Similarities and differences between women who breastfeed for short and long duration

Lifestyle behaviors and intervention preferences of early-stage lung cancer survivors and their family caregivers

PURPOSE

Lung cancer (LC) is a highly prevalent disease with more survivors diagnosed and treated at earlier stages. There is a need to understand psychological and lifestyle behavior needs to design interventions for this population. Furthermore, understanding the needs and role of family caregivers, especially given the risks associated with second-hand smoke, is needed.

METHODS

Thirty-one early-stage (stages I or IIA) LC survivors of (52% men) and 22 (50% women) caregivers (N = 53 total) completed surveys after surgery (baseline) and at 3- and 6-month follow-ups. Participants reported on psychological functioning, smoking, and physical activity (PA) as well as intervention preferences.

RESULTS

Survivors reported low levels of psychological distress and 3% were current smokers during the study. Approximately 79% were sedentary and not meeting national PA guidelines. Caregivers also reported minimal psychological distress and were sedentary (62% not meeting guidelines), but a larger proportion continued to smoke following the survivor's cancer diagnosis (14%). Both survivors and caregivers expressed interest in home-based PA interventions but differed regarding preferred format for delivery. Most (64%) caregivers preferred a dyadic format, where survivors and caregivers participate in the intervention together. However, most survivors preferred an individual or group format (57%) for intervention delivery.

CONCLUSION

Both LC survivors and family caregivers could benefit from PA interventions, and flexible, dyadic interventions could additionally support smoking cessation for family caregivers.

Social Contexts of Infant Feeding and Infant Feeding Decisions

BACKGROUND

Infant feeding takes place within a network of social relationships. However, the social context in which infant feeding advice is received remains underresearched.

OBJECTIVE

The objective of this study was to evaluate the social contexts of infant feeding by examining individual and relationship characteristics of mothers and network members associated with advice to exclusively breastfeed, exclusively formula feed, or use a combination of breast milk and formula.

METHODS

Information about 287 network members was reported by 80 low-income mothers during a one-time survey. Characteristics of relationships associated with mothers receiving advice (exclusively breastfeed/formula feed, combination feed) from each network member were identified using 2-level logistic regression analyses.

RESULTS

Mothers had greater odds of receiving advice to exclusively breastfeed from network members who help make feeding decisions (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.35-4.42), exclusively breastfed their own child or children (OR, 6.99; 95% CI, 2.96-16.51), and were health care providers (OR, 4.82; 95% CI, 1.70-13.67). Mothers had greater odds of receiving advice to breastfeed in combination with formula from network members who provided emotional support (OR, 2.45; 95% CI, 1.31-4.55), combination fed their own child or children (OR, 4.85; 95% CI, 1.80-13.05), and had an opinion that was important to the mother (OR, 2.67; 95% CI, 1.13-6.33). Mothers had greater odds of receiving advice to exclusively formula feed from network members who exclusively formula fed their own child or children (OR, 2.23; 95% CI, 1.07-4.66) than those who did not.

CONCLUSION

Social relationship characteristics and network members' infant feeding experiences may have implications for the advice new mothers receive. Future research should investigate social contexts of infant feeding longitudinally to inform interventions.

Exploring the influence of psychological factors on breastfeeding duration, phase 1: perceptions of mothers and clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area.

The influence of psychological factors on breastfeeding duration

AIM

This paper reports on a study examining the relationship between women's psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors.

BACKGROUND

The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design.

METHOD

Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview.

FINDINGS

Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy.

CONCLUSION

This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

A systematic review of lay views about infant size and growth

OBJECTIVES

To understand lay views on infant size and growth and their implications for a British population.

METHODS

A systematic review of parental and other lay views about the meanings and importance of infant size and growth using Medline, PsycInfo, CINAHL, Sociological Abstracts, IBSS, ASSIA, British Nursing Index ChildData, Caredata, SIGLE, Dissertation Abstracts (US), Index to Theses. 19 studies, most of which reported the views of mothers, from the US, Canada, the UK and Finland were reviewed.

RESULTS

Notions of healthy size and growth were dominated by the concept of normality. Participants created norms by assessing and comparing size and growth against several reference points. When size or growth differed from these norms, explanations were sought for factors that would account for this difference. When no plausible explanation could be found, growth or size became a worry for parents.

CONCLUSIONS

Parents consider the importance of contextual factors when judging what is appropriate or healthy growth. For public health advice to be effective, lay, as well as scientific, findings and values need to be considered.

Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews

BACKGROUND

The inclusion of qualitative studies in systematic reviews poses methodological challenges. This paper presents worked examples of two methods of data synthesis (textual narrative and thematic), used in relation to one review, with the aim of enabling researchers to consider the strength of different approaches.

