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Huber R, Menon M, Russell RB, Smith S, Scott S, Berns SD. Community infant safe sleep and breastfeeding promotion and population level-outcomes: A mixed methods study. Midwifery 2024; 132:103953. [PMID: 38430791 DOI: 10.1016/j.midw.2024.103953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/14/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
PROBLEM In the U.S., sudden unexpected infant deaths due to accidental suffocation and strangulation in bed are increasing. Though breastfeeding is a protective factor against sudden unexpected infant death, motivations to breastfeed often couple with unsafe infant sleep practices. Racial/ethnic disparities are present in sudden unexpected infant death, accidental suffocation and strangulation in bed, and breastfeeding. BACKGROUND Promoting infant safe sleep and breastfeeding through community-level initiatives could address disparities in related outcomes. AIM Investigate the relationship between community-level strategies and associated state-level outcomes for infant safe sleep and breastfeeding. METHODS We employed an intervention mixed methods framework and exploratory sequential design. The qualitative component entailed a hermeneutical phenomenological framework to analyze key informant interview data from seven U.S. community-level providers participating in a practice improvement initiative. The quantitative component entailed descriptively analyzing infant safe sleep and breastfeeding indicators from the 2019 Pregnancy Risk Assessment Monitoring System and Ohio Pregnancy Assessment Survey. Qualitative and quantitative data were linked through embedded integration. FINDINGS We identified two mixed insights: gaps in promotion and outcomes, and persistent disparities between infant safe sleep and breastfeeding promotion and outcomes. DISCUSSION Our findings indicate conversational approaches could improve infant safe sleep and breastfeeding promotion, outcomes, and relative disparities. We find that community collaboration is needed to address organizational capacity limitations in promoting infant safe sleep and breastfeeding. CONCLUSION Community-level organizations and providers should consider tailoring program offerings and care delivery to include conversational approaches and community collaboration to promote infant safe sleep and breastfeeding and decrease relative disparities in outcomes.
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Affiliation(s)
- Rebecca Huber
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA.
| | - Meera Menon
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Rebecca B Russell
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Sharla Smith
- Preventive Medicine and Public Health Department, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Kansas Birth Equity Network, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Stacy Scott
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA
| | - Scott D Berns
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA 02210, USA; Department of Pediatrics, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S Main St, Providence, RI 02903, USA
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Fan WQ, Chan C, Paterson S, Foster K, Morrow M, Bourne D, Ashworth J. Weekly Proactive Telephone Breastfeeding Standard Care by Lactation Consultants in the First Month Postpartum Prolongs Breastfeeding for Up to 6 Months. Nutrients 2023; 15:2075. [PMID: 37432209 DOI: 10.3390/nu15092075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
Many mothers, especially those with co-morbidities, do not achieve exclusive breastfeeding (EBF) for the first 6 months, with the loss of multiple health benefits including enhanced infant nutrition. We wished to evaluate whether proactive lactation consultant telephone advice in the first month postpartum improved breastfeeding rates for up to 6 months. A prospective cohort observational study was performed. Mother groupings included the following: Control (CG, n = 379)-standard postnatal care; Exposure (EG, n = 386)-standard postnatal care delivered by lactation consultant telephone contact for the first 3 weeks postpartum and then follow-up calls at 1, 3 and 6 months postpartum to ascertain breastfeeding status. Sore nipples (24%) and fussy/unsettled behaviour (14-19%) were common EG concerns. EG EBF rates were higher at 1 month (65% vs. 53%; p < 0.001), 3 months (57% vs. 49%; p = 0.041) and 6 months (45 vs. 33%; p < 0.001). EG EBF rates across the 6 months were higher for infants admitted to the NNU (52.9% vs. 37.5%, p = 0.003), obese mothers (58.3% vs. 37.2%, p < 0.001), mothers with depression (60.8% vs. 43.4%, p = 0.036) and all birth modes. Proactive early lactation advice significantly prolongs EBF and consequently enhances infant nutrition overall, including for mothers at risk of early breastfeeding cessation.
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Affiliation(s)
- Wei Qi Fan
- Northern Health, Melbourne, VIC 3076, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
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Pereira EL, Estabrooks PA, Arjona A, Cotton-Curtis W, Lin JCP, Saetermoe CL, Blackman KCA. A systematic literature review of breastfeeding interventions among Black populations using the RE-AIM framework. Int Breastfeed J 2022; 17:86. [PMID: 36528606 PMCID: PMC9758845 DOI: 10.1186/s13006-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lactation support resources are less likely to be located in close proximity to where Black families live and there is a systemic racist health care belief that Black women prefer bottle feeding (with infant formula) over breastfeeding. Together, these lead to lower reported breastfeeding rates of Black babies compared to other racial / ethnic groups. It is imperative to have a deeper understanding of the cultural aspects as well as the underlying limitations that prevent Black women / persons from being supported to breastfeed. There is a need to know how effective breastfeeding interventions are in reaching the intended population; how well they work in promoting breastfeeding initiation and continuation; and how successful they are when implemented at the setting and staff level. The purpose of this investigation was to establish the level of internal and external validity that was reported by breastfeeding intervention studies among Black communities. METHODS Studies on breastfeeding interventions on Black people that were published between the years 1990 and 2019 were carefully examined through PubMed, EBSCOhost, Web of Science, and OneSearch. A total of 31 studies fulfilled the requirements to be included for this evaluation. In order to extract the information from the articles, the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework extraction tool was utilized. RESULTS On average, the proportion of studies that reported across reach, effectiveness, adoption, implementation, and maintenance indicators was 54, 35, 19, 48, and 9%, respectively. Across core RE-AIM indicators only sample size (100%) and breastfeeding outcomes (90%) were reported consistently. External validity indicators related to representativeness of participants (16%) and sites (3%) were rarely reported. Similarly, adherence to intervention protocol, and indicator of internal validity, was reported in a small proportion of articles (19%). CONCLUSION This body of literature under-reported on aspects associated to both internal and external validity across all RE-AIM domains. The reporting of the individual level of representativeness; the setting level of representativeness; the intervention's adherence to the protocol; the expenses; and the factors of sustainability would benefit from improvement in future research.
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Affiliation(s)
| | - Paul A Estabrooks
- Department of Health & Kinesiology, University of Utah, Salt Lake City, USA
| | - Alejandro Arjona
- Department of Family & Consumer Sciences, California State University Northridge, Northridge, USA
| | - Wyconda Cotton-Curtis
- Department of Health Sciences, California State University Northridge, Northridge, USA
| | - Judith C P Lin
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Carrie L Saetermoe
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Kacie C A Blackman
- Department of Health Sciences, California State University Northridge, Northridge, USA.
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA.
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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Huang C, Hu L, Wang Y, Luo B. Effectiveness of early essential newborn care on breastfeeding and maternal outcomes: a nonrandomized controlled study. BMC Pregnancy Childbirth 2022; 22:707. [PMID: 36104660 PMCID: PMC9476579 DOI: 10.1186/s12884-022-05037-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breastfeeding and maternal health play crucial roles in improving newborn health, which is closely related to the development of families and society. Early essential newborn care, which emphasizes early exclusive breastfeeding and skin-to-skin contact, is recommended by the World Health Organization. This study aimed to explore the association of early essential newborn care with breastfeeding and maternal outcomes.
Methods
A nonrandomized controlled study was carried out from May 2020 to January 2021 in a tertiary hospital in Chengdu city, China. Pregnant women were recruited from the maternity ward before they gave birth. Early essential newborn care was performed for 91 mother-newborn pairs after birth in the intervention group, while routine birth care was performed for 91 mother-newborn pairs in the control group. Data on breastfeeding and maternal outcomes were collected pre-test and post-test and were recorded by trained data collectors and retrieved from hospital case record files.
Results
Compared with the control group, the intervention group had a higher incidence of early breastfeeding initiation, an earlier initiation and longer duration for the first breastfeeding, a higher incidence of successful first breastfeeding, more exclusive breastfeeding at hospital discharge, higher maternal breastfeeding self-efficacy, a shorter duration of the third stage of labour, lower postpartum blood loss, and lower scores of maternal pain and anxiety postpartum; the differences were statistically significant (p < 0.05).
Conclusion
The implementation of high-quality early essential newborn care can help mothers initiate early breastfeeding, improve exclusive breastfeeding rates at hospital discharge, enhance breastfeeding self-efficacy, promote the woman’s recovery from labour, and reduce maternal anxiety and pain in the postpartum period. High-quality early essential newborn care is recommended to policymakers and medical professionals to improve breastfeeding and maternal outcomes.
Trial registration
Chinese Clinical Trial Registry, Retrospective Registration (27/7/2021), registration number: ChiCTR2100049231.
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Consales A, Colombo L, Zanotta L, Morniroli D, Sannino P, Rampini S, Piccoli G, Donghi M, Marchisio P, Mosca F, Plevani L, Giannì ML. Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042020. [PMID: 35206209 PMCID: PMC8871806 DOI: 10.3390/ijerph19042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.
