The Role of Early Maternal Support in Balancing Full-Time Work and Infant Exclusive Breastfeeding: A Qualitative Study

Maternal COVID vaccination and breastfeeding during a pandemic: Habitus and health behavior decision making

OBJECTIVE

To examine the influence of habitus on women's health behavior regarding breastfeeding and subsequent COVID-19 vaccination.

DESIGN

A qualitative descriptive design, guided by Pierre Bourdieu's concept of habitus.

SAMPLE

Eighteen women who were postpartum, breastfeeding, and vaccinated against COVID- 19 either during pregnancy or while breastfeeding postpartum.

MEASURES

Individual semi-structured interviews.

RESULTS

Two major themes shaped participants' habitus: health-focused knowledge, and attitudes and beliefs. Attitudes and beliefs included five subthemes: (1) exposure/acceptance/expectations from family, (2) community acceptance of breastfeeding and COVID-19 vaccination, (3) socioeconomic status, (4) easily accessed support, and (5) outside experiences and exposure.

DISCUSSION

An individual's habitus impacts one's knowledge, attitudes, and beliefs and interacts with past behaviors when discussing options for infant feeding and health promoting behaviors such as vaccinations. A better understanding of how health care providers assess and utilize habitus in clinical management is needed.

Investigating interactive methods in remote chestfeeding support for lactation consulting professionals in Brazil

Objective

Lactation consultants (LCs) positively impact chestfeeding rates by providing in-person support to struggling parents. In Brazil, LCs are a scarce resource and in high demand, risking chestfeeding rates across many communities nationwide. The transition to remote consultations during the COVID-19 pandemic made LCs face several challenges to solve chestfeeding problems due to limited technical resources for management, communication, and diagnosis. This study investigates the main technological issues LCs have in remote consultations and what technology features are helpful for chestfeeding problem-solving in remote settings.

Methods

This paper implements qualitative investigation through a contextual study (n=10) and a participatory session (n=5) to determine stakeholders’ preferences for technology features in solving chestfeeding problems.

Findings

The contextual study with LCs in Brazil characterized (1) the current appropriation of technologies that help during consultations, (2) technology limitations that affect LCs’ decision-making, (3) challenges and benefits of remote consultations, and (4) cases that are easy and difficult to solve remotely. The participatory session brings LCs’ perceptions on (1) components for an effective remote evaluation, (2) preferred elements by professionals when providing remote feedback to parents, and (3) feelings about using technology resources for remote consultations.

Conclusion

Findings suggest that LCs adapted their methodologies for remote consultations, and the perceived benefits of this modality show interest in continuing to provide remote care as long as more integrative and nurturing applications are offered to their clients. We learned that fully remote lactation care might not be the main objective for overall populations in Brazil, but as a hybrid mode of care that benefits parents by having both modalities of consultations available to them. Finally, remote support helps reduce financial, geographic, and cultural barriers in lactation care. However, future research must identify how generalized solutions for remote lactation care can be, especially for different cultures and regions.

Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study

Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.

The Work of Breastfeeding Among Women of Low Socioeconomic Status: A Qualitative Metasynthesis

A theory-generating qualitative metasynthesis was used to explore the questions: (a) How do mothers of low socioeconomic status in the United States express their attitudes and beliefs on breastfeeding? (b) How do mothers of low socioeconomic status in the United States describe the types of support received related to breastfeeding? Databases were searched from January 2000 to June 2022. Eleven qualitative studies were evaluated, and six themes were identified. A model was developed illustrating how the themes impact a mother’s decision to breastfeed. Positive factors included shared narratives, knowledge of breastfeeding physiology, and social network. However, more negative influences were heard such as opinions passed on from family and friends, lack of teaching and anticipatory guidance, limited support and follow up, and the perception of conflicting messages from health care professionals. This model identifies constructs that can be used as starting points for interventions, policy development and/or health promotion education.

Work as an Understudied Driver of Racial Inequities in Breastfeeding

Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.

Shift-work and breastfeeding for women returning to work in a manufacturing workplace in Taiwan

Background

Although breastfeeding-friendly workplaces are provided to promote an employed mother’s breastfeeding intention, few studies have explored breastfeeding intentions and behavior after a mother returns to work on a shift work or non-shift work schedule. To explore the impact of breastfeeding-friendly support on the intention of working mothers with different work schedules to continue breastfeeding, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan from August 2011 to April 2012.

Methods

Female workers who met the inclusion criteria (maternity leave between January 2009 and January 2011) were invited to participate in the survey. A structured questionnaire survey was administered to 715 working mothers employed at an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. The questionnaire content included female employee demographic characteristics, employment characteristics, continued breastfeeding behavior after returning to work, access to lactation rooms, and employee perception of the breastfeeding policy and support when raising their most recently born child.

