The influence of psychological factors on breastfeeding duration

[Is it possible to calculate Cronbach's alpha with only two items?]

Introduction

Early pregnancy dispositional optimism and pregnancy outcomes among nulliparous people

BACKGROUND

Dispositional optimism, the expectation of positive outcomes after personal challenges, is a resilience factor associated with widespread health benefits. However, the data on pregnancy-related outcomes are more limited.

OBJECTIVE

This study aimed to assess the association of early pregnancy dispositional optimism with adverse perinatal outcomes.

STUDY DESIGN

This was a prospective cohort study completed between May 2019 and February 2022 at a single, large tertiary medical center. Nulliparous pregnant people were recruited from outpatient obstetrical care sites. Participants completed a validated assessment of dispositional optimism at <20 weeks of gestation and were followed up until delivery. The primary outcome was an adverse maternal outcome composite that included gestational diabetes mellitus, hypertensive disorders of pregnancy, and/or cesarean delivery. The secondary outcomes included individual composite components and a neonatal morbidity composite. Bivariate analyses compared characteristics and primary and secondary outcomes by dispositional optimism score quartile. Multivariable logistic regression compared outcomes by dispositional optimism score quartile with the highest quartile serving as the referent, controlling for confounders determined a priori.

RESULTS

Overall, 491 pregnant people were approached for participation, and 135 pregnant people (27.5%) declined participation. Among the 284 individuals who enrolled and had complete outcome data, the median dispositional optimism score was 16.0 (interquartile range, 14-18), and 47.9% of individuals experienced at least 1 adverse maternal outcome 135 (47.9%). After adjusting for confounders, the odds of adverse maternal outcomes were significantly higher in the lowest 2 optimism quartiles: quartile 1 (adjusted odds ratio, 3.33; 95% confidence interval, 1.57-7.36) and quartile 2 (adjusted odds ratio, 2.22; 95% confidence interval, 1.05-4.79) than the highest quartile. This was driven by significantly higher rates of hypertension (quartile 1: adjusted odds ratio, 2.62; 95% confidence interval, 1.12-6.29) and cesarean delivery (quartile 1: adjusted odds ratio, 2.75; 95% confidence interval, 1.20-6.55). There was no difference noted when quartile 3 was compared with quartile 4.

CONCLUSION

Lower early pregnancy dispositional optimism was associated with significantly higher odds of adverse maternal outcomes. Interventions targeting improvements in optimism may be a novel mechanism for reducing perinatal morbidity.

The Impact of Excessive Weight on Breastfeeding Intention, Initiation, and Duration

Background: Breastfeeding is widely recognized as the optimal feeding method for infants. However, breastfeeding goals are often unmet, especially in mothers with excessive weight. Potential factors associated with unmet goals could be disparities in care for women with higher body mass index (BMI) or mental health symptomology. Methods: Women enrolled in a longitudinal study were stratified by BMI into three groups: mothers with normal weight (18.5-24.9 kg/m2, n = 101), with overweight (25-29.9 kg/m2, n = 78), and with obesity (OB; 30-35 kg/m2, n = 48). Breastfeeding intention and standardized mental health questionnaires were administered at gestational weeks 12 and 36. The prevalence of initiation and duration of breastfeeding were determined based on self-reported breastfeeding start and end dates. Wilcoxon tests, pairwise proportion test, Cox proportional hazards regression, and linear regression were used. Results: Higher maternal weight status (OB) was significantly associated with lower breastfeeding intention and duration. As expected, higher breastfeeding intention scores were associated with significantly longer breastfeeding duration. Higher scores on the Beck Depression Inventory (BDI), associated with a greater number of depression symptoms, mediated the negative impact of weight status on breastfeeding intention. Conclusions: breastfeeding outcomes are negatively associated with maternal weight status and prenatal mental health with the relationship between the two being interconnected, despite subclinical scores on the BDI. Further research is needed to explore the role of mental health on breastfeeding outcomes. From these findings, targeted prenatal interventions for women with excessive weight and depressive symptoms would likely promote and improve breastfeeding outcomes. ClinicalTrials.gov: www.clinicaltrials.gov, ID #NCT01131117.

Reliability and validity of the brief version of the difficulties in emotion regulation scale in a sample of Turkish adolescents

BACKGROUND

Difficulty in regulating emotions increases during adolescence and can be associated with psychopathology. It is thus crucial to develop tools to identify adolescents at risk of having emotional difficulties. This study aimed to investigate the reliability and validity of a brief questionnaire in a sample of Turkish adolescents.

METHODS

A total of 256 participants (mean age = 15.51 ± 0.85) were recruited. They completed the original form of the Difficulties in Emotion Regulation Scale (DERS-36), a brief version of DERS (DERS-16), the Barrett Impulsivity Scale (BIS-11), and the Toronto Alexithymia Scale (TAS). Psychometric properties of DERS-16 were investigated by confirmatory factor analysis, Cronbach's alpha, and Pearson correlational analysis.

RESULTS

A five-factor model and second-order bifactor model of DERS-16 were confirmed. Cronbach's alpha values for the subscales varied between 0.69 and 0.88, while the reliability of the factors Difficulties in Emotional Processing and Difficulties in Emotion Regulation were 0.75 and 0.90, respectively. DERS-16 subscales were positively correlated with the BIS-11 and TAS. In addition, there were only minimal differences between the DERS-16 and DERS-36.

CONCLUSION

The DERS-16 is a valid and reliable scale for Turkish adolescents. The fact that it has fewer items than DERS-36, but has similar reliability and validity and can be used as two factors, provides significant advantages in terms of applicability.

Stress, social support, and racial differences: Dominant drivers of exclusive breastfeeding

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001-0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

The relationship between postpartum depression and appropriate infant feeding practice in eastern zone of Tigray, Ethiopia: A comparative cross-sectional study

BACKGROUND

Understanding the relationship between postpartum depression and infant feeding practice may help to reduce the indirect impact of postpartum depression on infant feeding practice. This will further have a positive impact on reducing infant morbidity and mortality attributed to improper feeding practices. Although studies in the country have assessed the prevalence of infant feeding practices, those assessing the association between postpartum depression and infant feeding practices are lacking. Therefore, this study aimed to compare appropriate infant feeding practices and their associated factors among postpartum depressed and non-depressed mothers in Eastern Tigray.

