Optimizing breastfeeding promotion and support in adolescent mothers

Promotion, Protection, and Support of Breastfeeding as a Human Right: A Narrative Review

Background: Despite the benefits of breastfeeding, there are significant disparities in rates among various racial, social, and economic groups. Society poses various barriers to breastfeeding, threatening the child's access to a basic human right. Exploring and understanding these issues can ensure that effective interventions are implemented. Objective: To present situations in which the mother's and child's basic human right to breastfeeding is threatened and to highlight opportunities to uphold their rights within social and health care systems. Methods: A literature search of relevant articles was performed via PubMed regarding (1) rights to optimal protections for breastfeeding, (2) situations in which the rights of breastfeeding parents are threatened, and (3) challenges in providing inclusive and equitable breastfeeding care along with strategies to uphold the human right to breastfeed. Results: Maternity leave of at least 12 weeks was associated with higher breastfeeding rates, whereas mandated breaks in the workplace resulted in either positive or inconclusive effects. Peer counseling, institutional initiatives, and mass media campaigns were among the most effective interventions; however, effects on breastfeeding varied among different racial groups. Conclusions: There are clear benefits of breastfeeding for mothers and infants, which highlight the importance of prioritizing breastfeeding as a basic human right. Regardless, there are numerous societal barriers to providing equitable breastfeeding care. Although there are interventions that have proven to be helpful in breastfeeding promotion, protection, and support, further standardized research will be beneficial in identifying effective and inclusive interventions.

Mothers' Breastfeeding Experiences of Emotional Support Needs: A Qualitative Study in Iran

Introduction: Breastfeeding is an important strategy to ensure health promotion and wellbeing. Since breastfeeding rates have consistently decreased around the world, protection, promotion, and supportive programs are considered as public health priorities. This study aims to explore breastfeeding mothers’ perceptions and experiences of emotional support needs.

Methods: This study was performed in five health centers and four hospitals affiliated to Mashhad University of Medical Sciences, Iran. Using a qualitative approach, 36 breastfeeding mothers, family members, and health providers attended individual semi-structured in-depth interviews. Data were analyzed using directed content analysis based on the Elo and Kyngas approach, with MAXQDA software version 10.

Results: Four categories of ‘need to tranquility and solace’, ‘sense of being loved and belongingness’, ‘creating hope, motivation, and confidence’, and ‘empathy and companionship’, and 12 subcategories including ‘not inducing stress’, ‘relieving the mother’s stress and worries’, ‘creating and maintaining tranquility’, ‘understanding and attention’, ‘receiving affection from significant others’, ‘being respected by others’, ‘ being inspired by significant others’, ‘being assured by family members’, ‘being motivated by significant others’, ‘interacting with others’, ‘having the companionship and presence of others’, and ‘receiving empathy from others’ were identified as the mothers’ emotional support needs.

Conclusion: Mothers need emotional support to sustain breastfeeding. Significant others, such as the husband, family members, and health providers play an important role in meeting breastfeeding mothers’ emotional support needs.

Effectiveness of experiential learning with empowerment strategies and social support from grandmothers on breastfeeding among Thai adolescent mothers

BACKGROUND

Grandmothers are important to successful breastfeeding because their knowledge, attitudes and experiences influence adolescent mothers' decision to initiate and to continue breastfeeding. The purpose of this study was to assess the effectiveness of an experiential learning with empowerment strategies and social support (ELESSS) programme for grandmothers according to improvements in the rate and duration of exclusive breastfeeding (EBF); knowledge and attitude (KA) regarding breastfeeding; and perceived social support among adolescent mothers.

METHODS

A quasi-experimental study was conducted in two hospitals, Banmi as an intervention hospital and Inburi as a control hospital, between May 2015 and March 2016. Forty-two pairs of adolescent mothers and grandmothers were recruited from each hospital. At the baseline, grandmothers in the intervention group attended 2 days of an ELESSS programme, and they attended a refresher course 2 and 4 months after delivery. The grandmothers in the control group and adolescent mothers in both groups received the routine programme. Participants were assessed at the baseline and at two and 6 months after delivery to determine the rate and duration of EBF, KA regarding breastfeeding and perceived social support.

