Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background

Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.

Objectives

To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.

Design

Evidence syntheses with stakeholder engagement.

Review methods

Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.

Results

We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.

Limitations

There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.

Conclusions

'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.

Future work

Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.

Study registration

This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

Lactation Initiation During COVID-19 at a Single Military Hospital

INTRODUCTION

Human milk is associated with positive short- and long-term health outcomes. Women's choice to breastfeed is influenced by personal, social, health, and economic factors. The COVID-19 pandemic impacted health care delivery, non-emergent health care services, and family lifestyles, primarily in the early months of 2020. The aim of this study was to determine if breastfeeding initiation rates differed during a global pandemic among women in the military health care system.

MATERIALS AND METHODS

This was a cross-sectional chart review study. We compiled all birthing event health records from March to August in 2019 and 2020 from a single military medical center. Of the 2,737 maternal-infant dyads available, 1,463 met complete inclusion criteria and were analyzed to determine associations between delivery year, maternal and infant characteristics, and initial feeding methods. Institutional research approvals were obtained from the university and medical center institutional review boards.

RESULTS

There was no significant association between breastfeeding initiation rates and delivery year (X2(1) = 2.898, P = .089). Some maternal and infant characteristics significantly associated with the feeding method in the logistic regression model and differed by delivery year. Black women were 1.9 times less likely to initiate breastfeeding compared to White women; this disparity became more pronounced in 2020. Multiparous mothers, those who gave birth via cesarean section, and those at earlier gestational ages (32-37 weeks) were less likely to initiate breastfeeding. Models differed by delivery year, with only Black race and cesarean birth significantly impacting the overall model in 2020. Maternal age, military status, military rank, marital status, birth complications, and infant gender were not associated with the feeding method.

CONCLUSIONS

Overall breastfeeding initiation rates did not differ during the COVID-19 pandemic when rates in 2020 were compared to those in the year prior. Race, birth method, parity, and gestational age were associated with breastfeeding initiation rates in women cared for at military centers.

Safety profile of the most ordered medications for breastfeeding patients in the emergency department

BACKGROUND

Emergency Medicine (EM) physicians routinely treat breastfeeding patients. Physicians frequently recommend pumping and dumping milk for perceived safety risks. We hypothesized that the majority of the most commonly ordered medications in the emergency department (ED) are safe for breastfeeding patients. Accordingly, we performed a comprehensive safety analysis of the commonly ordered medications and provided an algorithm for EM physicians to utilize when treating breastfeeding patient in the ED.

METHODS

We investigated the 90 most administered medications to female patients between the ages of 15 to 50 for common ED chief complaints at a tertiary care academic medical center from January 2018 to December 2022. A total of 145,960 doses were analyzed. We subsequently searched LactMed®, InfantRisk Application, and Pubmed® for all safety information on these medications and divided them by categories. Ultimately, we proposed a treatment algorithm for breastfeeding patients in the ED.

RESULTS

Analgesics were the most commonly ordered medications in the ED, and importantly analgesics ranging from ibuprofen to morphine are safe in limited doses in the ED setting. Antibiotics and antifungals pose limited restrictions. All systems-based medications have a variety of safe options available. Lastly, supplements and electrolytes are safe.

CONCLUSION

The majority of medications utilized in the acute setting are compatible with breastfeeding. There should be limited circumstances to advise pumping and dumping in the ED.

Impact of COVID-19 Public Health Restrictions on the Pregnancy Experience: A Mixed-Methods Study

The COVID-19 pandemic impacted the provision of obstetrical care. This mixed-methods study explores pregnant women's experiences during the COVID-19 pandemic using an explanatory sequential design. The experiences and opinions of obstetrical patients were elicited using an online questionnaire and semi-structured interview as a follow-up. There were 162 completed questionnaires, and 17 interviews. Qualitative analysis themes included worries about the intrapartum experience, its impact on partners, and lack of postpartum support for breastfeeding and mental health. This study provides an understanding of how the pandemic impacted pregnancy experiences, and the potential future repercussions of isolation and restrictions on wellbeing during public health crises.

Comparing factors associated with overall satisfaction for different forms of remote breastfeeding support in the UK

BACKGROUND

Remote forms of breastfeeding support, such as helplines and social media, offer a flexible and convenient form of support to offer help at critical points, e.g., when the risk of breastfeeding cessation is high. Currently, there is little known about who accesses different forms of remote breastfeeding support and what factors impact overall satisfaction. As part of an evaluation of the UK National Breastfeeding Helpline (NBH) (which offers breastfeeding support via a helpline and online media), we aimed to (a) understand who accesses different forms of NBH support, and (b) identify key factors associated with overall satisfaction for helpline and online media support.

METHODS

All service users who contacted the NBH between November 2021 and March 2022 were invited to participate in the evaluation via an online survey. Survey questions explored the type and timing of support, reasons for the contact, attitudes towards the help and support received, impact of the support on breastfeeding experiences and demographic factors. Chi-squared and Mann-Whitney tests explored variations in who accessed the helpline or online media. Multiple linear regression models were fitted to explore the factors related to the service users' 'overall satisfaction'. The quantitive data were combined with qualitative comments into descriptive themes.

RESULTS

Overall, online media users were significantly more likely to be younger, White, multiparous, less educated and have English as a first language compared to those who contact the helpline. Similar factors that significantly influenced overall satisfaction for both support models were the service being easy to access, receiving helpful information that met expectations, resolving breastfeeding issues, and feeling reassured and more confident. Significant factors for the helpline were callers feeling understood and more knowledgeable about breastfeeding following the call, being able to put into practice the information provided, feeling encouraged to continue breastfeeding, feeling that the volunteer gave the support that was needed, and seeking out additional support.

CONCLUSIONS

Online and helpline forms of breastfeeding support suit different demographics and call purposes. While optimal breastfeeding support needs to be accessible, flexible and instrumental, helpline users need real-time relational support to deal with more complex challenges.

The impact of continuous and intermittent supportive counseling on self-efficacy and continuation of breastfeeding in lactating women affected by COVID-19: a quasi-experimental trial

BACKGROUND

Promoting exclusive breastfeeding can have a great effect in reducing the complications and mortality rate of mother and child.

OBJECTIVE

The study aimed to compare the effects of continuous and intermittent supportive counselling on the self-efficacy and continuity of breastfeeding among Lactating mothers with COVID-19.

METHODS

The study was a semi-experimental research method and was conducted on 73 mothers with COVID-19 who were hospitalized in Ayatollah Mousavi Hospital in Zanjan, Iran from May 2021 to April 2022. In the continuous counselling group, counselling was provided daily for 14 days, while in the intermittent counselling group, counselling was provided once a week for four weeks. Breastfeeding continuity was assessed based on the World Health Organization's classification, and breastfeeding self-efficacy was measured using Dennis' standard breastfeeding self-efficacy questionnaire (BSE) up to four months after delivery. The data were analyzed using chi-square tests, independent t-tests, paired t-tests, analysis of variance with repeated measures, and survival analysis (Kaplan-Meier) with a 95% confidence level.

RESULTS

The survival analysis revealed that the cessation of exclusive breastfeeding occurred in 17 cases within the continuous counselling group and in 22 cases within the intermittent counselling group. The rates of continuation for exclusive breastfeeding were 52.8% and 40.5% in the continuous and intermittent counselling group respectively. However, no statistically significant differences were observed in the continuation of breastfeeding and the trend of changes in the mean scores of breastfeeding self-efficacies between the continuous and intermittent counselling groups. Furthermore, comparing the change in breastfeeding self-efficacy scores between the one-month and four-month follow-ups within the continuous counselling group, a statistically significant increase was observed.

