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Kready K, Doiron K, Chan KR, Way J, Justman Q, Powe CE, Silver P. A long-acting prolactin to combat lactation insufficiency. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.15.571886. [PMID: 38168384 PMCID: PMC10760067 DOI: 10.1101/2023.12.15.571886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Human infants are born to breastfeed. While 50% of lactating persons struggle to make enough milk, there are no governmentally-approved drugs to enhance lactation1. Here, we engineer a variant of the naturally-occurring driver of lactation, the hormone Prolactin, to increase its serum half-life and produce a viable drug candidate. Our engineered variant, Prolactin-eXtra Long-acting (Prolactin-XL), is comprised of endogenously active human prolactin fused to an engineered human IgG Fc domain designed to overcome the unique drug development challenges specific to the lactating person-infant dyad. Our Prolactin-XL has a serum half-life of 70.9h in mice, 2,625-fold longer than endogenously active prolactin alone (70.9h v. 0.027h). We demonstrate that Prolactin-XL increases milk production and restores growth of pups fed by dams with pharmacologically-ablated lactation. We show that Prolactin-XL-enhanced lactation is accompanied by reversible, lactocyte-driven changes in mammary gland morphology. This work establishes long-acting prolactins as a potentially powerful pharmacologic means to combat insufficient lactation.
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Affiliation(s)
- Kasia Kready
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts 02115, USA
- Synthetic Biology Hive, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Kailyn Doiron
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts 02115, USA
- Synthetic Biology Hive, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Katherine Redfield Chan
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA
| | - Jeffrey Way
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts 02115, USA
- Synthetic Biology Hive, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Quincey Justman
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Synthetic Biology Hive, Harvard Medical School, Boston, Massachusetts, 02115, USA
| | - Camille E. Powe
- Diabetes Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
- Departments of Medicine and of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, 02115
- Broad Institute, Cambridge, Massachusetts, 02142
| | - Pamela Silver
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, 02115, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts 02115, USA
- Synthetic Biology Hive, Harvard Medical School, Boston, Massachusetts, 02115, USA
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Kholina K, Brady J, Snelgrove-Clarke E, Rossiter MD, Whitfield KC. Dual modality feeders: a group of human milk feeders with unique practices and needs. Public Health Nutr 2023; 26:2882-2890. [PMID: 37927150 PMCID: PMC10755423 DOI: 10.1017/s1368980023002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Dual modality feeding (DMF) - feeding human milk interchangeably from the breast and from a bottle - comes with unique practical, emotional and relational challenges, as well as support needs. Yet, there is little research that explores the experiences of individuals who use DMF in the Canadian context. The aim of this study is to explore the practices, challenges, reasons and enablers of DMF. DESIGN Repeat, semi-structured one-on-one interviews were conducted at 8 weeks and 22 weeks postpartum. Interview transcripts were thematically analysed using a critical feminist lens. SETTING Nova Scotia, Canada. PARTICIPANTS Ten DMF mothers. RESULTS DMF practices were influenced by a mix of social and material circumstances, including breast-feeding challenges, the involvement of support persons, finances and access to lactation support. Individuals who predominantly fed at the breast expressed milk strategically to mitigate transitory breast-feeding challenges, for convenience under specific circumstances, and to share feeding responsibilities with other caregivers for personal and practical reasons. Individuals who mainly bottle-fed did so due to long-term breast-feeding challenges or a need to return to employment. Enablers of successful DMF were consistent between the two groups and included practical, personal and relational aspects. CONCLUSIONS DMF is a unique practice compared to feeding human milk solely from the breast or bottle. Despite the potential growing prevalence of DMF, it is currently understudied and inadequately addressed in existing support programmes in Nova Scotia. Tailored programming and public messaging are needed to support DMF families.
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Affiliation(s)
- Ksenia Kholina
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Hwy, Halifax, Nova Scotia, B3M 2J6Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia, Canada
| | - Jennifer Brady
- School of Nutrition and Dietetics, Acadia University, 15 University Ave, Wolfville, Nova Scotia, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Faculty of Health Sciences, Queen’s University, 92 Barrie Street, Kingston, ON, Canada
| | - Melissa D Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, 550 University Ave, Charlottetown, Prince Edward Island, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Hwy, Halifax, Nova Scotia, B3M 2J6Canada
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Quinn EA, Sobonya S, Palmquist AE. Maternal perceptions of human milk expression output: An experimental design using photographs of milk. Soc Sci Med 2023; 324:115871. [PMID: 37023658 DOI: 10.1016/j.socscimed.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. METHODS We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). RESULTS Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. CONCLUSIONS Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.
