Bases épidémiologiques pour la surveillance de l’allaitement maternel en France

[Breastfeeding promotion among deprived women in Haute-Normandie]

OBJECTIVES

The prevalence of breastfeeding in France is lower among deprived women than in the rest of the population. The Haute-Normandie region is severely affected by deprivation, especially among women.

PRIMARY OBJECTIVE

To describe breastfeeding promotion in deprived women living in Haute-Normandie. Secondary objectives: to describe the prevalence of breastfeeding and identify barriers to breastfeeding in the same population.

METHODS

This cross-sectional observational study was carried out in Haute-Normandie between March and June 2015, in three steps: 1) mailing questionnaires to actors working with deprived women, 2) analysis of child health certificates and 3) sociological interviews with 15 deprived women.

RESULTS

Only 4 of the 29 responding structures had implemented actions to promote breastfeeding among deprived women, with positive feed-back. Barely half of all deprived women had initiated breastfeeding in Haute-Normandie (Eure: 50%, Seine-Maritime: 54%). Finally, the same factors usually known to affect breastfeeding and its duration were also identified among deprived women living in Haute-Normandie.

CONCLUSION

Guidelines for actions to support breast-feeding among deprived mothers have been developed to guide local policies designed to reduce social inequalities in health in Haute-Normandie.

Breastfeeding duration, social and occupational characteristics of mothers in the French 'EDEN mother-child' cohort

Socio-demographic characteristics of mothers have been associated with exclusive breastfeeding duration, but little is known about the association with maternal full- and part-time employment and return to work in European countries. To study the associations between breastfeeding, any and almost exclusive (infants receiving breast milk as their only milk) breastfeeding, at 4 months of infant's age and the socio-demographic and occupational characteristics of mothers. We used the EDEN mother-child cohort, a prospective study of 2002 singleton pregnant women in two French university hospitals. We selected all mothers (n = 1,339) who were breastfeeding at discharge from the maternity unit. Data on feeding practices were collected at the maternity unit and by postal questionnaires at 4, 8 and 12 months after the birth. Among infants breastfed at discharge, 93% were still receiving any breastfeeding (83% almost exclusive breastfeeding) at the 3rd completed week of life, 78% (63%) at the 1st completed month, and 42% (20%) at the 4th completed month. Time of return to work was a major predictor for stopping breastfeeding: the sooner the mothers returned to work, the less they breastfed their babies at 4 months of infant's age, independently of full-time or part-time employment. The association was stronger for almost exclusive breastfeeding mothers than for any breastfeeding ones. In a society where breastfeeding is not the norm, women may have difficulties combining work and breastfeeding. Specific actions need to be developed and assessed among mothers who return to work and among employers.

[Prenatal breastfeeding information: survey in Pays de Loire, France]

OBJECTIVES

The main aim of this study was to evaluate how well expectant mothers were informed on breastfeeding by healthcare professionals. The secondary objective was to determine the factors associated with the initiation of breastfeeding.

POPULATION AND METHODS

The survey was conducted in a group of 500 women who had delivered at the Angers Hospital (France), based on a questionnaire filled out by the postpartum women during their hospital stay.

RESULTS

The rate of breastfeeding was 61.2%. More than a quarter (26.9%) of the women did not receive any prenatal breastfeeding information. The survey showed that 77.8% of the women had been informed of breastfeeding advantages for infants and 51.5% of breastfeeding advantages for themselves. Only 27.5% had received the advice of exclusive breastfeeding for 6months. Only 5.2% had been informed of the uselessness of breast preparation during pregnancy and a minority had been informed of correct and incorrect breastfeeding contraindications. Only 15.4% of fathers had been involved in a discussion on infant feeding practices during prenatal consultations. Only 4.8% of the women had come to prenatal classes on breastfeeding with a relative. The maternal factors positively associated with breastfeeding initiation were age between 25 and 34 years, non-French origin, a high socioeconomic status, being married, having been breastfed, and having previous experience with breastfeeding. Breastfeeding initiation was negatively associated with maternal smoking. All the factors concerning prenatal breastfeeding information in women were associated with the choice of breastfeeding.

CONCLUSION

This study pointed out the populations at risk of not breastfeeding. Breastfeeding information given to pregnant women by healthcare professionals may influence them on whether or not they choose to breastfeed their newborn. However, this survey showed that women are insufficiently informed on prenatal breastfeeding. Therefore, prenatal breastfeeding information should be improved.

[Lactation counselling support provided to mothers of preterm babies who intend to breastfeed. Evaluation of an educational intervention in a level III perinatal unit]

OBJECTIVE

To evaluate the educational intervention provided in a perinatal unit to support mothers of preterm babies who intend to breastfeed.

PATIENTS AND METHODS

The study was prospective and included all the infants born between 30 and 34 weeks of gestation at the Jeanne-de-Flandre university hospital in Lille and whose mothers intended to breastfeed. The studied period extended from January to December 2005, comparing the first and the last semester. The different actions were guided by the formation of the staff and lactation counselling to mothers, especially in the initiation of lactation. They were provided by one full-time nurse who was lactation consultant. The main outcome measure was the time to the first breast milk expression. Secondary outcome was the rate of infants breastfed at discharge.

RESULTS

Twenty-one educational interventions were organised for all the people working in the unit. One hundred thirty-two nurses and 17 doctors attended to these sessions. During the study period, 175 babies were born preterm at a gestational age between 30 and 34 weeks: 81 during the first semester and 94 during the second. The two populations were comparable for gestational age and the social class of the mothers, but the birth weight was higher during the second semester (1681+/-140 vs 1774+/-216 g, P=0, 01). Mothers of 65.1% of the neonates intended to breastfeed. The time of the first breast milk expression decreased significatively during the second semester (37,5 vs 30,7 h, P<0, 01). The rate of exclusively or partially breastfed neonates at discharge was stable (88,5 vs 91,9%, ns).

CONCLUSION

The program improved the initiation of lactation. This work emphasises the difficulties and the different steps necessary to promote breastfeeding in preterm babies with respect to developmental care.