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Tasket AL, Black MR, Brewer TL, Young ML. Educating Nurses to Improve Awareness and Use of a Human Milk Feeding Care Pathway for Opioid-Exposed Neonates. Nurs Womens Health 2024:S1751-4851(24)00162-4. [PMID: 39153739 DOI: 10.1016/j.nwh.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To increase nurses' awareness and use of a human milk feeding (HMF) and opioid use disorder (OUD) standardized care pathway to improve rates of HMF at discharge in opioid-exposed neonates (OENs). DESIGN Quality improvement project. SETTING/LOCAL PROBLEM Underutilizing an HMF and OUD standardized care pathway in an academic medical center led to declining HMF rates at discharge. PARTICIPANTS Staff nurses in the women and infants department (N = 311). INTERVENTION/MEASUREMENTS Nurses completed an asynchronous online educational module regarding awareness and use of the HMF and OUD standardized care pathway for supporting HMF in OENs. Monthly infographics were placed in each nursing unit to reinforce content. Nurses completed pre- and posteducation surveys to evaluate their knowledge and use of the pathway. After the education, rates of OENs receiving human milk at discharge were collected from the electronic health record. RESULTS A total of 240 (77.2%) nurses participated in the educational module; awareness of the pathway increased from 91.5% to 97.3%. HMF rate at discharge significantly increased from 29.8% to 59.4% (p = .03). CONCLUSION Improved awareness among nurses of a standardized HMF and OUD care pathway was associated with a doubling of HMF rates at discharge in OENs.
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Gavine A, Farre A, Lynn F, Shinwell S, Buchanan P, Marshall J, Cumming S, Wallace L, Wade A, Ahern E, Hay L, Cranwell M, McFadden A. Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-206. [PMID: 39054917 DOI: 10.3310/dgtp5702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding. Objectives To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS. Design Evidence syntheses with stakeholder engagement. Review methods Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops. Results We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence. Limitations There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics. Conclusions 'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK. Future work Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies. Study registration This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Shona Shinwell
- School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Joyce Marshall
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, UK
| | - Sara Cumming
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Louise Wallace
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Angie Wade
- Population, Policy and Practice, Great Ormond Street Institute of Child Health, London, UK
| | - Elayne Ahern
- Department of Psychology, University of Limerick, Castletroy, Ireland
| | - Laura Hay
- School of Health Sciences, University of Dundee, Dundee, UK
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3
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Short VL, Abatemarco DJ, Gannon M. Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder. Am J Perinatol 2024; 41:82-88. [PMID: 34839473 PMCID: PMC9142755 DOI: 10.1055/s-0041-1740145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD). STUDY DESIGN Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data. RESULTS Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding. CONCLUSION Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding. KEY POINTS · Breastfeeding has unique benefits for mother-infant dyads affected by maternal OUD.. · Breastfeeding decisions are influenced by maternal psychosocial factors (e.g., knowledge and attitudes), however, such factors have not been previously assessed in women in treatment for OUD.. · Results indicate that attitudes around breastfeeding are positive but knowledge gaps exist..
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Affiliation(s)
- Vanessa L Short
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Diane J Abatemarco
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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5
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Standish KR, Morrison TM, Wanar A, Crowell L, Safon CB, Colson E, Drainoni ML, Colvin BN, Friedman H, Schiff DM, Stulac S, Costello E, Parker M. Breastfeeding Decision-Making Among Mothers with Opioid Use Disorder: A Qualitative Study. Breastfeed Med 2023; 18:347-355. [PMID: 37115582 DOI: 10.1089/bfm.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Background: Factors that contribute to low initiation and continuation of breastfeeding among mothers with opioid use disorder (OUD) are poorly understood. Objective: To understand barriers and facilitators to breastfeeding initiation and continuation beyond the birth hospitalization for mothers with OUD. Materials and Methods: We conducted 23 in-depth, semistructured interviews with mothers with OUD who cared for their infants at home 1-7 months after birth. Our interview guide was informed by the Theory of Planned Behavior (TPB) framework, which has been used to understand decision-making regarding breastfeeding. An iterative approach was used to develop codes and themes. Results: Among 23 participants, 16 initiated breastfeeding, 10 continued after hospital discharge, and 4 continued beyond 8 weeks. We identified factors influencing breastfeeding decisions in the four TPB domains. Regarding attitudes, feeding intentions were based on beliefs of the healthiness of breastfeeding particularly pertaining to infant withdrawal or exposure to mothers' medications. Regarding social norms, breastfeeding was widely recommended, but mothers had varying levels of trust in medical professional advice. Regarding perceived control, infant withdrawal and maternal pain caused breastfeeding to be difficult, with decisions to continue modulated by level of outside support. Regarding self-efficacy, mothers weighed their own recovery and well-being against the constant demands of breastfeeding, impacting decisions to continue. Conclusion: Mothers with OUD face unique barriers to breastfeeding related to their infants' withdrawal as well as their own health, recovery, and social context. Overcoming these barriers may serve as future intervention targets for breastfeeding promotion among this high-risk population.
