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Pay at the pump?: Problems with electric breast pumps. Soc Sci Med 2021; 292:114625. [PMID: 34891033 DOI: 10.1016/j.socscimed.2021.114625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/11/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Abstract
Breast pump marketing promises mothers that they will be able to follow cultural and scientific mandates to breastfeed their babies, but on their own schedules, including working outside of the home. Relatively little attention has been paid to the problems that women may experience with breast pumps. The Food and Drug Administration (FDA) regulates breast pumps as medical devices, and the agency collects data on adverse events experienced by consumers and recalls. Existing literature on breast pumps was reviewed in the contexts of medicalization and biomedicalization, and regulatory data were analyzed using mixed methods to examine the problems that women have experienced with breast pumps, which include electrical problems, suction problems, fluid leaks, injuries, and infections. While electric breast pumps promise women convenience and efficiency in pumping, women may incur personal costs, in the form of pain, injuries, and infections. These findings have implications regarding the risks of using these devices, the design of future pumps, and the future research into medical devices for reproductive and women's health.
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Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant. Pediatrics 2021; 148:peds.2021-054272. [PMID: 34635582 DOI: 10.1542/peds.2021-054272] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Provision of mother's own milk for hospitalized very low birth weight (VLBW) (≤1500 g) infants in the NICU provides short- and long-term health benefits. Mother's own milk, appropriately fortified, is the optimal nutrition source for VLBW infants. Every mother should receive information about the critical importance of mother's own milk to the health of a VLBW infant. Pasteurized human donor milk is recommended when mother's own milk is not available or sufficient. Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother's own milk by providing institutional supports for early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding, when appropriate. Promotion of human milk and breastfeeding for VLBW infants requires multidisciplinary and system-wide adoption of lactation support practices.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, School of Medicine, Boston University, Boston, Massachusetts
| | - Lisa M Stellwagen
- University of California Health Milk Bank, San Diego, California.,Department of Pediatrics, University of California, San Diego, Health, San Diego, California
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,New York City Health + Hospitals/Elmhurst
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenda B Poindexter
- Children's Healthcare of Atlanta and School of Medicine, Emory University, Atlanta, Georgia
| | - Karen M Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Francis J, Mildon A, Stewart S, Underhill B, Tarasuk V, Di Ruggiero E, Sellen D, O'Connor DL. Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program. MATERNAL & CHILD NUTRITION 2020; 16:e12957. [PMID: 31984642 PMCID: PMC7296823 DOI: 10.1111/mcn.12957] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 01/24/2023]
Abstract
The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding-associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self-efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in-home visit by the lactation consultant, who was highly skilled and provided care in a non-judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well-established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.
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Affiliation(s)
- Jane Francis
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Alison Mildon
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
| | - Stacia Stewart
- Health Promotion & Community EngagementParkdale Queen West Community Health CentreTorontoOntarioCanada
| | - Bronwyn Underhill
- Health Promotion & Community EngagementParkdale Queen West Community Health CentreTorontoOntarioCanada
| | - Valerie Tarasuk
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Erica Di Ruggiero
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Daniel Sellen
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Joannah and Brian Lawson Centre for Child NutritionUniversity of TorontoTorontoOntarioCanada
| | - Deborah L. O'Connor
- Department of Nutritional SciencesUniversity of TorontoTorontoOntarioCanada
- Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoOntarioCanada
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Desorcy-Scherer K, Bendixen MM, Parker LA. Determinants of the Very Low-Birth-Weight Infant's Intestinal Microbiome: A Systematic Review. J Perinat Neonatal Nurs 2020; 34:257-275. [PMID: 32697547 PMCID: PMC7464589 DOI: 10.1097/jpn.0000000000000506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The intestinal microbiome is the genetic material from microorganisms residing in the intestinal tract. Very low-birth-weight infants (VLBW; birth weight ≤1500 g) are a physiologically compromised population undergoing a unique period of initial intestinal microbiome establishment. Evidence supports a connection between the intestinal microbiome and gastrointestinal illness that disproportionately affects VLBW infants. Necrotizing enterocolitis, an inflammatory and often necrotic condition of the intestine, and late-onset sepsis, a bloodstream infection occurring after 3 days of life, are thought to be associated with delayed or abnormal intestinal microbiome development. Here, we review the determinants, or factors, that influence the VLBW infant's intestinal microbiome and discuss clinical implications. PubMed, Web of Science, EMBASE, and CINAHL were systematically searched for publications addressing factors with the potential to affect the intestinal microbiome of VLBW infants. Results indicate that infant's age and weight, mode of delivery, antibiotic exposure, medication use, feeding regime, environment, and perinatal-/infant-associated factors may be important determinants of the microbiome in this vulnerable population. Clinicians have opportunities to support positive development of the VLBW infant's intestinal microbiome through antibiotic stewardship, support of human milk feeding, and hygienic care practices.
