Four-month breastfeeding duration in postcesarean women of different cultures in the Israeli Negev

Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review

Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.

Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature

BACKGROUND

The rate of exclusive breastfeeding remains low in many countries. Furthermore, cesarean delivery (CD) is increasing and may affect breastfeeding success.

OBJECTIVE

The objective was to conduct a systematic review and meta-analysis of observational studies to determine whether CD (prelabor or in-labor) is associated with a lower rate of breastfeeding compared with vaginal delivery (VD).

DESIGN

Studies published before January 2011 that reported breastfeeding up to 6 mo postpartum and compared outcomes after CD or VD, including foreign language publications, were identified through PubMed and bibliographic review. Prespecified data were extracted independently by multiple observers. The types of CD [prelabor (elective/scheduled) or in-labor (emergency)] were compared by subgroup analyses. Potential sources of study-level bias were analyzed by using meta-regression and sensitivity analyses.

RESULTS

The systematic review included 53 studies (554,568 subjects, 33 countries); 25 authors contributed additional data (245,455 subjects), and 48 studies (553,306 subjects, 31 countries) were included in the meta-analysis. Rates of early breastfeeding (any initiation or at hospital discharge) were lower after CD compared with after VD (pooled OR: 0.57; 95% CI: 0.50, 0.64; P < 0.00001) and lower after prelabor but not after in-labor CD (prelabor OR: 0.83; 95% CI: 0.80, 0.86; P < 0.00001; in-labor OR: 1.00; 95% CI: 0.97, 1.04; P = 0.86). In mothers who initiated breastfeeding, CD had no significant effect on any breastfeeding at 6 mo (OR: 0.95; 95% CI: 0.89, 1.01; P = 0.08).

CONCLUSIONS

There was a negative association between prelabor CD and early breastfeeding. If breastfeeding is initiated, mode of delivery has no apparent effect on the number of mothers still breastfeeding at 6 mo. Women and health care workers should be aware of the negative associations between CD and early breastfeeding and consequent implications for infants' well-being.

Evaluating effects of a prenatal breastfeeding education programme on women with caesarean delivery in Taiwan

AIMS

The aims of this study were: (1) to evaluate the effectiveness of a prenatal breastfeeding education programme for primigravida women who have elected caesarean section as a model of delivery and (2) to evaluate its effectiveness for encouraging a positive attitude to breastfeeding and rooming-in and to increase exclusive breastfeeding rates within hospital and at one month postpartum.

BACKGROUND

Prenatal preparation for pregnant women about breastfeeding enhances their practical knowledge and skills about breastfeeding techniques, which prepares them when encountering possible difficulties.

DESIGN

A quasi-experimental design was used.

METHODS

The targeted population was primigravidas at 36-39 weeks and who had chosen to deliver by caesarean section. The study consisted of approximately 100 individuals; the control group consisted of 46 subjects and the following 54 made up the experimental group. The study was conducted at a hospital in Taiwan.

RESULTS

The results of the study show that the subjects of the experimental group exhibited a more positive breastfeeding attitude (88.9 vs. 79.8, t = 7.40, p < 0.001), a higher 24 hours rooming-in rate (87% vs. 63%, chi(2) = 16.06, p < 0.001) and a higher exclusive breastfeeding rate (79.6% vs. 52.2%, chi(2) = 8.38, p = 0.004) during hospital stays and a higher exclusive breastfeeding rate (75.9% vs. 34.7%, chi(2) = 16.98, p < 0.001) for the one month postpartum period.

CONCLUSION

Results suggest that providing education booklets, videos and telephone interview on breastfeeding prior to a caesarean delivery may contribute to breastfeeding attitude and improved rooming-in and exclusive breastfeeding rates.

RELEVANCE TO CLINICAL PRACTICE

This breastfeeding education programme has proven to be successful in aiding women breastfeeding after a caesarean delivery and provides health care professionals with an evidence-based intervention.

A systematic review of professional support interventions for breastfeeding

OBJECTIVES

The objectives of this systematic review were first, to describe how breastfeeding is professionally supported during pregnancy, at maternity hospitals and during the postnatal period. Secondly, to find out how effective interventions are in supporting breastfeeding.