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Affiliation(s)
- Katherine R Standish
- Department of Family Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tierney M Morrison
- Department of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amita Wanar
- Department of Obstetrics and Gynecology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisa Crowell
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Bryanne N Colvin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Sara Stulac
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Eileen Costello
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Margaret Parker
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Renbarger KM, Phelps B, Broadstreet A, Abebe S. Factors Associated with Maternal Engagement in Infant Care When Mothers Use Substances. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:48-64. [PMID: 36874237 PMCID: PMC9983138 DOI: 10.1089/whr.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
Introduction Mothers who use substances can play a key role in the treatment and care of their infants. However, challenges exist to engaging these mothers in the care of their infant. The purpose of this study was to identify factors associated with maternal engagement in infant care when mothers are experiencing substance use disorders. Materials and Methods A systematic search was conducted using the databases of CINAHL, APA PsycINFO, and PubMed along with a manual search of Google Scholar between the years of 2012 and 2022. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of mothers who use substances or nurses; (5) included descriptions of interactions between mothers who use substances and their infants during postpartum care, and/or in the nursery or neonatal intensive care unit; and (6) conducted in the United States. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Results Findings from 22 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes that identified factors to maternal engagement. The seven descriptive subthemes included: (1) Attitudes Toward Mothers Who Use Substances; (2) Knowledge on Addiction; (3) Complicated Backgrounds; (4) Emotional Experiences; (5) Managing Infant Symptoms; (6) Model of Postpartum Care; and (7) Hospital Routines. Discussion Participants described stigma from nurses, complex backgrounds of mothers who use substances, and postpartum models that influenced mothers' engagement in infants' care. The findings suggest several clinical implications for nurses. Nurses should manage their biases and approach mothers who use substances in a respectful manner, increase their knowledge of issues and care related to addiction in the perinatal period, and promote family-centered approaches to care. Conclusion The findings of 22 qualitative studies described factors associated with maternal engagement in mothers who use substances that were integrated using a thematic synthesis method. Mothers who use substances have complex backgrounds and experience stigma which can negatively impact their engagement with their infants.
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Affiliation(s)
| | - Barbara Phelps
- School of Nursing, Ball State University, Muncie, Indiana, USA
| | | | - Sheila Abebe
- School of Nursing, Ball State University, Muncie, Indiana, USA
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7
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Burduli E, Winquist A, Smith CL, Brooks O, Chiou M, Balsiger D, Shogan M, McPherson SM, Barbosa-Leiker C, Jones HE. Supporting perinatal individuals with opioid use disorder and their newborns experiencing neonatal abstinence syndrome: impressions from patients and healthcare providers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:596-605. [PMID: 36166744 PMCID: PMC9645816 DOI: 10.1080/00952990.2022.2122483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Facilitating maternal-newborn involvement and care is critical for improving outcomes for perinatal individuals receiving opioid agonist therapy (OAT) and newborns experiencing Neonatal Abstinence Syndrome (NAS). Comprehensive education strategies are needed to prepare pregnant individuals receiving OAT for navigating the perinatal period.Objectives: Identify facilitators to successful care of perinatal individuals receiving OAT and newborns experiencing NAS via interviews with perinatal individuals and healthcare providers. The goal of identifying this information is to inform a future educational tool development.Methods: Ten perinatal individuals receiving OAT and ten healthcare providers participated in interviews conducted via phone or video conference using semi-structured, open-ended questions. Data were analyzed separately for the two groups and later merged across samples using a qualitative descriptive content analysis approach to identify themes.Results: Under the overarching theme of empowerment to improve outcomes for perinatal women, four themes arose from perinatal and provider interviews: 1) Preparation for Child Protective Services (CPS) involvement, 2) Healthcare providers shape experience through stigma and support 3) Caring for newborns with NAS, and 4) Managing health and resources during postpartum.Conclusion: Perinatal participants emphasized the importance of self-advocacy while navigating healthcare and social systems. Providers highlighted the importance of communicating expectations to empower patients. Education is needed for pregnant individuals receiving OAT on what to expect during pregnancy and postpartum, as well as for providers to help them optimally support their perinatal patients receiving OAT.