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Houghtaling B, Shanks CB, Ahmed S, Smith T. Resources Lack as Food Environments Become More Rural: Development and Implementation of an Infant Feeding Resource Tool (InFeed). JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019; 15:170-189. [PMID: 32467747 PMCID: PMC7254963 DOI: 10.1080/19320248.2019.1613275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Evaluating the availability and affordability of breastfeeding and formula-feeding supplies are critical for building food environments that support healthy infant development. This study details the development and implementation of the Infant Feeding Resource Tool (InFeed) in retail settings across Montana (n = 21). Interrater reliability was tested (n = 9), kappa 0.620. Analysis of variance found significant differences by rurality for InFeed scores, with infant feeding resources lacking in more rural Montana retail settings: Formula, p = .05 (rounded value); Equipment, p = .02; and Total, p = .03. Prices of infant feeding resources did not differ by rurality and InFeed scores did not differ by store type.
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Affiliation(s)
- Bailey Houghtaling
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Carmen Byker Shanks
- Food and Nutrition and Sustainable Food Systems, Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Selena Ahmed
- Sustainable Food and Bioenergy Systems, Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Teresa Smith
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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A Pilot Study of Mothers' Breastfeeding Experiences in Infants With Cleft Lip and/or Palate. Adv Neonatal Care 2019; 19:127-137. [PMID: 30325751 DOI: 10.1097/anc.0000000000000551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite the recognized importance of human milk (HM) use, breastfeeding is often discouraged for infants with cleft lip and/or palate because of their anatomical abnormalities. Poor weight gain may require formula for calorie supplementation. Stresses associated with caring for infants with cleft lip/palate may decrease rates of HM provision to these infants. PURPOSE This study investigates the experiences of mothers of infants with cleft lip/palate (CL/P) to determine choices and factors associated with providing HM to their infants. METHODS A retrospective telephone survey was administered to a cohort of mothers of infants with CL/P. RESULTS Fifty mothers agreed to participate in the survey. Most (78%) initiated use of HM for a median duration of 4 months, 32% provided HM for 6 months or more, and 79% exclusively expressed their HM. Poor supply was the most frequent challenge to providing HM and led to cessation in 46% of the mothers. Formula was used to supplement for poor supply or poor infant weight gain in 90% of the mothers. The best predictors of a mother's use of HM were child not in day care, genetic diagnosis, and gestational age at birth. Only 36% of mothers reported individual encouragement to provide HM, and 18% reported they were specifically discouraged from providing HM for their infants. IMPLICATIONS FOR PRACTICE Although initiation rates were high, there are opportunities to improve support for mothers to increase duration of HM provision in children with CL/P. IMPLICATIONS FOR RESEARCH This study establishes a baseline for future prospective studies looking at the impact of active encouragement and provision of lactation support within the cleft team setting.