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Affiliation(s)
- Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Lorenzo Colombo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Lidia Zanotta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
- Correspondence: ; Tel.: +39-0255032907
| | - Patrizio Sannino
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Serena Rampini
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Giulia Piccoli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Michaela Donghi
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Pediatric Unit, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Laura Plevani
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
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Abstract
BACKGROUND Maternal complications, including psychological/mental health problems and neonatal morbidity, have commonly been observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following birth may prevent health problems from becoming chronic, with long-term effects. This is an update of a review last published in 2017. OBJECTIVES The primary objective of this review is to assess the effects of different home-visiting schedules on maternal and newborn mortality during the early postpartum period. The review focuses on the frequency of home visits (how many home visits in total), the timing (when visits started, e.g. within 48 hours of the birth), duration (when visits ended), intensity (how many visits per week), and different types of home-visiting interventions. SEARCH METHODS For this update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (19 May 2021), and checked reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) (including cluster-, quasi-RCTs and studies available only as abstracts) comparing different home-visiting interventions that enrolled participants in the early postpartum period (up to 42 days after birth) were eligible for inclusion. We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period), and studies recruiting only women from specific high-risk groups (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 16 randomised trials with data for 12,080 women. The trials were carried out in countries across the world, in both high- and low-resource settings. In low-resource settings, women receiving usual care may have received no additional postnatal care after early hospital discharge. The interventions and controls varied considerably across studies. Trials focused on three broad types of comparisons, as detailed below. In all but four of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the well-being of mothers and babies, and to provide education and support. However, some interventions had more specific aims, such as to encourage breastfeeding, or to provide practical support. For most of our outcomes, only one or two studies provided data, and results were inconsistent overall. All studies had several domains with high or unclear risk of bias. More versus fewer home visits (five studies, 2102 women) The evidence is very uncertain about whether home visits have any effect on maternal and neonatal mortality (very low-certainty evidence). Mean postnatal depression scores as measured with the Edinburgh Postnatal Depression Scale (EPDS) may be slightly higher (worse) with more home visits, though the difference in scores was not clinically meaningful (mean difference (MD) 1.02, 95% confidence interval (CI) 0.25 to 1.79; two studies, 767 women; low-certainty evidence). Two separate analyses indicated conflicting results for maternal satisfaction (both low-certainty evidence); one indicated that there may be benefit with fewer visits, though the 95% CI just crossed the line of no effect (risk ratio (RR) 0.96, 95% CI 0.90 to 1.02; two studies, 862 women). However, in another study, the additional support provided by health visitors was associated with increased mean satisfaction scores (MD 14.70, 95% CI 8.43 to 20.97; one study, 280 women; low-certainty evidence). Infant healthcare utilisation may be decreased with more home visits (RR 0.48, 95% CI 0.36 to 0.64; four studies, 1365 infants) and exclusive breastfeeding at six weeks may be increased (RR 1.17, 95% CI 1.01 to 1.36; three studies, 960 women; low-certainty evidence). Serious neonatal morbidity up to six months was not reported in any trial. Different models of postnatal care (three studies, 4394 women) In a cluster-RCT comparing usual care with individualised care by midwives, extended up to three months after the birth, there may be little or no difference in neonatal mortality (RR 0.97, 95% CI 0.85 to 1.12; one study, 696 infants). The proportion of women with EPDS scores ≥ 13 at four months is probably reduced with individualised care (RR 0.68, 95% CI 0.53 to 0.86; one study, 1295 women). One study suggests there may be little to no difference between home visits and telephone screening in neonatal morbidity up to 28 days (RR 0.97, 95% CI 0.85 to 1.12; one study, 696 women). In a different study, there was no difference between breastfeeding promotion and routine visits in exclusive breastfeeding rates at six months (RR 1.47, 95% CI 0.81 to 2.69; one study, 656 women). Home versus facility-based postnatal care (eight studies, 5179 women) The evidence suggests there may be little to no difference in postnatal depression rates at 42 days postpartum and also as measured on an EPDS scale at 60 days. Maternal satisfaction with postnatal care may be better with home visits (RR 1.36, 95% CI 1.14 to 1.62; three studies, 2368 women). There may be little to no difference in infant emergency health care visits or infant hospital readmissions (RR 1.15, 95% CI 0.95 to 1.38; three studies, 3257 women) or in exclusive breastfeeding at two weeks (RR 1.05, 95% CI 0.93 to 1.18; 1 study, 513 women). AUTHORS' CONCLUSIONS The evidence is very uncertain about the effect of home visits on maternal and neonatal mortality. Individualised care as part of a package of home visits probably improves depression scores at four months and increasing the frequency of home visits may improve exclusive breastfeeding rates and infant healthcare utilisation. Maternal satisfaction may also be better with home visits compared to hospital check-ups. Overall, the certainty of evidence was found to be low and findings were not consistent among studies and comparisons. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
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Affiliation(s)
- Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shuko Nagai
- Department of International Cooperation, Research Institute of Tuberculosis, Tokyo, Japan
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Thepha T, Marais D, Bell J, Muangpin S. The Evaluation of Training for Health-Care Professionals and Community Leaders Regarding 6-Month Exclusive Breastfeeding in Northeast Thailand. J Perinat Educ 2021; 30:71-77. [PMID: 33897231 DOI: 10.1891/j-pe-d-19-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To address the reduction of the 6-month exclusive breastfeeding (EBF) rate in Northeast Thailand, a 3-year 6-month EBF intervention model was developed using concept mapping. A training for health-care professionals and community leaders was prioritized as the initial intervention. The aim was to assess the feasibility of the training intervention and its potential to improve 6-month EBF knowledge. A pre- and posttest, and an open question were conducted. Data were analyzed using t tests and thematic analysis. For the 17 health-care professionals and community leaders who participated, the mean 6-month EBF knowledge scores improved significantly from 5.28 to 10.21 (p value < .01). It is recommended that this workshop could be duplicated and scaled up in other regions across Thailand to standardize care.
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Dagla M, Mrvoljak-Theodoropoulou I, Vogiatzoglou M, Giamalidou A, Tsolaridou E, Mavrou M, Dagla C, Antoniou E. Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041988. [PMID: 33670797 PMCID: PMC7922856 DOI: 10.3390/ijerph18041988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: ; Tel.: +30-210-932-4415
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Marilena Vogiatzoglou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Anastasia Giamalidou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Eleni Tsolaridou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Marianna Mavrou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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10
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Wong MS, Mou H, Chien WT. Effectiveness of educational and supportive intervention for primiparous women on breastfeeding related outcomes and breastfeeding self-efficacy: A systematic review and meta-analysis. Int J Nurs Stud 2021; 117:103874. [PMID: 33548592 DOI: 10.1016/j.ijnurstu.2021.103874] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Breastfeeding promotion is an important topic for infant health; and different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches to educational and supportive interventions to improve breastfeeding. OBJECTIVE To examine the effects of different approaches to educational and supportive interventions that can help sustain breastfeeding and improve breastfeeding self-efficacy for primiparous postnatal women; and to identify key characteristics of the effective interventions in terms of delivery time, format and mode, main components, use of theoretical framework, and number of sessions. METHODS Eleven electronic databases and reference lists of the eligible articles were searched. Randomised controlled trials of educational and supportive interventions published in English and Chinese language over recent 20 years were identified and screened against the review criteria. Risk of bias of the included studies was assessed. Primary outcome measures were exclusive breastfeeding and partial breastfeeding rate. Secondary outcomes included breastfeeding self-efficacy, breastfeeding knowledge and other breastfeeding related outcomes. Meta-analysis was performed in terms of ≤2 months, 3-5 months and ≥6 months postpartum. RESULTS Thirteen articles that met the inclusion criteria were included and showed an acceptable risk of bias. Educational and supportive interventions were found effective in increasing exclusive breastfeeding rate at ≤2 months and 6 months, partial breastfeeding rate as well as enhancing breastfeeding self-efficacy at ≤2 months. The optimal delivery time, format and structure of the interventions included: (a) delivering from antenatal to postnatal period; (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups; (c) both individual and group basis; (d) being guided by self-efficacy theory; and (e) having ≥3 sessions. CONCLUSIONS The findings suggest multicomponent, theory-based intervention with ≥3 sessions delivered via both face-to-face teaching and telephone follow-ups across antenatal and postnatal period can be effective to enhance exclusive breastfeeding over 6-month, partial breastfeeding and breastfeeding self-efficacy over 2-month postpartum. REGISTRATION NUMBER CRD42020175473 at the International Prospective Register of Systematic Reviews (PROSPERO).
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Affiliation(s)
- Mei Sze Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Huanyu Mou
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
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11
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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12
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Brugaletta C, Le Roch K, Saxton J, Bizouerne C, McGrath M, Kerac M. Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review. F1000Res 2020; 9:1310. [PMID: 33628437 PMCID: PMC7898355 DOI: 10.12688/f1000research.24516.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/08/2023] Open
Abstract
Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.
