, 2023.

Methods and materials

This cross-sectional study used a multistage sampling technique to select 656 mothers residing in Debre Berhan city. The data was collected through face-to-face interviews using a semi-structured questionnaire. Bivariable and multivariable logistic regression models were employed to identify the factors associated with infant formula feeding. The findings are then presented as frequencies, percentages, and odds ratios.

Results

The prevalence of infant formula feeding in Debre Berhan city was 39.7 %. In addition, having a female child [AOR = 1.75, 95 % CI: 1.08-2.86], receiving a college education or higher [AOR = 5.79, 95 % CI: 2.38-14.08], being in the age category of 25-34 [AOR = 2.38, 95 % CI: 1.10-5.15] or 35-45 [AOR = 3.43, 95 % CI: 1.35-8.69], being a prime mother [AOR = 1.81, 95 % CI: 1.12-2.94], receiving breastfeeding advice [AOR = 4.64, 95 % CI: 2.78-7.75], delivering via a C-section [AOR = 5.39, 95 % CI: 2.54-11.42], initiating breastfeeding late [AOR = 2.26, (95 % CI: 1.41-3.64)], or being unaware of the risks associated with infant formula feeding [AOR = 5.48, 95 % CI: 3.20-9.39] were the factors that drove mothers towards infant formula feeding.

Conclusion

In Debre Berhan city, the prevalence of infant formula feeding was high. Fortunately, with appropriate interventions, most of the factors that led to infant formula feeding could be effectively addressed.

Outcomes of implementing the International Code of Marketing of Breast-milk Substitutes as national laws: a systematic review

BACKGROUND

The International Code of Marketing of Breast-milk Substitutes, or 'the Code,' sets standards to regulate marketing of commercial milk formula (CMF) to protect breastfeeding. World Health Organization member states are advised to legislate the Code into national law, but understanding of its implementation outcomes is limited. This systematic review aimed to examine implementation outcomes in countries implementing the Code as national law.

METHODS

We systematically searched five academic databases in September 2022 for articles published in English from 1982 to 2022. We double-screened titles/abstracts and then full texts for eligible articles reporting implementation outcomes of the Code in 144 eligible countries. We used the Mixed Methods Appraisal Tool for quality assessment and synthesized data thematically. We applied the Proctor et al. framework to guide synthesis of implementation outcomes, organizing our findings according to its taxonomy.

RESULTS

We included 60 eligible articles of the 12,075 screened, spanning 28 countries. Fifty-seven articles focused on legal compliance, 5 on acceptability, and 1 on feasibility. Compliance was assessed across multiple sources, including mothers, health workers, media, points of sale, and product labels. Maternal exposure to CMF promotion remained widespread, with reports of mothers receiving free samples and coupons, and encountering media advertisements. Compliance of health workers varied across countries, with many reporting contact with CMF companies despite legal prohibitions. Public hospitals generally showed better adherence to the national law than private ones. While implementing the Code as national law effectively regulated the promotion of CMF for infants aged 0-12 months in public settings and in the media, it remains insufficient in addressing the promotion of unregulated products like growing-up milk, which are often marketed through emerging strategies such as cross-promotion and digital advertising. Point-of-sales compliance was inconsistent, with many countries reporting non-compliant price-related promotions.

CONCLUSION

To enhance legal compliance, robust monitoring and reporting systems are necessary. Utilizing technology-assisted solutions for monitoring compliance can be an option for countries with limited human resources. Adequate training for health workers and communication strategies targeting shop managers about national law are also essential in enhancing their acceptability and compliance.

Factors Influence Breastfeeding Duration after High Risk and Low Risk Pregnancies

BACKGROUND

Breastfeeding provides vital nutrients and fosters maternal-infant bonding, benefiting both mother and child. However, breastfeeding duration is influenced by various factors, especially in women of high-risk pregnancy. This study aims to identify predictors of breastfeeding duration among women of high-risk and low-risk pregnancy, focusing on exclusive and mixed feeding practices.

METHODS

Conducted at a public hospital in Attica, Greece, this 20-month prospective cohort study (May 2020-January 2022) included 380 pregnant women, divided into high-risk and low-risk groups. The final sample of 157 women, after excluding non-breastfeeding participants, was assessed across five phases from prenatal to six months postpartum using interviews, calls, and surveys. Multiple linear regression identified key predictors, with statistical methods applied.

RESULTS

Results revealed birth weight as a consistent significant predictor of breastfeeding duration. For women with high-risk pregnancy, additional factors like infant gender, jaundice, and early introduction of solid foods influenced breastfeeding duration. The mixed breastfeeding model for women with high-risk pregnancy explained 72.9% of the variance. Exclusive and mixed breastfeeding models for women with low-risk pregnancy also highlighted birth weight's influence.

CONCLUSION

The findings highlight the important role of birth weight and other specific factors in determining breastfeeding duration among women of high-risk and low-risk pregnancy. Further research is needed to validate these findings across diverse populations.

Trends and disparities in ever-breastfeeding practice and early breastfeeding initiation in Ethiopia: a 20-year trend analysis from EDHS datasets

BACKGROUND

Ethiopia has had a long-standing national commitment to improving child health for the last five decades. However, evidence on trends of ever-breastfeeding and early initiation remained fragmented, and there existed a paucity of holistic evidence on the extent of the impacts of the policy and the associated factors. This study examined trends, disparities, and factors influencing ever-breastfed and early initiation in the last twenty years.

METHODS

The Ethiopian Demographic and Health Surveys (EDHS 2000-2019) datasets were used and extracted for children aged 0-23 months and their mothers. Data analyses were performed using SPSS version 25. Trend and time-series analysis was used to visualize changes over time. Multivariable logistic regression was used to identify associated factors.

RESULTS

Prevalence of ever-breastfeeding declined from 99.4% in 2000, to 84.01% in 2019; and early initiation showed inconsistency, increasing from 48.55% in 2000 to 69.57% in 2016 and remained unchanged (69.78%) in 2019. Maternal age, religion, and maternal healthcare utilization significantly influenced early initiation (p < 0.001). Both ever-breastfeeding and early initiation varied across regional states (< 0.001). Disparities in breastfeeding and early initiation were observed across socio-cultural settings and regional states (p < 0.05).

CONCLUSION

The prevalence of ever-breastfeeding declined nationwide between 2000 and 2019, which was not uniform and early initiation showed inconsistency across socio-cultural settings and regional states. These findings highlight the need to revisit current policies and interventions. Further research is crucial to inform the development of regionally tailored and culturally sensitive strategies that promote equitable and sustained breastfeeding improvement across Ethiopia.

The effect of on-site and on-call nurse on exclusive breastfeeding in two different hospital settings: a prospective observational cohort study

BACKGROUND

Exclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio.

METHODS

We conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group).

RESULTS

A total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group.

CONCLUSIONS

We can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section.

Factors Influencing Health Professionals' Decisions Regarding the Indication of Infant Formula: A Qualitative Exploration in Uruguay

BACKGROUND

Health systems are fundamental to the promotion and protection of breastfeeding. Health professionals have a pivotal influence on families' infant feeding decisions and may act as facilitators or barriers to adequate breastfeeding practices.

RESEARCH AIM

To explore factors influencing health professionals' decisions regarding the indication of infant formula in Montevideo, the capital of Uruguay, an emerging Latin American country.

METHOD

This was a qualitative study based on semi-structured interviews with 30 health professionals (neonatologists, pediatricians, family doctors, and nurses) working in primary and secondary care in both private and public health institutions. The interviews were audio-recorded, transcribed, and analyzed using content analysis based on deductive-inductive coding.

RESULTS

The narratives of the participants identified maternity wards as the healthcare sites where the indication of infant formula occurs most frequently. Motives underlying the indication of infant formula by health professionals were diverse. The type of birth and the conditions of the child and the mother were the most relevant in secondary care, whereas maternal work was the main determining factor in primary care. A wide range of factors encouraging and discouraging the indication of infant formula were identified by health professionals in primary and secondary healthcare locations, which were related to all the levels of influence of the socioecological model.

CONCLUSIONS

Strategies to reduce the use of infant formula in Uruguay should include improving the support and guidance provided to families in the maternity ward, strengthening the implementation and monitoring of the Baby-Friendly Hospital Initiative, and improving the current maternity leave regulations.