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Affiliation(s)
- Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA,Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Anna Winquist
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Michelle Chiou
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Danica Balsiger
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Maureen Shogan
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Sterling M. McPherson
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, UNC Horizons, University of North Carolina, Chapel Hill, NC, USA
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Abstract
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.
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Affiliation(s)
- Joan Younger Meek
- Department of Clinical Sciences, Florida State University College of Medicine, Orlando, Florida
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Mount Sinai, New York.,New York City Health+Hospitals Elmhurst
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Lembeck AL, Tuttle D, Locke R, Lawler L, Jimenez P, Mackley A, Paul DA. Breastfeeding and Formula Selection in Neonatal Abstinence Syndrome. Am J Perinatol 2021; 38:1488-1493. [PMID: 32604445 DOI: 10.1055/s-0040-1713754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to determine if formula selection, low lactose versus standard term formula, has an effect on outcomes with a comparison to breastfed infants. STUDY DESIGN Retrospective cohort study of neonates ≥35 weeks gestation born with Neonatal Abstinence Syndrome (NAS) was conducted from July 2014 to November 2016. Primary outcomes included length of pharmacologic treatment (LOT), and length of stay (LOS), and weight change per day comparing term standard and low lactose formula majority feeding infants with secondary outcomes comparing breast fed majority feeding infants. RESULTS After investigating feeding methods for 249 NAS infants, a direct comparison of formula groups showed no differences in LOS (3, 95% confidence interval [CI]: -1.1 to 7 days), LOT (3.9, 95% CI: -0.4 to 8.1 days), or weight change per day (-2.4, 95% CI: -11.7 to 6.9 g/day). Breastfeeding improved LOT by 6.9 (95% CI: 3.4-10.5) and 10.8 days (95% CI: 5.9-15.6) and LOS by 7.4 (95% CI: 4.1-10.7) and 10.3 (95% CI: 5.8-14.9) days all reaching significance, in comparison to term and low lactose formula groups, respectively. Weight change per day was greater in the breast versus formula feeding groups when compared individually. CONCLUSION We detected no benefit to low lactose formula in NAS infants. Breastfeeding is associated with clinical reduction in LOS and LOT but is associated with increased weight loss. KEY POINTS · Best formula choice for a neonatal abstinence syndrome (NAS) infant is unknown.. · Many NAS moms cannot breastfeed.. · Low lactose formula has no impact on NAS outcomes..
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Affiliation(s)
- Amy L Lembeck
- Division of Neonatology, Department of Pediatrics, Einstein Medical Center Montgomery, CHOP Newborn Care Network, East Norriton, Pennsylvania
| | - Deborah Tuttle
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware.,Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Locke
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware.,Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura Lawler
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware
| | - Pamela Jimenez
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware
| | - Amy Mackley
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware
| | - David A Paul
- Department of Pediatrics, Christiana Care Health System, Newark, Delaware.,Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania
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10
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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Obstet Gynecol Neonatal Nurs 2021; 51:29-40. [PMID: 34655544 DOI: 10.1016/j.jogn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.