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Romaine A, Clark RH, Davis BR, Hendershot K, Kite V, Laughon M, Updike I, Miranda ML, Meier PP, Patel AL, Smith PB, Cotten CM, Benjamin DK, Greenberg RG. Predictors of Prolonged Breast Milk Provision to Very Low Birth Weight Infants. J Pediatr 2018; 202:23-30.e1. [PMID: 30170862 PMCID: PMC6203611 DOI: 10.1016/j.jpeds.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged maternal breast milk (BM) provision in very low birth weight (VLBW) infants. STUDY DESIGN This was a cohort study of VLBW infants who initially received maternal BM and were born at one of 197 neonatal intensive care units managed by the Pediatrix Medical Group from 2010 to 2012. We used multivariable logistic regression to identify demographic, clinical, and maternal factors associated with provision of maternal BM on day of life (DOL) 30 and at discharge. RESULTS Median gestational age for all infants was 28 weeks (25th, 75th percentiles: 26, 30), and median maternal age was 28 years (23, 33). Of 8806 infants, 6261 (71%) received maternal BM on DOL 30, and 4003 of 8097 (49%) received maternal BM at discharge to home. Predictors of maternal BM provision at DOL 30 included increased maternal age, white maternal race, absence of history of necrotizing enterocolitis or late-onset sepsis, higher household income, lower education level, lack of donor BM exposure, and lower gestational age. CONCLUSIONS Our results suggest that maternal-infant demographic and clinical factors and household neighborhood socioeconomic characteristics were associated with provision of maternal BM at 30 postnatal days to VLBW infants. Identification of these factors allows providers to anticipate mothers' needs and develop tailored interventions designed to improve rates of prolonged maternal BM provision and infant outcomes.
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Affiliation(s)
- Andrew Romaine
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Briana R Davis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kaitlin Hendershot
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Vance Kite
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Madeleine Laughon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Isaac Updike
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - C Michael Cotten
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Pediatrics, Duke University School of Medicine, Durham, NC.
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Cartwright A, Boath E. Feeding infants with Down's Syndrome: A qualitative study of mothers' experiences. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gurley-Calvez T, Bullinger L, Kapinos KA. Effect of the Affordable Care Act on Breastfeeding Outcomes. Am J Public Health 2017; 108:277-283. [PMID: 29267066 DOI: 10.2105/ajph.2017.304108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess how the 2012 Affordable Care Act (ACA) policy change, which required most private health insurance plans to cover lactation-support services and breastfeeding equipment (without cost-sharing), affected breastfeeding outcomes. METHODS We used a regression-adjusted difference-in-differences approach with cross-sectional observational data from the US National Immunization Survey from 2008 to 2014 to estimate the effect of the ACA policy change on breastfeeding outcomes, including initiation, duration, and age at first formula feeding. The sample included children aged 19 to 23 months covered by private health insurance or Medicaid. RESULTS The ACA policy change was associated with an increase in breastfeeding duration by 10% (0.57 months; P = .007) and duration of exclusive breastfeeding by 21% (0.74 months; P = .001) among the eligible population. Results indicate no significant effects on breastfeeding initiation and age at first formula feeding. CONCLUSIONS Reducing barriers to receiving support services and breastfeeding equipment shows promise as part of a broader effort to encourage breastfeeding, particularly the duration of breastfeeding and the amount of time before formula supplementation.
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Affiliation(s)
- Tami Gurley-Calvez
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
| | - Lindsey Bullinger
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
| | - Kandice A Kapinos
- Tami Gurley-Calvez is with the University of Kansas Medical Center, Kansas City. Lindsey Bullinger is with the School of Public and Environmental Affairs, Indiana University, Bloomington. Kandice A. Kapinos is with the RAND Corporation, Arlington, VA
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Kapinos KA, Bullinger L, Gurley‐Calvez T. Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act. Health Serv Res 2017; 52:2175-2196. [PMID: 27861824 PMCID: PMC5682156 DOI: 10.1111/1475-6773.12598] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. This study examined whether mandated coverage of lactation support services under the Affordable Care Act (ACA) affects breastfeeding behavior. DATA SOURCE We studied the census of U.S. births included in the National Vital Statistics System from 2009 to 2014. STUDY DESIGN We used regression-adjusted difference-in-differences (DD) to examine changes in breastfeeding rates for privately insured mothers relative to those covered by Medicaid. We adjusted for several health and sociodemographic measures. We also examined the extent to which the effect varied across vulnerable populations-by race/ethnicity, maternal education, WIC status, and mode of delivery. PRINCIPAL FINDINGS Results suggest that the ACA mandate increased the probability of breastfeeding initiation by 2.5 percentage points, which translates into about 47,000 more infants for whom breastfeeding was initiated in 2014. We find larger effects for black, less educated, and unmarried mothers. CONCLUSIONS The Affordable Care Act-mandated coverage of lactation services increased breastfeeding initiation among privately insured mothers relative to mothers covered by Medicaid. The magnitude of the effect size varied with some evidence of certain groups being more likely to increase breastfeeding rates.