Addressing Infant and Young Child Feeding Recommendations From a Planetary Health Perspective

BACKGROUND

Current international infant and young child (IYC) feeding recommendations consider nutrition and health but not environmental impacts. Only a handful of countries have dietary guidelines that provide quantitative recommendations for food groups of environmental concern.

OBJECTIVES

This study aimed to perform a narrative review of the environmental impacts of commercial milk formula compared with breastfeeding and to analyze the degree to which current country-specific IYC feeding recommendations are aligned with sustainable dietary targets.

METHODS

A mixed-methods review was conducted, including the following: 1) a narrative review of the environmental impact of commercial milk formula compared with breastfeeding and 2) a comparison of recommended intake of meats and dairy for children IYC based on country-specific dietary guidelines compared with the EAT-Lancet Commission dietary targets (ELCT) for children 24 mo or older and adults and if the ELCT should be adjusted for the energy needs of IYC.

RESULTS

Formula feeding has a greater environmental impact (∼48% higher carbon footprint) than exclusive breastfeeding. Available country-specific dietary guidelines for meat and dairy products in children IYC are, in general, at or below the upper limits of the ELCT recommended ranges for older children and adults but are in most cases above the upper limit when adjusting for the energy needs of IYC.

CONCLUSIONS

Exclusive breastfeeding should be protected and promoted not only as the healthier but also as the most sustainable alternative. Available complementary dietary feeding recommendations of nonprocessed meat and dairy fall below current ELCT for older children and adults. Given that IYC require a more nutrient-dense diet than older children and adults and considering the small quantities they consume, we recommend using the unadjusted ELCT as reference for IYC feeding while specific international consumption recommendations are developed for this age group.

Women's perspectives on the role and impact of breastfeeding support groups in Ireland

BACKGROUND

Breastfeeding Support Groups are deemed effective in promoting breastfeeding initiation and duration, but few studies have addressed the mothers' perspectives.

RESEARCH AIM

To investigate the role and impact of Breastfeeding Support Groups on breastfeeding mothers in Ireland from the women's perspective. Specific objectives included the assessment over time of breastfeeding self-efficacy knowledge, use, and limitations of BSGs and whether they contributed towards women achieving their breastfeeding goals.

METHODS

An online survey using an established, validated Breastfeeding Self-Efficacy tool and custom-designed questions was administered at two time points as part of a larger sequential explanatory mixed methods' design. Cultural Historical Activity Theory was used as the theoretical framework.

RESULTS

Majority of respondents at Phase 1 (N = 978) were multiparous, urban dwellers, and breastfeeding more than twelve months. Mothers first attend Breastfeeding Support Groups primarily to meet other breastfeeding mothers with many attending multiple types of group formats weekly. Qualities considered extremely important in breastfeeding supporters were: personal breastfeeding experience breastfeeding knowledge empathy understanding and listening skills There was no statistical difference in breastfeeding self-efficacy over time (z = -1.296, p = .195, r = -0.06).

CONCLUSIONS

Participants attend Breastfeeding Support Groups to 'meet other mothers' in a convenient and local location, and not necessarily for a problem. Breastfeeding Support Groups normalise breastfeeding through social support, with breastfeeding supporters providing knowledge, empathy, understanding listening, and personal breastfeeding experience. Breastfeeding self-efficacy was high and did not increase over time, suggesting mothers need to be highly efficacious in this cohort to breastfeed.

Effectiveness of layperson-based interventions in promoting exclusive breastfeeding: A systematic review and meta-analysis

OBJECTIVE

The objective of this study is to determine the effectiveness of layperson-based interventions in sustaining exclusive breastfeeding and to identify the optimal characteristics of such layperson-led strategies for promoting exclusive breastfeeding.

METHODS

A systematic review and meta-analysis were conducted using a comprehensive search in seven electronic databases from their inception to January 2024. Two independent reviewers assessed the risk of bias using version 2 of the Cochrane Risk of Bias tool for randomized trials.

RESULTS

Out of the 29,703 articles identified, 27 studies met the inclusion criteria and were included in the analysis. A total of 38,412 participants were included in these studies. The majority of the included studies utilized home visits as the intervention method. However, there is limited data available for other interventions, such as group discussions, phone support, short message service, and combined approaches, making it difficult to determine their effectiveness. Laypersons, with or without breastfeeding experience, were found to be effective intervention providers.

DISCUSSION

Home visit interventions conducted by laypersons have proven effective in promoting exclusive breastfeeding. To maximize effectiveness, the content of home visits should be tailored based on the stages of pregnancy, and ideally, the duration of the visits should extend up to six months postpartum to sustain breastfeeding.

REGISTRATION

The protocol for this review is registered on PROSPERO (registration number: CRD42021235078). A major deviation from the protocol was the exclusion of network meta-analysis due to the small number of articles identified and the primary outcome being the exclusive breastfeeding rate.

Breastfeeding experiences of women with perinatal mental health problems: a systematic review and thematic synthesis

BACKGROUND

Despite its known benefits, breastfeeding rates among mothers with perinatal mental health conditions are staggeringly low. Systematic evidence on experiences of breastfeeding among women with perinatal mental health conditions is limited. This systematic review was designed to synthesise existing literature on breastfeeding experiences of women with a wide range of perinatal mental health conditions.

METHODS

A systematic search of five databases was carried out considering published qualitative research between 2003 and November 2021. Two reviewers conducted study selection, data extraction and critical appraisal of included studies independently and data were synthesised thematically.

RESULTS

Seventeen articles were included in this review. These included a variety of perinatal mental health conditions (e.g., postnatal depression, post-traumatic stress disorders, previous severe mental illnesses, eating disorders and obsessive-compulsive disorders). The emerging themes and subthemes included: (1) Vulnerabilities: Expectations versus reality; Self-perception as a mother; Isolation. (2) Positive outcomes: Bonding and closeness; Sense of achievement. (3) Challenges: Striving for control; Inconsistent advice and lack of support; Concerns over medication safety; and Perceived impact on milk quality and supply.

CONCLUSIONS

Positive breastfeeding experiences of mothers with perinatal mental health conditions can mediate positive outcomes such as enhanced mother/infant bonding, increased self-esteem, and a perceived potential for healing. Alternatively, a lack of consistent support and advice from healthcare professionals, particularly around health concerns and medication safety, can lead to feelings of confusion, negatively impact breastfeeding choices, and potentially aggravate perinatal mental health symptoms. Appropriate support, adequate breastfeeding education, and clear advice, particularly around medication safety, are required to improve breastfeeding experiences for women with varied perinatal mental health conditions.

An exploration of prenatal breastfeeding self-efficacy: a scoping review

BACKGROUND

Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period.

METHODS

8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively.

RESULTS

Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period.

CONCLUSION

This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes.

Diffuse optical spectroscopy of lactating and non-lactating human mammary physiology

Breastfeeding provides widely recognized advantages for infant and maternal health. Unfortunately, many women experience trouble with breastfeeding. Nevertheless, few suitable imaging modalities are available to study human lactation and determine the possible causes of breastfeeding problems. In this study, we apply broadband, quantitative diffuse optical spectroscopy (DOS) for this purpose. We present a study of fourteen lactating and eight similarly aged, premenopausal, non-lactating women to investigate the feasibility of DOS to study the optical and physiological differences between 1) lactating and non-lactating breasts, 2) the areolar and non-areolar region within the breast, and 3) lactating breasts before and after milk extraction. Our study shows that i) the median total hemoglobin concentration [tHb] of the lactating breast is 51% higher than for the non-lactating breast. ii) the median [tHb] of the lactating breast is 37% higher in the areolar region compared to the non-areolar region. iii) lactating breasts exhibit a positive median difference of 8% in [tHb] after milk extraction. Our findings are consistent with the expected physiological changes that occur during the lactation period. Importantly, we show that DOS provides unique insight into breast tissue composition and physiology, serving as a foundation for future application of the technique in lactation research.

Assessing the validity of maternal report on breastfeeding counselling in Kosovo's primary health facilities

BACKGROUND

Improving the quality of breastfeeding counselling delivered by primary care providers can improve breastfeeding outcomes and ultimately reduce mortality and morbidity of children and mothers. Accurate data on coverage and quality of primary care breastfeeding counselling is essential for monitoring progress; however, global and national indicators are limited. To help address this gap, this study validated indicators of receipt and quality of breastfeeding counselling during routine consultations for infant care at seven primary health facilities across Kosovo.

