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Mäkelä H, Axelin A, Kolari T, Niela-Vilén H. Exclusive breastfeeding, breastfeeding problems, and maternal breastfeeding attitudes before and after the baby-friendly hospital initiative: A quasi-experimental study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100806. [PMID: 36521260 DOI: 10.1016/j.srhc.2022.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Breastfeeding practices remain globally suboptimal despite many known maternal and neonatal health benefits and the Baby-Friendly Hospital Initiative as a global effort to support breastfeeding. OBJECTIVE We aimed to evaluate the effects of the implementation of the Baby-Friendly Hospital Initiative for a proportion of mothers who exclusively breastfed during a 6-month period, including breastfeeding problems, and maternal breastfeeding attitudes. METHODS Using a quasi-experimental non-equivalent two-group design, we recruited two independent samples of postpartum mothers in a maternity hospital to compare the situation before (N = 162) and after (N = 163) the implementation. We measured breastfeeding status and possible breastfeeding problems via text-message questions at 2 weeks, 1, 4 and 6 months after birth. We measured Mothers' attitudes toward breastfeeding at the maternity hospital and 4 months after birth using the Iowa Infant Feeding Attitude Scale. RESULTS The implementation of the Baby-Friendly Hospital Initiative had no effect on the proportion of mothers who exclusively breastfed, and we found no significant differences in exclusive breastfeeding at 6 months (41.3 % vs 52.9 %, p =.435). The intervention did not influence the reported number of breastfeeding problems (p =.260) or maternal breastfeeding attitudes (p =.354). More favourable breastfeeding attitudes (p <.001) and less problematic breastfeeding (p <.001) were associated positively with exclusive breastfeeding. CONCLUSION Exclusive breastfeeding rates did not increase after the intervention; however, the rates at baseline were already high. Ensuring the Baby-Friendly Hospital Initiative practices through pre- and postnatal periods and preparing mothers to manage common breastfeeding problems might improve breastfeeding rates. This trial was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.
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Affiliation(s)
- Heli Mäkelä
- University of Turku, Department of Nursing Science, Turku, Finland; Satakunta Hospital District, Satasairaala, Pori, Finland.
| | - Anna Axelin
- University of Turku, Department of Nursing Science, Turku, Finland
| | - Terhi Kolari
- University on Turku, Department of Biostatistics, University of Turku, Turku, Finland
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Cherubini KA, Schmidt MI, Vigo Á, Drehmer M. Breastfeeding rates and related factors at one year postpartum in women with gestational diabetes initially recruited for a diabetes prevention program. Can J Diabetes 2022; 46:441-448. [DOI: 10.1016/j.jcjd.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
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Parenting styles and types: Breastfeeding attitudes in a large sample of mothers. Midwifery 2021; 103:103142. [PMID: 34562688 DOI: 10.1016/j.midw.2021.103142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/02/2021] [Accepted: 09/05/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The importance of breastfeeding for both maternal and infant health is well established. However, it remains the case that only a small percentage of infants are breastfed after the first six months of life. Maternal negative breastfeeding attitudes are associated with a reduced likelihood of breastfeeding an infant, but they are a malleable target for practitioner interventions. By adjusting perceptions, and therefore behaviours within the population, maternal and infant health outcomes may be improved. As such, it is important to understand whether certain types of mother might feel more negatively about breastfeeding. Here. we investigated the relationships between parenting styles, personality traits, and breastfeeding attitudes. In addition, we aimed to address the interrelated nature of parenting styles by identifying 'types' of mother who may feel more negatively about breastfeeding. DESIGN A cross-sectional survey was used in order to measure parenting styles, personality traits, and attitudes to breastfeeding. PARTICIPANTS A sample of 1,347 mothers (age M = 31.4 years, SD = 7.4 years) participated. Recruitment took place through online mother and baby groups based predominantly in the United Kingdom. RESULTS More permissive and less uninvolved mothers felt positively about breastfeeding, but limited associations between personality factors and breastfeeding attitudes were found. We applied a cluster analytical approach to investigate whether there were particular 'types' of mothers in our sample, and if these showed systematic differences. Our analyses revealed two profiles, best described as 'high nurturance' (high scoring on authoritative and permissive) and 'low nurturance' (low scoring on these dimensions). These two types of mother showed significant differences along all four parenting styles, and our 'high nurturance' type was more conscientious and emotionally stable, and felt more positively about breastfeeding. CONCLUSIONS Parenting styles were associated with breastfeeding attitudes. Through identifying an underlying nurturance dimension that best explains differences in parenting styles across mothers, we provide a potential avenue to improving breastfeeding attitudes. By focussing on 'low nurturance' mothers in particular, professionals may be able to provide interventions to improve breastfeeding attitudes and, as a result, address low rates of breastfeeding in the UK.