BACKGROUND

Breastfeeding is an effective way to promote the health of infants. In many countries, the rates for breastfeeding remain lower than recommended. Many studies have examined breastfeeding promotion interventions; some of them are successful and some fail. It is important to find effective combinations of support.

DESIGN

Systematic review.

METHODS

Search of CINAHL, Medline and Cochrane Central Register databases were conducted for data collection. The search was limited to articles published in Finnish, Swedish and English between the year 2000 and March 2006, focusing on breastfeeding and breastfeeding support interventions. Two reviewers independently analysed 36 articles in the final analysis.

RESULTS

Interventions expanding from pregnancy to the intrapartum period and throughout the postnatal period were more effective than interventions concentrating on a shorter period. In addition, intervention packages using various methods of education and support from well-trained professionals are more effective than interventions concentrating on a single method.

CONCLUSIONS

During pregnancy, the effective interventions were interactive, involving mothers in conversation. The Baby Friendly Hospital Initiative (BFHI) as well as practical hands off -teaching, when combined with support and encouragement, were effective approaches. Postnatally effective were home visits, telephone support and breastfeeding centres combined with peer support. Relevance to clinical practice. Professionals need breastfeeding education and support of their organisations to act as breastfeeding supporters. The BFHI -programme is effective and it would be wise to include the core components of the programme in breastfeeding promotion interventions. Mothers benefit from breastfeeding encouragement and guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Cesarean delivery as a barrier for breastfeeding initiation: the Puerto Rican experience

The study's objective was to examine the relationship between cesarean section delivery and the initiation of breastfeeding in a representative sample of 1695 Puerto Rican women aged 15 to 49 years, who delivered their last healthy singleton child in Puerto Rico between 1990 and 1996. Secondary analysis of data collected in the population-based cross-sectional study Puerto Rico Reproductive Health Survey was performed. Bivariate and multivariate logistic regression analyses were used to examine the crude and covariate adjusted association between type of childbirth and initiation of breastfeeding. Overall, 36% of all births were performed by cesarean section, while initiation of breastfeeding was achieved by 61.5% of the women. Cesarean section was negatively related to breastfeeding initiation in multivariable logistic regression models (odds ratio=.64; 95% CI=0.51-0.81) after controlling for confounding variables. Intervention programs that aim to promote breastfeeding and that provide special assistance to women undergoing this procedure should be developed.

Jordanian women's experiences with the use of traditional family planning

The United Nations Population Fund (UNFPA) and the Hashemite Kingdom of Jordan Ministry of Health (MOH) have identified the importance of strengthening national capacity through the integration of reproductive health (RH) services into the primary health care system. It is reported that a high percentage of Jordanian women use traditional family planning (TFP) methods, frequently using them incorrectly. Our purpose in this qualitative descriptive study was to explore the issues and challenges related to the use of TFP among Jordanian women. Six focus groups with women of childbearing age (18-44 years of age; n = 51) were held in the northern, central, and southern regions of Jordan. Study participants used traditional methods such as withdrawal, periodic abstinence, and breastfeeding. Often TFP methods were used incorrectly, resulting in a high failure rate with unplanned pregnancies occurring within short inter pregnancy intervals. Women preferred using TFP because of side effects experienced while using modern family planning (MFP) methods, misconceptions, and lack of correct information about MFP methods. Husbands often declined to use condoms but supported the use of TFP methods. Women indicated that they have unmet needs for family planning and that they would consider using MFP methods if accurate information was available at health centers. They emphasized the importance of competent and knowledgeable health care providers (HCPs) who contribute to decision making regarding use of family planning.