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Bigalky J, Dietrich Leurer M, McCabe J, Mackey A, Laczko D, Deobald V. Advice from Canadian Mothers Who Express Human Milk: An Interpretive Description Qualitative Study. Matern Child Health J 2021; 26:342-350. [PMID: 34609705 DOI: 10.1007/s10995-021-03237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Human milk expression has become an increasingly common means for providing milk to an infant, with women expressing to address breastfeeding problems or to allow for flexible feeding options. This study explored the experiences and recommendations of mothers who expressed human milk, with this paper reporting on the advice mothers would offer to other mothers to address common challenges. METHODS Interpretive description was used in this qualitative project. Using purposive sampling, mothers of infants aged 0-24 months who expressed human milk were recruited to participate from two health regions in western Canada. Individual, audio-taped interviews were completed with 35 women. NVIVO™ software was used for data analysis. RESULTS Mothers reported the desire to offer experiential advice to other mothers navigating milk expression and encouraged other mothers to seek guidance from health care professionals such as lactation consultants, peer support online, and from family and friends. Experiential knowledge shared included: (a) product recommendations, (b) expression tips, (c) support for workplace expression, (d) encouragement to seek help, and (e) moral support. CONCLUSIONS Healthcare professionals should include evidence-based expression information as part of routine lactation support, while recognizing the importance of mother-to-mother knowledge transfer and emotional support. Services that assist mothers to determine and access pumps appropriate to their unique breastfeeding needs and goals should be offered, and the opportunity for peer support through creation of, or referral to, appropriate in-person or online support groups should be made available.
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Affiliation(s)
- Jodie Bigalky
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada.
| | - Marie Dietrich Leurer
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | - Janet McCabe
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - April Mackey
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | | | - Virginia Deobald
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
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Kendall E, Millard A, Beaumont J. The "weanling's dilemma" revisited: Evolving bodies of evidence and the problem of infant paleodietary interpretation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175 Suppl 72:57-78. [PMID: 33460467 DOI: 10.1002/ajpa.24207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/23/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
Breastfeeding is known to be a powerful mediator of maternal and childhood health, with impacts throughout the life course. Paleodietary studies of the past 30 years have accordingly taken an enduring interest in the health and diet of young children as a potential indicator of population fertility, subsistence, and mortality patterns. While progress has been made in recent decades toward acknowledging the agency of children, many paleodietary reconstructions have failed to incorporate developments in cognate disciplines revealing synergistic dynamics between maternal and offspring biology. Paleodietary interpretation has relied heavily on the "weanling's dilemma," in which infants are thought to face a bleak choice between loss of immunity or malnutrition. Using a review of immunological and epidemiological evidence for the dynamic and supportive role that breastfeeding plays throughout the complementary feeding period, this article offers context and nuance for understanding past feeding transitions. We suggest that future interpretative frameworks for infant paleodietary and bioarchaeological research should include a broad knowledge base that keeps pace with relevant developments outside of those disciplines.
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Affiliation(s)
- Ellen Kendall
- Department of Archaeology, Durham University, Durham, UK
| | - Andrew Millard
- Department of Archaeology, Durham University, Durham, UK
| | - Julia Beaumont
- School of Archaeological and Forensic Sciences, University of Bradford, Bradford, UK
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6
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Becker GE. Marketing Breast feeding Substitutes: A Discussion Document. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249239. [PMID: 33321893 PMCID: PMC7764067 DOI: 10.3390/ijerph17249239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
Marketing influences knowledge, attitudes, and decisions related to infant and young child nutrition, safety, development, parental confidence, and other aspects of health and wellbeing of the child. These attitudes and behaviours of parents, health workers, policy makers, and other influencers have short- and long-term effects on the child. There is an International Code of Marketing of Breast-Milk Substitutes. Is it time to have a code of marketing of breastfeeding substitutes?