METHODS

A comparative cross-sectional study was conducted from March 2019 to April 2019. A multistage random sampling technique was used to select 171 mothers with postpartum depression and 342 mothers without postpartum depression. Data were collected using a structured questionnaire from the Monitoring and Evaluating for Breastfeeding Practices toolkit, then entered into Epi- info and exported into SPSS for further analysis. A binary logistic regression was applied to determine the association between postpartum depression and appropriate infant feeding practice.

RESULTS

The overall prevalence of appropriate infant feeding practice was 37.6% (95% CI: 33.5%-41.9%). The prevalence was higher among mothers without postpartum depression 42.7% (95% CI: 42.9%-53.2%) than among postpartum depressed mothers 27.5% (95% CI: 24.7%-32.5%). The odds of appropriate infant feeding practice among mothers with infant birth orders of three or above was 58% (AOR = 0.42; 95% CI: 0.26-0.97) less than those mothers with infant birth orders of three and below. Households with monthly income 1000-1999 ETB (AOR = 2.26; 95% CI: 1.01-5.08), 2000-2999 ETB (AOR = 1.96; 95% CI: 1.21-4.73) and 3000-3999 ETB (AOR = 5.13; 95% CI: 1.97-13.4) were more likely to practice appropriate infant feeding.

CONCLUSION

The overall prevalence of appropriate infant feeding practices in the study area was low. A significantly higher proportion of mothers without postpartum depression practice appropriate infant feeding compared to mothers with postpartum depression. In addition, households with higher monthly incomes and mothers with infant birth orders three or above were significant determinants of appropriate infant feeding practice. Therefore, strengthening the provisions of nutritional education, integrating maternal mental health with routine maternal health care services, providing economic support to mothers with low income, and health education for multiparous women is a critical interventions to improve appropriate infant feeding practice.

Predictors of breastfeeding self-efficacy during the covid-19 pandemic

Background

Methods

Results

Conclusion

Exclusive breastfeeding and women's psychological well-being during the first wave of COVID-19 pandemic in Italy

Background

At the onset of the COVID-19 pandemic, support for breastfeeding was disrupted in many countries. Italy was severely impacted by the pandemic and is known to have the lowest exclusive breastfeeding rate of all European countries. Considering the inverse association between anxiety and breastfeeding, maternal concerns about the COVID-19 emergency could reduce breastfeeding rates. The aim of the study is to explore the association between infant feeding practices and maternal COVID-19 concerns.

Methods

This paper is a secondary analysis of the cross-sectional study COVID-ASSESS conducted in Italy in 2020. The original survey was administered in two phases: during the first lockdown and during the reopening. The survey included five sections: socio-demographic, medical history, concerns about the COVID-19 pandemic, infant feeding practices and psychometric evaluation. Participants were considered eligible for the post-hoc analyses if they were exclusively breastfeeding or they were feeding with infant formula (either alone or with breastfeeding) at the time of the interview.

Results

Between phase 1 and phase 2 there was a decrease in anxiety and concerns about the danger of COVID-19 to general health, except for concerns about their baby's health. Women using formula were more concerned about all the health topics investigated. Moreover, they showed higher levels of stress, state anxiety, somatization and PTSD symptoms.

Conclusion

Breastfeeding during the first pandemic lockdown in Italy seems to have been an independent factor associated with lower anxiety about COVID-19, fewer psychopathological symptoms, and a positive experience of infant feeding.

Promoting maternal self efficacy and paternal attitudes towards breastfeeding: a randomized controlled trial

BACKGROUND

Counseling is one of the ways to improve the quantity and quality of breastfeeding. The present study was conducted to investigate the effect of couple-centered counseling on fathers' attitudes and mothers' self-efficacy towards breastfeeding.

METHODS

This randomized controlled trial study was conducted on 60 primigravida pregnant women and their spouses who were randomly selected among the pregnant women referred to the two maternity hospitals of Malayer City, a city in the province Hamadan in western Iran. Data collection tools included the demographic characteristics questionnaire, Breastfeeding Self-Efficacy Questionnaire, and Iowa Infant Feeding Attitude Scale. The intervention was performed according to the principles of GATHER counseling (Greet, Ask, Tell, Help, Explain, and Return). Mothers' self-efficacy and fathers' attitudes toward breastfeeding were assessed before the intervention and 4 weeks after birth in both groups. Data were analyzed with SPSS version 23 software and using a significance level of p = 0.05.

RESULTS

The participants of the control and test groups were homogeneous in terms of demographic characteristics. The change in mothers' breastfeeding self-efficacy score after intervention in the test group had a statistically significant difference compared to the control group (30.43 ± 2.53; 95%CI: 25.41,35.44), and the change in the score of fathers' attitude towards breastfeeding had a statistically significant difference after the intervention in the test group compared to the control group (19.3 ± 2.05; 95%CI: -23.36, -15.23). In the test group, the change in fathers' attitude towards breastfeeding after the intervention was significant compared to before the intervention (30.36 ± 2.38; 95%CI: 25.43, 35.25).

CONCLUSIONS

Appropriate counseling programs can change fathers' attitudes toward breastfeeding and increase mothers' breastfeeding self-efficacy, so couples' presence in breastfeeding counseling is recommended.

Assessing the Psychometric Properties of the Chinese Version of Ten-Item Personality Inventory (TIPI) Among Medical College Students

Objective

The Ten-Item Personality Inventory (TIPI) was designed as a brief instrument of the Big Five personality traits. This study aimed to explore the internal consistency and structural validity of the Chinese version of TIPI (TIPI-C) in medical college students.

Methods

A cross-sectional study was conducted in 11 provinces of China. Spearman–Brown coefficient, standardized Cronbach’s α coefficient, and Cronbach’s α coefficient were applied to estimate the internal consistency. Spearman–Brown coefficient was applied to estimate split-half reliability. Principal components analysis (PCA) and confirmatory factor analysis (CFA) were used to identify the structural validity.

Results

A total of 2223 medical college students recruited from different regions of China were included. The Spearman–Brown coefficients of TIPI-C ranged from 0.129 to 0.786 and the Cronbach’s α coefficients ranged from 0.119 to 0.785. The split-half reliability of the Spearman–Brown coefficient was 0.508. The latent structure of Extraversion, Emotional Stability, and Conscientiousness complied with the intended structure, and the internal consistency coefficients of these three traits were supported. However, the internal consistency coefficients of Agreeableness and Openness were low and the structural validity was not supported.