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Byerly T, Buckman C, Tumin D, Bear K. Prematurity and breastfeeding initiation: A sibling analysis. Acta Paediatr 2020; 109:2586-2591. [PMID: 32249979 DOI: 10.1111/apa.15290] [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] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 12/30/2022]
Abstract
AIM Studies suggest breastfeeding initiation is less common for premature infants. This association may be confounded by socio-economic characteristics that correlate with the risk of premature birth. We compared premature and term-born children to determine whether prematurity independently predicted likelihood of breastfeeding continuation and duration. METHODS Data were obtained from women ages 15-44 years reporting at least two live pregnancies on the 2011-2017 National Survey of Family Growth. Participants completed a pregnancy and breastfeeding history. Breastfeeding initiation was defined as breastfeeding for at least 1 week, and duration of exclusive breastfeeding was recorded in months. Sibling fixed effects regression models were used to evaluate the impact of prematurity. RESULTS Among families with some children who were breastfed and others who were not (n = 2848 children), preterm birth was not associated with breastfeeding initiation (odds ratio = 1.11; P = .468). Among children who were ever breastfed, exclusive breastfeeding lasted 5% fewer months among children born preterm, compared with term-born siblings (incidence rate ratio = 0.95; P = .060). CONCLUSION Using sibling-group analysis to control for confounding, we found no independent association between prematurity and likelihood of breastfeeding initiation. This suggests interventions supporting breastfeeding for premature infants may need to address external barriers to breastfeeding not specifically preterm birth.
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Affiliation(s)
- Tiffany Byerly
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville North Carolina
| | - Cierra Buckman
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville North Carolina
| | - Dmitry Tumin
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville North Carolina
| | - Kelly Bear
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville North Carolina
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Buckman C, Diaz AL, Tumin D, Bear K. Parity and the Association Between Maternal Sociodemographic Characteristics and Breastfeeding. Breastfeed Med 2020; 15:443-452. [PMID: 32456452 DOI: 10.1089/bfm.2019.0284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: Although clinicians recognize the importance of breastfeeding for child health, breastfeeding initiation can be limited by maternal characteristics such as race/ethnicity, age at first birth, and educational attainment. We hypothesized that the strong influence of prior infant feeding experiences on multiparous women's decision to initiate and continue breastfeeding may mean that these maternal characteristics influence breastfeeding more strongly for primiparas than multiparas. Materials and Methods: Using Pregnancy Risk Assessment and Monitoring System (PRAMS) (Phase 8) survey data from 2016 to 2017, we analyzed mothers' responses to the supplemental question about parity, "Before you got pregnant with your new baby, did you ever have any other babies who were born alive?" Study variables were summarized by using weighted means and proportions and compared according to parity by using Wald tests. In the overall cohort, we evaluated the interaction between parity and each covariate by using logistic regression. Results: In our sample (N = 20,694), 40% of respondents were first-time mothers, and 88% had initiated breastfeeding. Primiparas were more likely to breastfeed than multiparas (92% versus 86%; p < 0.001), but they had shorter mean breastfeeding duration. On unadjusted analysis, four covariates were more strongly associated with breastfeeding initiation among primiparas than multiparas (maternal age, educational attainment, receiving breastfeeding information from a nurse or other medical professional, and receiving breastfeeding information from family or friends). Conclusions: Breastfeeding initiation is impacted more strongly by maternal characteristics for primiparas than multiparas.