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Affiliation(s)
| | - Lindsey Bullinger
- School of Public and Environmental AffairsIndiana UniversityBloomingtonIN
| | - Tami Gurley‐Calvez
- Department of Health Policy and ManagementUniversity of Kansa Medical CenterKansas CityKS
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Abstract
This review will provide an overview of quality improvement methods that have been used to improve human milk use (mother's own milk and donor milk) for very low-birth-weight infants in the hospital setting in the last decade. We will review the following: (1) evidence-based practices known to increase mother's own milk for very low-birth-weight infants; (2) individual hospitals with exemplary lactation programs and past and current US-based statewide quality improvement collaboratives focused on increasing mother's own milk; and (3) existing quality metrics for human milk and gaps in metrics. Finally, we will provide practical examples of key driver diagrams and change concepts that may be used to inform quality improvement for mother's own milk for very low-birth-weight infants.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, 88 E Newton St, Vose Hall, 3rd Floor, Boston, MA 02118.
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
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Crossland N, Thomson G, Morgan H, MacLennan G, Campbell M, Dykes F, Hoddinott P. Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability. MATERNAL & CHILD NUTRITION 2016; 12:726-39. [PMID: 27502101 PMCID: PMC5096021 DOI: 10.1111/mcn.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with 'a breast pump costing around £40 provided for free on the NHS' as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the 'appeal and value of breast pumps', 'sharing the load', 'perceived benefits', 'perceived risks' and issues related to 'timing'. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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Affiliation(s)
- Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Parker MGK, Burnham L, Mao W, Philipp BL, Merewood A. Implementation of a Donor Milk Program Is Associated with Greater Consumption of Mothers' Own Milk among VLBW Infants in a US, Level 3 NICU. J Hum Lact 2016; 32:221-8. [PMID: 26243756 DOI: 10.1177/0890334415598305] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether use of donor milk (DM) changes the provision of mothers' own milk (MOM) to very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU). OBJECTIVES To determine whether (1) the rates of any MOM and human milk consumption at feeding initiation and discharge and (2) the proportion of VLBW infants who stopped consuming any MOM and human milk during hospitalization changed in the 2 years after versus before implementation of a DM program in a US, inner-city, level 3 NICU. METHODS We studied VLBW infants admitted to Boston Medical Center in the 2 years before (n = 74) and after (n = 80) implementation of a DM program (June 2011). We used multivariable logistic regression to compare milk consumption at feeding initiation and discharge and Cox proportional hazards to compare the proportion of infants that stopped consuming milk during the hospitalization pre and post our DM program. RESULTS After adjustment for maternal race, age, insurance, delivery type, gestational age, and birth weight, we found a 6.0-fold increased odds (95% CI, 2.0-17.7) of consuming MOM at discharge and a 49% reduction in the cessation of MOM consumption during hospitalization (hazard ratio [HR], 0.51; 95% CI, 0.28-0.93) in the 2 years after versus before our DM program. CONCLUSION Implementation of a DM program was associated with greater consumption of MOM throughout hospitalization and at discharge among VLBW infants. Implementation of DM programs may augment support of mothers to provide breast milk in level 3 NICUs.