Conclusion

TIPI-C primarily stands out as a feasible instrument for brief measurements of the Extraversion, Emotional Stability, and Conscientiousness domains. Further research is required to evaluate the concurrent validity and the test–retest reliability of TIPI-C in different populations and potentially modify the instrument to be more suitable for the Chinese population.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

INTRODUCTION

While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.

METHODS

A methodological study with longitudinal design among 586 mother-infant dyads, as part of the "BrEaST Start in Life" project. BSES was assessed 24-48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.

RESULTS

With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach's α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7-17.1) at the 1st and adjOR = 13.7 (95% CI 2.7-68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.

CONCLUSIONS

The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Background

Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear.

Objectives

The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD.

Methods

Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum.

Results

Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support.

Conclusions

Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother’s screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study

BACKGROUND

Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index.

METHODS

This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors.

RESULTS

Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index.

CONCLUSIONS

Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.

Impact of Nipple Shield Use on Milk Transfer and Maternal Nipple Pain

Background: Nipple pain is a common cause of early cessation of breastfeeding. A nipple shield (shield) is often used to improve breastfeeding comfort. There are concerns that shield use may limit milk transfer. The aims of this study were to determine whether shield use reduces milk transfer and maternal nipple pain. Methods: A within-subject study of two groups of breastfeeding dyads (infants <6 months) was conducted; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) shield used for nipple pain. There were two monitored sessions where shield use was randomized. Test weights and pain questionnaires were completed, and percentage of available milk removed (PAMR) was calculated. Results: Twenty-five PG (6 ± 4 postnatal weeks) and 34 CG (9 ± 6 postnatal weeks) had similar 24-hour milk production (PG: 676 ± 239 mL, CG: 775 ± 162 mL, p = 0.083). PG mean milk transfer volume and PAMR did not differ with shield use (no shield: 46 mL, 59%; shield: 40 mL, 53%, volume p = 0.38, PAMR p = 0.64). CG mean volume and PAMR were reduced with shield use (no shield: 65 mL, 64%; shield: 31 mL, 33%, volume p < 0.001, PAMR p < 0.001). PG pain scores were similar with and without shield use (Visual Analog Scale p = 0.44, McGill p = 0.97). Conclusions: Shield use did not impact either milk production or milk transfer in breastfeeding women experiencing nipple pain.

The Relationship of Breastfeeding Patterns in the Neonatal Intensive Care Unit to Maternal Symptoms of Anxiety and Depression

Background: The studies related to psychiatric disorders have demonstrated high frequency of maternal stress, anxiety, and postpartum depression in mothers who have infants in neonatal intensive care unit (NICU). It is well known that maternal anxiety and depression adversely affect breastfeeding. The research aims to examine the association between the anxiety and depressive symptom severity of NICU mothers and feeding type (exclusively breastfed [EBF] or mixed fed [MF]) of their infants within first week of life in NICU. Methods: Data were collected from 93 mothers and 105 infants in a single-center, prospective, cross-sectional, descriptive study. The state-trait anxiety and depressive symptom severity of NICU mothers were evaluated using the Spielberger State-Trait Anxiety Inventory (STAI, including Spielberger State-Trait Anxiety Inventory-State [STAI-S], Spielberger State-Trait Anxiety Inventory-Trait [STAI-T]), and Edinburgh Postnatal Depression Scale (EPDS). Results: Breastfeeding exclusivity in NICU infants was significantly related to gestational age, birth weight, prenatal steroid, and assisted reproductive technology (ART; p = 0.022, 0.041, 0.028, 0.017, respectively). The comparison of STAI-S, STAI-T, and EPDS scores of NICU mothers between EBF and MF groups revealed that STAI-T score was significantly high in EBF group than that in the MF group (p = 0.019). Logistic regression analyses showed that a 1-unit increase in STAI-T score in NICU mothers was significantly associated with a 5.7% increase in the odds of breastfeeding exclusivity within first week in postpartum period (p = 0.033; odds ratio = 1.057, 95% confidence interval = 1.004-1.113). Conclusions: Contrary to estimates, clinically significant state and trait anxiety symptoms and depressive symptoms of NICU mothers do not affect breastfeeding exclusivity negatively within first week of life in NICU. Preterm infants under 32 gestational weeks and infants born with ART have a tendency to being EBF.

Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan?

BACKGROUND

Cases of breastfeeding- and breast-milk-related jaundice tend to increase with increased rates of breastfeeding. Diagnoses of jaundice often lead mothers to discontinue breastfeeding because of assumptions that breastfeeding may exacerbate neonatal jaundice and lengthen the duration of phototherapy treatment.

PURPOSE

This study was designed to explore the effect of neonatal jaundice on breastfeeding duration and exclusivity during the first 4 months postpartum.

METHODS

This study applied a two-group comparative and follow-up design. The two groups comprised 135 and 160 mothers of infants, respectively, with and without neonatal jaundice. All of the participants were recruited from three certified baby-friendly hospitals in northern Taiwan. Follow-up was conducted by telephone at 1 and 4 months postpartum.

RESULTS

Mean breastfeeding duration was longer in the group of participants whose infants had neonatal jaundice (group with neonatal jaundice) than in the group whose infants did not have this condition (group without neonatal jaundice; 102.00 vs. 89.85 days, p = .007). The degree of breastfeeding was higher in the group with neonatal jaundice, although the difference was significant only at 1 month postpartum and not during hospitalization or at 4 months postpartum. The results of a Cox regression model showed that the group without neonatal jaundice was more likely to discontinue breastfeeding (adjusted hazard ratio = 1.68, 95% CI [1.08, 2.62]). A generalized estimating equation model suggests that infants with neonatal jaundice had a higher likelihood of being breastfed for at least half of their feedings (adjusted OR = 1.53, 95% CI [1.04, 2.25]).

CONCLUSIONS

On the basis of the results of this study, neonatal jaundice is not an obstacle to breastfeeding in pro-breastfeeding hospital environments. Participants whose infants developed neonatal jaundice were found in this study to breastfeed more often, which promotes breastfeeding success.

The Beliefs About Breastfeeding Questionnaire (BAB-Q): A psychometric validation study

Objectives

Questionnaires used to assess women’s beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB‐Q).

Design

A two‐phase evaluation in an online cross‐sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten‐item questionnaire was proposed to assess women’s beliefs about the benefits and efforts of breastfeeding.

Methods

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences.

Results

EFA found a shortened 8‐item, 2‐factor model had good fit (χ² = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = −.40). CFA confirmed the solution in the cohort sample (χ² = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women’s beliefs significantly predicted the likelihood that women experienced breastfeeding as ‘much more’ positive and negative than they expected.