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Affiliation(s)
- Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Amy L Diaz
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Kelly Bear
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
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An Exploration of Complementary Feeding Practices, Information Needs and Sources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224311. [PMID: 31698714 PMCID: PMC6888072 DOI: 10.3390/ijerph16224311] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Following complementary feeding (CF) guidelines might be challenging for mothers lacking time, resources and/or information. We aimed to explore CF practices, information needs and channels used to obtain information in parents living in areas of socioeconomic deprivation. Sixty-four parents of infants aged 4–12 months completed a short questionnaire and 21 were interviewed. Mean (SD) weaning age was 5 ± 2.5 months, foods given >7 times/week included commercial baby foods (33%) and fruits (39%) while 86% gave formula daily. The main sources of CF information were friends and family (91%), the internet (89%) and health visitors (77%). Online forums (20%), e.g., Facebook and Netmums, were used to talk to other parents because they felt that “not enough” information was given to them by health professionals. Parents felt access to practical information was limited and identified weaning classes or online video tutorials could help meet their needs. Themes identified in qualitative findings were (1) weaning practices (i.e., concerns with child’s eating; and (2) information sources and needs (i.e., trust in the National Health Service (NHS) as a reliable source, need for practical advice). In conclusion, parents are accessing information from a number of non-evidence-based sources and they express the need for more practical advice.
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Nguyen B, Gale J, Nassar N, Bauman A, Joshy G, Ding D. Breastfeeding and Cardiovascular Disease Hospitalization and Mortality in Parous Women: Evidence From a Large Australian Cohort Study. J Am Heart Assoc 2019; 8:e011056. [PMID: 30871389 PMCID: PMC6475066 DOI: 10.1161/jaha.118.011056] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/01/2019] [Indexed: 01/04/2023]
Abstract
Background Few studies have investigated the longitudinal association between breastfeeding and maternal cardiovascular disease ( CVD ) outcomes. This study examined the association between breastfeeding and CVD hospitalization and mortality in a large Australian cohort. Methods and Results Baseline questionnaire data (2006-2009) from a sample of 100 864 parous women aged ≥45 years from New South Wales, Australia, were linked to hospitalization and death data until June 2014 and December 2013, respectively. Analysis was restricted to women without self-reported medically diagnosed CVD at baseline or without past CVD hospitalization 6 years before study entry. Never versus ever breastfeeding and average breastfeeding duration per child, derived from self-reported lifetime breastfeeding duration and number of children, and categorized as never breastfed, <6, >6 to 12, or >12 months/child, were assessed. Cox proportional hazards models were used to explore the association between breastfeeding and CVD outcomes. Covariates included sociodemographic characteristics, lifestyle risk factors, and medical and reproductive history. There were 3428 (3.4%) first CVD -related hospital admissions and 418 (0.4%) deaths during a mean follow-up time of 6.1 years for CVD hospitalization and 5.7 years for CVD mortality. Ever breastfeeding was associated with lower risk of CVD hospitalization (adjusted hazard ratio [95% CI]: 0.86 [0.78, 0.96]; P=0.005) and CVD mortality (adjusted hazard ratio [95% CI]: 0.66 [0.49, 0.89]; P=0.006) compared with never breastfeeding. Breastfeeding ≤12 months/child was significantly associated with lower risk of CVD hospitalization. Conclusions Breastfeeding is associated with lower maternal risk of CVD hospitalization and mortality in middle-aged and older Australian women. Breastfeeding may offer long-term maternal cardiovascular health benefits.
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Affiliation(s)
- Binh Nguyen
- Prevention Research CollaborationSydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Joanne Gale
- Prevention Research CollaborationSydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Natasha Nassar
- Menzies Centre for Health PolicySydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
- Child Population and Translational Health ResearchChildren's Hospital at Westmead Clinical SchoolThe University of SydneyCamperdownNew South WalesAustralia
| | - Adrian Bauman
- Prevention Research CollaborationSydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Grace Joshy
- National Centre for Epidemiology and Population HealthResearch School of Population HealthAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Ding Ding
- Prevention Research CollaborationSydney School of Public HealthThe University of SydneyCamperdownNew South WalesAustralia
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Muelbert M, Giugliani ERJ. Factors associated with the maintenance of breastfeeding for 6, 12, and 24 months in adolescent mothers. BMC Public Health 2018; 18:675. [PMID: 29855364 PMCID: PMC5984453 DOI: 10.1186/s12889-018-5585-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/22/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that adolescent mothers present a higher risk of not breastfeeding or of early interruption of this practice. Considering the scarcity of studies investigating the determining factors of breastfeeding in adolescent mothers, and the absence of studies exploring the determining factors of breastfeeding maintenance for different periods of time in a single population of adolescent mothers, the aim of this research was to identify factors associated with breastfeeding maintenance for at least 6, 12, and 24 months in adolescent mothers. METHODS Data analysis from a randomised control trial involving adolescent mothers recruited at a university hospital in southern Brazil. Participants were followed through the first year of life of their infants and reassessed at 4-7 years. Factors associated with any breastfeeding for at least 6, 12, and 24 months were assessed using multivariate Poisson regression. RESULTS Data for 228, 237, and 207 mothers were available, respectively. Breastfeeding maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with breastfeeding maintenance at all outcomes: infant not using a pacifier showed a higher probability of breastfeeding maintenance in the first 2 years. Maternal grandmother breastfeeding support and exclusive breastfeeding duration were associated with breastfeeding maintenance for 6 and 12 months. The other factors evaluated were associated with breastfeeding maintenance at only one of the time points assessed: 6 months, maternal skin color (black/brown); 12 months, female infant and partner breastfeeding support; and 24 months, older paternal age and multiparity. CONCLUSIONS The present findings shed light upon barriers and facilitators of breastfeeding practices among adolescent mothers. In order to contribute to the challenge of increasing BF duration among adolescent mothers interventions aimed at boosting breastfeeding maintenance among this population should take into consideration the determining factors here identified. Additionally, breastfeeding education and support should be provided continuously as factors influencing these practices vary with time. Thus, support for adolescent mothers during the different stages of breastfeeding need to be tailored to have a positive impact on breastfeeding experience.