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7
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Målqvist M. Breastfeeding hampered by complacency and commercial interests. Acta Paediatr 2020; 109:2177-2178. [PMID: 32815579 DOI: 10.1111/apa.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mats Målqvist
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS) Department of Women's and Children's Health Uppsala University Uppsala Sweden
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8
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Maxwell C, Fleming KM, Fleming V, Porcellato L. UK mothers' experiences of bottle refusal by their breastfed baby. MATERNAL AND CHILD NUTRITION 2020; 16:e13047. [PMID: 32558209 PMCID: PMC7503095 DOI: 10.1111/mcn.13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/17/2020] [Accepted: 06/02/2020] [Indexed: 01/17/2023]
Abstract
Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.
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Affiliation(s)
- Clare Maxwell
- Faculty of Health, School of Nursing and Allied Health, Henry Cotton Building, Liverpool John Moores University, Liverpool, UK
| | - Kate M Fleming
- Institute of Population Health Sciences, Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, UK
| | - Valerie Fleming
- Faculty of Health, School of Nursing and Allied Health, Henry Cotton Building, Liverpool John Moores University, Liverpool, UK
| | - Lorna Porcellato
- Public Health Institute, Exchange Station, Liverpool John Moores University, Liverpool, UK
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9
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Taylor AM, Alexander J, van Teijlingen E, Ryan KM. Commercialisation and commodification of breastfeeding: video diaries by first-time mothers. Int Breastfeed J 2020; 15:33. [PMID: 32354372 PMCID: PMC7193407 DOI: 10.1186/s13006-020-00264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many of aspects of our lives became increasingly commercialised in post-modern society. Although breastfeeding is perhaps a late comer to this process in recent years, it too has seen significant commercialisation facilitated by social media and our obsession with celebrity culture. This paper explores how the commercialisation and commodification of breastfeeding impacts mothers' experiences of breastfeeding. METHODS In a qualitative study, five mothers in the United Kingdom recorded their real-time breastfeeding experiences in video diaries. Using a multi-modal method of analysis, incorporating both visual and audio data, a thematic approach was applied. FINDINGS Women preparing for breastfeeding are exposed to increasing commercialisation. When things do not go to plan, women are even more exposed to commercial solutions. The impact of online marketing strategies fuelled their need for paraphernalia so that their dependence on such items became important aspects of their parenting and breastfeeding experiences. CONCLUSIONS The audio-visual data demonstrated the extent to which "essential" paraphernalia was used, offering new insights into how advertising influenced mothers' need for specialist equipment and services. Observing mothers in their video diaries, provided valuable insights into their parenting styles and how this affected their breastfeeding experience.
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Affiliation(s)
- Alison M Taylor
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK.
| | - Jo Alexander
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Kath M Ryan
- School of Pharmacy, University of Reading, Whiteknights Campus, Po Box 226, Reading, UK
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Palmquist AEL, Perrin MT, Cassar-Uhl D, Gribble KD, Bond AB, Cassidy T. Current Trends in Research on Human Milk Exchange for Infant Feeding. J Hum Lact 2019; 35:453-477. [PMID: 31206310 DOI: 10.1177/0890334419850820] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breastfeeding is critical for the healthy growth and development of infants. A diverse range of infant-feeding methods are used around the world today. Many methods involve feeding infants with expressed human milk obtained through human milk exchange. Human milk exchange includes human milk banking, human milk sharing, and markets in which human milk may be purchased or sold by individuals or commercial entities. In this review, we examine peer-reviewed scholarly literature pertaining to human milk exchange in the social sciences and basic human milk sciences. We also examine current position and policy statements for human milk sharing. Our review highlights areas in need of future research. This review is a valuable resource for healthcare professionals and others who provide evidence-based care to families about infant feeding.