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Affiliation(s)
- Margaret G K Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Laura Burnham
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Wenyang Mao
- Division of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Barbara L Philipp
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Anne Merewood
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Morgan H, Hoddinott P, Thomson G, Crossland N, Farrar S, Yi D, Hislop J, Moran VH, MacLennan G, Dombrowski SU, Rothnie K, Stewart F, Bauld L, Ludbrook A, Dykes F, Sniehotta FF, Tappin D, Campbell M. Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design. Health Technol Assess 2016; 19:1-522, vii-viii. [PMID: 25897655 DOI: 10.3310/hta19300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby. AIM To understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design. DESIGN Evidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout. SETTING UK. PARTICIPANTS The qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking. METHODS (1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test. RESULTS Out of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A 'ladder' logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical 'ladder' towards smoking cessation and breastfeeding. Incentive interventions provide opportunity 'rungs' to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women's capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave 'healthily' risk them feeling pressurised and failing. To avoid 'losing face', women may disengage. LIMITATIONS Included studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population. CONCLUSIONS Incentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important. STUDY REGISTRATION This study is registered as PROSPERO CRD42012001980. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Pat Hoddinott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Shelley Farrar
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Deokhee Yi
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jenni Hislop
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Bauld
- The Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Anne Ludbrook
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, UK
| | - Falko F Sniehotta
- Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - David Tappin
- Perinatal Epidemiology and Child Health Unit, School of Medicine, University of Glasgow, Glasgow, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Morgan H, Thomson G, Crossland N, Dykes F, Hoddinott P. Combining PPI with qualitative research to engage 'harder-to-reach' populations: service user groups as co-applicants on a platform study for a trial. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:7. [PMID: 29062508 PMCID: PMC5611582 DOI: 10.1186/s40900-016-0023-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/13/2016] [Indexed: 05/22/2023]
Abstract
PLAIN ENGLISH SUMMARY It is recommended that research studies are carried out with or by patients and the public through their involvement from the beginning and in as many stages as possible (known as PPI). Some studies formally invite patients and the public to participate in interviews and focused group discussions to collect views about topics (known as qualitative research). In our study on financial incentives for giving up smoking in pregnancy and breastfeeding, we combined both PPI and qualitative research to include the views of women with a range of experiences of smoking and breastfeeding. We involved two mother and baby groups in disadvantaged areas of North East Scotland and North West England as research partners on our team. First, we asked members to comment on our research plans and documents, which is standard PPI. Second, we asked members to participate in voice recorded discussions, contributing to qualitative research data. These discussions revealed different views from those that we heard through research interviews. They allowed us to develop more relevant research tools and resources. Members also helped us to identify people outside the groups who we could interview. Combining involvement and participation helped us to include the views of a wide range of women from 'harder-to-reach' groups who don't usually take part in research. This was important because the research was intended for women who could benefit from incentives to stop smoking in pregnancy and breastfeed, often present in such groups. Positive continuing relationships and trust improved on involvement or participation alone. BACKGROUND Patient and public involvement (PPI) in all research studies is recommended from the earliest point and in as many stages as possible. Qualitative research is also recommended in the early stages of designing complex intervention trials. Combining both together might enable inclusion of 'harder-to-reach' perspectives from the target population(s), particularly when the research is intended for their benefit. However, the interface between PPI and qualitative research has received little attention. In a multi-disciplinary, mixed methods study to inform the design of incentive trials for smoking cessation in pregnancy and breastfeeding, we combined PPI and qualitative research, with some overlap. Mother and baby groups from two geographically separate disadvantaged areas, with diverse experiences of the smoking and breastfeeding, but no training or previous involvement in research, were recruited as PPI research grant co-applicants. An iterative partnership approach facilitated involvement in research conduct and design across all project phases. Group PPI members were also invited to contribute to more formal qualitative data collection, as and when indicated by the research questions, and emerging analysis. RESULTS We engaged with 'harder-to-reach' women in mother and baby group settings, rather than in academic or home environments. These settings were relaxed and informal, which facilitated rapport-building, disclosures of unexpected information and maintained trust. Twenty-one women participated in standard PPI activities: feedback on study protocols and documents; piloting questionnaires and interview schedules. PPI members voiced some different perspectives from those captured within the qualitative dataset. Nineteen participated in focused qualitative research. Novel aspects were audio recorded PPI discussions, which contributed qualitative data; first, to interpret systematic review findings and construct intervention vignettes for use in the qualitative research; second, to assist with recruitment to improve sample diversity in the formal qualitative dataset; and third, to translate theory and findings presented in a researcher generated logic model into a lay tool. This had face validity for potential trial participants and used the metaphor of a ladder. CONCLUSIONS Combining and overlapping PPI and qualitative research added 'harder-to-reach' contributions, sample diversity, trust and engagement in creative approaches beyond what could be achieved through PPI or qualitative research alone.