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Affiliation(s)
- Mariana Muelbert
- Post-Graduate Program in Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS CEP: 90035003, Brazil.
| | - Elsa R J Giugliani
- Post-Graduate Program in Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Rua Ramiro Barcelos, 2400 2º andar, Porto Alegre, RS CEP: 90035003, Brazil
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Bentley JP, Nassar N, Porter M, de Vroome M, Yip E, Ampt AJ. Formula supplementation in hospital and subsequent feeding at discharge among women who intended to exclusively breastfeed: An administrative data retrospective cohort study. Birth 2017; 44:352-362. [PMID: 28737234 DOI: 10.1111/birt.12300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/10/2017] [Accepted: 06/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among women who intend to exclusively breastfeed, it is important to identify mothers and their infants who have a greater risk of formula supplementation in hospital, and are unlikely to recover exclusive breastfeeding at discharge. We investigated factors associated with in-hospital formula feeding among healthy term infants born to women who intended to exclusively breastfeed, and among this group, predictors of infant feeding at discharge. METHODS Retrospective cohort study utilizing routinely collected clinical data for women who intended to exclusively breastfeed and gave birth to healthy term infants in five hospitals in New South Wales, Australia, 2010-2013. Robust Poisson regression was used to obtain adjusted relative risks (aRR) for the associations between formula feeding in hospital, feeding at discharge, and associated factors. RESULTS Of 24 713 mother-infant dyads in the study population, 16.5% received formula in hospital. After adjustment, the strongest predictors of formula supplementation were breastfeeding difficulties (aRR 2.90 [95% confidence interval {CI} 2.74-3.07]), Asian born mother (aRR 2.07 [95% CI 1.92-2.23]), and neonatal conditions (aRR 2.00 [95% CI 1.89-2.13]). Among infants who received formula (n=3998), 49.3% were fully breastfeeding at discharge, 33.1% partially breastfeeding, and 17.5% formula-only feeding. Compared with formula-only feeding, special care nursery admission (aRR 1.23 [95% CI 1.17-1.30]) and ≥1 neonatal conditions (compared with none) were most strongly associated with fully breastfeeding at discharge (aRR 1.21 [95% CI 1.16-2.16]). CONCLUSION Women and their infants who receive formula in hospital need additional support to attain exclusive breastfeeding by hospital discharge. Such support is especially needed for younger women, smokers, and women with breastfeeding difficulties.
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Affiliation(s)
- Jason P Bentley
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Porter
- Research Integrity and Ethics Administration, The University of Sydney, Sydney, NSW, Australia
| | - Michelle de Vroome
- North Shore Ryde Health Service, Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Amanda J Ampt
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Nix K, Dodds L. Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study. CMAJ Open 2017; 5:E213-E221. [PMID: 28401137 PMCID: PMC5378534 DOI: 10.9778/cmajo.20160116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth. METHODS We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant. RESULTS Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth. INTERPRETATION Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth.
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Affiliation(s)
- Kimberley Nix
- Faculty of Medicine (Nix); Departments of Obstetrics & Gynecology and Pediatrics (Dodds), Dalhousie University, Halifax, NS
| | - Linda Dodds
- Faculty of Medicine (Nix); Departments of Obstetrics & Gynecology and Pediatrics (Dodds), Dalhousie University, Halifax, NS
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