RESULTS

Adolescent mothers in the intervention group had the EBF rate at 6 months of around 29%, whereas the control group had the EBF rate at 6 months of about 5%, and the proportion of EBF in the intervention group was six times that of the control group. The median EBF duration in the intervention group was 90 days, while the control group was 0 day. A repeated measure ANOVA analysis showed that the intervention group's participants had significantly better knowledge and attitudes towards breastfeeding, while the adolescent mothers in the intervention group had a significantly higher perceived level of social support.

CONCLUSION

The ELESSS programme proved to be effective in increasing the rate and duration of EBF in adolescent mothers. Grandmothers are key to promoting, protecting and supporting breastfeeding.

TRIAL REGISTRATION

ClinicalTrials.in.th: TCTR20161001002.

Promoting improved social support and quality of life with the CenteringPregnancy® group model of prenatal care

This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N = 120) with those in standard individual care (N = 221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p < 0.05) with associated improvements in quality of life in the psychological and relational domains (p < 0.05) compared to standard care participants who showed higher scores of perceived support from family (p < 0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.

COMPARISON OF BREASTFEEDING SELF-EFFICACY BETWEEN ADOLESCENT AND ADULT MOTHERS AT A MATERNITY HOSPITAL IN RIBEIRÃO PRETO, BRAZIL

ABSTRACT Objective: to measure and compare the breastfeeding self-efficacy between adolescents and adults mothers in the immediate postpartum. Method: is an observational, cross-sectional and comparative study, developed at a maternity hospital in Ribeirao Preto, Brazil. Data were collected between January and July 2014. The sample consisted of 306 adult mothers and 94 adolescent mothers. The breastfeeding self-efficacy scores were obtained using the Brazilian version of the Breastfeeding Self-Efficacy Scale. Student t-test was used to compare the values of breastfeeding self-efficacy between the groups of participants. We considered a 5% significance level (p=0.05). Results: most adolescents and adults mothers (54%) presented high levels of breastfeeding self-efficacy and there was no statistically significant difference between the scores of the two groups (p=0.3482) . Conclusion: health professionals need to be careful about breastfeeding self-efficacy in order to direct specific actions for each group of mothers (adolescents and adult mothers) to improve the breastfeeding rates.

Factors associated with breastfeeding initiation in adolescent mothers

OBJECTIVE

To identify the most influential factors on breastfeeding initiation in adolescent mothers in order to identify the highest risk population to focus education and support services.

STUDY DESIGN

Retrospective population-based cohort study of all non-anomalous live births in Ohio (2006-2007). Breastfeeding initiation rates were compared between adolescent mothers age ≤ 19 years and a reference group age >19 years. A multivariate logistic regression model assessed the association between breastfeeding initiation in adolescent mothers while adjusting for important concomitant risk factors including race, socioeconomic, demographic, prenatal, and delivery factors.

RESULTS

Of 308,380 births during the study period, following exclusions there were 30,402 mothers ≤ 19 years of age (10.5% of study population) and 257,840 mothers age >19 years. Of adolescent mothers, 44% initiated breastfeeding compared with 65% of older mothers, P < .001. Adolescents were 33% less likely to breastfeed after adjusting for important coexisting factors, adjusted relative risk 0.77 (95% CI 0.75-0.80). Socioeconomic factors had the most significant influence on breastfeeding initiation in adolescent mothers.

CONCLUSION

Adolescent mothers who have the least social support and are socioeconomically disadvantaged are the least likely to breastfeed their newborn infants. In addition, maternal perception, societal barriers, and a lack of prenatal intervention contribute unique barriers to breastfeeding in adolescence. Opportunities exist for school programs, baby-friendly hospitals, and postpartum education to improve breastfeeding rates in this population.

