The 25th anniversary of the Surgeon General's Workshop on Breastfeeding and Human Lactation: the status of breastfeeding today

Acupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sections

Breast milk is recognized and strongly recommended by the World Health Organization (WHO) as the optimal feeding for all babies. Breastfeeding is associated with better nutritional and non-nutritional outcomes when compared to formula feeding, and has proven health benefits to both infants and their mothers. This clinical research is to examine the feasibility and efficacy of Acupoint-Tuina therapy in treating postpartum women who underwent C-sections and suffered from insufficient milk production.The patients in the control group received standard medical care, while the patients in the Tuina group received Tuina therapy during the next 48 hours in addition to standard care, given once daily for 2 days. To evaluate the efficacy of Tuina therapy, patients of both groups were assessed for surface temperature of breasts, volume of breasts, volume of breast milk production, serum PRL level, and uterus recovery at various time points.Tuina therapy significantly increased the milk production when compared to the control group, for as much as 13-fold and 10-fold of that in the control group on the third and fourth postpartum days. In addition, Tuina therapy also significantly increased the full breast enlargement and the serum PRL level change, and decreased the breast surface temperature rise. Last but not the least, Tuina therapy also accelerated the post-surgery recovery of uterus.During the early postpartum days, Tuina therapy increases the milk production and promotes other physiological changes supporting lactation for postpartum women with C-section delivery and insufficient breast milk production. The novel intervention is warranted for further investigation and validation.

Boundary Creatures? Employed, Breastfeeding Mothers and ‘Abjection as Practice’

This paper contributes to theory on maternity, embodiment and organizations through advancing a contemporary theory of ‘abjection as practice’ in relation to breastfeeding and employment. Drawing upon the work of Margaret Shildrick and Julia Kristeva, it analyses a qualitative study of netnographic (internet) discussions among employed breastfeeding mothers, observing how lactating bodies are treated as abject within organizations. It proposes that hostile behaviour towards breastfeeding women could be seen as a form of ‘abjection as practice’, displaying a purposeful intent to exclude breast milk production from workplace contexts. In exploring the position of breastfeeding workers, the paper observes how breastfeeding women occupy an uncomfortable space on the borders between health ideals of ‘proper’ mothering and organizational notions of ‘good’ worker. The situation of breastfeeding employees is rendered ambiguous and such uncertainties invoke co-worker antipathy. Co-worker hostility towards breastfeeding colleagues appears validated at work because minimal action is taken to address deliberate utilization of ‘abjection as practice’ towards breastfeeding workers.

Quality indicators for human milk use in very low-birthweight infants: are we measuring what we should be measuring?

OBJECTIVE

The objective of this study was to compare the currently used human milk (HM) quality indicators that measure whether very low-birthweight (VLBW; <1500 g birthweight) infants 'ever' received HM and whether they were still receiving HM at discharge from the neonatal intensive care unit (NICU) to the actual amount and timing of HM received.

STUDY DESIGN

This study used data from a large NIH-funded cohort study and calculated whether VLBW infants ever received HM (HM-Ever) and of these infants, the percentage who were still receiving HM at NICU discharge (HM-DC). Then, the HM-DC indicator (exclusive, partial and none) was compared with the amount and timing of HM feedings received by these same infants.

RESULT

Of the 291 VLBW infants who met inclusion criteria, 285 received some HM (HM-Ever=98%). At NICU discharge (HM-DC), 24.2, 15.1 and 60.7% were receiving exclusive, partial and no HM, respectively. Of the 60.7% infants with no HM-DC, some had received higher amounts of HM during the NICU hospitalization than infants categorized as exclusive and partial for HM-DC. Of the infants with no HM-DC, 76.8 and 59.7% had received exclusive HM during the days 1-14 and days 1-28 exposure periods, respectively.

CONCLUSION

The average daily dose (HM-DD; in ml kg(-1) d(-1)) and cumulative percentage (HM-PCT; as % of cumulative enteral intake) of HM feedings were sufficient to significantly reduce the risk of multiple morbidities, including late-onset sepsis, necrotizing enterocolitis, neurocognitive delay and rehospitalization, in the majority of the VLBW infants who were discharged with no HM-DC. Quality indicators that focus on the amount and timing of HM feedings in the NICU should be added to the HM-Ever and HM-DC measures.

Lactation space design: supporting evidence-based practice and the baby-friendly hospital initiative

The design of spaces where lactation occurs within a healthcare facility often lacks careful attention to the environmental requirements of breastfeeding. Although numerous studies evoke overwhelming support for lactation initiation in hospitals, few designers may understand the importance of such spaces. Furthermore, many designers may be unaware of the contributions they may make to this initiative. Countless studies that support the philosophy that breast milk is the best nutritional option for babies have been conducted. There are many health and economic advantages of breastfeeding for babies, mothers, and communities. Research suggests that exclusive breastfeeding for the first 6 months of life reduces the rate of illness throughout infancy and beyond, saves lives, and could save billions of dollars in the United States each year.The Baby Friendly Hospital Initiative is a global program established to promote within healthcare facilities the facilitation of breastfeeding infants from birth. Results of this initiative show a significant increase in breastfeeding rates in many countries. The intuitive design response to such favorable research is to enhance the lactation environment, assuming that mothers who feel comfortable in lactation spaces will use them more frequently, which promotes lactation in healthcare facilities. Considering the numerous research-supported advantages of breastfeeding, designers would be prudent to seek and apply knowledge of the environmental needs to the design of lactation spaces. This may be achieved by becoming familiar with lactation procedures to understand the circulation, adjacencies, and spatial requirements of lactation programs. Incorporating this information into the design may allow the development of ideal spaces that facilitate lactation.

Working mothers, breastfeeding, and the law

Workplace barriers contribute to low rates of breastfeeding. Research shows that supportive state laws correlate with higher rates, yet by 2009, only 23 states had adopted any laws to encourage breastfeeding in the workplace. Federal law provided virtually no protection to working mothers until the 2010 enactment of the "reasonable break time" provision of the Patient Protection and Affordable Care Act. This provision nonetheless leaves many working mothers uncovered, requires break time only to pump for (not feed) children younger than 1 year, and exempts small employers that demonstrate hardship. Public health professionals should explore ways to improve legal support for all working mothers wishing to breastfeed. Researchers should identify the laws that are most effective and assist policymakers in translating them into policy.