Maternal-newborn nurses? experiences of inconsistent professional breastfeeding support

Mixed Messages in Women, Infants, and Children Lactation Support

Objective:

Breastfeeding provides health benefits, but women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are less likely to breastfeed than those not enrolled. This study aimed to investigate the forms of messaging that occur in WIC lactation support.

Methods:

Ethnographic methods were used over a 3-month period in 2021. Observations were collected at WIC lactation care counseling sessions and were complemented with interviews, observations of other interactions, and archival documents.

Results:

The findings of this study indicate women received mixed messages about breastfeeding, including the advice, personal experience, and policies discussed in lactation counseling.

Conclusions:

This study suggests women’s personal experiences may conflict with the messages they receive from lactation support. Recommendations for lactation support programs and training are discussed.

Experiences that influence how trained providers support women with breastfeeding: A systematic review of qualitative evidence

INTRODUCTION

There is a need to improve breastfeeding support interventions as although many are evidence-based, a sequential increase in breastfeeding rates is not evident. It is crucial to understand why the implementation of evidence-based guidelines in practice does not always translate to positive experiences for women and improve breastfeeding rates. This systematic review aims to synthesise breastfeeding support experiences of trained support providers and their impact on breastfeeding support practices.

METHODS

A strategy was developed to search seven databases including Medline and CINAHL and grey literature for qualitative studies. Studies eligible for inclusion reported professional and trained peer experiences of supporting women to breastfeed. PRISMA guidelines were followed and included studies were quality appraised using the CASP Qualitative Checklist. A thematic synthesis of included studies was undertaken and confidence in the review findings was assessed using the CERQual tool. The study protocol, registered in the International Prospective Register of Systematic Reviews PROSPERO registration number: CRD42020207380, has been peer reviewed and published.

FINDINGS

A total of 977 records were screened, which identified 18 studies (21 papers) eligible for inclusion comprising 368 participants. Following quality appraisal, all studies were deemed suitable for inclusion. The thematic synthesis resulted in four analytical themes: 1) A personal philosophy of breastfeeding support 2) Teamwork and tensions in practice 3) Negotiating organisational constraints and 4) Encounters with breastfeeding women. Findings demonstrated that a range of experiences influence practice, and practice evolves on continued exposure to such experiences. The potential of each experience to facilitate or inhibit breastfeeding support provision is fluid and context specific.

CONCLUSIONS

Experiences, as named above, are modifiable factors contributing to the development of a philosophy of breastfeeding support based on what the provider believes works and is valuable in practice. Further research is required into the range of factors which underpin context-specific breastfeeding support practice, to improve both women's experiences and intervention effectiveness.

Couples talk about breastfeeding: Interviews with parents about decision-making, challenges, and the role of fathers and professional support

Despite health benefits, sustained breastfeeding rates remain low in the United States, and the role of partners in breastfeeding is not well understood. Using a grounded theory approach, the current qualitative study explored how couples communicate regarding breastfeeding decisions and challenges. Mother-father dyads (n = 16) completed individual semi-structured interviews 1 year after the birth of their first child. Following iterative qualitative analysis, three phases of breastfeeding communication emerged: Should we try this? ( Mother's opinion counts) How do we make this work? (adjusting and problem-solving) and How do we settle into a routine? (gaining confidence, resolving issues) Findings underscore the complexity of defining the partner role in breastfeeding.

Breastfeeding History, Preschool Children's Sleep, and Obesity

Breastfeeding and sleep are both considered medically and physiologically protective factors for child health. Most existing research studied their impact on child health outcomes, respectively. Few studies examined the two factors collectively to explore any potential associations among a history of breastfeeding and quantity of sleep in children and child health. This study sought to uncover the association among breastfeeding history, the amount of sleep, and obesity in preschool-aged children to provide additional insights into their protective physical and psychological effects on health outcomes. As part of a larger study examining obesity in preschool children, the current investigation explored the association among obesity, a history of breastfeeding, and the total number of hours of preschool children's sleep, as reported by parents. Actual heights and weights were collected on a total of 1,693 children 3-5 years of age enrolled in licensed child care facilities in Mississippi. Descriptive analyses of the demographic and parent survey variables were conducted to explore the status related to breastfeeding in Mississippi. To understand the relationships between breastfeeding and covariates, bivariate analyses such as chi-square independent tests, Cochran-Mantel-Haenszel chi-square tests, and Fisher's exact tests were performed. Obesity was negatively correlated to breastfeeding, and Caucasian mothers were significantly more likely to breastfeed than African American mothers. Obesity was also negatively correlated to the amount of sleep, and African American children reportedly slept significantly less than Caucasian children. The average amount of time of sleep reported for children with a history of being breastfed was significantly higher than for those who were not breastfed, suggesting that breastfeeding could have a significant positive association with preschool children's sleep, serving as an additional protective factor obesity. The interaction between breastfeeding and subsequent sleep as children mature is an important area for future research to fully explore their foundational impact in family health practices that combat obesity in children and promote other subsequent health outcomes.