Assessment of breastfeeding practices and reasons for success in a military community hospital

The authors' objectives were (1) to assess factors associated with breastfeeding rates in the early postpartum period and (2) to assess factors contributing to successful breastfeeding among an active-duty and military-dependent population. In September 2002, a baseline breastfeeding survey was administered to women presenting for infant or postpartum care in a military health care facility. A lactation service was then established, and between May and September 2004, a cross-sectional survey was subsequently conducted. Surveys assessed demographics, breastfeeding history and practices, and perceived reasons for success and discontinuation. A total of 934 surveys were collected. Ninety-two percent of women initiated breastfeeding. Eighty-five percent were breastfeeding at 1 week. The rate was 67.0% at 6 weeks and 61.7% at 6 months. Prior breastfeeding experience predicted continued breast-feeding at 6 weeks (OR 2.04); higher education level predicted breastfeeding at 6 months (OR 2.55). Breastfeeding rates increased after the establishment of a lactation service.

Policies and Practices for Maternal Support Options during Childbirth and Breastfeeding Initiation After Cesarean in Southeastern Hospitals

OBJECTIVE

To describe policies, practices, and associated rationales of hospital obstetric units regarding mothers' support person options during childbirth and to explore practices concerning support of breastfeeding initiation after cesarean delivery.

DESIGN

Descriptive telephone survey.

SETTING

Hospitals in the southeastern region of the United States.

PARTICIPANTS

Convenience sample of 154 obstetric nurse manager and nurse representatives employed by the participating hospitals.

MAIN OUTCOME MEASURES

Types of policies regarding mothers' support person options during childbirth and immediate postpartum stage, initiation of breastfeeding after cesarean birth, and attitudes about policies.

RESULTS

All hospitals allowed two or more support persons during vaginal births, 89% permitted only one support person during nonemergent cesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mother's request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room.

CONCLUSIONS

Overall, maternal support policies, practices, and nurse representatives' attitudes were mother and family friendly, particularly related to vaginal births. Though breastfeeding initiation after cesarean birth was encouraging, support person options during nonemergent cesarean births and related rationales warrant further examination.

Breast-feeding initiation among post-caesarean women of the Negev, Israel

The objectives of the study were to increase post-Caesarean breastfeeding rates and decrease timing of post-Caesarean breastfeeding initiation in multicultural populations following a post-Caesarean breastfeeding intervention. The study was a prospective population-based evaluation of a breastfeeding intervention for post-Caesarean women of different cultures at a southern Israeli hospital. The study population consisted of 570 Jewish and Muslim post-Caesarean women who had delivered healthy, term infants. The control group (n=264) received standard hospital care and the intervention group (n=306) received early, culturally sensitive, post-Caesarean breast-feeding guidance and education by trained professionals. Timing of post-Caesarean maternal-infant contact and breastfeeding initiation outcomes for the Jewish and Muslim women significantly improved following the intervention.

The effect of training nursery staff in breastfeeding guidance on the duration of breastfeeding in healthy term infants

BACKGROUND

Promoting breastfeeding is a central aim of child health care. It is critical to develop approaches that are inexpensive, effective, and suitable across cultural and socioeconomic groups.

OBJECTIVE

To study the effect of training perinatal-neonatal nursing and medical staff in breastfeeding guidance on the duration of breastfeeding in a middle-income urban population.

METHODS

This was an interventional study with data collection before and after. The intervention was an intensive course on breastfeeding guidance provided to all of the neonatal nurses and midwives in a local general hospital (2001-2002). Data were collected on two cohorts of mothers and infants (before -1999 [n = 471], after -2003 [n = 364]) regarding the duration of breastfeeding and factors influencing its discontinuation.

RESULTS

The rate of breastfeeding initiation rose from 84% to 93% (p = 0.0001) and the mean duration of breastfeeding rose from 3.7 +/- 3.7 to 5.6 +/- 4.3 months (p = 0.0001). The rate of breastfeeding in the delivery room rose from 3% to 37% (p = 0.0001). Satisfaction with breastfeeding guidance in the hospital rose from 43% to 79% (p = 0.0001). However, there was no change in the proportion of mothers who planned to breastfeed this infant (88% in both cohorts) and no significant differences in the reasons given by the mothers for stopping breastfeeding.

CONCLUSION

Training hospital nursery staff in breastfeeding guidance is a potential, cost-effective intervention even in settings with relatively high rates of breastfeeding.