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Affiliation(s)
- Concetta Brugaletta
- Gastrointestinal Physiology Unit, University College London Hospitals NHS Trust, London, England, NW12BW, UK
| | - Karine Le Roch
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | | | - Cécile Bizouerne
- Mental Health and Care Practices Department, Action Contre la Faim, 75017 Paris, France
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, England, OX5 2DN, UK
| | - Marko Kerac
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, WC1E 7HT, UK
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13
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Kronborg H, Foverskov E. Multifactorial influence on duration of exclusive breastfeeding; a Danish cohort study. PLoS One 2020; 15:e0238363. [PMID: 32870906 PMCID: PMC7462295 DOI: 10.1371/journal.pone.0238363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
The multifactorial aspects of breastfeeding require measures at many levels to identify mothers in need of breastfeeding support from healthcare professionals. Our objective was to examine the relative importance of sociodemographic, pre/perinatal-, infant-, psychosocial-, and interaction-related factors affecting duration of exclusive breastfeeding. We used self-reported data from a community-based trial including 1265 women (response rate 49%) giving birth from January 2017 to February 2018. Data on outcome, duration of exclusive breastfeeding, were collected three and nine months postpartum; data on the study variables concerning known risk factors for breastfeeding cessation were collected two weeks postpartum. Crude and multiple Cox proportional hazards models were used for statistical analyses with additional analyses for time varying effects. Factors with an independent prognostic influence on duration of exclusive breastfeeding in fully adjusted models included early skin-to-skin contact (HR = 1.18 CI:1.04–1.33), intention to breastfeed (HR = 0.77 CI: 0.73–0.80), positive outcome evaluation, meaning the value mothers attributed to breastfeeding (HR = 1.33 CI: 1.08–1.63), higher level of self-efficacy (HR = 1.46 CI: 1.24–1.72), and maternal sense of security in relation to breastfeeding (HR = 1.31 CI: 1.14–1.50). Higher maternal BMI, lower self-efficacy, shorter breastfeeding duration of previous child, and hospitalization during birth were time dependent by affecting the exclusive breastfeeding duration primarily in the first months following birth. The results suggest that target groups in special need of early breastfeeding support are defined by being hospitalized, obese, having low self-efficacy or short previous breastfeeding experience. The extensive influence of psychosocial factors emphasizes the importance of including both practical facilitating guidance and positive verbal encouragement to ensure effective breastfeeding support.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Else Foverskov
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Nilsson IMS, Kronborg H, Rahbek K, Strandberg‐Larsen K. The significance of early breastfeeding experiences on breastfeeding self-efficacy one week postpartum. MATERNAL & CHILD NUTRITION 2020; 16:e12986. [PMID: 32543045 PMCID: PMC7296789 DOI: 10.1111/mcn.12986] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Many new mothers do not reach their breastfeeding goals. Breastfeeding self-efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self-efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self-efficacy in the first week postpartum, and drop in self-efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self-efficacy, and 26% drop in self-efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin-to-skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self-efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self-efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self-efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self-efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.
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Affiliation(s)
| | - Hanne Kronborg
- Department of Public Health, Section of NursingAarhus UniversityAarhusDenmark
| | - Keren Rahbek
- Department of Public health, Section of EpidemiologyCopenhagen UniversityCopenhagenDenmark
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15
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Minamida T, Iseki A, Sakai H, Imura M, Okano T, Tanii H. Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method? Infant Ment Health J 2020; 41:662-676. [PMID: 32578270 DOI: 10.1002/imhj.21866] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We investigated whether postpartum anxiety (PPA) and breastfeeding self-efficacy and bonding at the early postpartum period can be used to predict postpartum depression and the breastfeeding method, and we sought to identify factors related to postpartum depression. Of the 510 eligible women, 185 (36%) returned the questionnaire on all three occasions (1 day, 3 days, and 1 month after childbirth). The mothers' progress on the State-Trait Anxiety Inventory (STAI), Breastfeeding Self-Efficacy Scale Short Form (BFSES-SF), and Postnatal Bonding Questionnaire (PBQ) was observed over three periods. A repeated-measures ANOVA revealed that the mothers at high risk of developing postpartum depression (PPD) were those who did not show an increase in BFSES-SF score at early postpartum, and mothers whose bonding disorders have deteriorated rapidly. The results of the logistic regression analysis revealed a significant difference in employment as a factor related to postpartum depression. Compared to Regular, Part-time status was 4.4 times more likely and Unemployed status was 2.3 times more likely to cause postpartum depression. For the early detection of PPD, it is necessary to identify (1) mothers who do not show an increase in the BFSES-SF score, (2) mothers whose bonding disorders have deteriorated rapidly, and (3) part-time or unemployed mothers as characteristic of postpartum depression.
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Affiliation(s)
- Tomoko Minamida
- Prenatal and Postpartum Care Center, Osaka Midwives' Association, Osaka, Osaka, Japan
| | - Atsuko Iseki
- Gifu University School of Medicine Nursing Course, Gifu, Gifu, Japan
| | - Hiroko Sakai
- Graduate School of Nursing, Faculty of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masumi Imura
- Graduate School of Nursing, Department of Global Health Care and Midwifery, Japanese Red Cross College of Nursing, Shibuya, Tokyo, Japan
| | | | - Hisashi Tanii
- Center for Physical and Mental Health, Mie University, Graduate School of Medicine, Department of Health Promotion and Disease Prevention, Mie University, Tsu, Mie, Japan
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16
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The Effect of Kangaroo Mother Care, Provided in the Early Postpartum Period, on the Breastfeeding Self-Efficacy Level of Mothers and the Perceived Insufficient Milk Supply. J Perinat Neonatal Nurs 2020; 34:80-87. [PMID: 31895303 DOI: 10.1097/jpn.0000000000000434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the effect of kangaroo mother care, provided in the early postpartum period, on the breastfeeding self-efficacy level and the perceived insufficient milk supply. This study was conducted as the quasi-experimental design. The population of the study consisted of the mothers and their infants, to whom they gave birth in a university hospitals located in either eastern or western Turkey, between December 2016 and June 2017. In this study, mothers and their infants were randomly assigned to the experimental group (kangaroo mother care, n = 30) and the control group (n = 30). This study included 2500 to 4000 g birth weight infants who had no serious health problems and no sucking problems. The Introductory Information Form, the Breastfeeding Self-Efficacy Scale, and the Perception of Insufficient Milk Questionnaire were used to collect the data. In this study, kangaroo mother care was provided as a nursing intervention for the mothers in the experimental group twice a day until they were discharged. Any other application was not performed in the control group's mothers apart from the routine application. Ethical principles were adhered in all stages of the study. The breastfeeding self-efficacy mean score (65.50 ± 3.95) of the mothers who performed kangaroo mother care was higher than the mean score of the mothers who did not perform kangaroo mother care (55.50 ± 7.00) (P < .001). In addition, mothers in the experimental group (46.60 ± 3.40) perceived their milk more sufficiently than mothers in the control group (30.17 ± 11.37) (P < .001). In the study, a statistically significant correlation was determined between breastfeeding self-efficacy levels of mothers in the experimental group and the perceived insufficient milk supply (P < .05). In the study, kangaroo mother care increased breastfeeding self-efficacy perception of the mothers and reduced the perceived insufficient milk supply. This shows that kangaroo mother care can potentially have an important effect on breastfeeding perceptions.
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17
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Kronborg H, Væth M. Validation of the Breastfeeding Score-A Simple Screening Tool to Predict Breastfeeding Duration. Nutrients 2019; 11:nu11122852. [PMID: 31766388 PMCID: PMC6950692 DOI: 10.3390/nu11122852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/02/2019] [Accepted: 11/18/2019] [Indexed: 01/14/2023] Open
Abstract
Easy to use screening tools to identify mothers in risk of early breastfeeding cessation are needed. The purpose was to validate a revised version of the breastfeeding score, consisting of four questions addressing completed education, earlier breastfeeding duration, self-efficacy, and sense of security not knowing the exact amount of milk the baby ingests. We used two cohorts from 2004 (n = 633) and 2017 (n = 579) to explore the predictive validity of the breastfeeding score to identify mothers at risk of breastfeeding cessation within the first 17 weeks postpartum. The analyses included sensitivity and specificity, clinically relevant cut-points, and calibrations plots. A cut-point ≥5 points identified 61% of first-time and 42% of multiparous mothers in the validation cohort 2017 to be at risk of early breastfeeding cessation with a sensitivity and specificity of 80% and 60% for first-time, and 69% and 82% for multiparous, respectively. The corresponding numbers in the 2004 cohort were almost identical. The area under the receiver operating characteristic (ROC) curves were 0.77 and 0.78 and the calibration plots showed good agreement for the two cohorts. The breastfeeding score indicated good ability to discriminate between mothers at risk of early exclusive breastfeeding cessation. The simple form of the tool makes it easy to use in daily practice.