METHODS

A systematic review of lay perspectives of infant size and growth was conducted, locating 19 studies (including both qualitative and quantitative). The data extracted from these were synthesised using both a textual narrative and a thematic synthesis.

RESULTS

The processes of both methods are presented, showing a stepwise progression to the final synthesis. Both methods led us to similar conclusions about lay views toward infant size and growth. Differences between methods lie in the way they dealt with study quality and heterogeneity.

CONCLUSION

On the basis of the work reported here, we consider textual narrative and thematic synthesis have strengths and weaknesses in relation to different research questions. Thematic synthesis holds most potential for hypothesis generation, but may obscure heterogeneity and quality appraisal. Textual narrative synthesis is better able to describe the scope of existing research and account for the strength of evidence, but is less good at identifying commonality.

What information, advice, and support do women want with breastfeeding?

BACKGROUND

Breastfeeding conveys many benefits, but women often encounter difficulties in the first few weeks. The objective of this study was to examine women's perspectives on the information, advice, and support they receive with breastfeeding.

METHODS

A qualitative analysis was conducted of women's responses to open questions about their experiences of breastfeeding support. Participants were recruited as part of a randomized controlled trial of additional support from volunteer breastfeeding counselors, and they completed questionnaires when their babies were 6 weeks old.

RESULTS

Of the 720 women recruited to the trial, 654 began breastfeeding and completed postnatal questionnaires; 492 (75%) participants were first-time mothers and 200 (31%) were of minority ethnic origin. At 6 weeks, 249 (38%) women were exclusively breastfeeding, 183 (28%) were both breastfeeding and bottle-feeding, whereas 222 (34%) were exclusively bottle-feeding. Although many women commented positively on their experiences, others thought they did not receive the information and support they needed. Thematic analysis of women's responses to open questions identified five components of the support that women wanted: information about breastfeeding and what to expect, practical help with positioning the baby to breastfeed, effective advice and suggestions, acknowledgment of mothers' experiences and feelings, and reassurance and encouragement.

CONCLUSIONS

Maternity services should address the components identified by the study findings as constituting good breastfeeding support. Guidance and information for family members and training for those involved in peer or professional initiatives should take into account women's views on what support they want, together with when and how they want it provided.

The family management of breastfeeding low birth weight infants

Human milk plays a vital role in the health and development of low birth weight (LBW) infants, yet the initiation and duration rates of breastfeeding in this population are far below those of term infants. Families play an important role in the breastfeeding experience and therefore may contribute to the overall success or lack thereof of the experience. This qualitative study used naturalistic inquiry to describe the family management styles of 13 breastfeeding families of LBW infants. The family management style conceptual framework guided this inquiry, with management styles emerging from the families' definition of the experience and their management behaviors within their unique sociocultural context. These families described facilitating, maintaining, and obstructing family management styles. Through the identification of distinct management styles, interventions may be developed that will assist these families to achieve their breastfeeding goals.

A preliminary study of breast-feeding and maternal symptomatology

The association between breast-feeding status and maternal health is examined. A survey questionnaire was presented via the World Wide Web. Self-reports of 168 breast-feeding and 65 weaned mothers between 4 and 208 weeks postpartum were compared for physician visits, symptomatology, and Perceived Stress Scale scores in the last month. Breast-feeding was associated with fewer physician visits and symptoms and less perceived stress. Moreover, the longer a woman breast-fed before she weaned, the fewer the symptoms and less stress she reported. Breast-feeding is associated with better maternal health both during the breast-feeding period and after weaning. Further research on the effects on maternal health of breast-feeding is indicated. Future prospective longitudinal investigations should address the possible inhibition of lactation by stress and physiological mechanisms that may link breast-feeding and weaning with maternal health.

Successful breast-feeding as a result of a health education programme for mothers

