Antenatal education and breastfeeding in a cohort of primiparas

A Scoping Review of Breastfeeding Interventions and Programs Conducted Across Spanish-Speaking Countries

Breastfeeding is vital to a child's lifelong health and has significant positive benefits to mother's health. World Health Organization recommends beginning exclusively breastfeeding within the first hour after birth and continuing during the first 6 months of infant's life. The purpose of this review is to identify and examine breastfeeding interventions conducted across the Spanish-speaking countries. A scoping review of the literature was conducted across 14 databases for relevant publications published through April 2023 to find studies in Spanish-speaking countries that involved breastfeeding as an intervention component. A total of 46 peer-reviewed articles were included in this review, across 12 Spanish-speaking countries. Participants ranged from pregnant women, mothers, mother-infant pair, and health care professionals. Intervention at the individual level in combination with support from trained health care professionals or peer counselors seemed to have higher improvements in breastfeeding rates. The greatest improvement in exclusively breastfeeding for 6 months was seen in interventions that included prenatal and postnatal intensive lactation education, for a period of 12 months. The most effective interventions that improved rates of any breastfeeding included promotional activities, educations workshop, and training of health care staff along with changes in hospital care. Breastfeeding promotion is an economical and effective intervention to increase breastfeeding behavior and thereby improving breastfeeding adherence across Spanish-speaking countries.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus

BACKGROUND

This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment.

METHODS

This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed.

RESULTS

The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus.

CONCLUSIONS

Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

Successful breastfeeding among women with intention to breastfeed: From physiology to socio-cultural factors

BACKGROUND

Even if women have intention to breastfeed, they do not always achieve a successful breastfeeding.

AIM

This study aims to analyse factors affecting breastfeeding prevalence among mothers that intended to breastfeed.

METHODS

This is a prospective observational study involving 401 pregnant women that intended to breastfeed (asked at the 20th week). Breastfeeding prevalence was evaluated in reference to health-related, socio-cultural factors and healthcare professionals' interventions at 1 month, 6 months and 12 months after birth. Data were analysed using descriptive statistical methods, bivariate logistic regression and multivariate logistic regression modelling.

RESULTS

Independent factors negatively affecting breastfeeding prevalence related to mothers' and newborns' health parameters and birth characteristics included smoking during pregnancy, anaemia and use of analgesia during labour. Regarding sociocultural parameters, being an immigrant, higher education level, intention to breastfeed before pregnancy, comfort with public breastfeeding and bedsharing were positively linked to breastfeeding, while teat or pacifier use in the first week was negatively linked. Regarding healthcare professionals' practices, mother and father/partner antenatal education course attendance and exclusive breastfeeding at the hospital were positively associated with breastfeeding.

CONCLUSION

Breastfeeding is a very complex phenomenon affected by multiple and diverse variables. Physiological factors only affect the short term (1st month), while middle and long term BF affecting variables are mainly identical and include mostly socio-cultural factors and also BF related practices, especially in the first days after birth. These data should help to develop more effective breastfeeding promotion strategies.

Factors Influencing Uptake of Breastfeeding: The Role of Early Promotion in the Maternity Hospital

BACKGROUND

This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth.

METHODS

A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016-2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge.

RESULTS

Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding.

CONCLUSIONS

It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.

Breastfeeding in Hospitals: Factors Influencing Maternal Choice in Italy

Monitoring the prevalence of breastfeeding is one of the actions provided for in Italian National Health System. This study aims to observe the prevalence of breastfeeding in a representative set of birthing hospitals in the province of Catania, in Sicily, Italy, to assess the factors influencing women in their decisions to breastfeed during hospitalization after delivery. We conducted an observational study on 3813 questionnaires administered to mothers of newborns during their hospital stay from the years 2016 to 2018 in eight hospitals of various types. The average maternal age was 31.3 years ± 5.8. Sixty-nine percent of women did not attend a prenatal course. From childbirth to discharge, the percentage of women who breastfed was 88%, of whom 45% did exclusive breastfeeding. Only 35% of women who had a caesarean section adopted exclusive breastfeeding. In our experience, rooming-in was not associated with an increase in breastfeeding. We observed that both attendance to prenatal courses and the mother's education level played a minor role in influencing the mother's decision in breastfeeding A fairly high percentage of exclusive breastfeeding, 75%, was attained just in one hospital, where dedicated staff was deployed to encourage breastfeeding. The lowest percentage (12%) of exclusive breastfeeding was observed in a large private accredited health facility. Hospital presence of professionals trained in human lactation is a smart investment for society.