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Affiliation(s)
- Heather Morgan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD Scotland, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, PR1 2HE England, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA Scotland, UK
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Moran VH, Morgan H, Rothnie K, MacLennan G, Stewart F, Thomson G, Crossland N, Tappin D, Campbell M, Hoddinott P. Incentives to promote breastfeeding: a systematic review. Pediatrics 2015; 135:e687-702. [PMID: 25647672 DOI: 10.1542/peds.2014-2221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth. METHODS Searches of electronic databases, reference lists, and grey literature were conducted to identify relevant reports of published, unpublished, and ongoing studies. All study designs published in English, which met our definition of incentives and that were from a developed country, were eligible for inclusion. Abstract and full-text article review with sequential data extraction were conducted by 2 independent authors. RESULTS Sixteen full reports were included in the review. The majority evaluated multicomponent interventions of varying frequency, intensity, and duration. Incentives involved providing access to breast pumps, gifts, vouchers, money, food packages, and help with household tasks, but little consensus in findings was revealed. The lack of high-quality, randomized controlled trials identified by this review and the multicomponent nature of the interventions prohibited meta-analysis. CONCLUSIONS This review found that the overall effect of providing incentives for breastfeeding compared with no incentives is unclear due to study heterogeneity and the variation in study quality. Further evidence on breastfeeding incentives offered to women is required to understand the possible effects of these interventions.
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Affiliation(s)
- Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom;
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Kieran Rothnie
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Gillian Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - Nicola Crossland
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, Preston, United Kingdom
| | - David Tappin
- David Tappin, School of Medicine, University of Glasgow, United Kingdom; and
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom
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Crossland N, Thomson G, Morgan H, Dombrowski SU, Hoddinott P. Incentives for breastfeeding and for smoking cessation in pregnancy: An exploration of types and meanings. Soc Sci Med 2015; 128:10-7. [DOI: 10.1016/j.socscimed.2014.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thomson G, Morgan H, Crossland N, Bauld L, Dykes F, Hoddinott P. Unintended consequences of incentive provision for behaviour change and maintenance around childbirth. PLoS One 2014; 9:e111322. [PMID: 25357121 PMCID: PMC4214733 DOI: 10.1371/journal.pone.0111322] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022] Open
Abstract
Financial (positive or negative) and non-financial incentives or rewards are increasingly used in attempts to influence health behaviours. While unintended consequences of incentive provision are discussed in the literature, evidence syntheses did not identify any primary research with the aim of investigating unintended consequences of incentive interventions for lifestyle behaviour change. Our objective was to investigate perceived positive and negative unintended consequences of incentive provision for a shortlist of seven promising incentive strategies for smoking cessation in pregnancy and breastfeeding. A multi-disciplinary, mixed-methods approach included involving two service-user mother and baby groups from disadvantaged areas with experience of the target behaviours as study co-investigators. Systematic reviews informed the shortlist of incentive strategies. Qualitative semi-structured interviews and a web-based survey of health professionals asked open questions on positive and negative consequences of incentives. The participants from three UK regions were a diverse sample with and without direct experience of incentive interventions: 88 pregnant women/recent mothers/partners/family members; 53 service providers; 24 experts/decision makers and interactive discussions with 63 conference attendees. Maternity and early years health professionals (n = 497) including doctors, midwives, health visitors, public health and related staff participated in the survey. Qualitative analysis identified ethical, political, cultural, social and psychological implications of incentive delivery at population and individual levels. Four key themes emerged: how incentives can address or create inequalities; enhance or diminish intrinsic motivation and wellbeing; have a positive or negative effect on relationships with others within personal networks or health providers; and can impact on health systems and resources by raising awareness and directing service delivery, but may be detrimental to other health care areas. Financial incentives are controversial and generated emotive and oppositional responses. The planning, design and delivery of future incentive interventions should evaluate unexpected consequences to inform the evidence for effectiveness, cost-effectiveness and future implementation.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