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11
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Pandey R, Kanike N, Ibrahim M, Swarup N, Super DM, Groh-Wargo S, Kumar D. Lactose-free infant formula does not change outcomes of neonatal abstinence syndrome (NAS): a randomized clinical trial. J Perinatol 2021; 41:598-605. [PMID: 32868858 DOI: 10.1038/s41372-020-00797-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine if lactose-free formula, compared to lactose-containing formula, decreases the cumulative morphine dose required to treat neonatal abstinence syndrome (NAS). STUDY DESIGN In a double-blind clinical trial, we randomized 74 infants (36-42 weeks gestation) at risk for developing NAS due to in-utero exposure to opioids to receive either lactose-free (Similac Sensitive®) or lactose-containing (Similac Advance®) infant formula. The primary outcome measure was the cumulative dose of morphine used for the treatment of NAS during the first 14 days of life. RESULTS Data on 69 (4 withdrew consent and 1 ineligible)/74 randomized infants were analyzed. Patient characteristics between the infant groups fed lactose-free (n = 34) vs. lactose-containing (n = 35) infant formula were similar except more common maternal heroin abuse in the latter group (p = 0.013). Cumulative morphine dose (20.7 ± 19.8 vs. 23 ± 23.5 mg, p = 0.61) between the two groups were similar. CONCLUSION Lactose-free vs. lactose-containing infant formula did not change the outcomes of infants with NAS.
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Affiliation(s)
- Rajesh Pandey
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Neelakanta Kanike
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Pediatrics, Deaconess Women's Hospital, Newburgh, IN, USA
| | - Mugahid Ibrahim
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Pediatrics, Cork University Maternity Hospital (CUMH), Cork, Ireland
| | - Namita Swarup
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Dennis M Super
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Deepak Kumar
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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12
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Abstract
The opioid crisis has grown to affect pregnant women and infants across the United States, as evidenced by rising rates of opioid use disorder among pregnant women and neonatal opioid withdrawal syndrome among infants. Across the country, pregnant women lack access to evidence-based therapies, including medications for opioid use disorder, and infants with opioid exposure frequently receive variable care. In addition, public systems, such as child welfare and early intervention, are increasingly stretched by increasing numbers of children affected by the crisis. Systematic, enduring, coordinated, and holistic approaches are needed to improve care for the mother-infant dyad. In this statement, we provide an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.
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Affiliation(s)
- Stephen W Patrick
- Division of Neonatology, Department of Pediatrics and Health Policy, School of Medicine, Vanderbilt University and Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Wanda D Barfield
- Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Brenda B Poindexter
- Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Medical Hospital Center, Cincinnati, Ohio
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13
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Recto P, McGlothen-Bell K, McGrath J, Brownell E, Cleveland LM. The Role of Stigma in the Nursing Care of Families Impacted by Neonatal Abstinence Syndrome. Adv Neonatal Care 2020; 20:354-363. [PMID: 32868585 PMCID: PMC7467149 DOI: 10.1097/anc.0000000000000778] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current US opioid crisis has resulted in a significant increase in opioid use disorder among pregnant and parenting women. Substance use disorders, in general, are highly stigmatized conditions. Stigma serves as a well-documented global barrier to health-seeking behaviors and engagement in healthcare. While extensive research exists on the stigma of mental illness, few studies have explored the stigma experienced by families impacted by neonatal abstinence syndrome (NAS). PURPOSE Therefore, the purpose of this article is to explore the role of stigma in the care of families impacted by NAS. METHODS In this article, we present a discussion about the effects of stigma on this patient population and provide exemplars of stigma experiences from our previous research and the existing literature. FINDINGS/RESULTS Mothers of infants with NAS faced the challenges of overcoming stigma as they were often ostracized, excluded, and shamed. Nurses who provide care for these women and their infants have reported experiencing ethical distress, moral distress, and compassion fatigue. IMPLICATIONS FOR PRACTICE Greater awareness of the impact of opioid use on the maternal-child population has resulted in numerous educational offerings for healthcare providers; however, this alone is not adequate to end stigma. Fortunately, promising tools and methods have been developed for assisting nurses with addressing stigma in a manner that can be both nonconfrontational and highly effective. IMPLICATIONS FOR RESEARCH Future research is needed to explore and evaluate the efficacy of various existing strategies for counteracting harmful stigma in this patient population.