CONCLUSION

The results indicated no difference in the effectiveness of continuous and intermittent counseling methods in improving breastfeeding continuity in women with COVID-19. Further research is needed to explore the long-term effects of different counseling approaches on breastfeeding outcomes during crises.

TRIAL REGISTRATION

The study was registered on the Iranian Registry of Clinical Trials website on 29/06/2021 with the registration code IRCT20150731023423N19. It can be accessed via this link: https://irct.behdasht.gov.ir/user/trial/55391/view .

In-hospital breastfeeding and predictive factors during the SARS-CoV-2 pandemic: A retrospective cohort study - Aleitamento materno hospitalar e fatores preditores durante a pandemia pelo SARS-CoV-2: Coorte retrospectiva

PURPOSE

To analyze breastfeeding and the factors that positively influence the first hour of life, during hospitalization, and at discharge during the SARS-CoV-2 pandemic.

DESIGN AND METHOD

This is a retrospective cohort study, with data collected from medical records. Consisting of 225 mother-newborn dyads with deliveries between 2020 and 2021. Breastfeeding in the first hour of life, during hospitalization, and at discharge was considered as the outcome variable. The independent variables were sociodemographic, obstetric, and neonatal data. The analysis was performed with bivariate and multivariate regression through a generalized linear model (Poisson family), with a 5% significance level. It was approved by the Institutional Review Board (IRB), under approval number 4,911,317.

RESULT

Newborns of women without COVID-19 suspicion or diagnosis and who had skin-to-skin contact with their mother at birth are twice as likely to be breastfed in the first hour of life. Absence of complications in the newborn during hospitalization and no COVID-19 suspicion or diagnosis double the exclusive breastfeeding rate during hospitalization. Newborns exclusively breastfed during hospitalization present 1.6 times more chances of being exclusively breastfeeding at hospital discharge.

CONCLUSION

It was evidence that women who gave birth without COVID-19 suspicion, and newborns who had skin-to-skin contact with their mother at birth represented a predictive factor for favoring exclusive breastfeeding.

PRACTICE IMPLICATIONS

This research contributes to the innovation of evaluating breastfeeding in the newborn's first hour of life, during hospitalization, and at discharge in a pandemic context.

Feeding Practices of Stable Term and Late Preterm Neonates Born at a Tertiary Hospital in the Philippines during the COVID-19 Pandemic

Objective

We aimed to evaluate the impact of maternal COVID-19 infection and separation of the mother-baby dyad on feeding practices by determining modes of feeding upon discharge and following up at 2-3 days, 14 days, and 1 month post-discharge.

Methods

This was a prospective observational cohort study conducted at the Philippine General Hospital, a tertiary government COVID-19 referral center in Manila. Mothers who delivered between the months of July and August 2021, and whose COVID-19 status was known were followed up on their baby's mode of feeding at 2-3 days, 14 days, and 1 month post-discharge via phone call. For babies of COVID-19 positive mothers, presence of any symptoms (up to the 14-day time point only) as well as adherence to infection prevention and control practices were also identified.

Results

For all time points post-discharge, breastfeeding rates were higher in babies born to COVID-19-negative mothers and in those who were roomed in. However, the differences were not statistically significant. Of the 108 infants, 72.90% remained exclusively breastfed by 1 month of age, with 4.67% formula-fed and 22.43% on mixed feeding. Perception of insufficient milk supply was the most common reason for shifting to formula or mixed feeding. We found a significantly higher direct breastfeeding rate upon discharge in the roomed-in population compared to those admitted to the NICU. Risk factors affecting breastfeeding at 1 month of age was the presence of COVID-19 infection in the mother and mother-baby separation due to NICU admissionCOVID-19-positive mothers were 66.02% less likely (p=0.016, 95% CI 0.1411 to 0.8183) to still be breastfeeding at 1 month, and separation was not found to be a significant risk factor.

Conclusions

Feeding practices can be affected not only by COVID-19 infection in the mother and its attendant difficulties such as prolonged hospital stay and physical and social isolation, but also by limitations in the hospital environment that can have an impact on breastfeeding education, support, and opportunities for mother-child bonding.

Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BACKGROUND

Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.

METHODS

A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.

RESULTS

Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.

CONCLUSIONS

The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

Barriers Affecting Breastfeeding Practices of Refugee Mothers: A Critical Ethnography in Saskatchewan, Canada

Refugee mothers are vulnerable to cultural stereotyping and socioeconomic hardships when they migrate to a new country. This vulnerability often has a negative impact on refugee mothers' breastfeeding practices. Saskatchewan is one of the growing provinces in Canada that has a noticeable increase in refugee population with young children and limited availability of healthcare settings with baby-friendly status. Considering existing gaps in knowledge, this critical ethnographic study aimed to explore barriers that impede the breastfeeding practices of refugee mothers in Saskatchewan. After seeking ethics approval, data were collected using multiple methods, including in-depth interviews undertaken with 27 refugee mothers with young children of age range 1 day to 24 months, a review of media communications and field observations of community-based services/facilities available to refugee mothers. Findings suggest that psychosocial barriers, healthcare barriers, environmental barriers, and maternal and child health-related barriers impede the breastfeeding practices of refugee mothers in Saskatchewan. Breastfeeding practices of refugee mothers can be promoted through healthcare support, culturally appropriate services, interpretation services in healthcare settings, implementation of baby-friendly initiatives, hospital and community-based breastfeeding campaigns, and follow-up services. Collaborative efforts by healthcare settings, healthcare providers, policymakers, public health agencies, service providers, and governments are essential to support the breastfeeding practices of refugee mothers.

The importance of community resources for breastfeeding

BACKGROUND

Breastfeeding has long-lasting effects on children's cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g., education, race/ethnicity, income level) are associated with breastfeeding initiation and duration. Further, research shows significant variation in access to community resources by race/ethnicity. It is unclear how community resources may impact breastfeeding practices and how this might intersect with maternal race/ethnicity.

METHODS

This study combined nationally-representative data from the Study of Attitudes and Factors Effecting Infant Care (SAFE), which surveyed US mothers immediately after the infant's birth and at two to six months of infant age, with the Child Opportunity Index (COI) 2.0, a census tract measure of community resources associated with child development, to explore the association between community resources and breastfeeding initiation and whether this varies based on maternal race/ethnicity and country of birth. The SAFE Study used a stratified, two-stage, clustered design to obtain a nationally representative sample of mothers of infants, while oversampling Hispanic and non-Hispanic (NH) Black mothers. The SAFE study enrolled mothers who spoke English or Spanish across 32 US birth hospitals between January 2011 and March 2014.

RESULTS

After accounting for individual characteristics, mothers residing in the highest-resourced communities (compared to the lowest) had significantly greater likelihood of breastfeeding. Representation in higher-resourced communities differed by race/ethnicity. Race/ethnicity did not significantly moderate the association between community resources and breastfeeding. In examining within race/ethnic groups, however, community resources were not associated with non-US born Black and Hispanic mothers' rates of breastfeeding, while they were with US born Black and Hispanic mothers.

CONCLUSIONS

Findings suggest that even health behaviors like breastfeeding, which we often associate with individual choice, are connected to the community resources within which they are made. Study implications point to the importance of considering the impact of the contextual factors that shape health and as a potential contributor to understanding the observed race/ethnicity gap.