- * E-mail:
| | - Heather Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Nicola Crossland
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Linda Bauld
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
| | - Fiona Dykes
- Maternal and Infant Nutrition & Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, England
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Scotland
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Ryan K, Team V, Alexander J. Expressionists of the twenty-first century: the commodification and commercialization of expressed breast milk. Med Anthropol 2014; 32:467-86. [PMID: 23944247 DOI: 10.1080/01459740.2013.768620] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Breast milk expression has been promoted as liberating for women and as offering them more choices, but there has been little research on women's experiences of it and even less critical commentary on the consequences of its incorporation into mainstream behavior. Drawing on narratives of women in the United Kingdom about breastfeeding, we explore the increasingly popular practice of expressing and feeding expressed breast milk. We argue that breast milk has become commodified, breastfeeding commercialized and technologized, and the mother-infant relationship disrupted. We suggest that breastfeeding as a process is being undermined by vested interests that portray it as unreliable and reconstruct it in artificial feeding terms, so playing on women's insecurities. The major beneficiaries of expression are fathers who want increased involvement in infant care and commercial enterprises that aim to maximize profits for shareholders.
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Affiliation(s)
- Kath Ryan
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
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Abstract
This article provides the pediatric community with a practical overview of milk expression and an update on the recent literature. Approaches for working mothers, preterm infants, critically ill infants, and mothers before lactogenesis II are presented separately, as these groups may benefit from practices tailored to individual needs.
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Affiliation(s)
- Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0503, USA.
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Partyka B, Whiting S, Grunerud D, Archibald K, Quennell K. Infant nutrition in Saskatoon: barriers to infant food security. CAN J DIET PRACT RES 2011; 71:79-84. [PMID: 20525419 DOI: 10.3148/71.2.2010.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. METHODS Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. RESULTS Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. CONCLUSIONS Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.
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Affiliation(s)
- Brendine Partyka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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Buckley KM. A double-edged sword: lactation consultants' perceptions of the impact of breast pumps on the practice of breastfeeding. J Perinat Educ 2009; 18:13-22. [PMID: 20190850 PMCID: PMC2684034 DOI: 10.1624/105812409x426297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This qualitative descriptive study examined the beliefs and experiences of 12 lactation consultants regarding the impact of breast pumps on breastfeeding practices. Interview topics on breast pumps included types and patterns of use, mothers' experiences, and advantages and risks. The lactation consultants reported an increase in the use of breast pumps due to improved marketing, a change in society's view of pumps as a necessity rather than a luxury, and the impact of birthing technology. Reasons given for this increased use were mothers' need to have greater control over the breastfeeding process and to quantify the amount of breastmilk. Concerns were expressed regarding an overdependency on breastfeeding technology by some lactation consultants and mothers.
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Affiliation(s)
- Kathleen M Buckley
- KATHLEEN M. BUCKLEY is an associate professor in the University of Maryland School of Nursing. She also practices as a maternal-child home health nurse and lactation consultant for Adventist Home Health in Silver Spring, Maryland
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Abstract
The prevalence of overweight has risen to 19% in children aged 6 to 11 years and 17% in adolescents aged 12 to 19 years. This paper examines gestational and infancy factors that influence the risk of overweight in childhood. Important factors to eliminate the infancy connection to childhood obesity include the following: (a) maternal lifestyle patterns, (b) infant feeding transitions, and (c) environmental factors. Prevention efforts need to focus on practice, research, and public policy.
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Affiliation(s)
- Julia A Snethen
- University of Wisconsin-Milwaukee College of Nursing, WI 53201, USA.