Microglia, Lifestyle Stress, and Neurodegeneration

Recent years have witnessed a revolution in our understanding of microglia biology, including their major role in the etiology and pathogenesis of neurodegenerative diseases. Technological advances have enabled the identification of microglial signatures in health and disease, including the development of new models to investigate and manipulate human microglia in vivo in the context of disease. In parallel, genetic association studies have identified several gene risk factors associated with Alzheimer's disease that are specifically or highly expressed by microglia in the central nervous system (CNS). Here, we discuss evidence for the effect of stress, diet, sleep patterns, physical activity, and microbiota composition on microglia biology and consider how lifestyle might influence an individual's predisposition to neurodegenerative diseases. We discuss how different lifestyles and environmental factors might regulate microglia, potentially leading to increased susceptibility to neurodegenerative disease, and we highlight the need to investigate the contribution of modern environmental factors on microglia modulation in neurodegeneration.

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.

Comparing Weight-for-Length Status of Young Children in Two Infant Feeding Programs

Objectives A cross-sectional study comparing weight-for-length status of children 6-24 months old who participated in Nurse-Family Partnership (NFP) or Special Supplemental Program for Women, Infants, and Children (WIC). Methods Secondary analysis of NFP (n = 44,980) and WIC (n = 31,294) national datasets was conducted to evaluate infant and toddler growth trajectories. Weight-for-length status was calculated at 6, 12, 18, and 24 months based on World Health Organization criteria. Demographics and breastfeeding rates were also evaluated. Binary logistic regression was used to calculate odds ratios for high weight-for-length (≥97.7 percentile) at each time point. Results At 6 months, approximately 10 % of WIC and NFP children were classified as high weight-for-length. High weight-for-length rates increased for both groups similarly until 24 months. At 24 months, NFP children had significantly lower rates of excess weight (P = 0.03) than WIC children, 15.5 and 17.5 % respectively. At all time points, non-Hispanic white children had lower rates of high-weight for length than Hispanic and non-Hispanic black children. NFP infants were also found to have higher rates of ever being breastfed than WIC infants (P < 0.0001). Conclusions for Practice Infant and toddler populations served by NFP or WIC were found to be at increased risk for high weight-for-length. This study found NFP participation was associated with a small, but significant, protective impact on weight-for-length status at 24 months. Continued efforts need to be made in addressing weight-related racial/ethnic and socioeconomic disparities during early childhood.

Relationship between the Infant Feeding Preferences of Chinese Mothers' Immediate Social Network and Early Breastfeeding Cessation

BACKGROUND

The relationship between support from members of a mother's social network and breastfeeding continuation is receiving increased attention.

OBJECTIVES

The objectives of this study were to describe the infant feeding preferences of Chinese mothers' immediate social network and to examine the association between these preferences and early breastfeeding cessation.

METHODS

In total, 1172 mother-infant pairs were recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until breastfeeding stopped.

RESULTS

Over 40% of participants' partners preferred breastfeeding and half had no infant feeding preference. Only about 20% of participants' mothers or mothers-in-law preferred breastfeeding, and less than 10% reported that all of the 3 significant family members (partner, mother, and mother-in-law) preferred breastfeeding. The partner's preference for infant formula or mixed feeding (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.43-4.71) or having no preference (OR, 1.64; 95% CI, 1.16-2.30) was strongly associated with higher odds of stopping breastfeeding before 1 month. For every additional family member who preferred breastfeeding, the odds of stopping breastfeeding was reduced by almost 20% (OR, 0.81; 95% CI, 0.68-0.97). However, living with a parent-in-law (OR, 1.45; 95% CI, 1.02-2.07) was also a predictor of early breastfeeding cessation. Knowing someone who had breastfed for ≥ 1 month (OR, 0.64; 95% CI, 0.42-0.97) or having been breastfed as a child (OR, 0.67; 95% CI, 0.45-0.98) significantly lowered the odds of early breastfeeding cessation.