Results

A total of 715 employed mothers’ data were collected. Of the shift workers, 90.1% breastfed during maternity leave, but the breastfeeding rates after returning to work decreased to 21.5% for one to six months and 17.9% for more than six months. Of the non-shift workers, 87.6% breastfed during maternity leave and the breastfeeding rates after returning to work were 24.1% for one to six months and 34.6% for more than six months. Using a lactation room and taking advantage of breast-pumping breaks were significant factors for continuing to breastfeed one to six months after returning to work and more than six months after returning to work among shift workers and non-shift workers. In addition, among non-shift workers, a higher education level of the mother (odds ratio (OR) = 9.57) and partner support (OR = 4.89) had positive effects toward a mother continuing breastfeeding for more than six months after returning to work.

Conclusions

Workplaces or employers should provide more support to encourage employed mothers to take advantage of the breastfeeding room and breast-pumping breaks, enhance the frequency of the usage of lactation rooms, and increase the rate of continued breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00467-8.

Medical and Nursing Students' Perceptions of and Advice for Extended Breastfeeding: An Exploratory Study

Although the health benefits to both mother and child produced by breastfeeding have been documented, and numerous efforts have been made to promote breastfeeding rates in the United States, extended breastfeeding (breastfeeding beyond 12 months) research has been largely overlooked. Guided by the Framework of Integrative Normative Influences on Stigma, this study examined how extended breastfeeding was perceived among medical and nursing students and how perceptions of extended breastfeeding were translated into stigmatizing outcomes including attitudes, behavioral predispositions, and behavioral intention to encourage weaning. One hundred and sixteen medical and nursing students enrolled at a large mid-western University completed an online survey. Participants were asked to provide answers to questions regarding their knowledge of extended breastfeeding, attitudes toward it, perception about stigma associated with breastfeeding, and their behavioral intention to encourage future patients to wean. A lack of knowledge about extended breastfeeding was evident among the medical and nursing students; they also exhibited increasingly negative attitudes toward extended breastfeeding as the child's age increased. Medical and nursing students' behavioral intention to encourage weaning is associated with their pre-dispositional stigma of extended breastfeeding. Addressing stigma and negative attitudes toward extended breastfeeding in pre-healthcare students' curriculum may help future healthcare providers understand that while cultural norms in the United States do not tend toward extended breastfeeding, it is more common in other parts of the world, as well as help them understand health benefits to the child and to the mother.

Breastfeeding Experiences of Baccalaureate Nursing Students: A Qualitative Study

BACKGROUND

Students returning to school who are breastfeeding face unique challenges. There is limited literature on breastfeeding university students. Several researchers have studied breastfeeding employees in the workplace. Institutions of higher education closely mimic the employment environment. Breastfeeding college students who express their milk while at school share similar challenges to employed mothers. A baccalaureate nursing program is rigorous and little is known about the challenges facing breastfeeding student nurses returning to classes.

RESEARCH AIM

To explore the breastfeeding experience of baccalaureate nursing students.

METHODS

Our study was a cross-sectional descriptive qualitative design. Purposive sampling was used to enroll participants (N = 12). In depth, semi-structured interviews were conducted. Qualitative thematic analysis was used to analyze the data both manually and using Dedoose QDA software.

RESULTS

An overarching theme of pervasive conflict between the role of the breastfeeding mother and the role of the student nurse surfaced. Three interrelated organizing themes also emerged; challenging, vulnerability, and resilience. Time constraints, self-care versus role demands, and structural accommodations contributed to the challenges. Only one participant indicated a knowledge of her breastfeeding rights. All of the participants expressed gratitude for faculty and community support, regardless of conflicts.

CONCLUSION

Breastfeeding participants were both vulnerable and resilient. Faculty may improve experiences through providing specific areas of support. A breastfeeding support policy outlining student rights and faculty responsibilities is needed to educate, guide, and enforce protections. Health care providers may enhance breastfeeding students' experiences through anticipatory guidance, education, and continued support.

Determinants of Successful Exclusive Breastfeeding for Saudi Mothers: Social Acceptance Is a Unique Predictor

Recent guidelines motivate health care professionals to promote exclusive breastfeeding (EBF). The reported rate of EBF is low in Saudi Arabia. This study aimed to explore the determinants of successful exclusive breastfeeding for Saudi mothers. A cross-sectional, survey-based study was conducted in family medicine clinics. The dependent variable was the actual practice of EBF. Independent variables were the mothers’ demographic information, comfortableness with breastfeeding in public, knowledge and attitudes about breastfeeding, previous experience of successful breastfeeding, and a previous feeding plan. Statistical analysis was carried out using bivariate analysis and multinomial logistic regression. Out of the 322 respondents, only 28% practiced exclusive breastfeeding for the first six months. Perceived insufficient milk (p = 0.011) was associated with a lower EBF rate. Mothers’ degrees of comfort with breastfeeding in front of their relatives (p = 0.024) and in front of friends (p = 0.028) were significantly associated with their infants’ actual feeding practices for the first six months of their infants’ lives. Mothers reported that the absence of a suitable place for breastfeeding caused them to stop breastfeeding (p = 0.043) and was associated with their infant’s actual feeding practices for the first six months of their infant’s lives. An antenatal breastfeeding intention was considered a significant predictor of EBF; OR: 7.31 (95% CI: 2.24—23.84). Mothers who do not stop breastfeeding when they get sick have a 5.054 times higher chance of continuing EBF (95% CI: 1.037—24.627) than the formula-only feeding group. Thus, social acceptance is a unique predictor for their success in exclusive breastfeeding. Mothers have good intentions and a desire to breastfeed. Therefore, they must be guided through their pregnancy and postpartum period to overcome breastfeeding issues.