METHODS

Mothers' reports of breastfeeding counselling received during routine consultations for their infants (0-12 months of age) were collected by exit interview in 2019 and 2021 (n = 609). Responses were compared against direct observation of their consultation using a structured checklist (reference standard) by a trained third-party observer at the primary care facility. We assessed 13 indicators; ten were related to the receipt and content of breastfeeding counselling, and three were specific to the provider's interpersonal skills. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy.

RESULTS

Ten indicators had an agreement rate above 70% and seven indicators had high overall individual-level validity (AUC ≥ 0.7). High prevalence indicators recorded high sensitivity and low specificity, and the inverse for low prevalence indicators. More subjective indicators were less reliable, e.g., mothers over-reported the prevalence of all three indicators related to providers' interpersonal skills.

CONCLUSIONS

This study offers evidence on breastfeeding counselling quality by validating maternal reports of whether a provider discussed breastfeeding, the clinical content of that counselling, and how it was delivered. It is also situated in a primary care setting within a fragile state of which there is limited evidence. We observed that mothers reported accurately when asked directly to recall breastfeeding counselling services received. However, there is a need to further validate subjective questions about interpersonal skills and other measures for the 'experience of care' quality dimension.

Quantifying the association between doula care and maternal and neonatal outcomes

BACKGROUND

The United States suffers from an increasing rate of severe maternal morbidity, paired with a wide disparity in maternal health by race. Doulas are posited to be a useful resource to increase positive outcomes and to decrease this disparity.

OBJECTIVE

This study aimed to evaluate the association between doula care and a broad range of maternal and neonatal outcomes in various subpopulations.

STUDY DESIGN

This was a retrospective cohort study of deliveries that were recorded from January 2021 to December 2022 at a single institution where they received prenatal care. The exposure was receipt of doula care prenatally and at delivery. We evaluated both the maternal (cesarean delivery, cesarean delivery of nulliparous, term, singleton, vertex infant, vaginal birth after cesarean, gestational hypertension, preeclampsia, postpartum emergency department visit, readmission, and attendance of postpartum office visit) and neonatal (neonatal intensive care unit admission, unexpected complications in term newborns, breastfeeding, preterm delivery, and intrauterine growth restriction) outcomes. Because our institution previously employed targeted outreach by offering doula services to patients at highest risk, we used multiple methods to generate an appropriate comparison population. We conducted a multivariate logistic regression and conditional regressions using propensity scores to model the likelihood of doula care to generate adjusted risk differences associated with doula care. Analyses were repeated in populations stratified by race (White vs Black) and then by payor status (public vs commercial).

RESULTS

Our cohort included 17,831 deliveries; 486 of those received doula care and 17,345 did not. Patients who received doula care were more likely to self-report Black race, be publicly insured, and to live in a more disadvantaged neighborhood. Regardless of the analytical approach, for every 100 patients who received doula care, there were 15 to 34 more vaginal births after cesarean (adjusted risk difference, 15.6; 95% confidence interval, 3.8-27.4; adjusted risk difference, 34.2; 95% confidence interval, 0.046-68.0) and 5 to 6 more patients who attended a postpartum office visit (adjusted risk difference, 5.4; 95% confidence interval, 1.4-9.5; adjusted risk difference, 6.8; 95% confidence interval, 3.7-9.9) when compared with those who did not receive doula services. Infants born to these patients were 20% more like likely to be exclusively breastfed (adjusted risk ratio, 1.22; 95% confidence interval, 1.07-1.38), and doula care was associated with 3 to 4 fewer preterm births (adjusted risk difference, -3.8; 95% confidence interval, -6.1 to -1.5; -4.0; 95% confidence interval, -6.2 to -1.8) for every 100 deliveries that received doula care. Results were consistent regardless of race or insurance. Results were also consistent when doula care was redefined as having at least 3 prenatal encounters with a doula.

CONCLUSION

Doula care was associated with more vaginal births after cesarean delivery, improved attendance of postpartum office visits, improved breastfeeding rates, and fewer preterm deliveries. The effect of doula care was consistent across race and insurance status.

Relationship between Infant Feeding and the Microbiome: Implications for Allergies and Food Intolerances

Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications.

Unveiling injustice: Disrupting child removal policies and upholding breastfeeding: An emancipatory framework

Before colonization, Aboriginal and Torres Strait Islander communities had nurturing, holistic, and communitarian approaches that promoted extended and healthy lives for their children. Colonization, marked by policies of genocide and assimilation, has resulted in an alarming overrepresentation of Aboriginal and Torres Strait Islander children under the care of child protection agencies, resulting in compromised health outcomes and reduced life expectancies. We are conducting a study designed to enhance positive developmental outcomes for Aboriginal and Torres Strait Islander children by articulating and enabling the rights of mothers and children to breastfeed in the context of a child protection intervention and child removal. To understand and address this problem, it is critical to implement culturally safe, de-colonized, emancipatory research that is guided by and benefits Aboriginal and Torres Strait Islander communities. This article presents an emancipatory framework that we are applying to our study using an Aboriginal participatory action research approach, that serves as a guide for non-Indigenous researchers seeking to conduct research with Indigenous communities. We emphasize the importance of incorporating an Aboriginal participatory action research framework, using community consultation and codesign; culturally secure data collection methods, and paying attention to Indigenous data sovereignty. Developing trusting respectful relationships is conducive to knowledge acquisition, exchange, and use, when research approaches deeply rooted in community involvement are applied. A call to action by the critical midwifery studies collective, urges non-Indigenous researchers to become accountable allies that demonstrates respect for community leadership while actively striving to ensure research does not perpetuate further harm, and produces effective change. This article provides an overview of ways to conduct ethical emancipatory research with Indigenous participants, that is, of benefit to midwifery practitioners and is applicable to many areas of research, policy, and practice.

CastelLact Project: Exploring the Nutritional Status and Dietary Patterns of Pregnant and Lactating Women-A Comprehensive Evaluation of Dietary Adequacy

Promoting optimal nutrition in pregnant and lactating women is crucial for maternal and infant health. This study evaluated their nutritional status and dietary habits, assessing macro and micronutrient intake based on recommendations. A descriptive study with Spanish participants examined social, obstetric, dietary, and anthropometric data using quantitative and qualitative methods. The analysis of fatty acids by gas chromatography revealed significant variability, with notable deviations in specific fatty acids like C:10:0 and C:12:0. Despite some differences, the overall composition aligns with standards. During pregnancy, 53.8% consumed five meals/day. Grilling (92.3%) and baking (76.9%) were common. Food consumption frequency differed from recommendations. Lactating mothers' mean energy intake was 2575.88 kcal/day ± 730.59 standard deviation (SD), with 45% from carbohydrates and 40% from lipids, including 37.16 g ± 10.43 of saturated fatty acids. Diets during pregnancy lacked fruits, vegetables, legumes, nuts, and cereals. Lactating mothers partially met nutritional objectives, with an energy distribution skewed towards lipids and deficiencies in calcium, iodine, vitamin D, E, and folic acid. Promoting proper nutrition during pregnancy and lactation is essential to safeguard health and prevent chronic diseases.

Monitoring of the Main Reasons for Early Abandonment of Breastfeeding during the First Six Months of Life: A Secondary Analysis

The rate of six-month-old infants exclusively breastfed in Spain remains below the recommended rate. This study aimed to explore in detail the evolution of feeding during the first six months of life of a group of newborns, as well as to identify the reasons reported by the mothers for feeding change. A secondary analysis of two prospective longitudinal observational studies was conducted. In both studies, women participants, during the clinical puerperium, opted for exclusive breastfeeding for their newborns. The participants were followed up during the infants' first six months. A sample size of 314 participants was obtained, of which 77.1% (n = 232) were of Spanish origin, and 51% (n = 160) were primiparous. The prevalence of exclusive breastfeeding at six months was 55.4% (n = 174). During the first four months of life, the main reason for early abandonment of breastfeeding was the perception of insufficient milk production. After the fourth month, the predominant reason was starting work. Statistically significant differences were observed between the reasons for giving up and the total weeks of exclusive breastfeeding (p < 0.001) and total weeks of breastfeeding (p = 0.002). Early weaning from breastfeeding is a multifactorial phenomenon. However, depending on the moment cessation occurs, some reasons predominate over others and, in many cases, can be prevented. These results indicate the need to continue investing efforts to promote and protect breastfeeding in Spain.