CONCLUSIONS

The infant feeding preferences of mothers' immediate social network are significantly associated with breastfeeding continuation. Prenatal breastfeeding education programs should involve significant family members to promote breastfeeding.

Health Professionals' Attitudes and Beliefs About Breastfeeding

The aim of this descriptive study was to investigate how health-care providers perceived their role in breastfeeding and maternal support. Data was collected via interviews of 53 health-care professionals that provided care to breastfeeding women. The emerging themes included (a) understanding the benefits of breastfeeding: often lacking current knowledge, (b) lacking consistency: gaps between knowledge of benefits and actual clinical practice, (c) not knowing how to help: lack of assessment and therapeutic skills, and (d) understanding the barriers to breastfeeding: how health-care providers can make a difference. Data analysis suggests inconsistencies between the health-care provider's perceived support and behaviors, lack of knowledge, and significant lack of skill in the assessment and management of breastfeeding couples.

Supporting breast-feeding women from the perspective of the midwife: A systematic review of the literature

INTRODUCTION

In 2003 the World Health Organization (WHO) recommended that infants should be fed exclusively with breast milk until the age of six months. However, breast feeding rates remain lower than recommended. The crucial period for breast feeding support is the first two weeks after birth. During this period breast feeding support from the midwife is needed. The aim of this paper is to gain an in-depth understanding of the role of midwives in their support of breast-feeding women, from their own perspective.

METHODS

Two researchers independently conducted a systematic and comprehensive literature search. Studies needed an empirical qualitative research design (1), had to focus on the role of the midwife in the support of the breast-feeding woman from the midwife's perspective (2), and had to be published between January 2005 and December 2014 (3) in order to be included. Language restrictions were English, Dutch, German and French. Eight qualitative research studies were included, using mainly focus group and in-depth interview studies, which were reported in 11 papers representing 231 midwives and 24 maternity nurses. All but one study concerned midwives working in hospital settings. A critical appraisal was performed of each study.

FINDINGS

Midwives value breast feeding education and breast feeding support as a significant part of their role as a postnatal midwife. However, the ways in which a midwife approaches and supports the breast-feeding woman vary. We distinguished two perspectives: 'the midwife as technical expert' and 'the midwife as a skilled companion'. The 'technical expert' midwife is mainly breast centred, focuses on techniques, uses the hands on approach and sees a woman as a novice. The 'skilled companion' midwife is woman centred, focuses on the mother - infant relationship and uses a hands off approach during the breast feeding support. The midwives working in a hospital setting face many barriers when performing breast feeding support, such as time restraints, which makes it difficult for them to carry out their preferred role as a 'skilled companion'. These barriers can influence the breast feeding support negatively. Supporting factors, such as evidence based breast feeding guidelines, have a positive influence on the breast feeding support.

CONCLUSION

On the basis of findings of a synthesis of qualitative research studies, we conclude that the majority of the midwives provide breast feeding support as a technical expert and a minority as a skilled companion. Midwives prefer to be a skilled companion but face many barriers in their working contexts.

Mothers’ Perspectives on Effective Assistance With Breastfeeding Problems

Purpose: This qualitative study investigated maternal views on effective support strategies in the face of breastfeeding difficulties.

Methods: In semistructured interviews, 15 women who had encountered breastfeeding problems reflected on their experiences.

Results: Participants reported that managing breastfeeding problems was complex and that the level of provider competence in addressing these difficulties was variable. Social media emerged as a highly prevalent source of support among women facing breastfeeding problems.

Discussion: Virtual and face-to-face support strategies are compared; implications for providers are reviewed.

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

CONTEXT

Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting.

OBJECTIVES

To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge.

DESIGN AND SETTING

Cross sectional analysis combining nurse survey data with infant discharge data.

PARTICIPANTS

A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997).

METHODS

Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support).

RESULTS

The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001).

CONCLUSIONS

Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.

The Association of Low Social Support with Breast Milk Expression in Low-Income Mother-Preterm Infant Dyads

BACKGROUND

Premature infants benefit from receiving expressed breast milk (BM), but expressing breast milk is difficult for new mothers. Little is known about mothers' social support and BM expression during the premature infant's hospital stay.

OBJECTIVE

We examined whether low maternal social support was associated with breast milk expression initiation and low breast milk expression among low-income mothers of premature infants.

METHODS

Maternal intake interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least 2 of 10 social-environmental risks. Multivariable modified Poisson regression was used to examine the relationship between social support (Personal Resources Questionnaire 2000; dichotomized as low for lowest quartile), initiation (any breast milk expressed vs none), and low breast milk expression (if BM was < 30% of infant total milk/formula intake during hospitalization).