A Qualitative Study of Breastfeeding Experiences Among Mothers Who Used Galactagogues to Increase Their Milk Supply

OBJECTIVE

To qualitatively describe breastfeeding experiences among mothers who used galactagogues to increase their milk supply.

DESIGN

One-time, semistructured phone interviews.

SETTING

US.

PARTICIPANTS

Breastfeeding mothers (n = 19) who reported ever consuming foods, beverages, or herbal supplements to increase their milk supply in a cross-sectional online survey were purposefully sampled to participate in this qualitative study. Participants were diverse in terms of race and ethnicity, education, income, infant age (0-18 months), and prior breastfeeding experience (32% first-time breastfeeding).

PHENOMENON OF INTEREST

Reasons for trying to increase milk supply, sources of information about increasing milk supply, and strategies tried to increase milk supply.

ANALYSIS

Interviews were transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

Participants expressed determination and commitment to breastfeeding but unexpectedly struggled to breastfeed and increase their milk supply. They sought information from multiple sources and used individualized approaches to address milk supply concerns on the basis of recommendations from others, as well as the perceived convenience, cost, palatability, and safety of potential strategies.

CONCLUSIONS AND IMPLICATIONS

Results suggest a need to expand breastfeeding education and support so that lactating parents anticipate common breastfeeding challenges and are aware of evidence-based strategies for increasing their milk supply.

Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the Coronavirus Disease 2019 Pandemic

BACKGROUND

The coronavirus disease 2019 pandemic had worldwide economic impact, exacerbating food insecurity risk for vulnerable populations.

OBJECTIVE

To describe changes in practice and challenges and areas of need related to addressing food insecurity during the coronavirus disease 2019 pandemic for registered dietitian nutritionist survey respondents.

DESIGN

A cross-sectional, anonymous, online survey distributed via the Academy of Nutrition and Dietetics e-mail communication platform and social media accounts from April through May 2020 (Wave 1 [W1]) and December 2020-February 2021 (Wave 2 [W2]).

PARTICIPANTS AND SETTING

Participants were US-based registered dietitian nutritionists practicing in community-based settings to address food insecurity (W1: n = 454; W2: n = 331).

STATISTICAL ANALYSES

Responses were descriptively summarized using means ± SD, medians and interquartile ranges, or number of observations and percentages. Open-ended responses were manually reviewed and organized into major themes.

RESULTS

Respondents had about 10 years of experience in addressing food insecurity and were most commonly involved with the Special Supplemental Nutrition Program for Women, Infants and Children, federal school nutrition programs, or food banks. Participants described increased demand for food security assistance (W1: 68%; W2: 60%). Among respondents involved in food preparation and handling (W1: n = 183; W2: n = 110), supply chain (W1: 61%; W2: 56%) and staffing (W1: 37%; W2: 50%) challenges were commonly reported. Child nutrition program professionals (W1: n = 143; W2: n = 84) reported widespread implementation of optional program waivers, with the most commonly implemented waivers allowing noncongregate meal service (W1: 83%; W2: 81%), caregivers to pick up meals (W1: 69%; W2: 85%), and flexibility in mealservice times (W1: 75%; W2: 87%).

CONCLUSIONS

Respondents quickly adapted programs to ensure staff and client safety while continuing to provide essential food security services. They identified the need for ongoing nutrition program policy advocacy and timely access to best practice resources during public health emergencies.

The Impact of COVID-19 on Breastfeeding Initiation and Duration in a Low-Income Population, Washington, DC

Objective: To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on breastfeeding initiation (BFI) and duration among women enrolled in the Special Supplemental Nutrition Program for women, infants, and children (WIC) in Washington District of Columbia (DC). Materials and Methods: We used WIC program data from Washington DC to assess the pandemic's impact on BFI and duration among WIC recipients. t-Tests and unadjusted odds ratios compared breastfeeding outcomes before and during the pandemic. Multivariable logistic and linear regression models estimated the pandemic's impact on initiation and duration, respectively, while controlling for social determinants of health and other factors. Results: BFI was similar among women who gave birth before (61.4%) or during the pandemic (60.4%) (p = 0.359). However, the proportion of women who breastfed at 1 month decreased significantly from 56.1% (before pandemic) to 47.6% (during pandemic) (p < 0.0001). This pattern for duration continued at 3 and 6 months: 46.9% to 37.1% (p < 0.0001) at 3 months and 34.8% to 25.7% (p < 0.0001) at 6 months. On average, women who delivered during the pandemic breastfed 33.9 fewer days than those who delivered before (p < 0.0001). Conclusions: BFI among DC WIC recipients was similar for infants born before or during the pandemic, and determinants of initiation remained similar to previous reports (e.g., race/ethnicity, education). However, for women who initiated breastfeeding, average duration was significantly lower for infants born during the pandemic than before. Our findings suggest the importance of leveraging WIC and other breastfeeding supports to promote breastfeeding during pandemics and other emergencies.

Lactating nurses' experiences of return to work after lifting COVID-19 lockdown: A qualitative study

Aim

To explore the lactating nurses' experiences of return to work after lifting COVID-19 lockdown.

Background

Return to work is a key reason for the low rates of breastfeeding. Especially after lifting COVID-19 lockdown, case counts reached recorded highs. So lactating nurses face more challenges when they return to work.

Method

The empirical phenomenology method was used to conduct a qualitative study. Lactating nurses were recruited in a tertiary hospital through purposive and snowball sampling, and participated in semi-structured video interviews. Colaizzi's method was used to analyze the data.

Results

Three themes and 10 sub-themes emerged from the interview data of 15 participants. The first theme was "preparation for return to work", which helped lactating nurses adapt to return to work quickly. The second was "experiences of return to work". The inconvenience of pumping was mentioned repeatedly. In addition, the flexible work schedule was highlighted. The third was "experiences of infection". The attitudes toward breastfeeding differed due to different perceptions of COVID-19.

Conclusions

Lactation nurses easily interrupted or stopped breastfeeding when they returned to work after lifting COVID-19 lockdown. Recommendations include the further provision of longer periods of leave, flexible working arrangements, separate facilities for breast pumping, and breastfeeding strategies for epidemics.

Development of a mobile application -based breastfeeding program and evaluation of its effectiveness

BACKGROUND

Breastfeeding has many benefits for maternal and infant health. Mobile health interventions are increasingly used to increase breastfeeding initiation and support breastfeeding continuation.

PURPOSE

This study aimed to develop a mobile application-based breastfeeding program (MABBP) and to evaluate effectiveness.

DESIGN AND METHODS

This randomized controlled trial study was conducted with 73 mothers on the first postpartum day hospitalized in the postpartum service of a university hospital in Turkey. Mothers in the MABBP group (experimental group) were included in the mobile application-based breastfeeding training program on the first postpartum day. The Participant Information Form, the Infant Breastfeeding Assessment Tool (IBFAT), and the Breastfeeding Experience Scale (BES), Breastfeeding Follow-up Form, and Baby Physical Development Follow-up Form were administered. In the second follow-up, the Mobile Application Evaluation Form was used additionally to collect data from the MABBP group.

RESULTS

There was no significant difference between the postpartum first-day MABBP and control groups in the mean IBFAT scores. In the first and second follow-up, the rate of breastfeeding exclusively was higher and the rate of experiencing breastfeeding problems was lower in the MABBP group compared to the control group. While the mean BES score on the first postpartum day was significantly higher in the MABBP group compared to the control group, it was found to be significantly lower in the second follow-up.