Having Enough Milk to Sustain a Lactation Journey: A Call to Action

The rates of human milk feeding are suboptimal worldwide. Recommendations for healthy, term mother-infant dyads include early breastfeeding initiation, frequent skin-to-skin contact, and frequent breastfeeding. The normal physiology of lactation can be affected by prenatal factors such as diabetes, obesity, and excessive gestational weight gain. Furthermore, birth-related factors such as early-term gestation, stressful labor, unscheduled cesarean birth, and postpartum hemorrhage can additionally disrupt recommended practices such as early initiation of breastfeeding and skin-to-skin contact. Given that the first 2 to 3 days postpartum are critical to achieving timely secretory activation and establishing an adequate volume of milk, a proactive approach to care can include building awareness of risk factors and development of protocols for the effective early initiation of lactation.

Academy of Breastfeeding Medicine Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Period (Revised 2024)

Background: The Academy of Breastfeeding Medicine revised the 2015 version of this clinical protocol to review the evidence and provide recommendations related to breastfeeding promotion in the prenatal period. Key Information: Promoting and normalizing breastfeeding in the prenatal period can improve breastfeeding outcomes including initiation and duration of breastfeeding. Ideally, prenatal interventions should be a part of a comprehensive longitudinal breastfeeding support program. Recommendations: Clinicians or other health workers should discuss breastfeeding at each prenatal visit. Counseling topics should include the health benefits of breastfeeding versus not breastfeeding, the basics of breastfeeding (e.g., physiology, positioning), what to expect of hospital-based and immediate postpartum breastfeeding support (i.e., Baby-Friendly Ten Steps), and the risks of unnecessary supplementation. Medical, anatomical, and other risk factors for breastfeeding challenges should be identified, and targeted anticipatory guidance should be given. Prenatal counseling should include distribution of structured breastfeeding education at low literacy levels and in the parent's preferred language. Counseling should be culturally sensitive and patient-centered, including family members when appropriate. Prenatal support may integrate various health workers (e.g., medical doctors, midwives, community health workers, lactation consultants, among others) and include various modalities including telecommunication. Enhancing breastfeeding education for prenatal care providers is also imperative. Additional themes related to implementation of recommendations for specific populations are also reviewed.

'It's far from the norm': breastfeeding beyond 1 year in the Republic of Ireland

Breastfeeding is the optimal form of nutrition for infants and young children. The World Health Organization recommends that babies are breastfed exclusively for the first 6 months of life, and up to the age of 2 years or beyond in combination with complementary food. Breastfeeding initiation and continuation rates are suboptimal globally and very low in the Republic of Ireland where health promotion initiatives and healthcare professional support predominantly focus on the important phase of initiation and early months of the breastfeeding journey. This qualitative descriptive study aimed to explore the experiences of women who chose to breastfeed their children beyond 1 year of age in the Republic of Ireland. Fourteen women participated in semi-structured interviews. Interviews were transcribed verbatim and thematic analysis was conducted. The analysis generated three overarching themes: (1) Influences on breastfeeding beyond 1 year, (2) Sustaining breastfeeding and (3) Benefits of breastfeeding beyond 1 year. Family, friends, peers, culture and commercial milk formula marketing had an influence on breastfeeding journeys. Support, determination, knowledge, bed-sharing and Covid-19 pandemic social restrictions helped to sustain breastfeeding beyond 1 year. Benefits of breastfeeding beyond 1 year such as nutrition, strengthening of emotional bonds, development of a parenting tool, and protection of child and maternal health were identified. Our findings support the need for discussions and further research on the normalization of breastfeeding beyond 1 year in the Republic of Ireland, targeted health promotion initiatives and education programmes for healthcare professionals on supporting the continuation of breastfeeding.

Perinatal maternal factors influencing postpartum feeding practices at six weeks

OBJECTIVE

Despite the World Health Organization's recommendation of exclusive breastfeeding for the initial 6 months, breastfeeding rates decline within the first 6 weeks after delivery. This study aimed to (1) investigate the breastfeeding rate at 6 weeks postpartum and (2) explore the influence of perinatal factors on feeding patterns at 6 weeks postpartum.

METHOD

A total of 635 participants were enrolled from February to August 2023 at outpatient clinics in three tertiary hospitals in Nantong City. Variables were collected through questionnaires during the third trimester of pregnancy, including demographic information, pregnancy stress, anxiety, depression, sleep, and resilience. At 6 weeks postpartum, information regarding feeding patterns, delivery and postpartum situations, postpartum stress, anxiety, depression, sleep, and resilience was gathered. Initial single-factor analyses were conducted using feeding pattern as the dependent variable, and variables with significance were chosen as independent variables. The disordered multi-classification logistic regression model was then established using the stepwise forward method.

RESULTS

Within the first 6 weeks, 35.28% (224/635) of postpartum women exclusively breastfed their infants. Factors influencing exclusive breastfeeding and formula feeding at 6 weeks postpartum included breast pain, sleep quality, mental resilience, difference between postpartum and late pregnancy anxiety, insufficient milk supply, and maternal herself caring for the infant (P < 0.05). Factors influencing the transition from exclusive to partial breastfeeding were insufficient milk supply and maternal herself caring for the infant (P < 0.05).

CONCLUSION

The study reveals a relative low rate of exclusive breastfeeding in China's first 6 weeks postpartum, along with a comparison of perinatal factors affecting three different feeding patterns. Our findings may contribute additional evidence to the association between perinatal factors and feeding patterns. This study guides healthcare professionals in developing strategies to promote exclusive breastfeeding and improve personalized counseling for exclusive breastfeeding and mental health.

Effects of feeding patterns during the first 6 months on weight development of infants ages 0-12 months: a longitudinal study

The purpose of this study was to investigate the effect of feeding patterns during the first 6 months on weight development of infants ages 0-12 months. Using monitoring data from the Maternal and Child Health Project conducted by the National Center for Women and Children's Health of the Chinese Center for Disease Control and Prevention from September 2015 to June 2019, we categorized feeding patterns during the first 6 months as exclusive breastfeeding, formula feeding, or mixed feeding. We calculated weight-for-age Z scores (WAZ) according to the World Health Organization's (WHO) 2006 Child Growth Standard using WHO Anthro version 3.2.2. A multilevel model was used to analyze the effect of feeding patterns during the first 6 months on the WAZ of infants ages 0-12 months in monitoring regions. Length of follow-up (age of infants) was assigned to level 1, and infants was assigned to level 2. Characteristics of infants, mothers, and families and region of the country were adjusted for in the model. The average weight of infants ages 0-12 months in our study (except the birth weights of boys who were formula fed or mixed fed) was greater than the WHO growth standard. After we adjusted for confounding factors, the multilevel model showed that the WAZ of exclusively breastfed and mixed-fed infants were statistically significantly higher than those of formula-fed infants (coefficients = 0.329 and 0.159, respectively; P < 0.05), and there was a negative interaction between feeding patterns and age (both coefficients = - 0.020; P < 0.05). Infants who were exclusively breastfed were heavier than formula-fed infants from birth until 12 months of age. Mixed-fed infants were heavier than formula-fed infants before 8 months, after which the latter overtook the former. Infants' weight development may be influenced by feeding patterns during the first 6 months. Exclusive breastfeeding during the first 6 months may be beneficial for weight development of infants in infancy.

Effectiveness of a home-based peer support programme for Chinese mothers with low breastfeeding self-efficacy to increase the exclusivity and duration of breastfeeding: study protocol of a randomised control trial

INTRODUCTION

Breastfeeding is associated with many health benefits for both women and their newborns. Exclusive breastfeeding has been recommended for at least 6 months to optimise infant growth, development and health. In addition to standard care, community-based peer support is recommended to help mothers improve breastfeeding. A recent survey reveals that the rate of exclusive breastfeeding at 6 months post partum in Hong Kong is low, and half of all breastfeeding mothers never exclusively breastfeed. Taking into account the local practice for women to stay home during the first month post partum and social isolation during and post-COVID-19 pandemic, a home-based peer support programme with the aid of Zoom or Facetime is proposed. This study aims to evaluate the effectiveness of a home-based breastfeeding peer support programme in improving breastfeeding practices and achieving exclusive breastfeeding rate among women with low breastfeeding self-efficacy.