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18
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Huang P, Yao J, Liu X, Luo B. Individualized intervention to improve rates of exclusive breastfeeding: A randomised controlled trial. Medicine (Baltimore) 2019; 98:e17822. [PMID: 31764775 PMCID: PMC6882561 DOI: 10.1097/md.0000000000017822] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite breastfeeding is significant benefits for maternal and infant, the discontinuation of breastfeeding is high. Some of studies showed that the effect of intervention in improving the rate of exclusively breastfeeding is unclear. The aim of this study is to investigate the effectiveness of individualized intervention compared with routine care in improving rates of exclusive breast feeding. METHODS Women were divided into two groups. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. Significance was set at P < .05. RESULTS We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12-2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76-4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09-19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48-12.49). CONCLUSION The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.
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Affiliation(s)
- Pan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- West China School of Nursing/West China Second Hospital Obstetrics Department Sichuan University
| | - Jianrong Yao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xinghui Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Biru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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19
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Fair FJ, Ford GL, Soltani H. Interventions for supporting the initiation and continuation of breastfeeding among women who are overweight or obese. Cochrane Database Syst Rev 2019; 9:CD012099. [PMID: 31529625 PMCID: PMC6747740 DOI: 10.1002/14651858.cd012099.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant.Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long-term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. OBJECTIVES To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. SEARCH METHODS On 23 January 2019 we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are overweight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group. DATA COLLECTION AND ANALYSIS We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster-RCT) involving 831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high-income countries: USA (5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias.Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low-certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41 to 1.03). The trial did not report other important outcomes of interest in this review: non-initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum.Multiple methods of breastfeeding support versus usual care Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face-to-face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest.We are unclear about the effects of the intervention because we identified very low-certainty evidence for all of the important outcomes in this review: rate of non-initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks (average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); rate of exclusive breastfeeding at six months postpartum (RR 7.23, 95% CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2 trials, 223 women).The included trials under the above comparisons also reported on some of this review's secondary outcomes but very low-certainty evidence means that we are unclear about the effects of the intervention on those outcomes. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low-certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups.Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions.
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Affiliation(s)
- Frankie J Fair
- Sheffield Hallam UniversityFaculty of Health and WellbeingMundella House 34 Collegiate CrescentSheffieldUKS10 2BP
| | - Gemma L Ford
- Sheffield Hallam UniversityDepartment of Nursing and MidwiferyCity Campus, Howard StreetSheffieldUKS11WB
| | - Hora Soltani
- Sheffield Hallam UniversityFaculty of Health and WellbeingMundella House 34 Collegiate CrescentSheffieldUKS10 2BP
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Kassianos AP, Ward E, Rojas-Garcia A, Kurti A, Mitchell FC, Nostikasari D, Payton J, Pascal-Saadi J, Spears CA, Notley C. A systematic review and meta-analysis of interventions incorporating behaviour change techniques to promote breastfeeding among postpartum women. Health Psychol Rev 2019; 13:344-372. [PMID: 31117897 DOI: 10.1080/17437199.2019.1618724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
The benefits of exclusive breastfeeding are well documented, yet few women adhere to recommendations. We report the Behaviour Change Techniques (BCTs) within interventions trialled internationally after pregnancy to promote exclusive and mixed breastfeeding as well as evidence of effectiveness. PsycINFO, EMBASE and MEDLINE databases were screened. Twenty-three (n = 23) studies met inclusion criteria. Three authors independently extracted data, coded interventions using the BCT v.1 taxonomy, and assessed study quality. There was a moderate significant effect of the interventions promoting exclusive breastfeeding up to four weeks postpartum (OR 1.77, [95% CI: 1.47-2.13]) but this effect slightly declined beyond thirteen weeks (OR 1.63, [95% CI: 1.07-2.47]). Twenty-nine BCTs were identified within interventions. 'Credible source' and 'instruction on how to perform the behaviour' were the most prevalent and 'social support (unspecified)' contributed to the effectiveness of exclusive breastfeeding interventions five to eight weeks postpartum. Using BCTs with cognitive and behavioural aspects may help women develop coping mechanisms promoting exclusive breastfeeding. Further trials are needed in countries with low breastfeeding rates such as the UK. The use of programme theory during intervention development and clear description of intervention components is recommended. This meta-analysis provides guidance for trials evaluating postpartum breastfeeding interventions.
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Affiliation(s)
| | - Emma Ward
- b Norwich Medical School, University of East Anglia , Norwich , UK
| | - Antonio Rojas-Garcia
- a Department of Applied Health Research, UCL , London , UK
- c NIHR CLAHRC North Thames , London , UK
| | - Allison Kurti
- d Department of Psychiatry and Psychological Science, University of Vermont , Burlington , VT , USA
| | - Fiona C Mitchell
- e Psychological Sciences and Health, University of Strathclyde , Glasgow , UK
| | - Dian Nostikasari
- f Kinder Institute for Urban Research, Rice University , Houston , TX , USA
| | - Jamie Payton
- g Department of Computer and Information Sciences, Temple University , Philadelphia , PA , USA
| | | | - Claire Adams Spears
- h Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health , Atlanta , GA , USA
| | - Caitlin Notley
- b Norwich Medical School, University of East Anglia , Norwich , UK
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Yılmaz M, Aykut M. The effect of breastfeeding training on exclusive breastfeeding: a randomized controlled trial. J Matern Fetal Neonatal Med 2019; 34:925-932. [PMID: 31345049 DOI: 10.1080/14767058.2019.1622672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Although exclusive breastfeeding is very beneficial for children's and mothers' health, a limited number of infants are exclusively breastfed for 6 months. AIM This randomized controlled intervention study aims to determine the effect of breastfeeding training on mothers' knowledge, behaviors, and exclusive breastfeeding for 6 months. MATERIALS AND METHODS The participants were selected randomly for training (n = 60) and control groups (n = 60) among the pregnant women admitted to the obstetrics and gynecology polyclinics of a baby-friendly hospital. The training group received breastfeeding training during the prenatal and postnatal periods. The data were collected using a questionnaire during admission and at the postpartum 1st and 24th weeks through face-to-face interviews. The study was completed with 34 and 30 mother-infant pairs in the training and control groups, respectively. Analyzed using the chi-square, Student t, Mann-Whitney U, and Wilcoxon t-tests. RESULTS The difference between the number of correct answers in pre- and posttest was higher in the training group (four questions) than in the control group (two questions) (p < .001). The number of mothers exclusively breastfeeding for 6 months was significantly higher in the training group (26.5%) than in the control group (3.3%) (p = .015). The median of the exclusive breastfeeding period was longer in the training group (5 months) than in the control group (4 months) (p = .013). CONCLUSION Training and supporting pregnant women and breastfeeding mothers on breastfeeding increased their knowledge, the period of exclusive breastfeeding, and the rate of 6-month exclusive breastfeeding.
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Affiliation(s)
- Müge Yılmaz
- Department of Nutrition and Dietetics, Faculty of Health Science, Erciyes University, Kayseri, Turkey
| | - Mualla Aykut
- Department of Public Health, Erciyes University, Faculty of Medicine, Kayseri, Turkey.,Department of Nutrition and Dietetics, Faculty of Health Science, Nuh Naci Yazgan University, Kayseri, Turkey
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The effect of home-based intervention with professional support on promoting breastfeeding: a systematic review. Int J Public Health 2019; 64:999-1014. [PMID: 31197407 DOI: 10.1007/s00038-019-01266-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/29/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Low breastfeeding rate and high early cessation of breastfeeding are observed worldwide. There is a need to review the effects of home visits with professional support on promoting breastfeeding. The present study evaluated the efficacy of home visits on promoting breastfeeding outcomes (i.e., breastfeeding initiation rate, exclusive breastfeeding rate/duration, and breastfeeding rate/duration) using a systematic review. METHODS Search of EMBASE, MEDLINE, CENTRAL-Cochrane central register of controlled trials, PsycInfo, and ClinicalTrials.gov was conducted by February 28, 2019, to identify relevant studies. RESULTS A total of 26 studies were included. Fourteen of the included studies investigated rate/duration of exclusive breastfeeding; ten of them demonstrated a significant increase on the rate/duration of exclusive breastfeeding. Sixteen of the included studies investigated rate/duration of breastfeeding; four of them demonstrated a significant increase on the rate/duration of breastfeeding. Four studies evaluated initiation of breastfeeding and three of them did not show a significant effect. CONCLUSIONS Findings suggest that breastfeeding can be increased by home-based interventions with professional support. Support-based intervention is likely an effective way to promote breastfeeding.
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Cavalcanti DS, Cabral CS, de Toledo Vianna RP, Osório MM. Online participatory intervention to promote and support exclusive breastfeeding: Randomized clinical trial. MATERNAL AND CHILD NUTRITION 2019; 15:e12806. [PMID: 30825414 DOI: 10.1111/mcn.12806] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 02/04/2023]
Abstract
The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother-child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.