Social Factors Associated with Non-initiation and Cessation of Predominant Breastfeeding in a Mother-Child Cohort in Spain

Objective The aim of the study was to identify factors associated with non-initiation and cessation of predominant breastfeeding (PBF) in a mother-child cohort from Spain. Materials and Methods The analysis included 2195 mother-infant from birth to 14 months post- delivery recruited between 2004 and 2008. Maternal characteristics were collected during the pregnancy. Lactation data were obtained at 6 and 14 months after delivery. PBF was defined as intake of breast milk plus liquids like juices or water. The PBF cessation was calculated using the date that women started PBF and the date that she reported to start giving infant formula and/or food. The relationship between maternal variables and PBF initiation and cessation was modeled using logistic and Cox proportional hazards regression analysis. Results The prevalence of PBF at hospital discharge was 85.3, 53.4% at 3 months, 46.1% at 4 months and 7.2% at 6 month. Only two women continued PBF at 12 months and none at 14 months. The initiating of PBF was associated with higher levels of maternal education, being a first-time mother and worked in a non-manual occupation. Higher level of physical activity, not smoking and having a healthy BMI, were also positively associated with PBF initiation. PBF cessation was higher in young, obese women, who had had complications during the pregnancy, and who had lower levels of education and smoked. The employment status of women, in week 32 of pregnancy and also in month 14 post-delivery, determined likelihood of PBF cessation. Conclusions Healthier habits and education positively influenced PBF initiation and duration. Decrease in PBF duration rates in Spain can be interpreted in part as a consequence of women returning to work.

Screening for Mothers at Risk to Wean Early and Referral to a Lactation Support Person for Prolonging Breastfeeding

This project trialed the breastfeeding control (BFC) scale of the Breastfeeding Attrition Prediction Tool (BAPT) to identify mothers at high risk to wean early and to determine the effectiveness of a prenatal consult with a lactation support person on breastfeeding duration and intensity. Results indicated that mothers with lower scores on the BAPT-BFC scale showed a trend for decreased breastfeeding intensity at 8 weeks postpartum. Experimental and control groups had similar BAPT-BFC scores and breastfeeding intensity at 8 weeks. Overall, women who had low BAPT-BFC scores tended to be breastfeeding less at 8 weeks compared with mothers who scored very high. This finding would suggest the BAPT-BFC is a helpful tool for predicting breastfeeding success.

Can a Call Make a Difference? Measured Change in Women's Breastfeeding Self-efficacy Across Call Interactions on a Telephone Helpline

Background Telephone helplines providing 24-h specialist-nurse contact present a source of immediate support for women encountering challenges with breastfeeding and may serve to prolong breastfeeding duration by building self-efficacy. To date there is little evidence on interaction effectiveness and still less on the relative effectiveness for women from different socio-economic backgrounds. Research Aim To establish the effect on maternal breastfeeding self-efficacy of calls made to a nurse-led parenting helpline. Methods From a corpus of calls made to the Australian Child Health Line (N = 723), those made by women presenting a breastfeeding concern as a prime issue (n = 60) were scored for breastfeeding self-efficacy at commencement and completion of recorded interactions. Analyses examined the significance and direction of change from beginning to end of calls and compared difference in change across calls originating from high and low social advantage locations. Results A significant increase in self-efficacy was found, but with low effect size. There was considerable variation among calls; 53% showed improvement, 25% showed no change and 22% showed reduction in breastfeeding self-efficacy. While most calls were made by women from socially advantaged locations, change was more positive for the small number of callers from disadvantaged locations. Conclusion The potential of nurse-led reactive telephone support is evident, but dependent on qualities of the interaction. For women living in disadvantaged locations telephone support may be of particular significance given the greater social barriers to breastfeeding they are likely to encounter.

Framework for the establishment of a feasible, tailored and effective perinatal education programme

BACKGROUND

Antenatal education needs to be renewed and adapted to the needs of women.

OBJECTIVES

to assess women needs, identify factors that influence the desired outcomes, and propose a framework for developing new perinatal education based on the guidance published by the UK Medical Research Council for the development and evaluation of complex interventions in primary care.