METHODS AND ANALYSIS

The study is a two-armed randomised control trial and will include a total of 442 participants. Potential cases will be recruited and screened at four postnatal wards in Hong Kong public hospital. Eligible and consented cases will be randomly allocated into intervention or control groups at a 1:1 ratio. Control group (n=221) will receive standard care, while the intervention group (n=221) will receive home-based peer support as well as standard care. Trained peer counsellors will provide breastfeeding-related support through Zoom or Facetime at 10 days and 1 month post partum. Telephone follow-ups will be conducted at 1 month, 2 months, 3 months and 6 months post partum. Breastfeeding status, mother's breastfeeding self-efficacy and postpartum depression will be assessed and compared between the two arms.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (UW 20-564). The findings will be updated in trial registries and disseminated in peer-reviewed journals and academic conferences.

TRIAL REGISTRATION NUMBER

NCT04621266.

Inequalities in large-scale breastfeeding programmes in Bangladesh, Burkina Faso and Vietnam

Inequalities in breastfeeding programmes and practices have slowed global progress in providing the life-saving protection of breastfeeding for millions of infants despite well-known life-long impacts. As breastfeeding interventions are scaled up, inequalities in coverage and breastfeeding practices should be tracked, particularly in disadvantaged groups, who are likely to suffer the most serious health and developmental impacts of poor childhood nutrition. The literature provides evidence of inequalities in breastfeeding practices, but research is limited on socioeconomic disparities in the coverage of breastfeeding interventions. This paper (1) compares inequalities in breastfeeding practices in intervention and nonintervention areas and (2) documents inequalities in programme coverage by type of intervention. We disaggregated endline evaluation surveys in Bangladesh, Burkina Faso and Vietnam, where rigorous evaluations had documented significant overall improvements, and analysed whether inequalities in breastfeeding practices and programme coverage differed by treatment areas. We used Erreygers index to quantify inequalities and found that breastfeeding practices were largely pro-poor; intervention coverage was not consistently pro-poor. While counselling coverage often favoured women from the poorest quintile, public education/media coverage consistently favoured better-off women. Inequalities favoured more educated mothers in the coverage of combined interventions. None of the programmes had explicit equality objectives. The results indicate the need for introducing specific actions to reduce inequalities in breastfeeding policies and programmes. This is a priority unfinished agenda for nutrition programming.

Stakeholders' views of the Baby Friendly Initiative implementation and impact: a mixed methods study

BACKGROUND

The Baby Friendly Hospital Initiative (BFHI) was launched in 1991 as an intervention to support healthy infant feeding practices, but its global coverage remains around 10%. This study aimed to explore stakeholders' views of the Baby Friendly Initiative (BFI) programme, the barriers and facilitators to accreditation and its perceived impact.

METHODS

A mixed methods approach was used. An online survey was distributed through numerous professional networks from September 2020 to November 2020. Quantitative data were analyzed using descriptive statistics, with simple content analysis undertaken on open-ended responses. Individual semi-structured interviews were also undertaken and analyzed using inductive thematic analysis.

RESULTS

A total of 322 respondents completed the survey in part or in full, mainly from the United Kingdom. Fifteen key stakeholders and two maternity service users undertook interviews. Respondents were from various professional backgrounds and currently worked in different roles including direct care of women and their families, public health, education and those responsible for purchasing health services. Survey respondents viewed the BFI to have the greatest impact on breastfeeding initiation, duration, and infant health outcomes. Three overall themes were identified. The first was "BFI as an agent for change". Most participants perceived the need to implement the whole package, but views were mixed regarding its impact and the accreditation process. Secondly, BFI was regarded as only "one part of a jigsaw", with no single intervention viewed as adequate to address the complex cultural context and social and health inequities that impact breastfeeding. Finally, "cultural change and education" around breastfeeding were viewed as essential for women, staff and society.

CONCLUSIONS

The BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising. Although the BFI comprises a whole package, few survey respondents rated all aspects as equally important. Additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated.

Supporting breastfeeding for women with low education levels, psychosocial problems, and/or socioeconomic constraints: a scoping review protocol

OBJECTIVE

This scoping review aims to identify and map interventions and/or strategies used to support the initiation and continuation of breastfeeding for women at risk of delaying initiation, early cessation, or not breastfeeding due to low levels of education, psychosocial problems, and/or socioeconomic challenges in high-income countries.

INTRODUCTION

While breastfeeding has lifelong beneficial health effects for women and infants, there is a risk of delaying initiation, early cessation, or not initiating breastfeeding at all due to factors related to health inequalities, such as low levels of education, psychosocial problems, and/or socioeconomic constraints.

INCLUSION CRITERIA

This review will include eligible quantitative, qualitative, and mixed methods studies, as well as systematic reviews and gray literature. We will encompass studies conducted in high-income countries, focusing on interventions and/or strategies to support women with low levels of education, psychosocial problems, and/or socioeconomic constraints in the initiation and continuation of breastfeeding for up to 6 months postpartum.

METHODS

This review will follow the JBI methodology for scoping reviews, using the Participants, Concept, and Context framework. The primary search will be performed in the following databases: MEDLINE (PubMed), PsycINFO (EBSCOhost), Embase (Ovid), and CINAHL (EBSCOhost). We will include publications in English, Swedish, Norwegian, Danish, German, Bulgarian, Arabic, and Spanish, published from 1991 until the present. A data charting form will be developed and applied to all the included articles.

REVIEW REGISTRATION

The study is registered in Open Science Framework, DOI 10.17605/OSF.IO/TMP4V.

Health professional competency building for the Baby-Friendly Hospital Initiative in Malawi

Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby-Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low-income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in-service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in-service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI- and breastfeeding-specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.

Strengthening health visitors' breastfeeding support: Results from a cluster randomised study

AIMS

To assess the effect of the education programme on three constructs of health visitors' breastfeeding support: knowledge, self-efficacy and action competence. Furthermore, the study aimed to confirm the factor structure of these three constructs.

BACKGROUND

Health professionals are key in supporting breastfeeding women but studies report gaps in health professionals' breastfeeding support knowledge and competences. The present intervention study aimed to strengthen the breastfeeding support of families to improve breastfeeding rates. Health visitors received an interactive education programme to enhance their breastfeeding support knowledge, self-efficacy and action competence, including e-learning and a two-day course of lectures, role plays and discussions.

DESIGN

A pre- and post-test study was applied in a cluster randomised trial METHODS: Cluster units were Danish municipal health visiting programmes, randomised by stratifying for region and annual births per cluster. Health visitors from 21 clusters (11 intervention, 10 control) participated. The knowledge, self-efficacy and action competence were assessed in self-reported questionnaires before and after education (n=368; intervention n=176, control n=196). To analyse the effects, the intention-to-treat principle and linear mixed models were applied. Confirmatory Factor Analysis was used to confirm the factor structures of the hypothesised knowledge, self-efficacy and action competence constructs.

RESULTS

158 health visitors in the control arm and 157 in the intervention arm completed the baseline questionnaire and were analysed in intention-to-treat analyses. 125 and 116, respectively, completed the follow-up questionnaire and were analysed in sensitivity analyses. Health visitors in both trial arms had high levels of self-efficacy and action competence at baseline. Mean treatment effect of the education programme was 0.5 points (CI95 % 0.1-0.8) for knowledge, 2.4 points (CI95 % 1.6-3.3) for self-efficacy and 1.4 points (CI95 % 0.7-2.0) for action competence. The factor structure of the items used to measure knowledge, self-efficacy and action competence were confirmed.

CONCLUSIONS

The education programme improved the self-reported breastfeeding support knowledge, self-efficacy and action competence of health visitors. The factor structures of the instruments used to measure effects were confirmed by confirmatory factor analysis.

TRIAL REGISTRATION

Clinical Trials: NCT05311631. First posted April 5, 2022.