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ABM Clinical Protocol #2 (2007 revision): guidelines for hospital discharge of the breastfeeding term newborn and mother: "the going home protocol". Breastfeed Med 2007; 2:158-65. [PMID: 17903102 DOI: 10.1089/bfm.2007.9990] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Merewood A, Brooks D, Bauchner H, MacAuley L, Mehta SD. Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts. Pediatrics 2006; 118:e1048-54. [PMID: 17015498 DOI: 10.1542/peds.2005-2637] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Among premature infants, formula feeding increases the risk for necrotizing enterocolitis, delayed brainstem maturation, decreased scoring on cognitive and developmental tests, and delayed visual development. With this in mind, many interventions are designed to increase breast milk consumption in preterm infants. Breastfeeding initiation rates among US premature infants are not collected nationally, however, and published data on breastfeeding rates in this population are limited. In addition, national surveys calculate breastfeeding rates among term infants according to maternal race/ethnicity, but maternal birthplace is not recorded. This is likely to be important, because breastfeeding is the cultural norm in the countries of origin for many non-US-born US residents. Massachusetts has a diverse racial/ethnic population, including many non-US-born women. The goals of this study were to compare breastfeeding initiation rates among preterm and term infants in Massachusetts in 2002 and to determine the effect of maternal race/ethnicity and birthplace on breastfeeding initiation rates among term and preterm infants. METHODS Massachusetts Community Health Information Profile, an online public health database that was created by the Massachusetts Department of Public Health, includes breastfeeding initiation data that are obtained from the electronic birth certificate, which we used to compare breastfeeding rates among preterm and term infants. Birth-linked demographics and data that also were accessed were maternal age, race/ethnicity, birthplace, and health insurance (public or private) as an indicator of socioeconomic status and infant's gestational age. We assessed the association between breastfeeding initiation and maternal birthplace, as well as race/ethnicity and the other potential confounders, using logistic regression. RESULTS There were 80,624 births in Massachusetts in 2002, and 8.2% (6611) of newborns had a gestational age <37 weeks. The state's overall breastfeeding initiation rate was 74.6%. We excluded records of mothers who were younger than 15 years and older than 39 years, nonsingleton births, infants with a gestational age <24 weeks and >42 weeks, and records with missing data. Of the total births in Massachusetts, 67,884 (84%) met inclusion criteria for this study. Breastfeeding initiation rates were lowest among preterm infants of the youngest gestational ages. Breastfeeding initiation was 76.8% among term infants born at 37 to 42 weeks, 70.1% among infants born at 32 to 36 weeks, and 62.9% among infants born at 24 to 31 weeks. In univariate analysis, among preterm infants, a lower proportion of US-born black, Asian, and Hispanic mothers initiated breastfeeding than US-born white mothers; non-US-born black and non-US-born Hispanic mothers had the highest breastfeeding initiation rates. Among term infants, US-born black mothers had the lowest initiation rates, and non-US-born black and non-US-born Hispanic mothers had the highest. In multivariate logistic regression, however, after controlling for mother's age, race, birthplace, and insurance, US-born white mothers were least likely to breastfeed either term or preterm infants when compared with any other racial/ethnic group, including US-born black mothers. The likelihood that non-US-born Hispanic mothers would breastfeed was almost 8 times greater than that for US-born white mothers for a preterm infant and almost 10 times greater for a term infant. In multivariate logistic regression analysis stratified by gestational age for both preterm and term infants, older mothers and mothers with private health insurance were most likely to breastfeed. CONCLUSIONS In Massachusetts, preterm infants were less likely to receive breast milk than term infants, and the likelihood of receiving breast milk was lowest among the youngest preterm infants. In multivariate logistic regression, mothers who were born outside the United States were more likely than US-born mothers to breastfeed either term or preterm infants in all racial and ethnic groups. In an unexpected finding, US-born white mothers were less likely to breastfeed term or preterm infants than US-born black mothers or mothers of any other racial or ethnic group.
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Affiliation(s)
- Anne Merewood
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA.
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