CONCLUSION

It was determined that the MABBP contributed to the mothers' experiencing fewer breastfeeding problems and feeding the babies exclusively with breast milk at a higher rate.

PRACTICE IMPLICATIONS

This study suggests that pediatric nurses can support mothers during breastfeeding with the breastfeeding mobile application.

Association of maternal SARS-CoV-2 infection at the time of admission for delivery with labor process and outcomes of vaginal birth: A cohort study

INTRODUCTION

This study aimed to investigate the impact of maternal SARS-CoV-2 infection at the time of admission for delivery on labor process and outcomes of vaginal birth.

MATERIAL AND METHODS

A cohort study was carried out at the Obstetrics Department of Anhui Provincial Hospital, China, where universal reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 infection was introduced for all women admitted for labor and delivery from December 1-31, 2022. Women were divided into positive and negative groups based on the test result. All women having a singleton vaginal birth were included in final analysis. The effect of SARS-CoV-2 positivity on labor process and outcomes of vaginal birth was estimated by regression analyses.

RESULTS

Among a total of 360 women included, 87 had a positive SARS-CoV-2 test and 273 a negative test. Women in the positive group had an increased likelihood of having longer labor (median 9.3 vs 8.3 hours; sB [log-transformed] 0.19; 95% confidence interval [CI] 0.09-0.28), episiotomy (39.1% vs 23.8%; adjusted odds ratio [aOR] 2.31; 95% CI 1.27-4.21), grade III meconium-stained amniotic fluid (19.5% vs 7.0%; aOR 2.52; 95% CI 1.15-5.54) and postpartum hospital stay exceeding 37 hours (58.6% vs 46.5%; aOR 1.71; 95% CI 1.00-2.91). They had reduced rates exclusive breastfeeding (26.7% vs 39%; aOR 0.21; 95% CI 0.09-0.46) as well as mixed feeding (46.5% vs 52.2%; aOR 0.28; 95% CI 0.13-0.60) at 1 week postpartum. No significant differences were observed in other aspects of labor process and birth outcomes, including the uptake of labor analgesia, postpartum hemorrhage (>500 mL) or neonatal outcomes.

CONCLUSIONS

A positive maternal SARS-CoV-2 test in labor among women having vaginal birth was associated with a slightly longer duration of labor, increased likelihood of episiotomy, increased incidence of grade III meconium-stained amniotic fluid, a longer postpartum hospital stay and a lower rate of breastfeeding 1 week postpartum. However, it did not have an adverse impact on other birth outcomes.

Parents' experiences of infant and young child feeding during the COVID-19 pandemic in Ireland

OBJECTIVE

The WHO has urged member states to develop preparedness plans for infant and young child feeding (IYCF) during emergencies. Ireland has no such plan. We aimed to identify the needs of caregivers in Ireland with regards IYCF during the COVID-19 pandemic.

DESIGN

Online survey conducted in May-June 2020.

SETTING

Ireland, during the first period of severely restricted movement due to COVID-19 (lockdown).

PARTICIPANTS

Respondents (n 745) were primary caregivers of a child under 2 years; they were primarily well educated and likely of higher socio-economic status.

RESULTS

Among those who breastfed, being unable to access breast-feeding support groups and being unable to access in-person, one-to-one breast-feeding assistance were the biggest challenges reported. Nearly three quarters of those who had their babies during lockdown reported these challenges: 72·8 % and 68·8 %, respectively. For those using formula, the main challenges were structural in nature; approximately two-thirds of those who had their baby prior to lockdown feared there would be formula shortages and a third were unable to purchase formula due to shortages.

CONCLUSIONS

Regardless of how their babies were fed, parents in Ireland experienced multiple challenges with infant feeding during the COVID-19 crisis. Breast-feeding should be protected, supported and promoted, particularly during an infectious disease pandemic. Additionally, assurances around supply of infant formula could reduce parental stress during a pandemic or emergency. An IYCF in emergencies plan would clearly set out how we could best support and protect the nutrition of the most vulnerable members of our population.

Why do mothers mix milk feed their infants? Results from a systematic review

CONTEXT

Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially.

OBJECTIVE

An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF.

DATA SOURCES

Six databases were searched for relevant articles published in English from January 2012 to January 2022.

DATA EXTRACTION

Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF.

DATA ANALYSIS

A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger.

CONCLUSION

The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022304253.

Twitter discussions on breastfeeding during the COVID-19 pandemic

BACKGROUND

Breastfeeding is a critical health intervention in infants. Recent literature reported that the COVID-19 pandemic resulted in significant mental health issues in pregnant and breastfeeding women due to social isolation and lack of direct professional support. These maternal mental health issues affected infant nutrition and decreased breastfeeding rates during COVID-19. Twitter, a popular social media platform, can provide insight into public perceptions and sentiment about various health-related topics. With evidence of significant mental health issues among women during the COVID-19 pandemic, the perception of infant nutrition, specifically breastfeeding, remains unknown.

METHODS

We aimed to understand public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic through Twitter analysis using natural language processing techniques. We collected and analyzed tweets related to breastfeeding and COVID-19 during the pandemic from January 2020 to May 2022. We used Python software (v3.9.0) for all data processing and analyses. We performed sentiment and emotion analysis of the tweets using natural language processing libraries and topic modeling using an unsupervised machine-learning algorithm.

RESULTS

We analyzed 40,628 tweets related to breastfeeding and COVID-19 generated by 28,216 users. Emotion analysis revealed predominantly "Positive emotions" regarding breastfeeding, comprising 72% of tweets. The overall tweet sentiment was positive, with a mean weekly sentiment of 0.25 throughout, and was affected by external events. Topic modeling revealed six significant themes related to breastfeeding and COVID-19. Passive immunity through breastfeeding after maternal vaccination had the highest mean positive sentiment score of 0.32.

CONCLUSIONS

Our study provides insight into public perceptions and sentiment regarding breastfeeding during the COVID-19 pandemic. Contrary to other topics we explored in the context of COVID (e.g., ivermectin, disinformation), we found that breastfeeding had an overall positive sentiment during the pandemic despite the documented rise in mental health challenges in pregnant and breastfeeding mothers. The wide range of topics on Twitter related to breastfeeding provides an opportunity for active engagement by the medical community and timely dissemination of advice, support, and guidance. Future studies should leverage social media analysis to gain real-time insight into public health topics of importance in child health and apply targeted interventions.

Breastfeeding Disparities During the COVID-19 Pandemic: Race/Ethnicity, Age, Education, and Insurance Payor

BACKGROUND

There are well-documented disparities in rates of continued breastfeeding. Existing research regarding breastfeeding during COVID-19 has raised concerns that the pandemic may have exacerbated these disparities.

RESEARCH AIMS

The aim of this research was first to quantify disparities in any breastfeeding associated with the maternal factors of race/ethnicity, age, insurance payor, and zip code rates of education in North Carolina. Second, we aimed to investigate any changes in these disparities before and during the COVID-19 pandemic.

METHOD

This was an observational study, with a retrospective, longitudinal design. Participants included infants who were born in one of eight medical centers across North Carolina from either September 1, 2019 to October 31, 2019 (pre-COVID: n = 1,104) or from April 1, 2020 to May 31, 2020, (during COVID: n = 1,157), and whose caregivers reported whether they were breastfeeding at either a 3-month or 6-month postnatal follow-up (N = 2,261). Mixed effects logistic models, including random effects of zip code, assessed predictors associated with probability of breastfeeding cessation at 3- and 6-month child well-check.