RESULTS

Breast milk expression was initiated by 70.2% of mothers, and 32.3% of those mothers had low breast milk expression. In adjusted multivariable analyses, social support did not relate to the initiation of breast milk expression but was significantly associated with low breast milk expression among mothers who initiated (adjusted relative risk = 1.57; 95% confidence interval, 1.00-2.47).

CONCLUSION

Low social support was not associated with initiation but was associated with low breast milk expression during hospitalization. Interventions to enhance social support for mothers of premature infants, especially those reporting low social support from family and friends, may increase in-hospital expression and long-term breastfeeding.

Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care

OBJECTIVE

To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.

DATA SOURCES

Nurse survey and VLBW infant registry data.

STUDY DESIGN

Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk.

DATA COLLECTION

Primary nurse survey (N = 5,773, 77 percent response rate).

PRINCIPAL FINDINGS

VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities.

CONCLUSIONS

Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.

Characteristics of the NICU work environment associated with breastfeeding support

PURPOSE

The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support.

SUBJECTS AND DESIGN

This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative.

METHODS

Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds.

RESULTS

The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was associated with a 2% increase in infants provided breastfeeding support. A 1 SD higher score on the Staffing and Resource Adequacy PES-NWI subscale was associated with a 2% increase in infants provided breastfeeding support. There was no association between other NICU nursing characteristics or LCs and nurse-provided breastfeeding support.

CONCLUSIONS

Nurses provide breastfeeding support around the clock. On a typical shift, about 1 in 7 NICU infants receives breastfeeding support from a nurse. Lactation consultants are not routinely available in NICUs, and their presence does not influence whether nurses provide breastfeeding support. Better nurse staffing fosters nurse provision of breastfeeding support.

Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice

Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

Nursing students' views on promoting successful breastfeeding in Sweden

Promoting breastfeeding is important work for health-care personnel in the Swedish context. This promotion is multifaceted and demands the ongoing development of knowledge and competence among both health-care personnel and patients. The aim of the present study was to describe the nursing students' perspectives on breastfeeding in Sweden. Data were obtained in the form of written reflections from nursing students (n=65) and examined using manifest content analysis. The results show that the factors of importance in promoting successful breastfeeding are information about breastfeeding's benefits, traditions and cultural acceptance of the practice, and by government prohibition of infant formula. We conclude that knowledge about the benefits of breastfeeding needs to be prioritized continuously during education.

Maternal trait personality and breastfeeding duration: the importance of confidence and social support

Aim

To explore associations among breastfeeding duration, maternal personality and maternal attitudes and experiences of breastfeeding.

Background

Understanding influences on breastfeeding initiation and duration is critical to increasing breastfeeding rates and supporting new mothers. Maternal characteristics such as self‐efficacy, knowledge and confidence are known to enable women to breastfeed, but little is known about the influence of maternal trait personality on breastfeeding.

Design

An exploratory cross‐sectional survey.

Method

A total of 602 mothers with an infant aged 6–12 months old completed a self‐report questionnaire examining maternal trait personality, breastfeeding duration and attitudes and experiences of breastfeeding. Data were collected between March–June 2009.

Results

Mothers who reported high levels of extraversion, emotional stability and conscientiousness were significantly more likely to initiate and continue breastfeeding for a longer duration. Attitudes and experiences significantly associated with these personality traits such as perceived difficulties and lack of support may explain these patterns. For example, characteristics associated with introversion and anxiety may prevent women from seeking support or challenging negative attitudes of others at this critical time.

Conclusion

Understanding the influence of maternal personality may thus be a useful tool in antenatal support to recognize women who may need extra, directed support while facilitating discussion of potential barriers to breastfeeding.

Breastfeeding mothers' experiences: the ghost in the machine

We critically review qualitative research studies conducted from 2000 to 2012 exploring Western mothers' breastfeeding experiences. We used the search criteria "breastfeeding," "qualitative," and "experiences" to retrieve 74 qualitative research studies, which were reduced to 28 when the terms "existential'' and "research'' were applied. We found that the impact of technology and the pervasive worldwide marketing of infant formula devalued breastfeeding mothers' narratives in a number of ways. Women's bodies were viewed as machine-like objects and the breast was seen as a disembodied object. Dominated by technological narrative, women's bodies were considered unpredictable and hormonal, needing to be managed by health care professionals. This means the disseminating breastfeeding discourse needs to be reinterpreted for practical use. We found that some of the researchers utilized narrative informed by phenomenological philosophy that appears to edge closer to understanding mothers' experiences in a more profound way than nonphenomenological research. However, we need to be mindful of the transparency of terms in replacing one form of technological narrative with another.