METHODS

For this study: (a) four focus group sessions were held from October to November 2010 in Bizkaia (Spain) with 30 women exploring their needs during pregnancy and postpartum; (b) two literature reviews were conducted on women's needs at these times and theoretical models of healthcare education; and (c) seven discussion and consensus sessions were run with a group of experts composed of midwifes, gynaecologists, paediatricians, and paediatric and postpartum nurses.

RESULTS

Various areas for improvement were identified: needs assessment of each woman/family, consideration of pregnancy and childbirth as normal physiological processes, participation of fathers, establishment of social networks, continuity of postpartum care, better access to and training for midwives, and more flexible format and contents for the programme. We propose a woman-focused framework that includes three exploratory interviews during pregnancy, personalized interventions coordinated between professionals, empowerment to choose the type of birth, and postpartum activities.

CONCLUSION

New perinatal education should be on-going and focused on each woman. It is necessary to assess the feasibility of implementing this type of programme, depending on the context, professionals' readiness for change and characteristics of the proposed interventions. Then, its effectiveness and sustainability must be assessed.

[Perceived needs of women regarding maternity. Qualitative study to redesign maternal education]

OBJECTIVES

To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education.

DESIGN

Qualitative study with focus groups.

SETTING

Bizkaia health region, Basque Health Service (Osakidetza), Spain.

PARTICIPANTS

Thirty one women were recruited consecutively by midwives at six Osakidetza health centres.

METHODS

Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS.ti software.

RESULTS

The focus of the women worries changes over time. In early pregnancy, women's main concern was for "everything to go well". As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner.

CONCLUSION

Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women.

Psychological assessment among immigrant and Spanish women during the postpartum period in Spain

OBJECTIVE

to describe whether there were differences in sociodemographic, obstetric, perinatal and psychological variables between immigrant women and native-born women in Spain during the first 24 h after delivery.

BACKGROUND

The immediate postpartum period is a critical time when physical and psychological disorders are likely to occur. Immigrant women have, in general, poor perinatal and psychological results during this time.

METHODS

One hundred and three women at the Virgen de las Nieves University Hospital (Granada, Spain) were divided into two groups: 50 Spanish and 53 immigrants. The instruments used were the Life Orientation Test, the Stress Vulnerability Inventory, the Perceived Stress Scale and the Symptom Checklist-90-Revised (SCL-90-R). Sociodemographic and obstetric data were obtained from the healthcare providers reports.

RESULTS

During the postpartum period, the immigrant women had higher mean scores on the following subscales: interpersonal sensitivity (F(1,102) = 4.06; p < 0.05); depression (F(1,102) = 7.24; p < 0.01); phobic anxiety (F(1,102) = 4.83; p < 0.05), paranoid ideation (F(1,102) = 7.20; p < 0.01); and psychoticism (F(1,102) = 4.04; p < 0.05). When considering age, education, profession, job situation, immigrant status of the partner and duration of time in Spain as covariates, differences between groups were significant on obsessive-compulsiveness (F(1,102) = 5.37; p < 0.05) and depression (F(1,102) = 6.89; p < 0.05).

CONCLUSIONS

Immigrant women are in need of more psychological and emotional support from their families, midwives and the rest of healthcare providers than are native Spaniards immediately after delivery.

Participation in Prenatal Education, Knowledge and Attitude related to Delivery, Postpartum Care, Newborn Care in Nulliparous Women

PURPOSE

This study was done to identify content of prenatal education and to examine differences in prenatal education, knowledge, and attitude of nulliparous South Korean women.

METHODS

A cross-sectional survey design was used with 134 conveniently recruited nulliparous women. Data were collected through self-report questionnaires.

RESULTS

Average number of institutional prenatal education programs was 5.96 at clinics, 4.31 at health care centers, and 0.49 at hospitals. Women participated in an average 5.78 out of the 35 prenatal education contents: 15 types of prenatal and delivery, 10 postpartum self-care, and 10 parenting. Score for knowledge was 7.57out of 10. Women who participated in prenatal education (n=72) reported significantly higher scores in knowledge (t=2.71, p=.008) than women who did not participate (n=62). The average score for attitude was 7.22 out of 10. Nulliparous women over 36 weeks of gestational age had significantly higher scores for attitude (t=2.38, p=.019) than women under 36 weeks. There were significant positive correlations between newborn care knowledge and postpartum care self-efficacy (r=.26, p=.026), and newborn care knowledge and parenting confidence (r=.25, p=.034).

CONCLUSION

Results indicate that policy is needed to increase participation in prenatal education and to establish strategies for health care centers and hospitals to provide prenatal education.

Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis

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.