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Affiliation(s)
- Aunchalee E L Palmquist
- 1 Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maryanne T Perrin
- 2 Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Diana Cassar-Uhl
- 3 Maternal and Child Health Program, School of Public Health, University of Maryland, Cornwall, NY, USA
| | - Karleen D Gribble
- 4 School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, AUS
| | - Angela B Bond
- 5 Center for Evolution and Medicine, Arizona State University, Phoenix, AZ, USA
| | - Tanya Cassidy
- 6 Dublin City University, School of Nursing and Human Sciences, Glasnevin Campus, Dublin 9, Ireland
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11
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Shaw RM. Altruism, solidarity and affect in live kidney donation and breastmilk sharing. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:553-566. [PMID: 30155897 DOI: 10.1111/1467-9566.12805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Social scientists have recently diverged from mainstream bioethical discussion on the topic of the medical use of human biological materials for therapeutic, reproductive and research purposes. Rather than justifying the donation and provision of biological materials solely in terms of alleviating physical, psychological and social suffering, saving or enhancing life, and advancing biomedical knowledge, this work looks beyond humanist bioethics to take a social justice approach to questions of the life sciences. In this article, I draw insight from these accounts to propose an approach to the sociology of live kidney and breastmilk donation that is situated at the interface of the new sociology of morality and affect studies. To do so, I examine the moral economy of tissue provision with respect to its organisation around the discourse of altruism and the gift. I then turn to recent work on tissue economies, which are in the business of creating and producing biovalue, to discuss the manipulation of affect and the entanglement of new forms of bio-intimacy in the production and reproduction of somatic life. The aim of the article was to contribute to the study of the sociology of donation as a substantive field of specialisation within sociology.
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Affiliation(s)
- Rhonda M Shaw
- School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand
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12
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Cescutti-Butler L, Hemingway A, Hewitt-Taylor J. “His tummy's only tiny” – Scientific feeding advice versus women's knowledge. Women's experiences of feeding their late preterm babies. Midwifery 2019; 69:102-109. [DOI: 10.1016/j.midw.2018.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/10/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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13
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Gatrell C. Boundary Creatures? Employed, Breastfeeding Mothers and ‘Abjection as Practice’. ORGANIZATION STUDIES 2017. [DOI: 10.1177/0170840617736932] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper contributes to theory on maternity, embodiment and organizations through advancing a contemporary theory of ‘abjection as practice’ in relation to breastfeeding and employment. Drawing upon the work of Margaret Shildrick and Julia Kristeva, it analyses a qualitative study of netnographic (internet) discussions among employed breastfeeding mothers, observing how lactating bodies are treated as abject within organizations. It proposes that hostile behaviour towards breastfeeding women could be seen as a form of ‘abjection as practice’, displaying a purposeful intent to exclude breast milk production from workplace contexts. In exploring the position of breastfeeding workers, the paper observes how breastfeeding women occupy an uncomfortable space on the borders between health ideals of ‘proper’ mothering and organizational notions of ‘good’ worker. The situation of breastfeeding employees is rendered ambiguous and such uncertainties invoke co-worker antipathy. Co-worker hostility towards breastfeeding colleagues appears validated at work because minimal action is taken to address deliberate utilization of ‘abjection as practice’ towards breastfeeding workers.
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14
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Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. "Breastfeeding" without baby: A longitudinal, qualitative investigation of how mothers perceive, feel about, and practice human milk expression. MATERNAL & CHILD NUTRITION 2017; 13:e12426. [PMID: 28078789 PMCID: PMC5491350 DOI: 10.1111/mcn.12426] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
Abstract
Most American mothers who produce human milk (HM) now pump in place of some or all feeding at the breast, and most American infants are now fed pumped HM. We aimed to investigate mothers' perceptions of, attitudes toward, and practices for pumping and providing pumped HM. Results related to pumping are reported here. We conducted in-depth, semi-structured interviews among a diverse sample of 20 mothers who pumped, following each from pregnancy through infant HM-feeding cessation up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Mothers' reasons for pumping changed over time and reflected their needs and desires (e.g., latch difficulty, return to work, and increasing their milk supply). Mothers reported that pump type and quality were important to pumping success and that pumping was time-consuming, costly, and unpleasant compared to feeding at the breast. Regardless of how often mothers pumped, most felt pumping was necessary to meet their infant HM-feeding goals and was a welcome means of sharing with other caregivers the bonding opportunity and tasks they associated with feeding infants. Mothers interpreted output from pumping sessions to understand their ability to provide enough milk to meet their infants' needs. Mothers' reasons for pumping may signal constraints to infant HM feeding that may be addressed with policy changes. Mothers' attitudes and perceptions toward pumping indicate that, although pumping fills important and welcome roles for many mothers, the reality of its practice may make it an unacceptable or infeasible substitute for some.