Long-term breastfeeding support: failing mothers in need

This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child's first year. A convenience sample of 75 black and white WIC participants with infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers' comprehensive experiences of breastfeeding education and support from pregnancy through the interview date. Most mothers received education or support from a medical professional prenatally, at the hospital, or during the child's infancy, but most also reported receiving no education or support at one or more of these stages. Mothers often felt provided education and support was cursory and inadequate. Some mothers received misinformation or encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not given referrals to available resources, even after reporting breastfeeding challenges. Mothers received inconsistent messages regarding breastfeeding within and across institutions. Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals. Medical professionals should follow guidelines issued by their own organizations as well as those from the US Surgeon General, Healthy People 2020, and the Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should coordinate to provide consistent messages and practices within and across sites of care.

Strategies to support breastfeeding: a review

BACKGROUND

Mothers need to be given support, confidence and encouragement to successful breastfeeding. The importance of breastfeeding support has been addressed in numerous studies. However, reviews to explore strategies to support breastfeeding are sparse.

AIM

The study aims to explore strategies to support breastfeeding. It was also aimed to reveal how the international papers compare with the Turkish situation.

METHODS

Searches of CINAHL, PubMed, ScienceDirect, Scopus, Web of Science databases, Cochrane databases, Turkish health databases were conducted for data collection. The search was limited to articles published between the years 1995 and 2011, focusing on the strategies related to the support received by mothers. Two experts independently read and analysed 38 articles.

FINDINGS

Thirty-eight papers were included in this review. The findings identified strategies to support breastfeeding. These include collaboration with community and family members; confidence building; appropriate ratio of staffing levels; development of communication skills; and 'closing the gap' in inequalities in health.

CONCLUSION

Mothers benefit from strategies that encourage breastfeeding, with guidance that supports their self-efficacy and feelings of being capable and empowered, and is tailored to their individual needs.

Healthcare professionals' and mothers' perceptions of factors that influence decisions to breastfeed or formula feed infants: a comparative study

AIM

This article is a report of a study comparing healthcare professionals' and mothers' perceptions of factors that influence the decision to breastfeed or formula feed an infant.

BACKGROUND

The World Health Organisation recommends that mothers should breastfeed exclusively for the first 6 months of age and then continue to do so alongside complementary foods for the first 2 years and beyond. However, levels of breastfeeding in the United Kingdom are below the recommended targets. Low levels of actual or perceived professional support and understanding are associated with formula use.

METHODS

Twenty professionals working closely with mothers of young infants completed a semi-structured interview exploring the reasons they believed mothers chose to use formula milk. Twenty-three mothers with an infant aged 6-12 months also reflected on their experiences of milk feeding. The data were collected during 2007-2008.

RESULTS

Professionals described a range of influences on maternal decisions to breastfeed or formula feed including lack of knowledge, support and help with difficulties. These were strongly echoed in the reasons mothers gave for formula use, suggesting clear professional understanding of the challenges relating to breastfeeding. Although keen to give further support, professionals raised issues of lack of time and resources to support mothers.

CONCLUSION

Contrary to maternal beliefs of poor professional understanding, professionals had a clear perception of influences affecting early milk feeding choice. Further resources and recognition are needed for healthcare professionals working with new mothers to enable them to offer increased support, with the aim of increasing breastfeeding duration.

An evaluation of hospital breastfeeding policies in the Philadelphia metropolitan area 1994-2009: a comparison with the baby-friendly hospital initiative ten steps

OBJECTIVE

The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time.

METHODS

In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding.

RESULTS

Mean breastfeeding rates at suburban hospitals were significantly higher than urban hospitals (72% vs. 49%, p = 0.015). Most hospitals were classified as high or moderately high implementers on six of the Ten Steps, including staff training (67%), printed information distributed to breastfeeding mothers (94%), breastfeeding initiation (61%), oral breastfeeding instruction given to mothers (83%), infant feeding schedules (89%), and hospital postpartum support (83%). Most hospitals reported partial or low implementation on two maternity practices: infant formula supplementation (61%) and rooming-in (72%).

CONCLUSIONS

In the past 15 years, hospitals in the Philadelphia area have an increased awareness about breastfeeding and enhanced support of breastfeeding by healthcare professionals. In spite of an increase in overall breastfeeding rates, formula supplementation in hospitals and contact time between mothers and their newborns continue to be areas of concern.