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Affiliation(s)
- Pamela Recto
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Kelly McGlothen-Bell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Jacqueline McGrath
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Elizabeth Brownell
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
| | - Lisa M. Cleveland
- School of Nursing (Drs Recto, McGlothen-Bell, McGrath, Brownell, and Cleveland) and Center for Research to Advance Community Health (Dr Recto), The University of Texas Health Science Center at San Antonio
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14
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Yonke N, Jimenez EY, Leeman L, Leyva Y, Ortega A, Bakhireva LN. Breastfeeding Motivators and Barriers in Women Receiving Medications for Opioid Use Disorder. Breastfeed Med 2020; 15:17-23. [PMID: 31692370 DOI: 10.1089/bfm.2019.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Women with opioid use disorder (OUD) are encouraged to breastfeed, but have lower breastfeeding rates than the general population. Objective: We examined self-reported barriers and motivators for breastfeeding in women with OUD and the relationship between maternal/postnatal factors and breastfeeding noninitiation/discontinuation. Materials and Methods: A cross-sectional design was used; 40 women with OUD who were eligible to breastfeed were included. Information about breastfeeding initiation, duration, barriers/motivators, demographic characteristics, and self-efficacy was obtained through semi-structured interviews at 4-8 weeks postpartum. Wilcoxon rank sum or Fisher's exact test was used to examine the relationship between maternal/postnatal factors and never-initiated/discontinued breastfeeding. Results: Respondents were 29.3 ± 5.3 years old; most were prescribed buprenorphine (77.5%); and 36.8% of infants were treated for neonatal opioid withdrawal syndrome with methadone or morphine. Most (75.0%) participants initiated breastfeeding; 50.0% continued breastfeeding at 4-8 weeks. The most common motivators included infant health (100%) and bonding (45.0%). On average, women reported discontinuing breastfeeding at 3.3 ± 1.1 weeks postpartum. The most common barriers were concerns regarding transfer of medications or other substances to the infant (50.0%) and concerns about breast milk supply (35.0%). Mean self-efficacy scores were similar among those who continued versus never-initiated/discontinued breastfeeding (33.5 versus 33.0; p = 0.388). Neonatal intensive care unit admission was associated with never-initiated/discontinued breastfeeding (p = 0.047). Conclusion: Women with OUD share many similar motivators and barriers to breastfeeding with the general population. Unique concerns include infant exposure to medications or substances, even in those who are eligible to breastfeed, which should be addressed by targeted education for patients and providers.
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Affiliation(s)
- Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Elizabeth Yakes Jimenez
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Alyssa Ortega
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ludmila N Bakhireva
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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15
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Clark RRS. Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice. J Midwifery Womens Health 2019; 64:545-558. [PMID: 31294522 DOI: 10.1111/jmwh.12982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations. METHODS CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy. RESULTS Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. DISCUSSION Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.
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Affiliation(s)
- Rebecca R S Clark
- Department of Community and Public Health, Johns Hopkins University, Baltimore, Maryland
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16
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Short VL, Cambareri K, Gannon M, Alexander K, Abatemarco DJ. A Pilot Study to Assess Breastfeeding Knowledge, Attitudes, and Perceptions of Individuals Who Work in Perinatal Opioid Use Disorder Treatment Settings. Breastfeed Med 2019; 14:307-312. [PMID: 30888210 DOI: 10.1089/bfm.2018.0257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Although current evidence suggests that there are unique benefits of breastfeeding for mothers receiving comprehensive treatment, including counseling and pharmacotherapy, for opioid use disorder (OUD) and their infants, breastfeeding rates in this population are low. Support and counseling about breastfeeding are key predictors of infant feeding behaviors. Thus, identifying knowledge and attitudes regarding breastfeeding of individuals who work in OUD treatment facilities could offer insight into targets for breastfeeding-promotion interventions in such settings. Materials and Methods: Individuals who work at two urban perinatal OUD treatment centers were e-mailed a link to complete a questionnaire electronically. Breastfeeding knowledge, attitudes, and perceptions of those who completed the questionnaire were described using descriptive statistics. Results: Among the 24 survey respondents, most correctly identified the health benefits of breastfeeding for infants with neonatal abstinence syndrome, whereas less than half correctly identified the health benefits of breastfeeding for all infants. Only 16% reported receiving work-related breastfeeding education. The leading perceived breastfeeding challenges for women in treatment for OUD were (1) concern with transfer of medication (e.g., methadone) through breast milk, (2) daily commutes for treatment, and (3) beliefs that formula is better than breastfeeding. Conclusions: Professionals who work in perinatal OUD treatment centers could benefit from education regarding breastfeeding in mothers in treatment for OUD.