Breastfeeding rates of Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis

BACKGROUND

Australian Aboriginal and Torres Strait Islander (referred to hereafter as Aboriginal) women breastfeed at lower rates than non-Aboriginal women, and rates vary across and within Aboriginal populations.

AIM

To determine rates of breastfeeding initiation and maintenance and compare individually collected survey data with existing routinely collected state and national breastfeeding data for Aboriginal women.

METHODS

CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English and reporting breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Screening and quality assessment included co-screening 10 % of papers. Two reviewers completed data extraction. A proportional meta-analysis was undertaken for breastfeeding initiation and narrative data synthesis used to summarise breastfeeding maintenance.

FINDINGS

The initial search identified 12,091 records, with 31 full text studies retrieved, and 27 reports from 22 studies met inclusion criteria. Breastfeeding initiation was 79 % (95 % CI 0.73, 0.85), however, rates were lower than non-Aboriginal women. Maintenance ranged between one week and five years. Rates and definitions varied significantly between studies, with inconsistencies in government collection and reporting of breastfeeding.

CONCLUSION

Significant variation in definitions and reporting make comparisons difficult. Breastfeeding rates were below recommended targets. Future pattern and trend analyses require standardised measures and definitions. Current collection and reporting of breastfeeding data, particularly routinely collected state-based data, is inadequate to present an accurate picture of current breastfeeding in Australia for Aboriginal women and infants, and to effectively inform interventions and policies.

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background

Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.

Objectives

To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.

Design

Evidence syntheses with stakeholder engagement.

Review methods

Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.

Results

We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.

Limitations

There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.

Conclusions

'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.

Future work

Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.

Study registration

This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

Bottle-feeding practice and its associated factors among mothers of children aged 0 to 23 months in sub-Saharan Africa: a multi-level analysis of demographic and health surveys (2015-2022)

BACKGROUND

Avoidance of bottle feeding is recommended as it interferes with optimal suckling behavior, is difficult to keep clean, and is an important route for the transmission of pathogens. However, there is a current shift towards breastfeeding for a short period and the introduction of bottle feeding in both the developed and developing worlds. Bottle-feeding practice and its individual- and community-level determinants are not addressed in sub-Saharan Africa. Therefore, this study aimed to fill this gap and assess the pooled prevalence and associated factors of bottle feeding among mothers of children less than 23 months of age.

METHODS

Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 86,619 mother-child pairs was included in the current study. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

The overall pooled prevalence of bottle feeding among mothers of children aged 0 to 23 months in sub-Saharan Africa was 13.74% (95% CI: 13.51%, 13.97%). Factors like maternal age [AOR = 1.09; 95% CI (1.04, 1.14)], educational status [AOR = 2.83; 95% CI (2.58, 3.10)], marital status [AOR = 1.16; 95% CI (1.09, 1.24)], maternal occupation [AOR = 0.76; 95% CI (0.73, 0.79)], media exposure [AOR = 0.80; 95% CI (0.76, 0.85)], wealth index [AOR = 1.21; 95% CI (1.15, 1.29)], sex of the household head [AOR = 1.17; 95% CI (1.12, 1.24)], family size [AOR = 1.06; 95% CI (1.01, 1.12)], number of under-five children [AOR = 1.11; 95% CI (1.04, 1.19)], place of delivery [AOR = 1.06; 95% CI (1.00, 1.12)], mode of delivery [AOR = 1.41; 95% CI (1.31, 1.52)], counseling on breastfeeding [AOR = 0.88; 95% CI (0.84, 0.92)], age of the child [AOR = 1.65; 95% CI (1.57, 1.75)], and residence [AOR = 1.64; 95% CI (1.56, 1.72)] were significantly associated with bottle-feeding practices.

CONCLUSION

Nearly one out of seven children aged 0 to 23 months received bottle feeding in sub-Saharan African countries. Older mothers, higher mothers' educational status, unmarried women, richest families, non-working mothers, exposed to media, female-headed households, large family size, having one under-five children, home delivery, cesarean delivery, children aged 6-11 months, and urban residence were significantly associated with an increased risk of bottle feeding. Breastfeeding promotion programs are advised to target mothers who are older, educated, working, rich, gave birth at home, have a large family size, are delivered by cesarean section, have children aged 6-11 months, and reside in urban areas to achieve a significant decrease in bottle feeding rates in sub-Saharan Africa.

Effect of brewer's yeast or beta-glucan on breast milk supply following preterm birth: the BLOOM study - protocol for a multicentre randomised controlled trial

BACKGROUND

Many individuals who experience preterm birth struggle with early breast milk supply, which can translate into suboptimal longer-term breastfeeding outcomes. Further investigations into the potential role of early non-pharmacological and pharmacological interventions in improving breast milk production soon after birth is growing. While natural galactagogues, such as brewer's yeast, are widely perceived by women to be safer than pharmaceutical galactagogues and are taken by many women, evidence to support their efficacy is largely absent. The BLOOM study has been designed to determine the efficacy and safety of brewer's yeast and beta-glucans, derived from Saccharomyces cerevisiae, when administered soon after birth for increasing early breast milk supply in mothers who have delivered preterm.

METHODS

The BLOOM study is a multicentre, double-blinded, randomised controlled trial that will assess if brewer's yeast or beta-glucan can increase early breast milk production following preterm birth. Target population are mothers of preterm infants born at less than 34 weeks' gestation who intend to provide breast milk for their infant, are less than 72 h following birth and able to give informed consent. Participants will be randomly allocated into three parallel groups at 1:1:1 ratio (n = 33 per group) to receive either brewer's yeast, beta-glucan or placebo capsules for seven days. The primary outcome is total expressed breast milk volume over a 24-hour period on day 7 of intervention. Participants and their infants will be followed until the infant reaches term corrected age or is discharged home from the neonatal unit (whichever occurs first).

DISCUSSION

The use of brewer's yeast as a galactagogue to enhance milk production is extremely common amongst breastfeeding mothers, however, there are no trials evaluating its efficacy and safety. This will be the first randomised controlled trial to evaluate the efficacy and safety of two commonly used galactagogues, brewer's yeast and beta-glucan, compared with placebo in improving maternal breast milk supply following preterm birth. The trial will also evaluate whether early intervention with galactagogues soon after a preterm birth improves longer-term breastfeeding outcomes.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12622000968774 (registered on 8 July 2022) and UTN U1111-1278-8827.

Cultural hierarchies in health: Does inherited sociocultural position (biraderi) shape diet and nutrition among British Pakistani children? Protocol for a mixed-methods study

This study aims to explore links between biraderi-a form of identity-based social grouping and stratification which cuts across religions among South Asians-and infant and child nutrition among British Pakistanis using data from the Born in Bradford cohort study. The study will entail a mixed-methods approach to (i) develop an operational framework of biraderi for epidemiologic analyses and apply it to longitudinal data from the Born in Bradford cohort study, (ii) quantify and describe child nutrition and dietary patterns for biraderi sub-groups, and (iii) investigate whether known mechanisms of identity-based segregation, graded inequality, and network effects operate through diet and nutrition in the UK. Using Krieger's ecosocial theory as an integrative framework we will (iv) re-conceptualise and interpret the role of biraderi / caste in the social construction and embodied experience of how infants and children eat in the UK. Following a literature review on biraderi and health, we will convene and consult a lay consultation group in Bradford through focus groups and academic experts through a Delphi study to guide planning, implementation, interpretation and dissemination of our secondary data analysis. In addition to being the first study to look at biraderi-based nutritional inequalities in the UK, our study is innovative in that we will formally involve experts and users in the design and interpretation of our quantitative analyses. Findings will be applicable in any part of the world where children experience disadvantage linked to sociocultural hierarchy and identity. Our findings will be of particular use in (i) identifying women and children at particular risk of suboptimal breastfeeding practices, poor complementary feeding, and unhealthy diets in primary school in the UK, and (ii) elucidating the sociocultural pathways through which inequalities in population health nutrition outcomes are expressed.