The association between women's perceptions of professional support and problems experienced on breastfeeding cessation: a Western Australian study

A cross-sectional survey was used to determine the association among women's breastfeeding problems, their perceptions of support from midwives and child health nurses, and breastfeeding cessation in the first 10 weeks postbirth in a sample of Western Australian women (N = 2669). Primiparous women (75.8%) experienced significantly more problems that multiparous women (52.6%). Although 78.8% of all women agreed or strongly agreed that staff were helpful with feeding, 53.4% confirmed that different midwives offered different feeding advice; however, receiving different advice from midwives around feeding was not associated with breastfeeding cessation. Differences in breastfeeding cessation were associated with parity. Primiparous women's cessation was associated with experiencing any breastfeeding problems, unhelpful hospital midwives, and unhelpful information from child health nurses, whereas for multiparous women, this included 2 or more breastfeeding problems, not being able to choose when to feed, and unhelpful information from child health nurses.

Variables associated with breastfeeding duration

OBJECTIVE

To identify the variables associated with breastfeeding duration.

DATA SOURCES

The health science reference databases of CINAHL, PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION

Meta-analyses, Cochrane reviews, literature reviews, and quantitative and qualitative studies published in English from 1998 through 2008.

DATA EXTRACTION

Data included all variables, both positive and negative, that were found to influence the outcome of breastfeeding duration.

DATA SYNTHESIS

Demographic factors that influence breastfeeding duration are race, age, marital status, education, socioeconomics, and Special Supplemental Nutrition Program for Women, Infants, and Children status. Biological variables consisted of insufficient milk supply, infant health problems, maternal obesity, and the physical challenges of breastfeeding, maternal smoking, parity, and method of delivery. Social variables included paid work, family support, and professional support. Maternal intention, interest, and confidence in breastfeeding were psychological variables.

CONCLUSION

Human lactation is a complex phenomena and the duration of breastfeeding is influenced by many demographic, physical, social, and psychological variables.

Breastfeeding knowledge, attitudes, and practices among providers in a medical home

OBJECTIVE

Breastfeeding offers numerous health advantages to children, mothers, and society. From obstetrics to pediatrics, breastfeeding dyads come in contact with a wide range of healthcare providers. The American Academy of Pediatrics (AAP) calls for pediatricians to support breastfeeding enthusiastically and for all children to have a medical home. We studied an inner-city healthcare system with a Dyson Community Pediatrics Training Initiative Model Medical Home clinic, to explore how a breastfeeding/baby-friendly medical home might be built upon this framework. We describe breastfeeding knowledge, attitudes, and practices among a full range of providers and healthcare system-level barriers to effective and coordinated breastfeeding services.

METHODS

We conducted eight focus groups using semistructured interviews: (1) pediatricians; (2) obstetricians; (3) pediatric nurses and allied health professionals; (4) obstetric nurses and allied health professionals; (5) 24-hour telephone triage answering service nurses; (6) public health nurses; (7) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) personnel; and (8) lactation consultants and peer counselors.

RESULTS

We identified gaps in providers' breastfeeding knowledge, counseling skills, and professional education and training. Providers' cultures and attitudes affect breastfeeding promotion and support. Providers used their own breastfeeding experiences to replace evidence-based knowledge and AAP policy statement recommendations for breastfeeding dyads. There were communication disconnects between provider groups. Providers underestimated their own, and overestimated others', influence on breastfeeding. The system lacked a coordinated breastfeeding mission.

CONCLUSIONS

This study illuminated key disconnectedness challenges (and, hence, opportunities) for a model medical home in fostering continuous, comprehensive, coordinated, culturally effective, and evidence-based breastfeeding promotion and support.

The breast-feeding conversation: a philosophic exploration of support

Nurses play a vital role in mothers' early experiences with breast-feeding. Literature enumerates both supportive and nonsupportive behaviors, as well as the "interpersonal" aspect of breast-feeding support, although little direction is given to nurses about how to facilitate the relationship. This article conceptualizes breast-feeding support within Gadamerian hermeneutics as a conversation among nurses, mothers, and their newborns. Hermeneutically, breast-feeding conversation encompasses a text (a particular feeding at the breast), conversational partners (a mother, her newborn, and a nurse), and a dialogue that facilitates effective breast-feeding and maternal breast-feeding confidence through interpretation or understanding of the text. History and language are essential as a partnership is formed.