Conclusions

The eight‐item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB‐Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required.

Maternal Depressive Symptoms and Infant Feeding Practices at Hospital Discharge: Findings from the Born in Queensland Study

INTRODUCTION

This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge.

METHODS

Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July-December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding.

RESULTS

About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009).

CONCLUSIONS FOR PRACTICE

Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge.

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study

BACKGROUND

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.

OBJECTIVES

To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.

DESIGN

A single-blind, randomised controlled trial.

SETTING

A prenatal clinic of a teaching hospital.

PARTICIPANTS

First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.

METHODS

A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.

RESULTS

Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p < .001), and postpartum at 1-week (p < .001), 1-month (p < .001) and 3-months (p < .01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p < .001) and 6-months postpartum (MD: 7.0, p < .05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).

CONCLUSIONS

The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.

TRIAL REGISTRATION

Registered with www.clinicaltrials.gov (NCT03807726).

Duration of Breastfeeding and Maternal-Related Factors in Iran, Systematic Review and Meta-Analysis

BACKGROUND

Although the benefits of breastfeeding are commonly approved, there remains a significant discrepancy between maternal practices and World Health Organization (WHO) guidelines in some countries.

OBJECTIVES

We had two aims in this study; average duration of breastfeeding, and its maternal determinants.

DATA SOURCES

A web-based citation index was used for citing documents.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

We included observational studies evaluating breastfeeding duration among children who were at least two years old and not older than five were included in Iran.

SYNTHESIS METHODS

The pooled mean and mean differences were considered. Heterogeneity was evaluated with the I² statistic.

RESULTS

The pooled mean of breastfeeding duration was calculated at 17.31 months. Children with younger mothers and lower birth orders had shorter durations of breastfeeding. Women with a high school and higher education level had early cessation of breastfeeding in comparison with less educated women.

LIMITATIONS

The main limitation of the current study was lack of librarian assistance.

CONCLUSIONS

The pooled mean of breastfeeding duration in Iranian children aged 2-5 was less than WHO recommendations. Accurate identification of the effect a mother's level of education has on duration of lactation requires standardized categorization.

IMPLICATIONS OF KEY FINDINGS

Raising awareness among women can be an effective strategy in increasing the duration of lactation.

Psychosocial barriers and enablers of exclusive breastfeeding: lived experiences of mothers in low-income townships, North West Province, South Africa

Background

Despite national efforts to promote exclusive breastfeeding (EBF), South Africa’s EBF rate is only 32 %. The aim of this study was to examine the rate of EBF discontinuation and the lived experiences of breastfeeding mothers at postnatal time points 3–14 days, 4–8 weeks, 10–14 weeks and 20–24 weeks.

Methods

This community-based mixed-methods study collected data within a prospective cohort study on sociodemographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 6–8 weeks with infant feeding data collected at 4–8, 10–14 and 20–24 weeks from 159 mothers living in low income areas. Six focus groups with 32 mothers with infants aged 6–24 weeks were conducted. Descriptive statistics was used for the quantitative data and thematic analysis for qualitative data.

Results

The majority of mothers were unmarried (84.9%), living with family (69.2%) and unemployed (74.2%). Exclusive breastfeeding decreased from 34% at 4–8 weeks to 9.7% at 20–24 weeks. Mixed feeding with infant formula increased from 17.0 to 30.6% and food feeding from 3.1 to 54.2%. While there were no statistically significant associations between EBF and any of the quantitative sociodemographic variables, in the qualitative data, codes associated with barriers were more than enablers. The themes were Mothers’ attributes (wellbeing, experiences and relationships) with the code mother’s stress the strongest barrier, Mother’s knowledge, attitudes and practices of breastfeeding with the code conventional medicines the strongest barrier, Family environment with the code home setting the strongest barrier, Social environment with public spaces and places a barrier and in Baby cues the code baby stomach ailments the barrier. Within these same themes mother’s positive emotions, benefits of breastfeeding, support in the home, access to information and services from health professionals and baby’s health were strong enabling factors.

Conclusions

Low EBF, high mixed feeding and a high EPDS score were explained by the barriers identified in the qualitative data. The data suggests that mothers from low-income households would be better supported through interventions that address food insecurity; family relationships and those that build confidence in mothers and resilience in confronting difficult and hostile breastfeeding environments.

Enhancing Breastfeeding - Home-Based Education on Self-Efficacy: A Preventive Strategy

Background:

The aim of this study is to evaluate the effects of home-based education intervention on the exclusivity and promoting the rates of self-efficacy of breastfeeding.

Materials and Methods:

A randomized controlled trial was conducted Arak University of Medical Sciences in Takeghani Hospital in Iran between June 2015 and October 2015. A total of 130 eligible and voluntary women hospitalized in Arak University of Medical Sciences Hospital postpartum wards were randomized to receive usual care (n = 65) or education with CD and pamphlets (n = 65). Data regarding exclusive breastfeeding were collected using Denis and Fox's breastfeeding self-efficacy questionnaire. The primary outcome was collected by one assistant researcher during first postpartum visit. The secondary outcome was collected 4 weeks after birth of babies by telephone interviews. Data analysis was performed using descriptive (frequency, mean), independent samples t-test, Student's t-test, t²-test, and Chi-square test. All values of P < 0.05 were considered statistically significant.

Results:

There was no significant differences between the intervention and control groups with regard to age (P = 0.086) and gestational age (P = 0.741). The breastfeeding self-efficacy scores were higher in the intervention group (63.66 ± 6.11) than in the control group (57.04 ± 6.18) after 1 month of childbirth (P = 0.001). The exclusive breastfeeding rate in intervention group was 89.2 (n = 58) at 1^st month after education compared with 55.4% (n = 36) in control group (P = 0.001).

Conclusions:

In a setting, a high breastfeeding rate and self-efficacy scores were found in education group. Therefore, nurses and midwives are thus required to adopt various health education strategies, such as home education, encourage breastfeeding.

You can't flight, you need to fight-A qualitative study of mothers' experiences of feeding extremely preterm infants

AIM

To describe mother's experiences of feeding their extremely preterm infant.

BACKGROUND

When an infant is born extremely preterm, there is a long rocky road for the mother if she wants to breastfeed. Some manage to reach their goals, others do not. Studies of feeding extremely preterm infants in the neonatal intensive care unit (NICU) are scarce.

DESIGN

A qualitative method with an inductive approach.