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Affiliation(s)
- Julia P. Felice
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Rei Yamada
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Adriana J. Wong
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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15
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Sheehan A, Bowcher WL. Messages to new mothers: an analysis of breast pump advertisements. MATERNAL & CHILD NUTRITION 2017; 13:e12313. [PMID: 27103601 PMCID: PMC6866098 DOI: 10.1111/mcn.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Abstract
The mass media is replete with all kinds of advice, products and ideas about 'motherhood' with advertising being a major source of information on the latest products and consumer trends. Advertising is a key means of promoting ideas about infant feeding, and yet, there has been little in the way of critical analyses of breast pump advertisements in order to reveal the kinds of messages they convey about this method of feeding. This article makes an important step towards addressing this gap through analysing three advertisements for breast pumps from a popular Australian magazine for mothers. We utilize a social semiotic framework to investigate not just what choices are made in the design of the ads but also what those choices mean in terms of the overall message of the ads. Our analysis identifies three core messages: 'breastfeeding and breast pumping are the same with the purpose being to produce breast milk only', 'using breast pumps facilitates quality time with the baby' and 'mothers need outside expertise (including breast pumps) to ensure baby's development'. We believe it is important for those who provide information and support for breastfeeding women to be aware of the subtle, naturalized messages that ads convey so that they may better understand what may be underlying women's decisions regarding methods of infant feeding. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Athena Sheehan
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
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16
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Ryan-Fogarty Y, Becker G, Moles R, O'Regan B. Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services. WASTE MANAGEMENT (NEW YORK, N.Y.) 2017; 61:405-414. [PMID: 28089082 DOI: 10.1016/j.wasman.2016.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/25/2016] [Accepted: 12/17/2016] [Indexed: 06/06/2023]
Abstract
Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding.
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Affiliation(s)
| | | | - Richard Moles
- Department of Chemical Sciences, University of Limerick, V94 T9PX, Ireland.
| | - Bernadette O'Regan
- Department of Chemical Sciences, University of Limerick, V94 T9PX, Ireland.
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Abstract
OBJECTIVE In this paper, we apply psychological agency theory to women's interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration. DESIGN Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency. FINDINGS Women's agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty. CONCLUSION Health professionals as co-agents with women are well positioned to maintain, enhance or restore women's sense of agency. Breastfeeding goals should be included in women's birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.
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Affiliation(s)
- Kath Ryan
- a School of Pharmacy , University of Reading , Reading , UK
| | - Victoria Team
- b School of Social Sciences , Monash University , Melbourne , Australia
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18
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Crossland N, Thomson G, Morgan H, MacLennan G, Campbell M, Dykes F, Hoddinott P. Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability. MATERNAL & CHILD NUTRITION 2016; 12:726-39. [PMID: 27502101 PMCID: PMC5096021 DOI: 10.1111/mcn.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with 'a breast pump costing around £40 provided for free on the NHS' as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the 'appeal and value of breast pumps', 'sharing the load', 'perceived benefits', 'perceived risks' and issues related to 'timing'. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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19
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Flaherman VJ, Hicks KG, Huynh J, Cabana MD, Lee KA. Positive and negative experiences of breast pumping during the first 6 months. MATERNAL & CHILD NUTRITION 2016; 12:291-8. [PMID: 25134622 PMCID: PMC6860131 DOI: 10.1111/mcn.12137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers with milk supply concern. We conducted 10 focus groups of 56 mothers who had milk supply concern in the first month after birth. A paid, trained facilitator led groups in a semi-structured approach. Sessions were audiorecorded and transcribed verbatim. The transcripts were coded independently by two investigators and analysed using grounded theory. We identified five themes related to the experience of pumping among mothers with milk supply concern: (1) additional control over breastfeeding from pumping: 'I would feed and then give him … whatever I could manage to pump to him'. (2) Painful experience: 'The first time I pumped my boobs hurt so bad'. (3) Pumped volume affected milk supply concern: 'Pump and there was hardly anything coming out that's when I started to worry'. (4) Pumping interfered with other nurturing activities: 'While you're pumping, you can't touch the baby'. (5) Frustration from inconsistent provider advice: 'They told me to pump … and then said, "That's going to cause your milk to increase too much" '. Mothers had positive and negative experiences with pumping. Clinicians should assess a mother's experience shortly after she initiates pumping, as further management and counselling may be necessary to avoid barriers to successful breastfeeding.