RESULTS

Overall, younger maternal age, being non-Hispanic Black, not having commercial insurance, and residing in a zip code with lower rates of higher education, were all independently associated with earlier breastfeeding cessation across both cohorts. Disparities did not significantly change during the COVID-19 pandemic.

CONCLUSION

We did not find support for the hypothesis that the COVID-19 pandemic might have exacerbated breastfeeding disparities. Nevertheless, there is a continued need to eliminate existing disparities.

Use of a Supplemental Feeding Tube Device and Breastfeeding at 4 Weeks

BACKGROUND

Mothers having difficulty breastfeeding their infants may use alternative supportive feeding methods. Although a supplemental feeding tube device is commonly used, efficacy for supporting sustained breastfeeding remains unknown.

PURPOSE

To describe supplemental feeding tube device use by breastfeeding mothers as an alternative feeding method through exploration of associations between supplemental feeding tube device use and continued breastfeeding at 4 weeks of infant's age.

METHOD

Forty mothers participated. They were interviewed during the birth hospitalization and at 4 weeks postpartum. Questions addressed use of supplemental feeding tube devices, breastfeeding issues, and continued breastfeeding relationships. We examined the relationship between LATCH scores at 2 to 3 days of life.

RESULTS

Breastfeeding mothers who chose to supplement with bottle-feeding instead of use of a supplemental feeding tube device were 30% less likely to continue breastfeeding at a medium/high/exclusive level.

CONCLUSION

Use of the supplemental feeding tube device may help avoid the potentially detrimental effect of bottle-feeding on continued breastfeeding.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

BACKGROUND

Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge.

METHODS

An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge.

RESULTS

308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge.

CONCLUSIONS

Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Understanding the current and future usage of donor human milk in hospitals: An online survey of UK neonatal units

The use of donor human milk (DHM) where there is a shortfall of maternal milk can benefit both infant and maternal outcomes but DHM supply is not always assured. This study aimed to understand current DHM usage in UK neonatal units and potential future demand to inform service planning. An online survey was disseminated to all UK neonatal units using Smart Survey or by telephone between February and April 2022 after development alongside neonatal unit teams. Surveys were completed by 55.4% of units (108/195) from all 13 Operational Delivery Networks. Only four units reported not using DHM, and another two units only if infants are transferred on DHM feeds. There was marked diversity in DHM implementation and usage and unit protocols varied greatly. Five of six units with their own milk bank had needed to source milk from an external milk bank in the last year. Ninety units (84.9%) considered DHM was sometimes (n = 35) or always (n = 55) supportive of maternal breastfeeding, and three units (2.9%) responded that DHM was rarely supportive of breastfeeding. Usage was predicted to increase by 37 units (34.9%), and this drive was principally a result of parental preference, clinical trials and improved evidence. These findings support the assumption that UK hospital DHM demand will increase after updated recommendations from the World Health Organization (WHO) and the British Association of Perinatal Medicine. These data will assist service delivery planning, underpinned by an ongoing programme of implementation science and training development, to ensure future equity of access to DHM nationally.

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers' access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context.

Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Association of continuity of carer and women's experiences of maternity care during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND

Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have analysed the association between continuity of carer and how women felt about the changes to pregnancy care and birth plans.

AIM

To describe pregnant women's self-reported changes to their planned pregnancy care and associations between continuity of carer and how women feel about changes to their planned care.

METHODS

A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia.

FINDINGS

1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer were more likely to rate the changes to care as neutral/positive (p<.001) when compared with women who received partial or no continuity.

DISCUSSION

Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who received full continuity of carer experienced fewer changes to care and were more likely to feel neutral/positive about the changes than women who did not receive full continuity of carer.

Telemedicine Breastfeeding Consultation: The Saudi Experience

Background Telemedicine is widely used in health specialties. Yet, the experience of telemedicine use and its effectiveness in breastfeeding support is a research gap. The purpose of this study was to describe the pattern of telemedicine use for breastfeeding support in Saudi Arabia and to explore patients' satisfaction with the service. Methods A cross-sectional survey was conducted in outpatient settings at Ministry of Health facilities in several Saudi regions. The number of breastfeeding consultations over one year (2021) was analyzed in terms of region, month, method of consultation, and women's maternity status. Data on patient satisfaction and telemedicine techniques were gathered during 2022. Results Across the 16 regions enrolled in the project, 51,571 remote breastfeeding consultations were conducted, representing 28.2% of the total consultations. The eastern region reported the highest percentage (40.7%), and the southern region reported the lowest (2.4%). Almost two-thirds of the consultations were provided to lactating mothers (62.91%). Most data (90%) were collected from breastfeeding clinics in hospitals, and nurses were the main primary health care providers. The mean was 4,255 consultations per month. In terms of technology, telemedicine consultations were mostly conducted by phone (50%) and WhatsApp (38%). Satisfaction with telemedicine was reported by 80% of the participants, with a statistical difference found in those favoring telemedicine over in-person care (p=0.032), particularly for those using phone consultations and Telegram (p<0.001). WhatsApp respondents had the commonest neutral responses (p<0.001). Conclusion Telemedicine breastfeeding care has been widely established with high patient satisfaction. A national protocol outpatient lactation services with an intergrated hospital and primary care services and involvement of different health care professionals are recommended. Although breastfeeding counselling is proven to have a positive change on breastfeeding indicators, telemedicine tool per se needs further work on its role in breastfeeding indicators. Triage of cases to be evaluated face-to-face or referral to a specialist after telemedicine lactation care is an area for future work.

Breastfeeding and room-sharing during COVID-19 in the Netherlands: The impact of perinatal healthcare support

AIM

The recommendations of 6 months of exclusive breastfeeding (EBF) and parent-infant room-sharing (RS) are often not followed. As these early caregiving practices may have been affected by the COVID-19-related restrictions, we documented BF and RS practices in the Netherlands (2020-2021) and the effects of perceived perinatal healthcare support.

METHODS

Pregnant women and mothers of an infant younger than 6 months (N = 784) completed online questionnaires (e.g., demographic information, the impact of COVID-19 on their lives aspects, infant childcare practices) twice: at the beginning of the pandemic and when the infant reached 6 months of age.

RESULTS

The pandemic EBF practices mirrored pre-pandemic Dutch reports (17.8 %; Mduration = 3.4 months), while RS rates and duration seemingly doubled (30.6 %; Mduration = 3.98 months). Higher maternal education (r = 0.18) and multiparity (r = 0.08) were significantly associated with longer EBF, and similarly for education (r = 0.17) and multiparity (r = 0.11) with RS durations. Higher perceived perinatal healthcare support predicted shorter RS duration [β = -0.509, t(5,596) = -2.27, p = .023].

CONCLUSION

While the COVID-19 pandemic did not impact EBF, it may have promoted RS. The negative association between perinatal healthcare support and RS may suggest that parents who need more support from their providers also experience more challenges adhering to RS recommendations, yet this hypothesis remains to be corroborated.