METHODS

Nine mothers giving birth to extremely preterm infants were interviewed by telephone after discharge from the NICU. The interviews were transcribed verbatim and analysed with qualitative content analysis. The COREQ checklist was followed.

RESULTS

The overall theme was "you can't flight, you need to fight." The theme reflects the mothers' will to do the best for their infants even if the struggle with milk expression and breastfeeding practice evoked feelings of helplessness, exposure, worry and disappointment. The categories forming the theme were as follows: The wish to provide own breastmilk; For the infant's best; Loss of control; and Help to reach the goals.

CONCLUSION

The mothers had a strong will to provide breastmilk to their infants but requested more support in order to be successful.

RELEVANCE TO CLINICAL PRACTICE

There is a need for evidence-based support programmes for mothers of extremely preterm infants to encourage them to persevere with milk expression and breastfeeding over time.

Breastfeeding as a balancing act - pregnant Swedish women's voices on breastfeeding

Background

Breastfeeding provides health benefits to both women and children. The rationale behind an individual woman’s decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.

Methods

Eleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.

Results

When interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women’s experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.

Conclusions

Pregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman’s experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.

Trial registration

Ethical approval for the study was obtained from the Regional Ethical Review Board in Uppsala (Dnr: 2017/256).

Breastfeeding practices 2008-2009 among Chinese mothers living in Ireland: a mixed methods study

Background

Migration to another country has a potential influence on breastfeeding practices. A significant difference in breastfeeding rates between Irish nationals and non-nationals has been reported. This study was conducted to explore breastfeeding practices of the Chinese in Ireland, one of the largest Irish ethnic groups, and to explore the influence of living in Ireland on breastfeeding practices. This is the first and the only migration study so far on breastfeeding practices among the Chinese in Ireland.

Methods

A sequential explanatory mixed methods approach was adopted. The first phase was a cross-sectional self-administered retrospective mailed survey, to explore breastfeeding practices and determinants of breastfeeding among a convenience sample of Chinese mothers living in Ireland (n = 322). Recruitment was conducted in the Dublin metropolitan area, with the application of the snowball technique to increase sample size. The second phase consisted of seven semi-structured focus groups (n = 33) conducted in Dublin, to explore the influence of living in Ireland on breastfeeding among Chinese mothers who had given birth in Ireland. Quantitative data were analyzed by univariate and multivariate logistic regression analyses, and informed the qualitative data collection. Qualitative data were analyzed by thematic content analyses, to explain and enrich the qualitative results.

Results

The breastfeeding initiation rate among Chinese immigrants to Ireland who gave birth in Ireland (CMI) (75.6%) was high and close to that of Chinese immigrant mothers who gave birth in China (CMC) (87.2%). However, giving birth in Ireland was independently associated with a shorter duration of breastfeeding (< 4 months) among Chinese immigrants. Qualitative results explained that a shorter breastfeeding duration among CMI than that of CMC was mainly due to cultural conflicts, a lack of family support, language barriers, immigrants’ low socioeconomic status, and mothers’ preference for infant formula on the Irish market. Both quantitative and qualitative data revealed a strong cultural belief in the efficacy of the traditional Chinese postpartum diet for breast milk production for both CMC and CMI. Antenatal feeding intention was a strong determinant for breastfeeding initiation and duration among CMI.

Conclusion

Migration to Ireland was found to be associated with a shorter duration of breastfeeding of the Chinese. Culturally sensitive and language-specific education and support of breastfeeding is needed for the Chinese mothers living in Ireland. The mixed methods design presented here might serve as a template for future migration research on breastfeeding.

A Moderated Mediation Model of Maternal Perinatal Stress, Anxiety, Infant Perceptions and Breastfeeding

This study examined a moderated mediation model of relations among maternal perinatal stress/anxiety, breastfeeding difficulties (mediator), misperceptions of infant crying (moderator), and maternal breastfeeding duration to understand risk factors for early breastfeeding termination. It was hypothesized that more breastfeeding difficulties would mediate the relation between greater prenatal stress/anxiety and shorter breastfeeding duration, and that perceptions of response to infant crying as spoiling would moderate the relation between more breastfeeding difficulties and reduced breastfeeding duration. Additionally, it was hypothesized that participants who breastfed through 6 months would demonstrate less postnatal stress/anxiety and there would be a positive relation between fewer breastfeeding difficulties and less postnatal stress/anxiety through 6 months. Participants included 94 expectant mothers at 33-37 weeks gestation and 6 months (±2 weeks) postpartum. Greater prenatal anxiety was associated with shorter breastfeeding duration. Results presented are the first to document negative relations between prenatal (as opposed to postnatal) anxiety and breastfeeding duration (as opposed to frequency or other indicators) in a U.S. sample. Future studies should seek to replicate findings in a more diverse sample and compare findings from clinical and non-clinical samples. Studies may also wish to explore the effects of anxiety prevention/intervention on breastfeeding duration.

The effects of early pacifier use on breastfeeding: A randomised controlled trial

BACKGROUND

The majority of observational studies have found associations between pacifier use and shorter breastfeeding duration. Results from four randomised controlled trials did not reveal any difference in breastfeeding outcomes. The relationship between early pacifier use and breastfeeding outcomes remains unclear.

AIM

To investigate whether a recommendation of early pacifier use affects the proportion of breastfeeding at six months compared to a recommendation to avoid pacifier use during the first two weeks.

METHODS

An open, randomised controlled trial with parallel group design; 239 primiparous mothers and their term infants were randomly assigned to an intervention group or a control group. The primary outcome was the proportion of breastfeeding at six months. Secondary outcomes were the proportions of breastfeeding and breastfeeding problems at two and four months. To investigate factors which may influence breastfeeding, a multivariate logistic regressions analysis was performed.

FINDINGS

A total of 209 participants (87.5%) completed the study. There were no significant differences between the groups with respect to breastfeeding at six months. No negative association for breastfeeding between early versus late introduction of pacifier was found. Factors significantly associated with cessation of breastfeeding at six months were: use of nipple shield, intention to breastfeed, severe breastfeeding problems at two weeks, pacifier use at two months and lower educational level.

CONCLUSION

Early versus late recommendation of pacifier introduction did not affect the proportion of breastfeeding at six months. However, the compliance to the randomised group was insufficient. No negative association was found in the observational analysis.