Describing adolescent breastfeeding environments through focus groups in an urban community

PURPOSE

Breastfeeding is a potential solution to improve health outcomes for adolescent mothers and infants. Adolescence is a risk factor for low breastfeeding rates and is associated with a higher risk for perinatal complication. This study investigated facilitators and barriers to adolescent breastfeeding initiation and duration in an urban setting.

METHODS

Four, 1-hour focus groups were conducted. Twenty-nine (N = 29) adolescent mothers and pregnant adolescents participated and described attitudes toward breastfeeding, attitudes among family and friends, current knowledge, and barriers and facilitators for breastfeeding.

RESULTS

Four themes emerged, including the following: behavioral histories of breastfeeding, community assets, social support, and barriers. Participants identified positive histories and community resources such as local hospitals and social services as facilitators. Lifestyle, independence, lack of support from family and primary care providers, social stigma/embarrassment, and difficulty with breastfeeding techniques were described as barriers.

CONCLUSION

A comprehensive and integrated primary care and public health community effort is needed to support and improve adolescent breastfeeding. Further examination of integrated interventions focused on adolescent breastfeeding behaviors through an environmental approach is needed.

Evidence-based interventions to support breastfeeding

Considerable progress has been made in the past decade in developing comprehensive support systems to enable more women to reach their breastfeeding goals. Given that most women in the United States participate in some breastfeeding, it is essential that each of these support systems be rigorously tested and if effective replicated. Additional research is needed to determine the best methods of support during the preconception period to prepare women to exclusively breastfeed as a cultural norm.

Canadian adolescent mothers' perceptions of influences on breastfeeding decisions: a qualitative descriptive study

BACKGROUND

There is increased recognition of the importance of breastfeeding at a national level as evidenced by the increased number of Canadian mothers initiating breastfeeding. However, adolescent mothers (<19 years), compared to all other mothers, have lower rates of breastfeeding initiation and duration. The purpose of this study was to examine the facilitating influences and barriers to initiating, and continuing breastfeeding, as perceived by adolescent mothers in Durham Region, Ontario, Canada.

METHODS

The principles of interpretive description guided this qualitative study. A purposeful, homogenous sample of 16 adolescent mothers (15-19 years) were recruited to complete individual, semi-structured, face-to-face interviews. Conventional content analysis was used to code data, identify concepts and synthesize them into overall themes.

RESULTS

Adolescent mothers in this study expressed that the decision to breastfeed was made prenatally and while partner and family member opinions about breastfeeding initiation were influential, the decision was made independently. Mothers were primarily motivated to initiate breastfeeding due to the health benefits for the infant. Lower breastfeeding duration rates were found among mothers who decided to only "try" breastfeeding when compared to the mothers who committed to breastfeeding. Influences on continued breastfeeding included: 1) the impact of breastfeeding on social and intimate relationships; 2) the availability of social support; 3) the physical demands of breastfeeding; 4) mothers' knowledge of breastfeeding practices and benefits; and 5) mothers' perceived sense of comfort in breastfeeding.

CONCLUSIONS

The results of this study provide health care providers new conceptual insight and understanding of the factors that influence adolescents' decisions to "try" breastfeeding and to continue providing breastmilk to their infants. Professional implications drawn from this study include active engagement of adolescents in the pre and postnatal periods, including early assessment of potential barriers surrounding breastfeeding decisions. This early professional interaction highlights the professional as a form of support, and allows for sharing of evidence-informed breastfeeding information and practical breastfeeding skills. Inclusion of adolescents' positive social support networks should be emphasized in professional breastfeeding support. Motivational interviewing is a promising prenatal strategy to influence behavior change and reduce ambivalence in decision-making about breastfeeding, creating opportunities for health care providers to tailor interventions.

Care of adolescent parents and their children

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Background

Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers.

Methods

This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys.

Results

Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems.

Conclusions

Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers.

The development and psychometric testing of the Supportive Needs of Adolescents Breastfeeding Scale

AIM

To report the development and psychometric testing of the Supportive Needs of Adolescents Breastfeeding Scale.