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Affiliation(s)
| | | | | | - Mônica Maria Osório
- Post-Graduate Program in Nutrition, Pernambuco Federal University, Recife, Brazil
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Outcome Measures in Interventions That Enhance Breastfeeding Initiation, Duration, and Exclusivity: A Systematic Review. MCN Am J Matern Child Nurs 2019; 43:341-347. [PMID: 30339580 DOI: 10.1097/nmc.0000000000000472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this review was to examine outcome measures used in interventions focusing on enhancement of breastfeeding initiation, duration, and exclusivity. METHODS A literature search guided by search terms on outcome measures of breastfeeding interventions was conducted using PubMed, CINAHL Plus, & PsycINFO databases on publications between 2006 and 2017. RESULTS Nine studies were included in this review, using PRISMA guidelines. Rates of breastfeeding initiation, duration, and exclusivity were measured during specific points in time. Data collection methods involve interviews, self-report, observations, and/or feeding logs. Although breastfeeding types (exclusive breastfeeding, predominant breastfeeding, and complementary breastfeeding) were measured, methods of infant feeding (breastfeeding and bottle feeding) were rarely assessed, ignoring significant mediators or moderators of breastfeeding. CONCLUSIONS There were methodological limitations to the reviewed studies: (1) a 24-hour recall bias, (2) misclassification of breastfeeding categories, (3) lack of consistency in breastfeeding definitions, and (4) few reports of the reason for breastfeeding discontinuation. Future studies should focus on the modifiable cause of the problem: outcome measures attributed to the targets of the intervention, followed by breastfeeding initiation, duration, and/or exclusivity.
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Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Giugliani ERJ, Nunes LM, Issler RMS, Santo LCDE, Oliveira LDD. Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial. J Pediatr (Rio J) 2019; 95:166-172. [PMID: 29447832 DOI: 10.1016/j.jped.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/03/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. METHODS This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. RESULTS The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days). CONCLUSIONS The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.
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Affiliation(s)
- Elsa Regina Justo Giugliani
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Pediatria, Porto Alegre, RS, Brazil
| | - Leandro Meirelles Nunes
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Pediatria, Porto Alegre, RS, Brazil.
| | - Roberto Mário Silveira Issler
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Pediatria, Porto Alegre, RS, Brazil
| | - Lilian Cordova do Espírito Santo
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Departamento de Enfermagem Materno Infantil, Porto Alegre, RS, Brazil
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Kronborg H, Foverskov E, Væth M, Maimburg RD. The role of intention and self-efficacy on the association between breastfeeding of first and second child, a Danish cohort study. BMC Pregnancy Childbirth 2018; 18:454. [PMID: 30466403 PMCID: PMC6251224 DOI: 10.1186/s12884-018-2086-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of parity on breastfeeding duration may be explained by physiological as well as psychosocial factors. The aim in the present study was to investigate the mediating influence of intention and self-efficacy on the association between the breastfeeding duration of the first and the following child. METHODS A 5-year Danish cohort study with data from online questionnaires was used. Data came from 1162 women, who participated in the "Ready for child" trial in 2006-7 and gave birth to their second child within 5 years in 2011-3. Analysis included multiple regression models with exclusive/any breastfeeding duration of first child as the exposure variables, intention and self-efficacy measured as mediators, and exclusive/any breastfeeding duration of the second child as the outcome variables. RESULTS Duration of exclusive breastfeeding of the first child was significantly associated with exclusive breastfeeding duration of the second child (p < 0.001) and with the self-reported intention and self-efficacy in the ability to breastfeed the second child (p < 0.001). The exclusive breastfeeding period was slightly longer for the second child. Self-efficacy and intention mediated the association between breastfeeding duration in the first and second child. Together the two factors explained 48% of the association in exclusive breastfeeding and 27% of the association in any breastfeeding between the first and second child. CONCLUSION Due to a reinforcing effect of intention and self-efficacy, breastfeeding support should focus on helping the first time mothers to succeed as well as to identify the second time mother with low self-efficacy and additional need for support.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, 8000, Aarhus C, Denmark.
| | - Else Foverskov
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Væth
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus C, Denmark
| | - Rikke D Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark
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Abdulahi M, Fretheim A, Magnus JH. Effect of breastfeeding education and support intervention (BFESI) versus routine care on timely initiation and exclusive breastfeeding in Southwest Ethiopia: study protocol for a cluster randomized controlled trial. BMC Pediatr 2018; 18:313. [PMID: 30257661 PMCID: PMC6158863 DOI: 10.1186/s12887-018-1278-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant mortality rates are still high in Ethiopia. Breastfeeding is regarded as the simplest and least expensive strategy for reduction of infant mortality rates. Community-based educational and support interventions provided prenatally and postnatally are effective in increasing breastfeeding rates. However, such interventions are not widely implemented in Ethiopia. This study aims to assess the effect of breastfeeding education and support on timely initiation and duration of exclusive breastfeeding. METHODS A cluster-randomized controlled trial at the community level will be conducted to compare the effect of breastfeeding education and support versus routine care. The intervention will be provided by Women Development Army leaders who are already in the country's health system using a 40-h WHO breastfeeding counseling course, "Infant and Young Child Feeding Counseling: an integrated course" and the "Training of Trainers Manual for Counseling on Maternal, Infant and Young Child Nutrition" in the local language. Culturally appropriate operational packages of information will be developed for them. Using preset criteria at least 432 pregnant women in their third trimester will be recruited from 36 zones. Visits in the intervention arm include two prenatal visits and 8 postnatal visits. Supervisory visits will be conducted monthly to each intervention zone. Data will be entered into Epi-data version 3.1 and analyzed using STATA version 13.0. All analysis will be done by intention to treat analysis. We will fit mixed-effects linear regression models for the continuous outcomes and mixed-effects linear probability models for the binary outcomes with study zone as random intercept to estimate study arm difference (intervention vs. routine education) adjusted for baseline value of the outcome and additional relevant covariates. The protocol was developed in collaboration with the Jimma Zone and Mana district Health office. Ethical clearance was obtained from the Institutional Review Board of University of Oslo and Jimma University. This study is partly funded by NORAD's NORHED programme. DISCUSSION We expect that the trial will generate findings that can inform breastfeeding policies and practices in Ethiopia. TRIAL REGISTRATION ClinicalTrials.gov NCT 03030651 January 25, 2017 version 3 dated 16 July 2018.
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Affiliation(s)
- Misra Abdulahi
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Atle Fretheim
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jeanette H. Magnus
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, USA
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Campbell T, Shackleton N. Pre-pregnancy body mass index and breastfeeding initiation, early cessation and longevity: evidence from the first wave of the UK Millennium Cohort Study. J Epidemiol Community Health 2018; 72:1124-1131. [DOI: 10.1136/jech-2017-209074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/20/2018] [Accepted: 08/17/2018] [Indexed: 11/04/2022]
Abstract
BackgroundInternational evidence indicates relationships between pre-pregnancy body mass index (BMI) and breastfeeding behaviours. This study aims to assess associations between key points in the breastfeeding trajectory (initiation, early cessation and longevity) and pre-pregnancy BMI in a recent, nationally representative British cohort. It also aims to explore in the British context potential moderation by mothers’ ethnic group.MethodsThe sample comprises 17 113 mothers from the UK Millennium Cohort Study who have information on pre-pregnancy BMI. Associations between pre-pregnancy BMI categories and breastfeeding initiation, early cessation and longevity are tested using logistic regression. Directed acyclic graphics identify appropriate minimal adjustment to block biasing pathways and classify total and direct effects.ResultsAfter adjusting for confounders, there are large differences in breastfeeding early cessation and longevity by pre-pregnancy BMI group. Differences in propensity to initiation are negligible. Having begun breastfeeding, overweight and obese mothers are more likely to cease in the first week and less likely to continue past 4 months. Observed potential mediators within pregnancy and delivery provide little explanation for relationships. Evidence for moderation by ethnicity is scant.ConclusionsThe causal mechanisms underlying relationships between pre-pregnancy overweight, obesity, and breastfeeding behaviours require further research. However, this study suggests pre-pregnancy BMI as one predictive measure for targeting support to women less likely to establish breastfeeding in the early days, and to continue beyond 4 months. The nature of support should carefully be considered and developed, with mind to both intended and potential unintended consequences of intervention given the need for additional investigation into the causes of associations.