Personality Traits Predict Meeting the WHO Recommendation of 6 Months' Breastfeeding: A Prospective General Population Cohort Study

BACKGROUND

Although personality as well as anxiety and depression are recognized as predictors for breastfeeding initiation, evidence of an association of these factors with 6 months' exclusive breastfeeding as recommended by the World Health Organization (WHO) is sparse.

PURPOSE

The purpose of this study was to investigate the associations of personality and symptoms of anxiety and depression during and after pregnancy with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

METHODS

In their first trimester of pregnancy, 5784 pregnant women were enrolled in Dutch primary obstetric care centers and hospitals, of which 2927 completed the breastfeeding assessments 6 months postpartum. We performed logistic regression analyses to test the associations of "big five" personality traits (NEO Five Factor Inventory), anxiety (State-Trait Anxiety Inventory), and depression (Edinburgh Postnatal Depression Scale) symptom levels during pregnancy and postpartum with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

RESULTS

Agreeableness (odds ratio [OR] = 1.18, P = .006) and openness (OR = 1.31, P < .001) were positively associated with meeting the WHO recommendation, whereas extraversion (OR = 0.83, P = .005) and neuroticism (OR = 1.18, P = .006) were negatively associated. After adjustment for both antenatal and postpartum symptom levels of anxiety and depression, the associations of the agreeableness, extraversion, and openness personality traits remained strong and statistically significant (P < .05).

IMPLICATIONS FOR PRACTICE

Patient-centered care should take personality into account in an effort to tailor interventions to optimize breastfeeding behavior.

IMPLICATIONS FOR RESEARCH

In contrast to earlier findings, personality traits may be of greater importance than symptoms of anxiety and depression for meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.

Maternal Report of Outcomes of Chiropractic Care for Infants

OBJECTIVE

The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom.

METHODS

This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate.

RESULTS

In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events.

CONCLUSION

In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.

Beyond health care providers' recommendations: understanding influences on infant feeding choices of women with HIV in the Eastern Cape, South Africa

Background

Despite the array of studies on infant feeding practices of HIV-infected women, gaps still exist in the understanding of the underlying reasons for their infant feeding choices. Potential for behavioural change exists, especially in the light of the 2016 updated World Health Organization guideline on HIV and infant feeding. The aim of this paper is to determine the rate of adoption of exclusive breastfeeding in this cohort, examine the determinants of infant feeding choices of HIV-infected women and assess the underlying reasons for these choices.

Methods

This was a mixed methods study conducted between September 2015 and May 2016. It analyses the quantitative and qualitative data of 1662 peripartum women enrolled in the East London Prospective Cohort Study across three large maternity services in the Eastern Cape. Women with HIV reported their preferred choices of infant feeding. In addition, participants explained the underlying reasons for their choices. Descriptive and inferential statistics summarised the quantitative data, while thematic content analysis was performed on qualitative data.

Results

Of the 1662 women with complete responses, 80.3% opted to exclusively breastfeed their babies. In the adjusted model, up to grade 12 education level (AOR: 1.81; 95% CI: 1.14, 2.86), rural/peri-urban residence (AOR:1.44; 95% CI: 1.05, 1.96), alcohol use (AOR: 1.65; 95% CI: 1.25, 2.18), negative or unknown HIV status at booking (AOR:1.85; 95% CI:1.27, 2.70), currently married (AOR:1.43; 95% CI:1.01, 2.02) and WHO Clinical Stage 2–4 (AOR:1.77; 95% CI: 1.15, 2.72) were significantly associated with the decision to exclusively breastfeed. Health care providers’ recommendations, perceived benefits of breastfeeding, unaffordability of formula feeding, and coercion were the underlying reasons for wanting to breastfeed; while work/school-related demands, breast-related issues, and fear of infecting the baby influenced their decision to formula feed.

Conclusion

The majority of HIV-infected women chose to breastfeed their babies in the Eastern Cape. Following up on these women to ensure they breastfeed exclusively, while also addressing their possible concerns, could be an important policy intervention. Future studies should focus on how early infant feeding decisions change over time, as well as the health outcomes for mother and child.

Does the type of maltreatment matter? Assessing the individual and combined effects of multiple forms of childhood maltreatment on exclusive breastfeeding behavior

BACKGROUND

Childhood maltreatment (CM) has been associated with a range of adult health outcomes; however, extant research has focused more on exposure to a single form of abuse rather than multiple forms. Moreover, very few studies have specifically investigated the impact of CM on exclusive breastfeeding (EBF) outcomes.

OBJECTIVES

This study aims to examine: (1) the individual and combined effects of multiple forms of CM on EBF outcomes; and (2) whether postpartum depression and maternal stress act to mediate or moderate the association between CM and EBF.

METHOD

Cross-sectional survey data were collected between October 2015 and January 2016 from 426 women of Bangladesh who were six months postpartum.

RESULTS

Based on the adjusted multivariate logistic regression model, women who experienced childhood sexual abuse (CSA) were significantly less likely to exclusively breastfeed babies than their non-abused counterparts (AOR: 0.38, 95% CI [0.15, 0.92]). When a composite measure was created to examine the additive effects of adverse childhood experiences, a dose-response association was observed between the reported number of different types of CM and early termination of EBF. Though experiencing postpartum depression and maternal stress do not mediate the effect of CSA on EBF, they do moderate them such that the odds of early termination of EBF are notably higher among women who experienced CSA in combination with postpartum depression or high levels of stress.

CONCLUSIONS

Findings from this study offer some insight into the intergenerational effects associated with CM experiences, and underpin the need for effective policies and programs to prevent or reduce its occurrence and improve the EBF outcomes.

Infant Feeding Practices in China and Ireland: Ireland Chinese Mother Survey

Introduction: Migration to another country may induce changes in infant feeding practices especially where such practices differ considerably between the two countries. This study was undertaken to compare the infant feeding practices between Chinese mothers who gave birth in Ireland (CMI) with immigrant Chinese mothers who gave birth in China (CMC), and to examine the factors that influence these practices.

Methods: A cross-sectional self-administrated survey was conducted among a convenience sample of 322 Chinese mothers living in Ireland. Data were obtained from mailed questionnaires. Infant feeding practices between CMC and CMI were compared by Chi-square or independent sample t-test. Binary logistic regression analyses were further performed to test the differences in infant feeding practices between two groups, after controlling for potential socio-demographic confounders.