BACKGROUND

Nurses worldwide can influence adolescent mothers' decisions to initiate and continue breastfeeding through understanding their social support needs in the early postpartum. Review of the literature reveals a lack of instruments that measure adolescents' perceptions of supportive nursing behaviours when initiating breastfeeding.

METHOD

An instrument development and psychometric evaluation study was conducted. In phase 1, scale items were developed from the literature using social support theory. Eight lactation consultants evaluated the scale's content validity in phase 2. During phase 3, the psychometric properties of the scale were tested using item analysis, scale reliability, and exploratory factor analysis. A convenience sample of 101 adolescents, aged 15-20 years old, was recruited during their postpartum stay at three hospitals in the USA between July 2009-July 2010.

RESULTS

Content validity index was 0·82. Alpha estimate of internal consistency was 0·83. Principal components analysis resulted in a 3 factor scale that explained 48% of the total variance: Practical support, Informational support and Miscellaneous.

CONCLUSION

The findings suggest evidence of the scale's adequate internal consistency. The factor analysis suggests two clear underlying dimensions of support: instrumental/emotional/appraisal and informational/emotional/appraisal, and a third miscellaneous dimension related to immediate skin-to-skin care and mothers' support persons. Further exploration of the possible global implications of the scale's dimensions is needed.

Breastfeeding experiences among physicians

BACKGROUND

During medical school and residency training, physicians are taught that breastfeeding is the preferred feeding for all infants, with rare exceptions. But evidence is accumulating that while physician mothers have a high rate of breastfeeding initiation, they face significant obstacles to sustained breastfeeding.

METHODS

In our academic medical center, we conducted a brief survey of physicians who have young children, to explore their own experiences with breastfeeding. The survey explored the physician-as-parent's own experiences with breastfeeding -- prenatal intentions, postnatal difficulties, ability to meet goals, emotions if goals were not met, resources for support pre- and postnatally, and ideas about what would have helped her breastfeed longer.

RESULTS

Two-thirds of the physicians who initiated breastfeeding had difficulties. Among those with difficulties, about three-fourths were able to resolve them.

CONCLUSIONS

Even mothers who are medical professionals experience, and often cannot overcome, difficulties with breastfeeding. Women in medicine need enhanced breastfeeding support and services/resources. Advocacy is needed, in our work environments, for better breastfeeding support not only for our physician colleagues, but also for all lactating employees within our institutions.

Práticas alimentares no primeiro ano de vida

O estudo buscou analisar a literatura publicada referente às práticas alimentares no primeiro ano de vida de filhos de mães adolescentes, por meio de uma revisão integrativa nas bases de dados Lilacs, Medline e Cochrane, no período de 2000 a 2010. Foram utilizadas as palavras-chave: adolescente, aleitamento materno, alimentação mista e nutrição do lactente, sendo selecionados onze artigos científicos, que compuseram a amostra do estudo. Os resultados apontaram a incipiência de pesquisas publicadas sobre o tema proposto, sobretudo para as que versam sobre alimentação complementar, desvelando uma lacuna na produção mundial sobre o tema. Novas pesquisas, portanto, precisam ser desenvolvidas com foco em mães adolescentes, devendo-se explorar a alimentação infantil em toda sua dimensão.

Infant feeding experiences among teen mothers in North Carolina: Findings from a mixed-methods study

Background

Adolescent mothers in the U.S. are much less likely to initiate breastfeeding than older mothers, and teens who do initiate breastfeeding tend to breastfeed for shorter durations. The purpose of this mixed-methods study is to investigate breastfeeding practices, barriers and facilitators among adolescent mothers ages 17 and younger.

Methods

Quantitative descriptive analyses are conducted using data from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The population-based sample comprises 389 teens ages 13-17 giving birth to a live born infant in North Carolina in 2000 - 2005 and in 2007. Qualitative analyses are based on in-depth interviews with 22 Black, White and Hispanic teen mothers residing in rural and urban areas of North Carolina conducted between November 2007 and February 2009.