Estimating carbon and water footprints associated with commercial milk formula production and use: development and implications of the Green Feeding Climate Action Tool

Carbon offset frameworks like the UN Clean Development Mechanism (CDM) have largely overlooked interventions involving food, health, and care systems, including breastfeeding. The innovative Green Feeding Climate Action Tool (GFT) assesses the environmental impact of commercial milk formula (CMF) use, and advocates for breastfeeding support interventions as legitimate carbon offsets. This paper provides an overview of the GFT's development, key features, and potential uses. The offline and online GFT were developed using the DMADV methodology (Define, Measure, Analyze, Design, Verify). The GFT reveals that the production and use of CMF by infants under 6 months results in annual global greenhouse gas (GHG) emissions of between 5.9 and 7.5 billion kg CO2 eq. and consumes 2,562.5 billion liters of water. As a national example, in India, one of the world's most populous countries, CMF consumption requires 250.6 billion liters of water and results in GHG emissions ranging from 579 to 737 million kg CO2 eq. annually, despite the country's high breastfeeding prevalence among infants under 6 months. The GFT mainly draws on data for low- and middle-income countries (LMICs), as many high-income countries (HICs) do not collect suitable data for such calculations. Despite poor official data on breastfeeding practices in HICs, GFT users can input their own data from smaller-scale surveys or their best estimates. The GFT also offers the capability to estimate and compare baseline with counterfactual scenarios, such as for interventions or policy changes that improve breastfeeding practices. In conclusion, the GFT is an important innovation to quantify CMF's environmental impact and highlight the significance of breastfeeding for planetary as well as human health. Women's contributions to environmental preservation through breastfeeding should be recognized, and breastfeeding interventions and policies should be funded as legitimate carbon offsets. The GFT quantifies CMF's carbon and water footprints and facilitates financing breastfeeding support as a carbon offset initiative under CDM funding facilities.

Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature

BACKGROUND

Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open.

RESULTS

Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes.

CONCLUSIONS

This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.

The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome

The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life followed by complementary foods and sustained breastfeeding for at least 2 years, underscoring its pivotal role in reducing infant mortality and preventing various illnesses. This perspective delves into the intricate relationship between breastfeeding practices, early life antibiotic exposure, and infant gut microbiome development, highlighting their profound influence on child health outcomes. Antibiotics are extensively prescribed during pregnancy and childhood, disrupting the microbiome, and are related to increased risks of allergies, obesity, and neurodevelopmental disorders. Breastfeeding is a significant determinant of a healthier gut microbiome, characterized by higher levels of beneficial bacteria such as Bifidobacterium and lower levels of potential pathogens. Despite widespread recognition of the benefits of breastfeeding, gaps persist in healthcare practices and support mechanisms, exacerbating challenges faced by breastfeeding families. This highlights the pressing need for comprehensive research encompassing breastfeeding behaviors, human milk intake, and their impact on infant health outcomes. Additionally, promoting awareness among healthcare providers and families regarding the detrimental effects of unnecessary formula supplementation could facilitate informed decision-making and bolster exclusive breastfeeding rates. Moreover, donor human milk (DHM) is a promising alternative to formula, potentially mitigating disruptions to the infant gut microbiome after antibiotic exposure. Overall, prioritizing breastfeeding support interventions and bridging research gaps are essential steps towards improving child health outcomes on a global scale.

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Postpartum hypogalactia (PH) is prominent during lactation and may negatively impact the mother's or infant's health. Acupuncture is widely used to increase maternal breast milk production. However, the effects of acupuncture on PH remain unclear. Therefore, this review aimed to evaluate the efficacy and safety of acupuncture in individuals with PH.

MATERIALS AND METHODS

Articles on potentially eligible randomized controlled trials (RCTs) on acupuncture for PH published from database inception to October 2023 were retrieved from the PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP databases. Two reviewers independently screened the records, extracted essential information, and evaluated the methodological quality of the RCTs using the revised Cochrane risk-of-bias (RoB) tool. The primary outcome was a change in serum prolactin (PRL) levels before and after treatment. Secondary outcomes included milk secretion volume (MSV), total effective rate (TER), mammary fullness degree (MFD), and exclusive breastfeeding rate (EBR). Meta-analyses were performed using RevMan v5.4. Finally, the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool.

RESULTS

This study included 19 RCTs involving 2,400 participants. The included studies were classified as having an unclear to high RoB. Our findings indicated that, overall, acupuncture showed a significant effect in increasing serum PRL levels (standardized mean differences [SMDs] = 1.09, 95% confidence interval [CI]: 0.50, 1.68), MSV (SMD = 1.69, 95% CI: 0.53, 2.86), TER (relative risk [RR] = 1.25, 95% CI: 1.10, 1.42), and EBR (RR = 2.01, 95% CI: 1.07, 3.78) compared to that in the control group; however, no difference in MFD (SMD = 1.17, 95% CI: -0.09, 2.42) was observed. In the subgroup analysis, acupuncture combined with Chinese herbs or conventional treatment was significantly more effective in increasing serum PRL levels, MSV, and TER than did Chinese herbs or conventional treatment alone. Moreover, acupuncture alone resulted in significantly higher serum PRL levels compared to Chinese herbs; however, this benefit was not observed for TER and MFD. The quality of evidence was critically low.

CONCLUSION

Acupuncture may effectively increase milk secretion in women with PH. However, owing to the low quality of evidence, further rigorously designed studies are warranted to confirm our findings.

Prevalence, patterns, and determinants of breastfeeding cessation among mothers of children under 24 months in Uganda

BACKGROUND

Breastfeeding duration is a critical component of infant and child nutrition, providing immediate and long-term benefits to both children and their mothers. This study uses data from the lot quality assurance sampling (LQAS) survey to examine the prevalence, patterns, and determinants of breastfeeding cessation in Uganda.

METHODS

This study was a secondary analysis of data collected by the cross-sectional LQAS surveys in 2021 and 2022 covering 77 districts in Uganda. The LQAS survey methodology employs a systematic sampling approach to assess whether predefined quality standards are met within specific subgroups of a population. The study employed spatial analysis, bivariate analysis and logistic regression, both with and without clustering, to explore associations between independent variables and breastfeeding cessation. Unadjusted and adjusted odds ratios with 95% confidence intervals were calculated. Statistical significance was set at 5%.

RESULTS

Overall, the study analysed 26,377 records of mothers with children under 24 months old. The mothers' mean age was 27.9 years while that of their children was 11.0 months. While the general breastfeeding cessation rate was 17.7%, cessation was highest (49.7%) among mothers of children 18-23 months. Factors associated with increased odds of breastfeeding cessation included older child's age, older mother's age, using modern family planning, being pregnant and having an unknown pregnancy status. Lower odds of breastfeeding cessation were observed among mothers who; were married, lived in larger households, lived in rural residences, whose children received vitamin A supplementation and among all other regions compared to Kampala.

CONCLUSION

One in five mothers cessed breastfeeding before their child reached 2 years, with a significant increase in cessation odds among mothers of older children. These findings underscore the importance of interventions to promote breastfeeding continuation and adequate nutrition for non-breastfed infants, particularly in regions with high cessation rates.

Breastfeeding interventions and programmes conducted in Portuguese-speaking sovereign states: A scoping review

AIM

This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese-speaking sovereign countries.

METHODS

Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre-defined Portuguese-speaking countries.

RESULTS

Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework.

CONCLUSION

While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese-speaking countries.

Exploring Infant Feeding Experiences and Maternity Care Practices in Appalachia

OBJECTIVES

Our aim was to explore postpartum individuals' experiences and perceptions of breastfeeding and International Board Certified Lactation Consultants' (IBCLC) knowledge and perceptions of maternity care practices and perceived barriers to breastfeeding among their patient populations in Appalachia.

METHODS

Semistructured interviews were conducted with seven IBCLCs and seven postpartum individuals. Interviews were recorded and transcribed. Thematic analysis was conducted to determine emergent themes and subthemes related to knowledge/perceptions, experiences, and barriers to breastfeeding among postpartum individuals, as well as emergent themes associated with the knowledge and perceptions of maternity care practices, easy-/difficult-to-implement Baby-Friendly Hospital Initiative maternity care practices, and perceived barriers to breastfeeding among IBCLCs.

RESULTS

Postpartum individuals recruited from an Appalachian obstetrics/gynecology clinic were aware of the benefits of breastfeeding, but their infant feeding journeys were more stressful than they expected, and they had limited access to lactation support and breastfeeding education/information. IBCLCs identified the benefits of the Baby-Friendly maternity care practices but mentioned some risks, especially when there is a lack of communication and coordination among providers. Environmental and informational barriers were identified by both postpartum individuals and IBCLCs as breastfeeding challenges potentially amenable to change.