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Muda CMC, Ismail TAT, Jalil RA, Hairon SM, Sulaiman Z, Johar N. Maternal Factors Associated with the Initiation of Exclusive Breastfeeding among Mothers at One Week after Delivery in Two Selected Hospitals in Kelantan, Malaysia. Malays J Med Sci 2018; 25:112-121. [PMID: 30914853 PMCID: PMC6422543 DOI: 10.21315/mjms2018.25.4.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
Background The first week following delivery usually coincides with the initiation of exclusive breastfeeding. This study aimed to determine the prevalence of and the associated factors regarding the initiation of exclusive breastfeeding among mothers at one week after delivery in two selected hospitals in the state of Kelantan, Malaysia. Methods A cross-sectional study was conducted from March to August 2015 among post-partum mothers, who were selected through systematic sampling. A newly developed and validated questionnaire on the participants’ data, knowledge and attitude items and a breastfeeding practice checklist were used. The mothers were interviewed in the post-natal ward, and their breastfeeding practices were determined through a phone call at one week following delivery. Descriptive statistics and simple and multiple logistic regressions were used for the data analysis. Results A total of 335 participants were included. The prevalence of exclusive breastfeeding at one week post-partum was 77.9% (95% CI: 73.0%, 82.2%), with significant associated factors being previous exclusive breastfeeding experience [adjusted odds ratio (AOR) 2.48; 95% CI: 1.37, 4.49; P-value = 0.003] and the mean total score of knowledge [AOR 1.06; 95% CI: 1.01, 1.11; P-value = 0.011]. Conclusion Every mother should receive breastfeeding education, with special emphasis on those with no previous experience. The weak areas of knowledge identified herein should be strengthened during health education.
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Affiliation(s)
- Che Muzaini Che' Muda
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Kedah State Health Office, Simpang Kuala, Jalan Kuala Kedah, 05400 Alor Setar, Kedah, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Rohana Ab Jalil
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nazirah Johar
- Lactation Secretariat, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Muda CMC, Ismail TAT, Jalil RA, Hairon SM, Sulaiman Z, Johar N. Postnatal breastfeeding education at one week after childbirth: What are the effects? Women Birth 2018; 32:e243-e251. [PMID: 30057368 DOI: 10.1016/j.wombi.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/30/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The first week after childbirth is a crucial period for exclusive breastfeeding initiation. OBJECTIVE This study aims to determine the association of postnatal breastfeeding education with knowledge, attitude, and exclusive breastfeeding practice at six months after childbirth among women who delivered at two district hospitals in the northeast part of Peninsular Malaysia. METHODS This is a quasi-experimental study design. A newly developed and validated questionnaire was used to determine scoring for baseline and six months after childbirth. The intervention consisted of individualized postnatal breastfeeding education delivered by researchers using flipchart one week after childbirth and breastfeeding diary in addition to usual care. The comparison group received the usual postnatal care by health clinics. Repeated measure analysis of variance and multiple logistic regression analysis were used. RESULTS A total of 116 participants were included in this study (59 in intervention group and 57 in comparison group). Six months after childbirth, the adjusted mean score of knowledge and attitude of the intervention group were significantly higher than that of the comparison group (p<0.001 and p=0.002, respectively). More participants in the intervention group (n=26, 44.1%) exclusively breastfed their infants compared with 15 (26.3%) in the comparison group (p=0.046). Postnatal breastfeeding education was significantly associated with exclusive breastfeeding practice six months after childbirth [adjusted odds ratio 2.31; 95% confidence interval: 1.02, 5.14; p=0.040]. CONCLUSIONS Postnatal breastfeeding education was significantly associated with an improvement in women's knowledge, attitude and exclusive breastfeeding practice six months after childbirth.
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Affiliation(s)
- Che Muzaini Che' Muda
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Tengku Alina Tengku Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Rohana Ab Jalil
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zaharah Sulaiman
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nazirah Johar
- Lactation Unit, Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Kristensen IH, Kronborg H. What are the effects of supporting early parenting by enhancing parents' understanding of the infant? Study protocol for a cluster-randomized community-based trial of the Newborn Behavioral Observation (NBO) method. BMC Public Health 2018; 18:832. [PMID: 29973172 PMCID: PMC6032542 DOI: 10.1186/s12889-018-5747-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Support to strengthen the early parent-infant relationship is recommended to ensure the infant’s future health and development. Little is known about the universal approaches taken by health visitor to support this early relationship. The aim of this study is to investigate the effects of health visitors’ use of the Newborn Behavioral Observation (NBO) method among new parents. Methods This is a cluster-randomised community-based study implemented in four Danish municipalities. Health visitors will conduct the trial, and the geographical districts they work in will constitute the clusters as units of randomisation. The participants will be approximately 2800 new families, randomised into an intervention or a comparison group according to their health visitor. The families are recruited at the first postpartum home visit. Parents in both groups receive care as usual: parents in the intervention group also receive the standardised NBO method in home visits performed from 3 weeks to 3 months postpartum. Data consist of self-reported parent questionnaires and video recordings of a selected group of vulnerable first-time mothers recorded 4 months postpartum. The self-reported data are obtained: at baseline 1 week postpartum and then at follow-up 3, 9 and 18 months postpartum. Data will be analysed using the intention-to-treat method and the analyses will include comparison of change in the primary variables across time supplemented by multiple regression analysis. The primary study outcomes are measured by the following factors: parental confidence, infants’ socio-emotional development and mother-infant relationship. Other measures include parental mood and stress, breastfeeding duration and utility of the health visitor services. Data collection among the health visitors in both groups will serve to monitor any change in practice regarding the work with early parent-infant interactions. Discussion This protocol describes an evaluation of the NBO method used universally in health visiting practice. The intervention seeks to support early parenting by increasing parents’ understanding of their infants’ cues. The NBO is currently implemented in Denmark even though an evaluation of the NBO has yet to be made in a community setting in Denmark and internationally. The study may contribute to building an increasingly evidence-based practice for health visitors. Trial registration ClinicalTrials.gov ID: NCT03070652. Registered February 22, 2017.
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Affiliation(s)
| | - Hanne Kronborg
- Section of Nursing, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Galipeau R, Baillot A, Trottier A, Lemire L. Effectiveness of interventions on breastfeeding self-efficacy and perceived insufficient milk supply: A systematic review and meta-analysis. MATERNAL AND CHILD NUTRITION 2018; 14:e12607. [PMID: 29655287 DOI: 10.1111/mcn.12607] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/26/2017] [Accepted: 02/04/2018] [Indexed: 12/23/2022]
Abstract
The aim of this systematic review and meta-analysis was to assess the efficacy on an intervention on breastfeeding self-efficacy and perceived insufficient milk supply outcomes. The literature search was conducted among 6 databases (CINAHL, Medline, PsyncInfo, Scopus, Cochrane, and ProQuest) in between January 2000 to June 2016. Two reviewers independently assessed the articles for the following inclusion criteria: experimental or quasi-experimental studies; healthy pregnant women participants intending to breastfeed or healthy breastfeeding women who gave birth to a term singleton and healthy baby; intervention administered could have been educational, support, psycho-social, or breastfeeding self-efficacy based, offered in prenatal or postnatal or both, in person, over the phone, or with the support of e-technologies; breastfeeding self-efficacy or perceived insufficient milk supply as outcomes. Seventeen studies were included in this review; 12 were randomized controlled trials. Most interventions were self-efficacy based provided on 1-to-1 format. Meta-analysis of RCTs revealed that interventions significantly improved breastfeeding self-efficacy during the first 4 to 6 weeks (SMD = 0.40, 95% CI 0.11-0.69, p = 0.006). This further impact exclusive breastfeeding duration. Only 1 study reported data on perceived insufficient milk supply. Women who have made the choice to breastfeed should be offered breastfeeding self-efficacy-based interventions during the perinatal period. Although significant effect of the interventions in improving maternal breastfeeding self-efficacy was revealed by this review, there is still a paucity of evidence on the mode, format, and intensity of interventions. Research on the modalities of breastfeeding self-efficacy should be pursued.
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Affiliation(s)
- Roseline Galipeau
- Nursing Department, Université du Québec en Outaouais, Saint-Jérôme, Quebec, Canada
| | - Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Alexia Trottier
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Linda Lemire
- Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
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Chanani S, Waingankar A, Shah More N, Pantvaidya S, Fernandez A, Jayaraman A. Participation of pregnant women in a community-based nutrition program in Mumbai's informal settlements: Effect on exclusive breastfeeding practices. PLoS One 2018; 13:e0195619. [PMID: 29621355 PMCID: PMC5886586 DOI: 10.1371/journal.pone.0195619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother’s pregnancy. Methods The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. Results The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. Conclusions Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices.