Results: High breastfeeding initiation rates were found in both groups (CMC: 87.2%; CMI: 75.6%); however sharp reductions in breastfeeding rates at 3 months (49.1%) and 6 months (28.4%) were found among CMI but not CMC (P < 0.05). Introduction of water within 1 week after childbirth was common for CMC in comparison with CMI. CMI were more likely than CMC to introduce infant formula to their child within the first 4 months after childbirth. The timing of introduction of rice porridge, vegetables, fruits and meats did not differ between CMC and CMI.

Conclusions: Cultural and perceptional factors, and changes caused by migration contribute to the decline in breastfeeding duration among CMI. Language-specific breastfeeding support and education among Chinese mothers in Ireland is needed, in particular to encourage mothers to breastfeed for 6 months or more.

Concept Analysis

The literature is replete with references to the concept of breastfeeding self-efficacy. This concept is relevant to the nursing and lactation disciplines and requires analysis to gain a mutual understanding of the term. Clarification of the concept of self-efficacy as it relates to breastfeeding will standardize the use of this terminology in professional practice and research. The authors conducted a review of recent literature to identify the attributes, definition, antecedents, and consequences of breastfeeding self-efficacy. Model, related, borderline, and contrary cases further illustrate the concept. Several empirical referents for breastfeeding self-efficacy are identified and analyzed for validity, reliability, and adaptability.

The association between psychological factors and breastfeeding behaviour in women with a body mass index (BMI) ≥30 kg m-2 : a systematic review

Breastfeeding can play a key role in the reduction of obesity, but initiation and maintenance rates in women with a body mass index (BMI) of ≥30 kg m^-2 are low. Psychological factors influence breastfeeding behaviours in the general population, but their role is not yet understood in women with a BMI ≥30 kg m^-2 . Therefore, this review aimed to systematically search and synthesize the literature, which has investigated the association between any psychological factor and breastfeeding behaviour in women with a BMI ≥30 kg m^-2 . The search identified 20 eligible papers, reporting 16 psychological factors. Five psychological factors were associated with breastfeeding behaviours: intentions to breastfeed, belief in breast milk's nutritional adequacy and sufficiency, belief about other's infant feeding preferences, body image and social knowledge. It is therefore recommended that current care should encourage women to plan to breastfeed, provide corrective information for particular beliefs and address their body image and social knowledge. Recommendations for future research include further exploration of several psychological factors (i.e. expecting that breastfeeding will enhance weight loss, depression, anxiety and stress) and evidence and theory-based intervention development.

Factors Associated with Maternal Wellbeing at Four Months Post-Partum in Ireland

This study aimed to examine factors associated with maternal wellbeing at four months post-partum in the Irish context. Socio-demographic, health behaviour and infant feeding data were collected in pregnancy, at birth and at 17 weeks post-partum. Maternal distress, body image and resilience were measured at 17 weeks post-partum. Binary logistic regression predicted maternal distress and statistical significance was taken at p < 0.05. One hundred and seventy-two women were followed-up in pregnancy, at birth and at 17 weeks post-partum. Three in five (61.6%, n106) initiated breastfeeding. At 17 weeks post-partum, 23.8% (n41) were exclusively or partially breastfeeding and over a third (36.0%, n62) of all mothers were at risk of distress. In multivariate analyses, independent predictors of distress included: low maternal resilience (p < 0.01, odds ratio (OR): 7.22 (95% confidence interval [CI]: 2.49⁻20.95)); unsatisfactory partner support (p = 0.02, OR: 3.89 (95% CI: 1.20⁻12.65)); older age (p = 0.02, OR: 1.11 (95% CI: 1.02⁻1.21)); and breastfeeding (p = 0.01, OR: 2.89 (95% CI: 1.29⁻6.47)). Routine assessment of emotional wellbeing and targeted interventions are needed to promote a more healthful transition to motherhood among women in Ireland.

Breastfeeding performance in Iranian women

AIM

Studies have shown that breastfeeding has both short-term and long-term useful effects on mother's and newborn's health. This study was conducted with the aim of determining predictors of breastfeeding performance in women who were referred to health centres in Tabriz City, Iran, in 2014 to 2015.

METHODS

This cross-sectional study cluster-sampled 220 breastfeeding women with infants aged 4 to 6 months. The Breastfeeding Self-Efficacy Scale, the Iowa Infant Feeding Attitude Scale, the personal resource questionnaire-85, and a researcher-developed knowledge questionnaire were used to collect data. Multivariate linear regression model was used to determine predictors of breastfeeding performance.

RESULTS

The results showed that participants' breastfeeding performance mean (SD) value was 3.6 (1.2) of 6. There were significant relationships between breastfeeding performance and breastfeeding self-efficacy (P = .033) but not between social support, knowledge, attitudes, and breastfeeding performance (P > .05). Breastfeeding self-efficacy, occupation, family income sufficiency, and living with the family were identified as predictors of breastfeeding performance.

CONCLUSION

Given the relationship between breastfeeding self-efficacy and breastfeeding performance, strengthening mothers' self-efficacy should be considered, especially when compiling programs to promote breastfeeding. Increasing breastfeeding self-efficacy in women improves their breastfeeding performance: In developing programs to promote breastfeeding culture, women's self-efficacy should be considered.

Perceptions of northeast Thai breastfeeding mothers regarding facilitators and barriers to six-month exclusive breastfeeding: focus group discussions

Background

The 6-month exclusive breastfeeding rate in the Northeast region of Thailand has recently significantly decreased in contrast to all other regions in Thailand. The factors that have influenced this decrease remain unknown. Hence, it is suggested that an investigation into factors that could improve or hinder EBF for 6 months in Northeast Thailand may be required to inform the development of relevant interventions to improve this situation. This study aimed to identify perceived facilitators and barriers to providing exclusive breastfeeding for 6 months in Northeast Thailand among breastfeeding mothers.

Methods

Six focus group discussions were conducted with a total of 30 mothers aged 20 to 40 years who had children aged between 4 and 6 months and were currently breastfeeding or had breastfeeding experience. Participants were recruited through self-selection sampling from Khonkaen hospital (urban), Numphong hospital (peri-urban) and private hospitals (urban) in Khonkaen, Thailand. Thematic analysis was employed to analyse the data.