CONCLUSIONS

To support postpartum mothers in the Appalachian region, environmental barriers (eg, lack of lactation support) and informational barriers (eg, lack of prenatal education) need to be addressed.

A perinatal social nutrition approach to improve breastfeeding in a culturally diverse group of low-income women

Alima, Perinatal Social Nutrition Centre, is an established community organization that adopts a perinatal social nutrition approach to provide multidimensional support to women living in vulnerable conditions, particularly those with a precarious migratory status. This study aims to (i) determine which maternal characteristics, pregnancy-related variables, and structural features of the Alima intervention are associated with breastfeeding; and (ii) examine whether the association between attending breastfeeding workshops and breastfeeding characteristics differ according to maternal factors. The Alima digital database was used to analyze data from women who received the perinatal intervention between 2013 and 2020. Infant feeding data were retrieved at 2 weeks postpartum (T0, n = 2925), 2 months postpartum (T2, n = 1475), and 4 months postpartum (T4, n = 890). Logistic regressions were used to estimate the odds of overall and exclusive breastfeeding depending on sociodemographic characteristics, pregnancy-related variables, and features of the intervention. The prevalence of overall and exclusive breastfeeding was, respectively, 96.1% and 60.7% at T0; 93.0% and 58.5% at T2; 83.0% and 48.4% at T4. Higher education, previous breastfeeding experience, and recent immigration were associated with a higher likelihood of breastfeeding at each time point. Breastfeeding workshop attendance was associated with a greater likelihood of overall and exclusive breastfeeding at T2 and T4, with a stronger effect among women aged 35 or less, those with lower education, and those with excessive gestational weight gain. In conclusion, the Alima intervention is associated with positive breastfeeding outcomes, especially among vulnerable women living with precarious migratory status in Canada.

The social and healthcare professional support drawn upon by women antenatally during the COVID-19 pandemic: A recurrent, cross-sectional, thematic analysis

OBJECTIVE

To explore antenatal experiences of social and healthcare professional support during different phases of social distancing restriction implementation in the UK.

DESIGN

Semi-structured interviews were conducted via telephone or video-conferencing software between 13 July 2020 - 2 September 2020. Interviews were transcribed and a recurrent, cross-sectional, thematic analysis was conducted.

PARTICIPANTS

Twelve antenatal women were interviewed during UK social distancing restrictions (Timepoint 1; T1) and a separate sample of twelve women were interviewed in the initial easing of these restrictions (Timepoint 2; T2).

FINDINGS

T1 themes were: 'Maternity care as non-essential' and 'Pregnancy is cancelled'. T2 themes were: 'Technology is a polarised tool' and 'Clinically vulnerable, or not clinically vulnerable? That is the question'.

KEY CONCLUSIONS

At T1, anxieties were ascribed to the exclusion of partners from routine care, and to perceived insensitivity and aggression from the public. For T2, insufficient Governmental transparency led to disillusionment, confusion, and anger. Covert workplace discrimination also caused distress at T2. Across timepoints: deteriorated mental wellbeing was attributed to depleted opportunities to interact socially and scaled back maternity care.

IMPLICATIONS FOR PRACTICE

Recommendations are made to: protect maternal autonomy; improve quality of mental health and routine care signposting; prioritise parental community support in the re-opening of 'non-essential' services; prioritise the option for face-to-face appointments when safe and legal; and protecting the rights of working mothers.

The impact of ever breastfeeding on children ages 12 to 36 months: A secondary data analysis of the standardization study of the Dominican system for evaluating early childhood development

Extensive research has shown that breastfeeding offers many benefits to children, including advantages in lifelong health, physical development, cognitive function, behavior, and brain development, compared to those not breastfed. In the Dominican Republic, the prevalence of exclusive breastfeeding among infants aged 0-6 months remains low, and the lack of a surveillance system has made it challenging to measure the impact of breastfeeding on early childhood development (ECD). This study aims to address the effect of ever breastfeeding on ECD. We conducted secondary data analysis from the Dominican System for Measuring Early Childhood Development (SIMEDID), a screening tool adapted and validated to the Dominican context that measures four areas of development: gross-motor, fine-motor, language, and socioemotional development. The data from SIMEDID can be cross-analyzed with other datasets generated by the National Institute for Early Childhood Comprehensive Care (INAIPI) that include information about breastfeeding. The children were evaluated during the standardization study of SIMEDID. To determine the breastfeeding impact, we: 1) conducted an analysis of covariance using ECD scores as dependent variables and ever breastfed as the independent variable, with age and sex as covariates (previously confirmed with an analysis of variance indicating the relevance of age and sex at birth in ECD); 2) analyzed the relative risk (RR) of developmental delay by breastfeeding status. We studied a sample of 699 Dominican children aged 12-36 months who receive services at INAIPI (the government institution responsible for administering comprehensive early childhood services). The results show that ever breastfed children had higher scores in overall ECD than those who were not; higher scores in language and fine motor development primarily drove this effect. The never breastfed group had a greater risk of developmental delay in fine motor and socioemotional development. These findings underscore the importance of promoting and supporting breastfeeding to improve child neurodevelopmental outcomes. This is particularly relevant in low-resource settings, where mothers may need additional support. Moreover, the study's results provide evidence of SIMEDID's validation, which can help inform future research and evidence-based decision-making toward optimal ECD in similar contexts.

Breast Hypoplasia and Decreased Lactation From Radiation Therapy in Survivors of Pediatric Malignancy: A PENTEC Comprehensive Review

PURPOSE

Breast hypoplasia and impaired lactation are poorly studied sequelae of chest radiation therapy (RT) in children. The Pediatric Normal Tissue Effects in the Clinic female breast task force aimed to quantitate the radiation dose-volume effects on these endpoints.

METHODS AND MATERIALS

A literature search was conducted of peer-reviewed manuscripts evaluating breast hypoplasia and lactation after chest RT in children, yielding 789 abstracts. Only 2 studies on children irradiated at <4 years of age for angioma of the breast provided dosimetric data correlated with breast hypoplasia. For patients who received brachytherapy, the dose was converted to external beam RT in equivalent 2 Gy fractions (DEBRT), although the limitations of this type of mathematical conversion need to be recognized. We calculated relative risks (RR) and 95% confidence intervals (95% CIs) based on these data. Only 1 study was relevant to the lactation endpoint, in which patients were given RT for Hodgkin lymphoma at age 14 to 40 years.

RESULTS

The 3 studies involved 206 patients in total. In patients <4 years old at the time of RT, the prevalence of patient-perceived breast hypoplasia was 38% (RR 2.5; 95% CI, 1.3-4.6) after DEBRT of <0.34 Gy, 61% (RR 4.0; 95% CI, 2.1-7.4) after DEBRT 0.34-0.97 Gy, and 97% (RR 6.3; 95% CI, 3.6-10.8) after DEBRT ≥0.97 Gy to the breast anlage. A simple linear regression model (r = 0.72; P < .001) showed that the treated breast was smaller than the untreated breast by 13% at DEBRT = 0.5 Gy, 20% at DEBRT = 1 Gy, 32% at DEBRT = 2 Gy, 51% at DEBRT = 4 Gy, 66% at DEBRT = 6 Gy, 79% at DEBRT = 8 Gy, and 90% at DEBRT = 10 Gy. The risk of unsuccessful breastfeeding was 39% after a median mediastinal dose of 41 Gy, compared with 21% in a sibling control group (P = .04). RT dose of ≥42 Gy was not associated with less breastfeeding success compared with <42 Gy, and data on lower doses were unavailable.

CONCLUSIONS

Based on extremely limited data, young adults exposed to thoracic RT as children seem to be at significant risk of breast hypoplasia and impaired lactation. Doses as low as 0.3 Gy to immature breasts can cause breast hypoplasia. Additional studies are needed to quantify dose and technique effects with modern RT indications. Prospective collection of clinical outcomes and dosimetric factors would enhance our understanding of RT-induced breast hypoplasia and impaired lactation.

Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation

BACKGROUND

Despite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators.

METHODS

Employing a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 - July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement.

RESULTS

Data analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants' meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team's evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support.

CONCLUSION

This study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.