The present study aims to prove an improvement in breast-feeding practices in mothers who received written instructions for successful breast-feeding and had individual counselling at the time of taking this questionnaire. The instructions were based on the results of a study carried out in Slovenia in 1993 and published in the Journal of Advanced Nursing (1998), 27, 1250-1256 (Hoyer & Pokorn 1998). The variables that were then found statistically significant in the initial and continued breast-feeding became the basis of written instructions for breast-feeding. The results obtained in the new current study were compared with that basic study which included 881 mothers. This was possible because the conditions of breast-feeding between 1993 and 1995 (when the new study was launched) had not changed. The idea of baby-friendly hospital initiative (BFHI) had not yet come into force in Slovenia. The current study comprised 203 pregnant women who were first visited during their 8th month of pregnancy. In order to collect data on breast-feeding and deliver instructions, a field nurse visited each mother eight times until the completion of first year and continued to visit them every third month and for all those who were still breast-feeding after that time, until the end of the lactation period. Statistical analysis was carried out by means of SPSS statistical package and survival analysis. All mothers in the study started breast-feeding. By the end of the first month 84.7% of them were still breast-feeding, while by the end of the third month it dropped to 74.9%, and by the end of the sixth month to 45.8%. Among these, breast-feeding alone was practised in the first week by 25.7%, by the end of the first month by 16.4%, and by the end of the third month by 9.5%. All the observed parameters were better than in the basic study. The mean duration of breast-feeding was 217 days, while the longest duration was 852 days. The survival analysis showed a statistically significant difference in the duration of breast-feeding. In the current study group, mothers weaned their infants at a slower rate than in the group from the year 1993. It has been found that the written instructions as well as personal encouragement by the field nurse exerted a favourable influence on breast-feeding practices, which was taken as a guideline for our further professional work and change of standards in the field of breast-feeding promotion.

Nurses' attitudes, subjective norms, and behavioral intentions toward support of breastfeeding mothers

Fifty maternal-newborn nurses and 136 breastfeeding mothers participated in a prospective study designed to identify characteristics of nurses and external factors that influence nurses' ability to provide effective informational, technical, and emotional support to breastfeeding mothers and their infants. Ajzen and Fishbein's theory of reasoned action guided the study. Using questionnaire data, multiple regression analyses revealed that the nurses' supportive behavior was best predicted by their breastfeeding knowledge and attitudes. The nurses' intentions to provide support did not influence their actual behavior. Breastfeeding knowledge deficits also were identified. Because breastfeeding knowledge is predictive of nurses' supportive behavior, that knowledge must be accurate and complete to promote breastfeeding success and be considered helpful by the mother.

Falling by the wayside: a phenomenological exploration of perceived breast-milk inadequacy in lactating women

OBJECTIVE

To provide insight into the lived experience of breast feeding, in primiparous women. The main focus was upon women's perceptions related to the adequacy of their breast milk, for the purpose of exclusively nourishing their babies.

DESIGN

A longitudinal, phenomenological study involving in-depth, interactive interviews, conducted at 6, 12 and 18 weeks following the birth of the women's babies.

PARTICIPANTS AND SETTING

A convenience sample of ten primiparous women were recruited prior to discharge from a maternity unit, in the north of England, in 1998.

FINDINGS

Two groups of participants emerged, three who became increasingly confident and empowered by breast feeding and the remaining seven whose confidence progressively diminished, with six of them expressing concern that their breast milk was inadequate. Four major themes related to the participants' perceptions emerged from the analysis: the quest to quantify and visualise breast milk; anxiety regarding the adequacy of their diet; breast feeding as a challenging journey, with most feeling that they had 'fallen by the wayside' (this related partly to inadequate and conflicting advice given by health professionals); and finally, unmet needs for support, nurturing and replenishment in return for 'giving out'.

CONCLUSION

Perceived breast-milk inadequacy is underpinned by a complex and synergistic interaction between socio-cultural influences, feeding management, the baby's behaviour, lactation physiology and the woman's psychological state.

IMPLICATIONS

Education of midwives and health visitors is required in relation to the needs of breast-feeding mothers within a Western industrialised society. Strong social policy is vital in the UK, to initiate socio-cultural changes, which would enable women who commence breast feeding to perceive it as an empowering and fulfilling experience and not one of 'falling by the wayside'.

A home visit program for breastfeeding education and support

A home visit program for breastfeeding education and intervention was developed to provide support for mothers and infants at risk for breastfeeding failure. This program was developed to supplement the Early Discharge Program for mothers and newborns who were discharged within 24 hours of delivery. A breastfeeding assessment tool was developed for use in the hospital and during the early discharge home visit. Home visits are provided by a registered nurse with mother-infant assessment skills and competence to provide breastfeeding education, problem management, emotional support, and referrals to lactation consultants or physicians as needed. The response from patients and physicians has been positive. As the demand for services grew, the program was modified to include other mothers and infants (e.g., those delivering via cesarean and high-risk, preterm, and borderline preterm infants in need of breastfeeding support). The readmission rate for breastfeeding infants who receive a home visit is lower than for infants who do not receive a home visit. Patient satisfaction surveys have been positive.

Is there competition between breast-feeding and maternal employment?

Theory suggests that the decision to return to employment after childbirth and the decision to breast-feed may be jointly determined. We estimate models of simultaneous equations for two different aspects of the relationship between maternal employment and breast-feeding using 1993-1994 data from the U.S. Food and Drug Administration’s Infant Feeding Practices Study. We first explore the simultaneous duration of breast-feeding and work leave following childbirth. We find that the duration of leave from work significantly affects the duration of breast-feeding, but the effect of breast-feeding on work leave is insignificant. We also estimate models of the daily hours of work and breast-feedings at infant ages 3 months and 6 months postpartum. At both times, the intensity of work effort significantly affects the intensity of breast-feeding, but the reverse is generally not found. Competition clearly exists between work and breast-feeding for many women in our sample.