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Affiliation(s)
- Sheila Chanani
- Society for Nutrition, Education and Health Action, Mumbai, India
- * E-mail:
| | | | - Neena Shah More
- Society for Nutrition, Education and Health Action, Mumbai, India
| | | | - Armida Fernandez
- Society for Nutrition, Education and Health Action, Mumbai, India
| | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Mumbai, India
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Interventions that Enhance Breastfeeding Initiation, Duration, and Exclusivity: A Systematic Review. MCN Am J Matern Child Nurs 2018; 41:299-307. [PMID: 27286289 DOI: 10.1097/nmc.0000000000000264] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this review was to evaluate breastfeeding interventions trialed to date and recommend directions for future needs in breastfeeding research. METHODS A literature review was conducted using PubMed, CINAHL Plus, and PsycINFO databases to identify studies that evaluated efficacy or effectiveness of breastfeeding interventions on breastfeeding initiation, duration, or exclusivity as a primary, secondary, or tertiary outcome. Combinations of search terms included breastfeeding, feeding behavior, prenatal/patient education, health promotion, social support, perinatal/prenatal/intrapartum/postnatal care, and postpartum period. RESULTS Six studies were included in this review, using PRISMA guidelines. Acquisition of knowledge and skills, emotional support by healthcare providers, and self-efficacy over maternal confidence in her ability to breastfeed were factors the intervention studies relied on to affect breastfeeding practices. Although these factors were addressed in the studies, breastfeeding mothers had difficulty transferring what they gained from interventions into their real-life breastfeeding practices as evidenced by the highest drop-off rate of exclusive breastfeeding in the early postpartum. CONCLUSIONS There were conceptual limitations to the reviewed studies: (1) lack of understanding of maternal perception of infant behavior and (2) perceived insufficient milk as a remaining primary reason for breastfeeding discontinuation. There were methodological limitations: (1) lack of theory-based interventions and (2) lack of intervention fidelity. Future studies involving breastfeeding should focus on the causes of the problems driven by theory-based interventions integrated with intervention fidelity.
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Kim SK, Park S, Oh J, Kim J, Ahn S. Interventions promoting exclusive breastfeeding up to six months after birth: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2018; 80:94-105. [PMID: 29407349 DOI: 10.1016/j.ijnurstu.2018.01.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 11/24/2017] [Accepted: 01/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that mothers practice exclusive breastfeeding (EBF) of their infants for 6 months. Various breastfeeding support interventions have been developed to encourage mothers to maintain breastfeeding practices. Research aim: This study aims to review how effectively breastfeeding support interventions enable mothers to practice EBF for 6 months and to suggest the best intervention strategies. METHODS Six databases were searched, including MEDLINE, EMBASE, Cochrane, CINAHL, PsycINFO, and KoreaMed. The authors independently extracted data from journals written in English or Korean and published between January 2000 and August 2017. Randomized controlled trials (RCTs) reporting EBF until 6 months were screened. RESULTS A total of 27 RCTs were reviewed, and 36,051 mothers were included. The effectiveness of breastfeeding support interventions to promote EBF for 6 months was significant (odds ratio [OR] = 2.77; 95% confidence interval [CI]: 1.81-3.76). A further subgroup analysis of intervention effects shows that a baby friendly hospital initiative (BFHI) intervention (OR = 5.21; 95% CI: 2.15-12.61), a combined intervention (OR = 3.56; 95% CI: 1.74-7.26), a professional provider led intervention (OR = 2.76; 95% CI: 1.76-4.33), having a protocol available for the provider training program (OR = 2.87; 95% CI: 1.89-4.37) and implementation during both the prenatal and postnatal periods (OR = 3.32; 95% CI: 1.83-6.03) increased the rate of EBF for 6 months. CONCLUSION We suggest considering a multicomponent intervention as the primary strategy and implementing BFHI interventions within hospitals. Evidence indicates that intervention effectiveness increases when a protocol is available for provider training, when interventions are conducted from the pre- to postnatal period, when the hospital and community are connected, and when healthcare professionals are involved.
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Affiliation(s)
| | - Seyeon Park
- Chungnam National University, Daejeon, South Korea
| | - Jiwon Oh
- Chungnam National University, Daejeon, South Korea
| | - Jisoon Kim
- Chungnam National University, Daejeon, South Korea
| | - Sukhee Ahn
- Chungnam National University, Daejeon, South Korea.
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Pilot test of a home-based program to prevent perceived insufficient milk. Women Birth 2017; 30:472-480. [DOI: 10.1016/j.wombi.2017.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 04/17/2017] [Accepted: 04/25/2017] [Indexed: 11/21/2022]
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Meedya S, Fernandez R, Fahy K. Effect of educational and support interventions on long-term breastfeeding rates in primiparous women: a systematic review and meta-analysis. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2307-2332. [PMID: 28902698 DOI: 10.11124/jbisrir-2016-002955] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Long-term breastfeeding, including exclusive breastfeeding for six months and continuation of breastfeeding with complementary food until two years of age, has been recommended by the World Health Organization. However, despite the clear benefits of long-term breastfeeding (six months and beyond), the rates of breastfeeding still continue to remain low. Although there are some individual interventional studies that aimed to increase prolonged breastfeeding rates among both multiparous and primiparous women, there is no systematic review or meta-analysis to examine the effectiveness of those interventions among primiparous women who had no previous breastfeeding experience. OBJECTIVES The aim of this review was to identify the effects of professional educational and support interventions on breastfeeding rates at six months and up to two years postpartum compared to the standard care among primiparous women. INCLUSION CRITERIA TYPES OF PARTICIPANTS Studies that included primiparous women aged 18 and over who intended to breastfeed. TYPES OF INTERVENTION(S) Studies that investigated the effect of educational and support interventions provided by health professionals during the antenatal, postnatal period or both. TYPES OF STUDIES Randomized controlled trials. OUTCOMES Studies with reported breastfeeding rates at six months or up to two years postpartum. SEARCH STRATEGY A three-step search strategy was utilized in this review. The search was conducted in Cochrane, MEDLINE and CINAHL databases. Only trials that met the inclusion criteria and published in English were considered for this review. Databases were searched from their commencement year to May 2016. METHODOLOGICAL QUALITY Two independent reviewers selected the papers using the standardized critical appraisal tool from the Joanna Briggs Institute. DATA EXTRACTION AND DATA SYNTHESIS Data was extracted using the standardized Joanna Briggs Institute data extraction instrument. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan v5.3 (Copenhagen: The Nordic Cochrane Centre, Cochrane). In the absence of trials comparing the same outcomes, meta-analysis could not be performed; the findings have therefore been presented in a narrative form, including tables and figures to aid in data presentation where appropriate. RESULTS Ten randomized controlled trials were included in this review. Interventions with only one antenatal or postnatal component were not effective in increasing breastfeeding rates at six months. However, based on one trial, an intervention that included antenatal education and support in combination with postnatal education and support doubled the rate of breastfeeding at six months among primiparous women randomized to the intervention group compared to the control group (p = 0.28). CONCLUSION Despite the good methodological quality of the trials, due to the heterogeneity of the interventions and outcome measures (types of breastfeeding) it was not possible to identify any specific effective intervention. However, based on a single trial, it appears that a combination of antenatal and postnatal education interventions may be useful in increasing breastfeeding rates at six months.
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Affiliation(s)
- Shahla Meedya
- 1School of Nursing, University of Wollongong, Wollongong, Australia 2Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence, University of Wollongong, Wollongong, Australia; St George Hospital, Kogarah, Australia 3School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
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Abstract
BACKGROUND Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. OBJECTIVES To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. SELECTION CRITERIA Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. MAIN RESULTS We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. AUTHORS' CONCLUSIONS Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
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Affiliation(s)
- Naohiro Yonemoto
- Translational Medical Center, National Center of Neurology and PsychiatryDepartment of Epidemiology and Biostatistics4‐1‐1 OgawahigashimachiKodairaTokyoJapan187‐8553
| | - Therese Dowswell
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Shuko Nagai
- Research Institute of TuberculosisDepartment of International Cooperation3‐1‐24 Matsuyama,KiyoseTokyoTokyoJapan204‐8533
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraSetagaya‐kuTokyoTokyoJapan157‐0074
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A systematic approach towards the development of quality indicators for postnatal care after discharge in Flanders, Belgium. Midwifery 2017; 48:60-68. [PMID: 28347927 DOI: 10.1016/j.midw.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/27/2016] [Accepted: 02/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE to develop a set of quality indicators for postnatal care after discharge from the hospital, using a systematic approach. DESIGN key elements of qualitative postnatal care were defined by performing a systematic review and the literature was searched for potential indicators (step 1). The potential indicators were evaluated by five criteria (validity, reliability, sensitivity, feasibility and acceptability) and by making use of the 'Appraisal of Guidelines for Research and Evaluation', the AIRE-instrument (step 2). In a modified Delphi-survey, the quality indicators were presented to a panel of experts in the field of postnatal care using an online tool (step 3). The final results led to a Flemish model of postnatal care (step 4). SETTING Flanders, Belgium PARTICIPANTS: health care professionals, representatives of health care organisations and policy makers with expertise in the field of postnatal care. FINDINGS after analysis 57 research articles, 10 reviews, one book and eight other documents resulted in 150 potential quality indicators in seven critical care domains. Quality assessment of the indicators resulted in 58 concept quality indicators which were presented to an expert-panel of health care professionals. After two Delphi-rounds, 30 quality indicators (six structure, 17 process, and seven outcome indicators) were found appropriate to monitor and improve the quality of postnatal care after discharge from the hospital. KEY CONCLUSIONS AND IMPLICATIONS FOR CLINICAL PRACTICE: the quality indicators resulted in a Flemish model of qualitative postnatal care that was implemented by health authorities as a minimum standard in the context of shortened length of stay. Postnatal care should be adjusted to a flexible length of stay and start in pregnancy with an individualised care plan that follows mother and new-born throughout pregnancy, childbirth and postnatal period. Criteria for discharge and local protocols about the organisation and content of care are essential to facilitate continuity of care.