Implications of the COVID-19 pandemic on breastfeeding and health promotion: perceptions of breastfeeding women

This article aims to understand the implications of the COVID-19 pandemic on breastfeeding and health promotion actions within primary care from the perception of breastfeeding women. This qualitative study was developed with 24 women who breastfed during the first year of the pandemic. Data were analyzed using Content Analysis and interpreted in the light of the Interactive Breastfeeding Theory (IBT). The pandemic affected the vulnerability of the mental health of breastfeeding women, entailed difficulties for the continuity of breastfeeding and early insertion of formulas, impacted COVID-19 preventive measures in breastfeeding, and produced changes in the work of breastfeeding women. Furthermore, areas for improvement were identified in health promotion actions and the mother-child binomial support due to the interruption of childcare visits. Actions to promote child health in primary care were unsatisfactory. However, most study participants maintained exclusive breastfeeding for the first six months, which could adversely affect child morbimortality.

Breastfeeding prevalence in newborns of mothers with COVID-19: a systematic review

OBJECTIVES

to compare exclusive breastfeeding prevalence versus artificial feeding in newborns of mothers with COVID-19.

METHODS

a systematic review of prevalence, according to JBI. Searches in PubMed®, Embase, CINAHL, LILACS and Web of Science™ databases in August 2021. Cross-sectional, longitudinal or cohort studies were selected, without language and time limitations that showed breastfeeding prevalence or that allowed calculation.

RESULTS

fifteen articles published in 2020 and 2021, cohort (60%) or cross-sectional (40%) were analyzed. The average of exclusive breastfeeding in mothers with COVID-19 was 56.76% (CI=39.90-72.88), and artificial breastfeeding, 43.23% (CI = 30.99 - 55.88), without statistically significant differences.

CONCLUSIONS

despite the recommendations for maintaining breastfeeding, there was a reduction worldwide, when compared to periods prior to the pandemic. With advances in science, these rates have improved, showing the impact of evidence on practices. As limitations, study sources are cited. It is recommended to carry out new studies. PROSPERO registration CRD42021234486.

A qualitative analysis of women's postnatal experiences of breastfeeding supports during the perinatal period in Ireland

Ireland has among the lowest rates of breastfeeding worldwide. Despite policies to support breastfeeding, breastfeeding initiation and exclusivity remain low in Ireland. Greater knowledge about support received in the maternity unit may-in part-shed light on why this is so. Our aim was to analyse women's experiences of the breastfeeding supports available in the early postnatal period in Ireland. We conducted an analysis of an open-ended question on a cross-sectional survey about breastfeeding support conducted in the Republic of Ireland in 2022. Participants were asked to provide comments about the breastfeeding support they received in the maternity unit or during your home birth. Data were analysed using Braun and Clarke's six-step Thematic Analysis Framework. There were 5,412 unique responses to the survey and 2,264 responses to the question of interest. Two themes were generated from the data: (i) 'Breastfeeding support in theory but not in practice.' Although breastfeeding was promoted by healthcare professionals antenatally, breastfeeding challenges were rarely mentioned. Participants then felt unsupported in overcoming challenges postnatally. (ii) 'Support was either inaccessible due to lack of staff/time, inadequate; i.e., unhelpful or non-specific, and/or physically inappropriate.' Most participants described receiving supports that were less than optimal in aiding them to establish breastfeeding. While many described difficulties in accessing supports, others found support to be 'non-specific,' 'rushed' and sometimes 'rough.' A lack of knowledge, time and support from healthcare professionals was frequently described, which was often recognised as a failing of the healthcare system. Women require practical, informative, and specific breastfeeding support. Barriers such as lack of time and trained staff in the maternity unit need to be addressed.

Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic

Background

Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic.

Methods

This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes.

Results

A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 n = 4,967, COVID-19 n = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, p < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, p < 0.001), metabolic acidosis (0.7% vs. 1.2%, p = 0.02), NICU admission (5.1% vs. 6.4%, p = 0.009), antibiotic (0.7% vs. 1.7%, p < 0.001), and nasal CPAP (1.2% vs. 1.8%, p = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes.

Conclusion

During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.

What Are the Implications of COVID-19 on Breastfeeding? A Synthesis of Qualitative Evidence Studies

INTRODUCTION

Exclusive breastfeeding until six months of life is the ideal way to feed infants. However, there is a significant number of infants who have never breastfed, despite the beneficial properties of breastfeeding. On the other hand, the coronavirus outbreak had significant effects on people's health, both mentally and physically, and has also impacted the breastfeeding process.

AIM

The aim of this study was to investigate the implication of COVID-19 on breastfeeding through qualitative data from databases.

METHODS

We searched online databases (PubMed, Google Scholar, PsycINFO) for studies published from 2019 to 2023. 'Out of the 2598 papers we found, only 12 were included in the review'. More specifically, from the 1558 papers remaining from the title and abstract evaluation as well as duplicates, a further 1546 papers belonging to our exclusion criteria were removed (all types of reviews, letters to editors, and quantitative articles).

RESULTS

Our results covered three subjects: breastfeeding support during the pandemic, effects of social containment measures on breastfeeding, and additional outcomes regarding breastfeeding. Most voices found the effects of the pandemic on breastfeeding beneficial, with reduced professional support and a high degree of support from the environment. Additional negative factors were observed, as well as consequences of the pandemic in women's lives.

CONCLUSIONS

COVID-19 was the occasion to understand the power of the supportive environment of the woman, especially the partner, in establishing and maintaining breastfeeding. Therefore, policy makers and health professionals, especially midwives, should implement family-centered breastfeeding strategies that are more supportive of the partner role, providing problem counseling when and where deemed necessary.

The impact of health policies and the COVID-19 pandemic on exclusive breastfeeding in Chile during 2009-2020

In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by  - 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.

The contributions of parental lactation on offspring development: It's not udder nonsense!

The Developmental Origins of Health and Disease (DOHaD) hypothesis describes how maternal stress exposures experienced during critical periods of perinatal life are linked to altered developmental trajectories in offspring. Perinatal stress also induces changes in lactogenesis, milk volume, maternal care, and the nutritive and non-nutritive components of milk, affecting short and long-term developmental outcomes in offspring. For instance, selective early life stressors shape the contents of milk, including macro/micronutrients, immune components, microbiota, enzymes, hormones, milk-derived extracellular vesicles, and milk microRNAs. In this review, we highlight the contributions of parental lactation to offspring development by examining changes in the composition of breast milk in response to three well-characterized maternal stressors: nutritive stress, immune stress, and psychological stress. We discuss recent findings in human, animal, and in vitro models, their clinical relevance, study limitations, and potential therapeutic significance to improving human health and infant survival. We also discuss the benefits of enrichment methods and support tools that can be used to improve milk quality and volume as well as related developmental outcomes in offspring. Lastly, we use evidence-based primary literature to convey that even though select maternal stressors may modulate lactation biology (by influencing milk composition) depending on the severity and length of exposure, exclusive and/or prolonged milk feeding may attenuate the negative in utero effects of early life stressors and promote healthy developmental trajectories. Overall, scientific evidence supports lactation to be protective against nutritive and immune stressors, but the benefits of lactation in response to psychological stressors need further investigation.

Relationship between social support and post-discharge mental health symptoms in mothers of preterm infants

BACKGROUND

Social support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant.

METHODS

Mothers of infants less than 33 weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant's discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures.

RESULTS

Of 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated with all 3 PMADs. Social support explained between 21% and 26% of the variance in depression, anxiety and post-traumatic stress symptoms.

CONCLUSION

Increased social support may buffer PMAD symptoms in mothers of preterm infants after discharge. Research is needed to determine effective screening and interventions aimed at promoting social support for all parents during and following their infant's hospitalisation.