Current lifestyle and exclusive breastfeeding: an impossible balance?

427 women were included in this observational cohort study to determine the rate of exclusive (EB), mixed (MB) and artificial breastfeeding (AB) and the personal reasons and social factors influencing this decision. An initial survey was conducted within the first 36 h postpartum and a second wave was carried out 3 months after delivery. 55.74% (238) of the patients intended to EB, 32.55% (139) AB and 11.71% (50) MB. After 3 months, a high percentage in group EB (75.23%) maintained EB. The main reason for switching to AB was the absence of milk or weight loss of the newborn. In conclusion, EB is the preferred form for feeding newborns. When these women returned to their workplace, most of them wanted to continue with EB. Women with higher academic degrees chose more often EB.IMPACT STATEMENTWhat is already known on this subject? The benefits of exclusive breastfeeding are well known. However, in modern western societies, it is not easy to combine breastfeeding with day-to-day activity. Work activity, age or previous parity are some of the factors that may influence the election of the type of lactation.What do the results of this study add? Exclusive breastfeeding is the preferred method for feeding newborns immediately postpartum and 3 months later. Work activity does not seem to influence or to switch the choice. However, the level of education could be a determinant of adherence to exclusive breastfeeding.What are the implications of these findings for clinical practice and/or further research? Assessing the factors that favour adherence to exclusive breastfeeding might be a useful tool to its promotion. This study warrants further multivariate analyses on the same topic and additional studies in other social contexts.

Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women

Background

Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally.

Methods

A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women’s working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624).

Results

Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well.

Conclusions

The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers – individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers’ self-esteem and outcomes such productivity and abstentionism.

Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant's failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support.

An Exploratory Look at the Role of Childcare Providers as a Support and Resource for Breastfeeding Mothers

Introduction: The childcare setting remains largely unexplored as a potential barrier to breastfeeding continuation and, therefore, the lack of interventions targeting childcare providers may be a missed opportunity for improved breastfeeding support. This article explores the perceptions of 25 first-time breastfeeding mothers on navigating the critical transition to childcare and the role of childcare providers regarding breastfeeding support. Methods: Mothers were selected if they indicated an intent to breastfeed on a prenatal questionnaire and had enrolled their child in childcare. Semistructured interviews guided by Bronfenbrenner's bioecological model were conducted to capture mothers' experiences. Responses were analyzed utilizing thematic analysis to generate themes rooted in mothers' experiences with childcare and breastfeeding. Results: A thematic analysis resulted in three key themes: Providers are not Critically Evaluated, A Stressful Transition, and Childcare as a Service, not Support. These themes indicated that although mothers intended to continue breastfeeding during and after the transition to childcare, they had not previously given much consideration to the childcare setting beyond that of a service provider. Conclusion: Findings illustrate new considerations to support modern breastfeeding mothers through the transition to work and childcare are needed such as basic and practical education and training to prepare childcare providers to support breastfeeding mothers in the way that best meets their needs, enhanced education for mothers on how to seek and evaluate providers for breastfeeding competence, and policy initiatives focused on fostering engagement between mothers and providers. By taking mothers' perceptions into consideration, researchers, practitioners, and policymakers can offer breastfeeding support that mothers will be receptive to and more likely to engage with, thereby advancing the health of both mothers and infants.

Sources of Information and Support for Breastfeeding: Alignment with Centers for Disease Control and Prevention Strategies

BACKGROUND AND OBJECTIVES

Research consistently supports health benefits of breastfeeding; however, rates in the United States remain below Healthy People 2020 goals. To increase breastfeeding, information and support are needed from multiple sources. Given differences in breastfeeding rates by demographic characteristics, sources of information and support may also differ. In addition, recent research suggests potential differences in health outcomes related to feeding method (direct breastfeeding only, feeding expressed human milk, combination-feeding with formula). This study examined (1) information and support received within Centers for Disease Control and Prevention (CDC)-defined strategies for supporting breastfeeding mothers, (2) differences in rates of information and support received by demographics, and (3) associations with feeding method at 6 weeks postpartum.

MATERIALS AND METHODS

A sample of 447 women participating in the Synergistic Theory Research Obesity and Nutrition Group (STRONG) Kids 2 study completed surveys with questions from the CDC Survey on Infant Feeding Practices II related to sources of information and support for breastfeeding and breast pump use, and about demographics and feeding method at 6 weeks postpartum.

RESULTS

Frequencies of supports received within each category indicate that professional supports were the most pervasive, followed by support from friends and relatives. However, women at greater risk for breastfeeding cessation (lower education, Women, Infants, and Children participants, single mothers) received information and support at lower rates. Education and information support was the only source significantly associated with feeding method.

CONCLUSION

New approaches are needed to increase efficacy of information delivery, especially for at-risk populations, to better meet CDC recommendations.