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Affiliation(s)
- Vanessa L Short
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Cambareri
- 2 School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Meghan Gannon
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Alexander
- 3 College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Diane J Abatemarco
- 1 Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
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17
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Abstract
The health impact of opioid use disorder on women and infant health alongside persistent rates of unintended pregnancy calls for better targeted reproductive healthcare for all women, especially those receiving treatment for opioid treatment disorder and decreasing barriers to care. This cross-sectional mixed-methods study explored the reproductive intentions and contraceptive practices of women (N = 50) in medication-assisted treatment of opioid use disorder with a focus on knowledge and use of long-acting reversible contraception (LARC), specifically intrauterine devices and implants. Eighty-four percent of the 50 women interviewed had experienced at least 1 unintended pregnancy, and 30% were using contraceptive methods with high failure rates. Although approximately 75% of women indicated awareness of both forms of LARCs, only 6% reported current or past use of either device. Qualitative results found the greatest barriers to the uptake of LARC were women's expressed fears of complications and inaccurate information from family, friends, and acquaintances. Increasing awareness of the benefits of LARC as ideal contraception for women who may desire a future pregnancy is important for improving reproductive health for women receiving treatment of opioid use disorder.
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18
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Howard MB, Wachman E, Levesque EM, Schiff DM, Kistin CJ, Parker MG. The Joys and Frustrations of Breastfeeding and Rooming-In Among Mothers With Opioid Use Disorder: A Qualitative Study. Hosp Pediatr 2018; 8:761-768. [PMID: 30401783 DOI: 10.1542/hpeds.2018-0116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate perspectives of mothers with opioid use disorder regarding breastfeeding and rooming-in during the birth hospitalization and identify facilitators and barriers. METHODS We conducted in-depth qualitative interviews with 25 mothers with opioid use disorder 1-12 weeks after delivery. Grounded theory analysis was used until thematic saturation was reached. Findings were triangulated, with experts in the field and a subset of informants themselves, to ensure data reliability. RESULTS Among 25 infant-mother dyads, 36% of infants required pharmacologic treatment, 72% of mothers initiated breastfeeding, and 40% continued until discharge. We identified the following themes: (1) information drives maternal feeding choice; (2) the hospital environment is both a source of support and tension for mothers exerting autonomy in the care of their infants; (3) opioid withdrawal symptoms negatively impact breastfeeding; (4) internal and external stigma negatively impact mothers' self-efficacy; (5) mothers' histories of abuse and trauma affect their feeding choice and bonding; (6) mothers' recovery makes caring for their infants emotionally and logistically challenging; and (7) having an infant is a source of resilience and provides a sense of purpose for mothers on their path of recovery. CONCLUSIONS Future interventions aimed at increasing breastfeeding and rooming-in during the birth hospitalization should focus on education regarding the benefits of breastfeeding and rooming-in, supporting mothers' autonomy in caring for their infants, minimizing stigma, and maximizing resilience.
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Affiliation(s)
- Mary Beth Howard
- Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston, Massachusetts; .,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - Elisha Wachman
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - Emily M Levesque
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - Davida M Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts
| | - Caroline J Kistin
- Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
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19
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McGlothen KS, Cleveland LM. The Right to Mother's Milk: A Call for Social Justice That Encourages Breastfeeding for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder. J Hum Lact 2018; 34:799-803. [PMID: 30040908 DOI: 10.1177/0890334418789401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kelly S McGlothen
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lisa M Cleveland
- 1 School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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