Results

In quantitative analyses, 52% (196 of 389) of North Carolina teen mothers initiated breastfeeding, but half of those who initiated breastfeeding (92/196) stopped within the first month postpartum. Hispanic teens (44/52 or 89%) were much more likely than Black (61/159 or 41%) or White teens (87/164 or 52%) to initiate breastfeeding and to continue for a longer duration. Nearly sixty two percent (29/52) of Hispanic respondents breastfed for greater than four weeks as compared to 16% (29/159) of Black respondents and 26% (39/164) of White respondents. Common barriers to breastfeeding initiation and continuation included not liking breastfeeding, returning to school, nipple pain, and insufficient milk. Qualitative data provided context for the quantitative findings, elucidating the barriers and facilitators to breastfeeding from the teens' perspective and insight into the ways in which breastfeeding support to teens could be enhanced.

Conclusions

The large number of adolescents ceasing breastfeeding within the first month points to the need for more individualized follow-up after hospital discharge in the first few days postpartum, to address common technical challenges and to provide assistance managing the transition back to school. Provision of an extra home visit or outpatient visit for teens within the first few days following hospital discharge, and advocacy to make schools more compatible with breastfeeding, could potentially help teens who desire to breastfeed to successfully continue. These interventions warrant further research to test their effectiveness among adolescents.

Psychometric testing of the breastfeeding self-efficacy scale-short form among adolescents

PURPOSE

This study aimed to (a) psychometrically assess the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) antenatally and postnatally among adolescents, and (b) examine the relationship between breast-feeding self-efficacy and adolescent demographic variables. The BSES-SF is used internationally but has not been psychometrically tested with an adolescent population.

METHODS

A methodological study was conducted in which 103 pregnant adolescents were recruited from two prenatal clinics at a tertiary care setting in western Canada. The BSES-SF was administered at 34 weeks' gestation and again at 1 and 4 weeks postpartum.

RESULTS

The Cronbach's alpha coefficient was .84 for the antenatal assessment and .93 for the postnatal assessment. Antenatal BSES-SF scores significantly predicted breast-feeding initiation, whereas antenatal and postnatal scores predicted duration and exclusivity to 4 weeks postpartum. Other reliability and validity results are consistent with previous research with adult samples. Study findings indicate prenatal classes and professional support may be particularly important sources of information to increase adolescent breast-feeding self-efficacy.

CONCLUSIONS

Results provide evidence that the scale may be a valid and reliable measure of breast-feeding self-efficacy among adolescents, predicting breast-feeding initiation, duration, and exclusivity.

Adolescent mothers' breastfeeding social support needs

OBJECTIVE

To define aspects of social support that adolescents need from nurses when initiating breastfeeding in the early postpartum.

DATA SOURCES

MEDLINE and CINAHL databases for years 2000 to 2009.

DATA EXTRACTION

Three searches were done using the following subject terms: adolescent mothers and breastfeeding (12 studies), adolescent mothers and breastfeeding and support (24 studies), and breastfeeding and adolescent mothers and attitudes (15 studies). The 18 studies that were chosen for this synthesized review illuminated the dimensions of social support identified by House.

DATA SYNTHESIS

The four types of supportive behavior categories identified by House were described in these studies (informational, instrumental, emotional, and appraisal). Esteem support as defined by Sarafino seemed to be synonymous with appraisal support. Many studies identified the importance of network support as a fifth category of supportive behavior in increased breastfeeding duration among adolescents; network support was included in this synthesis. These five types of social support provide a framework for defining supportive nurse behaviors.

CONCLUSIONS

Nurses in the early postpartum can promote the long-term health of adolescents and their children through the social support they offer adolescent mothers as they initiate breastfeeding. Network support appears to be essential to adolescents' breastfeeding experiences and needs to be included with informational, instrumental, emotional, and esteem/appraisal support when investigating support for this population. By integrating the five dimensions of social support into their care, nurses play an essential role in providing adolescents with the positive experiences that are so important to establishing breastfeeding.