Results

Five main themes, with 10 sub-themes, were identified as either facilitators (+) or barriers (−), or in some cases, as both (+/−). Breastfeeding knowledge, perceptions, maternal circumstances, support, and traditional food were the main identified themes. Mother’s breastfeeding knowledge, intention to breastfeed, and social media were perceived as facilitators. Perceptions, employment, and formula milk promotion were perceived as barriers. Family, healthcare, and traditional food were perceived as both facilitators and barriers. The perception that social media was a way to access breastfeeding knowledge and support mothers in Northeast Thailand emerged as a new facilitating factor that had not previously been identified in Thai literature relating to facilitators and barriers to exclusive breastfeeding. Intention to breastfeed, family support, healthcare support and traditional food were mentioned by all groups, whereas mothers from urban areas specifically mentioned mother’s breastfeeding knowledge, social media and employment sub-themes. Only mothers from the peri-urban area mentioned formula milk promotion and only mothers who had delivered in public hospitals mentioned the perceptions sub-theme.

Conclusions

Knowledge about these facilitators and barriers may inform the design and development of specific and relevant interventions to improve the 6-month exclusive breastfeeding rate in the Northeast region of Thailand and be useful in other contexts. Social media emerged as a newly perceived facilitator in the Thai context and may be a useful inclusion in a 6-month exclusive breastfeeding intervention model.

Electronic supplementary material

The online version of this article (10.1186/s13006-018-0148-y) contains supplementary material, which is available to authorized users.

Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood

Studies of pregnancy-specific anxiety suggest that it is a distinct construct which predicts perinatal outcomes more effectively than other general measures of anxiety. In response, a novel measure of postpartum-specific anxiety (PSAS) has been developed and validated, but it is not yet clear whether it possesses the same predictive power as its pregnancy-specific counterparts. The aim of this short-term prospective study was to (a) test the predictive validity of the PSAS in the context of one specific perinatal outcome, infant-feeding, and (b) examine whether the PSAS may be more efficacious at predicting infant-feeding outcomes and behaviours than the more commonly used general measures. Eight hundred mothers of infants aged between 0 and 6 months completed the PSAS alongside general measures of anxiety and depression at baseline. A subsample (n = 261) returned to complete a follow-up questionnaire examining infant-feeding outcomes and behaviours two weeks later. Hierarchical regression models revealed that the PSAS was associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum. PSAS scores were also significantly associated with infant-feeding behaviours including a lower perceived enjoyment of food, and greater perceived food responsiveness and satiety responsiveness in the infant. As hypothesised, the PSAS was a stronger predictor of infant-feeding outcomes and behaviours than general anxiety and depression. The findings provide evidence for the predictive validity of the PSAS and call for the use of childbearing specific measures of mood when attempting to predict perinatal outcomes. Replication of these findings across other indices of maternal and infant health is now necessary.

A Cluster Randomised Trial to Determine the Efficacy of the "Feeding Buddies" Programme in Improving Exclusive Breastfeeding Rates Among HIV-Infected Women in Rural KwaZulu-Natal, South Africa

This cluster randomised trial in KwaZulu-Natal South Africa, evaluated the implementation of a Feeding Buddies (FB) programme to improve exclusive breastfeeding (EBF) amongst human immunodeficiency virus infected mothers. Eight clinics were randomly allocated to intervention and control arms respectively. Pregnant women attending the prevention of mother-to-child transmission program and intending to EBF were enrolled: control (n = 326), intervention (n = 299). Intervention mothers selected FBs to support them and they were trained together (four sessions). Interviews of mothers occurred prenatally and at post-natal visits (day 3, weeks 6, 14 and 22). Breastfeeding results were analysed (Stata) as interval-censored time-to-event data, with up to four time intervals per mother. EBF rates at the final interview were similar for control and intervention groups: 44.68% (105/235) and 42.75% (109/255) respectively (p = 0.67). In Cox regression analysis better EBF rates were observed in mothers who received the appropriate training (p = 0.036), had a community care giver visit (p = 0.044), while controlling for other factors. Implementation realities reduced the potential effectiveness of the FBs.

Aspectos Subjetivos da Amamentação e Desmame: Evidências em Três Casos

RESUMO Este estudo investigou aspectos subjetivos da amamentação e do desmame aos três e oito meses de vida do bebê. Utilizou-se delineamento de estudo de caso coletivo, sendo que três mães primíparas responderam a uma entrevista sobre diversos aspectos da maternidade, sobretudo, a amamentação e o desmame. Análise de conteúdo qualitativa das respostas, baseada na psicanálise, revelou que a amamentação pode indicar uma relação incestuosa mãe-bebê, na qual este pode ser tomado como objeto de desejo materno. As mães também relataram experiências de prazer e desprazer associadas à amamentação, evidenciando ambivalências e dificuldades presentes. Portanto, este estudo indicou que a amamentação e o desmame abarcam significados e implicações para além do biológico, remetendo à relação mãe-filho, bem como à história constitutiva da própria mãe.

Breastfeeding initiation: An in-depth qualitative analysis of the perspectives of women and midwives using Social Cognitive Theory

OBJECTIVE

to explore women's and midwives' expectations, knowledge and experiences of breastfeeding initiation using Social Cognitive Theory.

DESIGN

a qualitative study using focus group discussions and individual interviews. Breastfeeding initiation was defined for this study as a process within the first 48hours after birth. Data were analysed using qualitative inductive analysis then further deductive analysis using Social Cognitive Theory (SCT).

SETTING AND PARTICIPANTS

a purposefully selected sample of primigravid antenatal and postnatal women (n=18) and practising midwives (n=18) from one Health Board area in Scotland.

FINDINGS

attachment of the baby to the breast at birth was hindered by sleepy babies and the busy unfamiliar hospital environment. These resulted in mothers struggling to maintain their motivation to breastfeed and to develop low self-efficacy. Instinctive attachment was rare. Midwives who considered it was normal for babies to be sleepy and unable to attach or feed at birth did not facilitate instinctive baby behaviour. Midwives sometimes experienced lack of autonomy and environmental circumstances that made women centred care difficult. Furthermore caring for high numbers of women, dependent on their help, resulted in reduced self-efficacy for providing effective breastfeeding support.

KEY CONCLUSIONS

interviewing both women and midwives specifically about initiation of breastfeeding has allowed for deeper insights into this critical period and enabled a comparison between the data obtained from mothers and midwives. The findings suggest that instinctive attachment is not an expectation of either mothers or midwives and results in a loss of breastfeeding confidence in both.

IMPLICATIONS FOR PRACTICE

to facilitate initiation there is a need for more research to develop appropriate maternal and midwifery skills, and make changes to the cultural environment in hospitals. Social Cognitive Theory could be used as a framework in both the antenatal and immediate postnatal period to develop strategies and materials to increase women's and midwives' self-efficacy specifically in initiation.