The effect of work status on initiation and duration of breast-feeding

OBJECTIVES

In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration.

METHODS

Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion.

RESULTS

Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work.

CONCLUSION

Part-time work is an effective strategy to help mothers combine breast-feeding and employment.

The effect of lateral asymmetries on breast feeding skills: can midwives' holding interventions overcome unilateral breast feeding problems

OBJECTIVE

to determine whether the three human lateral asymmetrical behaviours (maternal handedness, maternal preferred cradling side, neonatal preferred head turning) affected the development of a unilateral breast feeding problem (UBP).

DESIGN

quasi-experimental comparing 32 postnatal women who reported a UBP with 28 who did not.

SETTING

maternity unit in the south of England.

PARTICIPANTS

60 mother/baby pairs where it was the mother's first attempt at breast feeding, there were no structural abnormalities of the breasts or nipples, no obstetric abnormalities, and where the mother had had no more than 100 mg pethidine in labour. The babies had to be less than 72 hours old at recruitment, show no abnormal behaviour, such as floppiness or irritability, and weighed 2500 g or more.

MEASUREMENTS AND FINDINGS

handedness test, preferred cradling side established, neonatal preferred head turning established, demographic data. The two groups of women did not differ on demographic characteristics, but multiparous women were less likely to report a UBP or a neonatal preferred feeding side and more likely to be feeding at six weeks post delivery. Neither dominant handedness nor maternal preferred holding side alone were associated with a UBP but when the dominant hand was different from the preferred holding side, the women were more likely to have a problem side and to report a preferred feeding side. A neonatal head turning preference was associated with a UBP but not with success/failure of breast feeding at six weeks post-delivery. There were no associations between the holding interventions used by midwives and the successful continuation of breast feeding until six weeks post-delivery.

KEY CONCLUSIONS

there is no conclusive evidence associating the management of a UBP with differing intervention holds.

IMPLICATIONS FOR PRACTICE

there is a need of further research to select the most appropriate intervention to help an individual mother and baby.

Women's experiences with breastfeeding longer than 12 months

This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas who breastfed longer than 12 months. They were compared with 541 primiparas who weaned their infants within the first year. Greater age, education, and weeks of exclusive breastfeeding were associated with longer duration of breastfeeding. More than two-thirds (68%) of the women who breastfed longer than one year returned to employment before their infant was 1 year old. The most frequently chosen reason for long-term breastfeeding was that breastfeeding was a special time for mother and baby that the mother was not ready to give up. Nearly half of the women reported breastfeeding their babies on demand. At 12 to 15 months, 54 percent of the babies slept in a crib in a separate room, and 37 percent slept in the same bed with their mother all or part of the night. Most mothers (57%) considered their support group to be slightly or moderately important in influencing their decision to breastfeed beyond a year, and 10 percent considered it to be extremely important. The major themes that emerged from women's comments were the importance of being strong in the face of social unacceptability, development of a close mother-child bond, and the naturalness of breastfeeding beyond 12 months. Health caregivers should recognize the emotional and interpersonal aspects of long-term breastfeeding, support the breastfeeding relationship, and avoid contributing to the development of "closet nursers" so that women may feel free to discuss their concerns about their child's health.

Breastfeeding care in Ohio hospitals: a gap between research and practice

OBJECTIVE

To assess current breastfeeding care in Ohio hospitals and compare that care to research-based principles.

DESIGN

Survey.

SETTING

Ohio hospitals that provide maternity care.

PARTICIPANTS

All 141 Ohio hospitals that provide maternity care were invited to participate. One-hundred sixteen (83%) hospitals returned usable surveys completed by obstetric nurse managers.

MAIN OUTCOME MEASURE

A 38-item questionnaire provided data on hospital demographics and information regarding the care of breastfeeding mother-infant dyads.

RESULTS

Research-based practices common in Ohio's hospitals include demand feeding, breastfeeding education, and breastfeeding as the initial neonatal feeding. Common non-research-based practices include supplemental fluid administration, postpartum nipple treatments, mandatory initial nursery stays, limited sucking time, restricted maternal-infant contact, distribution of formula packs, minimal follow-up care, and the suspension of breastfeeding for hyperbilirubinemia.

CONCLUSIONS

Despite positive changes in perinatal care, a number of non-research-based practices persist in Ohio hospitals for the care of the breastfeeding mother-infant dyad.