The impact of COVID-19 on breastfeeding rates: An international cross-sectional study

BACKGROUND

Breastfeeding promotes children's health and is associated with positive effects to maternal physical and mental health. Uncertainties regarding SARS-CoV-2 transmission led to worries experienced by women and health professionals which impacted breastfeeding plans. We aimed to investigate the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic.

METHODS

This study is part of a broader international prospective cohort study about the impact of the COVID-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19). We analysed data from 5612 women, across 12 countries. Potential covariates of breastfeeding (sociodemographic, perinatal, physical/mental health, professional perinatal care, changes in healthcare due to the pandemic, COVID-19 related, breastfeeding support, governmental containment measures and countries' inequality levels) were studied by Generalized Linear Mixed-Effects Models.

RESULTS

A model encompassing all covariates of interest explained 24% of the variance of breastfeeding rates across countries (first six months postpartum). Overall, first child (β = -0.27), age of the child (β = -0.29), preterm birth (β = -0.52), admission to the neonatal/pediatric care (β = -0.44), lack of breastfeeding support (β = -0.18), current psychiatric treatment (β = -0.69) and inequality (β = -0.71) were negatively associated with breastfeeding (p < .001). Access to postnatal support groups was positively associated with breastfeeding (β = 0.59; p < .001). In countries with low-inequality, governmental measures to contain virus transmission had a deleterious effect on breastfeeding (β = -0.16; p < .05) while access to maternity leave protected breastfeeding (β = 0.50; p < .001).

DISCUSSION

This study shows that mother's COVID-19 diagnosis and changes in healthcare and birth/postnatal plans did not influence breastfeeding rates. Virtual support groups help women manage breastfeeding, particularly when their experiencing a first child and for those under psychiatric treatment. The complex associations between covariates and breastfeeding vary across countries, suggesting the need to define context-specific measures to support breastfeeding.

The Effect of Maternal SARS-CoV-2 Infection on Neonatal Outcome

(1) Background: Neonates born to SARS-CoV-2 positive mothers are at risk of infection, as well as adverse outcomes due to the infection. The aim of our study was to analyze the impact of maternal SARS-CoV-2 infection on neonatal outcome. (2) Methods: We conducted a prospective, longitudinal study. We collected data on maternal symptomatology upon admission and their correlation with the development of the infant. Through a questionnaire we analyzed the impact on breastfeeding of the separation of the mother from the newborn, as well as the maternal psycho-emotional effect. (3) Results: Ninety infants were enrolled in the study, from one twin pregnancy and the rest singleton pregnancies. Out of the 89 mothers, 34 showed symptoms. Neonates from mothers with anosmia and ageusia had a higher value of WBC and lymphocytes (p = 0.06 and p = 0.04). Breastfeeding was started in 57.3% of mothers after their discharge from hospital and only 41.6% of the whole study group continued at the follow-up visit. Mothers who described a negative experience during hospitalization associated a 2.42 times higher risk of not continuing breastfeeding. (4) Conclusion: None of the infants enrolled in the study had SARS-CoV-2 infection either at birth or within the first two months of life. Breastfeeding was started with more than half newborns after discharge from hospital. The negative experience generated by the separation from their babies influenced breastfeeding.

COVID-19 Vaccination and Breastfeeding Mothers in Kahta District, Turkey

We aimed to determine the attitudes and behaviors of breastfeeding mothers regarding the vaccine by examining their knowledge of the COVID-19 virus vaccine and their hesitations about it. The research is a cross-sectional and descriptive study conducted in the Kahta district of Adıyaman, a southeastern province in Turkey, between January and May 2022. The study population consisted of 405 mothers who applied to the Kahta State Hospital Pediatrics outpatient clinic. A questionnaire form was used as a data collection tool, and a consent form was obtained from the participants. The vaccination rate (89%) of those who graduated from high school and above was significantly higher than that of those who graduated from secondary school or below (77.7%). As the economic situation worsened, the vaccination rate decreased. The vaccination rate (85.7%) of mothers whose breastfed child was 0-6 months old was found to be significantly higher than that of those with 7-24-month-olds (76.4%) (p:0.02). The rate of being vaccinated (73.3%) of those who had a new type of COVID-19 virus infection was significantly lower than the rate of being vaccinated (86.3%) of those who did not have a COVID-19 virus infection. The vaccination rate of those who received information from their family doctor and the internet was higher than that of those who received information from radio/TV and people around. The rate of mothers thinking babies should stop breastfeeding who graduated from secondary school or below was higher (53.2%) than the rate of mothers who graduated from high school or above (30.2%) to be vaccinated against the COVID-19 virus. To eliminate the hesitancy about vaccination in mothers, it is necessary to inform and educate the whole society correctly, starting with families with low education and economic levels.

Tethered Oral Tissue Release Among Breastfed Infants: Maternal Sources of Information and Treatment

BACKGROUND

Despite limited clinical consensus regarding surgery for tethered oral tissues ("tongue-tie") for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.

RESEARCH AIM

To explore experiences of breastfeeding mothers with infants having undergone "tongue-tie" surgery.

METHOD

This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.

RESULTS

The sample was predominantly white (n = 86; 95%), non-Hispanic (n = 84; 93%), married/cohabitating (n = 85; 94%), and currently providing their own milk (n = 81; 89%).Difficult latch was the primary reason for seeking help. Participants reported lingual (n = 84; 93%), labial (n = 79; 88%), and buccal (n = 16; 17%) tissue-release, with 80% (n = 73) reporting > 1 released. For each tissue released, > 80% (n = 72) of participants felt "very confident" in their ability to correctly identify it and 97% (n = 87) felt "very involved" and "strongly agreed" with surgical release. International Board Certified Lactation Consultants^® were the most frequently identified source of information (n = 45; 50%) and referrals (n = 38; 42%), while pediatric dentists most frequently performed interventions (n = 60; 67%).

CONCLUSIONS

Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.

Social Support for Breastfeeding Practice During the COVID-19 Second Wave in Thailand: A Cross-Sectional Study

BACKGROUND

Since December 2020, the second wave of COVID-19 in Thailand has had a considerable impact, and mothers have struggled to receive breastfeeding support in hospitals. In this situation, there has been limited research that addresses social support for breastfeeding and the influences of support in determining breastfeeding outcomes.

RESEARCH AIMS

(1) To describe the influence of COVID-19 on social support for breastfeeding and breastfeeding practices in the Thai context, and (2) to examine breastfeeding duration with different levels of social support from families and healthcare providers.

METHOD

This descriptive, cross-sectional online survey design was part of a larger multi-methods project about breastfeeding behaviors and experiences among postpartum mothers during the COVID-19 pandemic. Online questionnaires were administered from August to November 2021 to participants (N = 390) who were from three provinces in Thailand and had given birth 6-12 months prior to the survey.

RESULTS

Exclusive breastfeeding for 6 months was observed in less than half of the participants (n = 146, 37.4%). Perceptions of breastfeeding support were generally high overall among both family (Mdn = 45, IQR = 7) and healthcare providers (Mdn = 43, IQR = 7). Participants who perceived more breastfeeding support from families than the median had significantly longer exclusive breastfeeding durations than those who perceived less breastfeeding support than the median (z = -2.246, p = .025). The same pattern was present for breastfeeding support from healthcare providers (z = -2.380, p = 0.017).