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Affiliation(s)
| | | | | | - Michael D. Cabana
- Department of PediatricsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kathryn A. Lee
- Department of Family Health Care NursingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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20
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Breast pump use amongst mothers of healthy term infants in Melbourne, Australia: A prospective cohort study. Midwifery 2016; 33:82-9. [DOI: 10.1016/j.midw.2015.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/09/2015] [Accepted: 10/17/2015] [Indexed: 11/21/2022]
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21
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Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D, Campbell M. Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technol Assess 2016; 19:1-522, vii-viii. [PMID: 25897655 DOI: 10.3310/hta19300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. AIM To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. DESIGN Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. SETTING UK. PARTICIPANTS The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. METHODS (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. RESULTS Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A 'ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical 'ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity 'rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave 'healthily' risk them feeling pressurised and failing. To avoid 'losing face', women may disengage. LIMITATIONS Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. CONCLUSIONS Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important. STUDY REGISTRATION This study is registered as PROSPERO CRD42012001980. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deokhee Yi
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jenni Hislop
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- The Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Falko F Sniehotta
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - David Tappin
- Perinatal Epidemiology and Child Health Unit, School of Medicine, University of Glasgow, Glasgow, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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McInnes RJ, Arbuckle A, Hoddinott P. How UK internet websites portray breast milk expression and breast pumps: a qualitative study of content. BMC Pregnancy Childbirth 2015; 15:81. [PMID: 25881251 PMCID: PMC4429834 DOI: 10.1186/s12884-015-0509-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Exclusive breastfeeding for six months is recommended but few parents achieve this; particularly younger and less well-educated mothers. Many parents introduce infant formula milk to manage feeding but describe a desire to express breastmilk alongside a lack of support or information. The Internet is highlighted as a key resource. This study aimed to examine UK websites on expressing breastmilk to identify key messages and how information is provided. Methods We used search terms in Google to identify websites with information rich content on expressing breastmilk and breast pumps. Ten sites were purposively selected at two time points in 2013 and 2014 to represent 3 categories: commercial, NHS or 3rd sector (voluntary or not for profit). Each site was reviewed by two researchers, data and reflective analytical notes were uploaded into NVivo and thematic data analysis undertaken. Results Sites varied considerably in their design, use of images, videos, audio files, product placement and marketing opportunities. Three key themes emerged: depiction of expressing; reasons to express; and recommendations about expressing. Inconsistent and conflicting information was common within and between sites. Expressing was portrayed as similar to, but easier than, breastfeeding although at the same time difficult and requiring to be learned. Expressed breastmilk is promoted by mainly commercial sites as immediately available, although pumps were also presented as needing to be concealed, not heard or seen. Health benefits were the overarching reason for expressing. Although predicated on separation from the baby, commercial sites identified this as a positive choice while other sites focused on separation due to circumstance. Commercial sites emphasised restrictions related to breastfeeding, lack of sleep and bonding with the father and wider family. Non-commercial sites emphasised hand expression, with some not mentioning breast pumps. Practical information about starting expressing in relation to infant age or duration of breastfeeding was conflicting. Conclusions Internet information about expressing breastmilk is inconsistent, incomplete and not evidence informed. The lack of research evidence on the relationship between expressing and feeding outcomes has provided opportunities for commercial companies, which have the potential to further exacerbate observed health inequalities. Access to good quality information based on robust evidence is urgently required.
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Affiliation(s)
- Rhona J McInnes
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Alix Arbuckle
- Master of Health Research (MRes) programme, School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4LA, UK.
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Waldby C. 'Banking time': egg freezing and the negotiation of future fertility. CULTURE, HEALTH & SEXUALITY 2014; 17:470-482. [PMID: 25247927 DOI: 10.1080/13691058.2014.951881] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This paper examines the relatively recent practice of non-medical egg freezing, in which women bank their eggs for later use in conceiving a child. Non-medical egg freezing has only been available for about the last five years, as new vitrification techniques have made the success rates for actual conception more reliable than the earlier method of slow freezing. I draw on interviews with both clinicians and women who have banked their eggs to consider how this novel practice articulates with broader issues about the relationship between sexuality, reproduction and the political economy of household formation. Non-medical egg-freezing provides a technical solution to a number of different problems women face with regard to the elongation of the life course, the extension of education, the cost of household establishment and the iterative nature of relationship formation, thematised by the ubiquity of internet dating among the interviewees. I focus on the ways women used egg freezing to manage and reconcile different forms of time.
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Affiliation(s)
- Catherine Waldby
- a Faculty of Arts, Sociology and Social Policy , University of Sydney , Sydney , Australia
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