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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Wood NK, Sanders EA. Mothers With Perceived Insufficient Milk: Preliminary Evidence of Home Interventions to Boost Mother–Infant Interactions. West J Nurs Res 2017; 40:1184-1202. [DOI: 10.1177/0193945916687552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother–infant interactions through home interventions designed to overcome PIM as a result of the infant’s behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother–infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother–infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother’s sensitivity to cues, cognitive growth fostering, infant’s clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother–infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.
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Meedya S, Fahy K, Parratt JA. The Milky Way educational and support programme: Structure, content and strategies. Women Birth 2016; 29:388-93. [DOI: 10.1016/j.wombi.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/04/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
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Kronborg H, Foverskov E, Nilsson I, Maastrup R. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 26799605 DOI: 10.1111/mcn.12251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/13/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022]
Abstract
The present study addressed the contentious discussions about the benefits and risks of nipple shield use. The objective was to explore self-reported reasons for using a nipple shield and examine associations pertaining to the mother, the infant and duration of breastfeeding. Data were collected from 4815 Danish mothers (68%) who filled out a self-administered questionnaire with open and closed question. Data were analyzed by content and statistical descriptive and multivariable analysis. Results showed that 22% of the mothers used nipple shields in the beginning and 7% used it the entire breastfeeding period. Primiparae used nipple shields more often than multiparae, and early breastfeeding problems as well as background factors like lower age, education and higher body mass index were associated with a higher likelihood of using nipple shields. Characteristics of infants associated with introducing nipple shields were lower- gestational age and birthweight. The use of nipple shields was furthermore found to be associated with a threefold increased risk of earlier cessation of exclusive breastfeeding: among primiparae odds ratio = 3.80 (confidence interval 2.61-5.53); among multiparae odds ratio = 3.33 (confidence interval 1.88-5.93). Mothers' own descriptions underlined how various early breastfeeding problems led to the use of nipple shields. Some mothers were helped through a difficult period; others described the use creating a kind of dependence. The results highlight how nipple shields may help breastfeeding mothers in the early period but is not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark
| | - Else Foverskov
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark.,Department of Public Health, Section of Social Medicin, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Nilsson
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark.,Danish Committee for Health Education, Copenhagen, Denmark
| | - Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Sinha B, Chowdhury R, Sankar MJ, Martines J, Taneja S, Mazumder S, Rollins N, Bahl R, Bhandari N. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104:114-34. [PMID: 26183031 DOI: 10.1111/apa.13127] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/12/2015] [Accepted: 06/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To provide comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above. METHODS Of 23977 titles identified through a systematic literature search in PUBMED, Cochrane and CABI, 195 articles relevant to our objective, were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity, we explored its causes by subgroup analysis and meta-regression and applied random effects model. RESULTS Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding. CONCLUSION To promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.
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Affiliation(s)
- Bireshwar Sinha
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - M Jeeva Sankar
- Department of Pediatrics; Newborn Health Knowledge Centre; ICMR Center for Advanced Research in Newborn Health; All India Institute of Medical Sciences; New Delhi India
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health; Centre for International Health; University of Bergen; Bergen Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
| | - Nigel Rollins
- Department of Maternal; Newborn, Child and Adolescent Health; World Health Organization; Geneva Switzerland
| | - Rajiv Bahl
- Department of Maternal; Newborn, Child and Adolescent Health; World Health Organization; Geneva Switzerland
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies; New Delhi India
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Meedya S, Fahy K, Parratt J, Yoxall J. Supporting women to achieve breastfeeding to six months postpartum – The theoretical foundations of a successful program. Women Birth 2015. [DOI: 10.1016/j.wombi.2015.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yonemoto N, Dowswell T, Nagai S, Mori R. Schedules for home visits in the early postpartum period. ACTA ACUST UNITED AC 2015; 9:5-99. [PMID: 25404577 DOI: 10.1002/ebch.1960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. OBJECTIVES To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. SELECTION CRITERIA Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. MAIN RESULTS We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge. The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support. For most of our outcomes only one or two studies provided data, and overall results were inconsistent. There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no strong evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. AUTHORS' CONCLUSIONS Overall, findings were inconsistent. Postnatal home visits may promote infant health and maternal satisfaction. However, the frequency, timing, duration and intensity of such postnatal care visits should be based upon local needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
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Affiliation(s)
- Naohiro Yonemoto
- Department of Epidemiology and Biostatistics, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Japan
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Kronborg H, Foverskov E, Væth M. Breastfeeding and introduction of complementary food in Danish infants. Scand J Public Health 2015; 43:138-45. [DOI: 10.1177/1403494814567171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The purpose of the present study was to describe early feeding patterns in Danish infants. Methods: A self-administered questionnaire was sent to 7113 mothers of newborns in the western part of Denmark approximately 6 months postpartum. A total of 5127 mothers (72%) returned the questionnaire and 4526 (88%) of the responding mothers provided valid answers to questions on infant nutrition. Results: Breastfeeding was initiated after birth by 97%. At the ages of 2, 4 and 6 months, 68%, 55% and 7% of the infants, respectively, were fully breastfed, i.e. they received mother’s milk only. Full breastfeeding at 4 months was for infants significantly associated with higher birth weight, longer gestational age and singleton birth; for mothers it was associated with older ages, higher educational level, lower BMI and multiparity. During the first weeks, 14% of the infants were introduced to formula and this proportion increased to 32%, 43% and 74% at 2, 4 and 6 months, respectively. Only 20% of the infants never received formula during the first 6 months of life. Time for introduction of solid food was associated with breastfeeding status. At 4 months, 3% of the previously fully breastfed infants were introduced to solid food, 12% of the partially breastfed and 17% of the non-breastfed. At 6 months, 87% of the infants had been introduced to solid food. Conclusions: The majority of Danish mothers introduced infants to solid food between 4 and six months, and did not exclusively breastfeed until 6 months, as recommended by WHO.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Denmark
| | - Else Foverskov
- Department of Public Health, Section for Nursing, Aarhus University, Denmark
- Department of Social Policy, London School of Economics and Political Science, UK
| | - Michael Væth
- Department of Public Health, Section for Biostatistics, Aarhus University, Denmark
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Kronborg H, Foverskov E, Væth M. Predictors for early introduction of solid food among Danish mothers and infants: an observational study. BMC Pediatr 2014; 14:243. [PMID: 25270266 PMCID: PMC4263048 DOI: 10.1186/1471-2431-14-243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/25/2014] [Indexed: 11/12/2022] Open
Abstract
Background Early introduction of complementary feeding may interfere with breastfeeding and the infant’s self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food. Methods In an observational study Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503 infants. Data were analysed using ordered logistic regression models. Outcome variable was time for introduction to solid food. Results Almost all of the included infants 4386 (97%) initiated breastfeeding. At weeks 16, 17–25, 25+, 330 infants (7%); 2923 (65%); and 1250 (28%), respectively had been introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors. Among maternal factors, lower maternal age, higher BMI, and being primipara were significant predictors, and among attachment factors mother’s reported perception of the infant as being temperamental, and not recognising early infant cues of hunger were significant predictors for earlier introduction of solid food. Supplementary analyses of interactions between the predictors showed that the association of maternal perceived infant temperament on early introduction was restricted to primiparae, that the mother’s pre-pregnancy BMI had no impact if the infant was fully breastfed at week five, and that birth weight was only associated if the mother had reported early uncertainty in recognising infant’s cues of hunger. Conclusions Breastfeeding was the single most powerful indicator for preventing early introduction to solid food. Modifiable predictors pointed to the importance of supporting breastfeeding and educating primipara and mothers with low birth weight infants to be able to read and respond to their infants’ cues to prevent early introduction to solid food.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
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Blixt I, Mårtensson LB, Ekström AC. Process-oriented training in breastfeeding for health professionals decreases women's experiences of breastfeeding challenges. Int Breastfeed J 2014; 9:15. [PMID: 25221613 PMCID: PMC4163059 DOI: 10.1186/1746-4358-9-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 08/30/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women's satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months. METHODS An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n = 540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n = 162) started before the intervention was initiated. Data for control group B (n = 172) were collected simultaneously with the intervention group (IG) (n = 206). Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months. RESULTS Women in IG were more satisfied with the breastfeeding counselling (p = 0.008) and felt the breastfeeding counselling was more coherent (p = 0.002) compared to control groups, when exclusive breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p = 0.01). CONCLUSION A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration < 3 months. TRIAL REGISTRATION ACTRN12611000354987.
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Affiliation(s)
- Ingrid Blixt
- Department of Obstetrics and Gynaecology, Eskilstuna, Mälarhospital, Sweden
| | - Lena B Mårtensson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Anette C Ekström
- School of Health and Education, University of Skövde, Skövde, Sweden
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