CONCLUSIONS

While the exclusive breastfeeding rate was better than the pre-pandemic rate, successful breastfeeding was more common when participants perceived that they had received breastfeeding support. Policymakers should execute breastfeeding support systems along with COVID-19 management.

Medication Intake as a Factor for Non-Initiation and Cessation of Breastfeeding: A Prospective Cohort Study in Greece during the COVID-19 Pandemic

Pharmacological treatment may become a barrier for a mother’s breastfeeding goals. We aimed to investigate maternal medication intake as a factor for non-initiation and cessation of breastfeeding and the effect of professional counseling on maternal decision-making. Throughout 2020,847 women were recruited from five healthcare institutions. Information was gathered prospectively with an organized questionnaire through interview during hospitalization and through telephone at 1, 3 and 6 months postpartum. Results revealed that from the 57 cases of breastfeeding cessation due to medication intake, only 10.5%received evidence-based counseling from a physician. Unfortunately, 68.4% (n = 39/57) of the participants ceased breastfeeding due to erroneous professional advice. The compatibility of medicines with breastfeeding was examined according to the Lactmed and Hale classification systems, which showed discrepancy in 8 out of 114 medicines used, while 17.5% and 13.2% of the medicines, respectively, were not classified. Educational level, employment at six months postpartum, mode of delivery, previous breastfeeding experience, medication intake for chronic diseases, physician’s recommendation and smoking before pregnancy were factors significantly correlated with breastfeeding discontinuation due to medication intake. The COVID-19 restrictions protected women from ceasing breastfeeding due to medication intake. Maternal and lactation consultancy should be strictly related to evidence-based approaches.

COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination

Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk-benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.

Women's experiences and views on early breastfeeding during the COVID-19 pandemic in Norway: quantitative and qualitative findings from the IMAgiNE EURO study

BACKGROUND

Little is known about women's experience of care and views on early breastfeeding during the COVID-19 pandemic in Norway.

METHODS

Women (n = 2922) who gave birth in a facility in Norway between March 2020 and June 2021 were invited to answer an online questionnaire based on World Health Organization (WHO) Standard-based quality measures, exploring their experiences of care and views on early breastfeeding during the COVID-19 pandemic. To examine associations between year of birth (2020, 2021) and early breastfeeding-related factors, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multiple logistic regression. Qualitative data were analysed using Systematic Text Condensation.

RESULTS

Compared to the first year of the pandemic (2020), women who gave birth in 2021 reported higher odds of experiencing adequate breastfeeding support (adjOR 1.79; 95% CI 1.35, 2.38), immediate attention from healthcare providers when needed (adjOR 1.89; 95% CI 1.49, 2.39), clear communication from healthcare providers (adjOR 1.76; 95% CI 1.39, 2.22), being allowed companion of choice (adjOR 1.47; 95% CI 1.21, 1.79), adequate visiting hours for partner (adjOR 1.35; 95% CI 1.09, 1.68), adequate number of healthcare providers (adjOR 1.24; 95% CI 1.02, 1.52), and adequate professionalism of the healthcare providers (adjOR 1.65; 95% CI 1.32, 2.08). Compared to 2020, in 2021 we found no difference in skin-to-skin contact, early breastfeeding, exclusive breastfeeding at discharge, adequate number of women per room, or women's satisfaction. In their comments, women described understaffed postnatal wards, early discharge and highlighted the importance of breastfeeding support, and concerns about long-term consequences such as postpartum depression.

CONCLUSIONS

In the second year of the pandemic, WHO Standard-based quality measures related to breastfeeding improved for women giving birth in Norway compared to the first year of the pandemic. Women's general satisfaction with care during COVID-19 did however not improve significantly from 2020 to 2021. Compared to pre-pandemic data, our findings suggest an initial decrease in exclusive breastfeeding at discharge during the COVID-19 pandemic in Norway with little difference comparing 2020 versus 2021. Our findings should alert researchers, policy makers and clinicians in postnatal care services to improve future practices.

Breastfeeding practices in nursing mothers during COVID-19 pandemic: Dual center study in Karachi, Pakistan

Objective

To identify the breastfeeding practices in nursing mothers during the COVID-19 pandemic.

Methods

This descriptive cross-sectional study was conducted in the Pediatrics and Gynecology & Obstetrics departments at two of the tertiary care hospitals in Pakistan from September 2020 to February 2021. Recently delivered mothers and mothers of children till two years of age on breastfeeding/formula feed were consecutively enrolled.

Result

Of 484 participants, breastfeeding was practiced by 180 (37.2%) participants, formula-fed by 85 (17.6%), and mix feed by 219 (45.2%) participants. Out of 185 mothers who had to breastfeed previous babies, 80.2% of mothers still opted to breastfeed their newborns despite the COVID-19 pandemic. Breastfeeding practices exhibited higher incidence in illiterate mothers (aOR 0.229 95% CI 0.05-0.95, p- 0.042), housewives (aOR 0.35 95% CI 0.13-0.95 p-0.040) and shorter length of stay (aOR 0.290 95% CI 0.15-0.57, p- 0.001) while formula /mixed feeding was found higher in mothers with exposure to formula feeding in previous babies (aOR 17.842, 95% CI 8.33-38.19, p- 0.001) and mothers with pain after delivery (aOR 4.526, 95% CI 2.11-9.71, p-<0.001).

Conclusion

Mothers who had to breastfeed their babies in a previous pregnancy, who were less educated, and housewives with a shorter stay in hospital have shown a stronger association with breastfeeding whereas mothers who had previous exposure to formula milk and pain after delivery have shown association to formula feed or mixed feed.

Social support and mental health in maternity: Effects of the COVID-19 pandemic

BACKGROUND

Motherhood involves a process of adaptation and the perception of social support influences mental health, breastfeeding or newborn care among others. The COVID-19 pandemic has generated a distancing from family, friends and health professionals.

METHODS

Quantitative, descriptive, cross-sectional study. The present study aims to describe and analyze the social support and mental health of mothers during this period.

METHODS

The sample were 179 women with children older than 6 months. The questionnaires used were the DUKE-UNC-11 and GHQ-12. Data analysis was carried out with Spearman's Rho and Mann Whitney U test.

RESULTS

75.8% of the sample perceived normal social support during the pandemic. Within the dimensions of social support, women reported perceiving satisfactory confidential support, while affective support was perceived as low. Correlational analysis reported a significant relationship between mental health, confidential support and affective support. Group comparison noted greater confidential support in primiparous.

CONCLUSIONS

The sample is sensitive to changes originated by COVID-19 constraints influencing perceived social support and mental health. Affective and confidential support as well as the involvement of health professionals and the environment are fundamental for mental health during the first year of maternity.

RELEVANCE TO CLINICAL PRACTICE

Mothers' mental health is sensitive and vulnerable to social changes, in this case, those that occurred as a consequence of the COVID-19 outbreak.

The effect of tele-education delivered to mothers during the COVID-19 pandemic on breastfeeding success and perceived breastfeeding self-efficacy: Randomized controlled longitudinal trial

This study was conducted to determine the effect of tele-education offered to mothers during the COVID-19 pandemic on breastfeeding success and perceived breastfeeding self-efficacy. The mothers were divided into experimental (n = 28) and control groups (n = 28). They were followed-up postnatal 1st week, 4th week, 3rd month, and 6th month in both groups. The researchers provided a 4-week long education and counseling service to mothers in the experimental group via direct phone calls and text messages. It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.