Associations of Maternal Beliefs and Distress in Pregnancy and Postpartum With Breastfeeding Initiation and Early Cessation

Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time

Introduction

Positive maternal mental health is associated with improved outcomes for infants, and yet the consideration of maternal mental health is often neglected in breastfeeding interventions. Breastfeeding interventions typically focus on breastfeeding promotion, and do not always include supports for the mother. This may result in isolated perceived pressure to breastfeed, the mental health impacts of which are not well understood.

Methods

This mixed-methods, longitudinal study examined whether perceived pressure to breastfeed was associated with depression, suicide ideation, anxiety, birth trauma and stress concurrently and 4 weeks later for postpartum mothers. It also examined qualitative experiences of feeding.

Results

Perceived pressure to breastfeed was associated with increased anxiety, stress and birth trauma symptoms four weeks later. Thematic analysis suggested this may be due to difficulties living up to the "breast is best" ideal, believing breastfeeding was part of success as a mother, lack of choices and autonomy in feeding choices for infants and general lack of support.

Discussion

As such it appears we may be doing more harm than good by focusing our interventions for breastfeeding primarily on increasing pressure to breastfeed, and interventions should consider strategies for promoting positive maternal mental health alongside breastfeeding.

Emotional intelligence and stress and their relationship with breastfeeding self-efficacy in mothers of premature infants

BACKGROUND

Premature infants need to be hospitalized in the neonatal intensive care unit (NICU) for long periods of time, which can increase anxiety and stress in their mothers. Additionally, the breastfeeding rate is lower among preterm infants. This study aimed to determine stress levels and emotional intelligence in mothers of preterm infants and their relationship with breastfeeding self-efficacy.

METHODS

This descriptive-correlational study was performed with a convenience sampling of 210 mothers of premature infants admitted to the neonatal intensive care unit in Tabriz, Iran in 2021. Data collection tools included socio-demographic checklist, perceived stress scale (PSS14), Dennis' breastfeeding self-efficacy scale, and the Schering emotional intelligence questionnaire. Data were analyzed using SPSS software version 16 via descriptive and inferential statistics (Pearson correlation and one-way ANOVA and modified general linear model).

RESULTS

Study findings demonstrated that most of the mothers had low stress (75.2%) and high breastfeeding self-efficacy (61.9%). The mean (SD) of emotional intelligence of the participants was 88.18 (16.60), ranging from 33 to 165. The results of the general linear model by modifying the demographic characteristics showed that the variables of emotional intelligence (B = 0.23, P = 0.03), stress (B=-0.56, P = 0.01), gestational age (B = 2.81, P < 0.001) and number of deliveries (B = 9.41, P < 0.001) were predictors of breastfeeding self-efficacy.

CONCLUSION

The findings showed that mothers of preterm infants had low emotional intelligence, and the majority of them had low perceived stress and high breastfeeding self-efficacy. Findings highlight the importance of addressing maternal stress and enhancing emotional intelligence to promote successful breastfeeding in mothers of preterm infants. Healthcare providers and managers are encouraged to offer support and educational programs to mothers of preterm infants, aiming to enhance their emotional intelligence. Further research and interventions focusing on these factors are warranted to improve the overall well-being of both mothers and infants in the neonatal intensive care unit.

Effect of positive emotion intervention during late pregnancy on improving colostrum secretion: a randomised control trial protocol

INTRODUCTION

Though evidence has revealed the beneficial effects of cognitive improvement interventions on breastfeeding, the effect of psychological interventions has rarely been studied. This study aims to test whether promoting a positive emotion intervention, 'Three Good Things' intervention, during the last trimester of pregnancy can enhance early colostrum secretion and breastfeeding behaviours by modulating the hormones associated with lactation (prolactin and insulin-like growth factor I). We will attempt to promote exclusive breastfeeding by using physiological behavioural measures.

METHODS AND ANALYSIS

This study is designed as a randomised controlled trial conducted in the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. The participants will be randomly divided into two groups using stratified random grouping: the intervention group will receive 'Three Good Things' intervention, while the control group will write about three things that come to mind first. These interventions will be continued from enrolment until the day of delivery. Maternal blood hormone levels will be tested approaching delivery and the following day after birth. Behavioural information about breastfeeding will be collected 1 week afterwards.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committees of the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. Results will be disseminated through peer-reviewed journals or international academic conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2000038849.

The Godmother Project: A Virtual Initiative to Support Pregnant and Postpartum Women in Brazil During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic increased maternal distress and demand for social support and educational services, while restriction measures decreased the availability of these services.

PROJECT DESCRIPTION

The Godmother Project, a person-centered, WhatsApp-based support and health education initiative, was created after all in-person perinatal educational activities offered at 3 Brazilian hospitals were canceled in 2020. The project was developed in response to pregnant/postpartum women who called the hospitals with questions for health care professionals (HCPs). Health education nurses teamed up with staff from the communication department to design a project to (1) provide a direct communication channel between women and HCPs to answer health-related questions, (2) offer reliable virtual health education material, (3) identify women in need of additional assessment/referrals, (4) offer each woman continuous support from a specific nurse educator (Godmother), and (5) offer a virtual forum where women going through similar experiences could interact.

PROJECT DEVELOPMENT AND ROLLOUT

The project provides direct communication between WhatsApp groups of 25-30 pregnant/postpartum women and a Godmother. It also offers access to a virtual library of educational materials prepared in response to women's needs/demands. The project, which began in July 2020 with 1 WhatsApp group of 5 women and 1 Godmother, currently has 305 groups, 6,942 active participants, and 4 Godmothers. Enrollments and WhatsApp groups continued to increase despite reestablishment of in-person educational activities in 2022. The vast majority of 232 participants surveyed in December 2021 were very satisfied with the project, the Godmothers, and the educational materials.

CONCLUSIONS

Our findings suggest that WhatsApp groups of pregnant/postpartum women led by dedicated nurse educators can be an important tool to educate and support women during the perinatal period. This type of initiative may be especially important in contexts of physical distancing requirements or situations where social support is unavailable.

A Comparison of Audio-Only and Audio-Visual Tele-Lactation Consultation Services: A Mixed Methods Approach

BACKGROUND

The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life; however, a lack of access to breastfeeding resources influences breastfeeding initiation and continuation. Tele-lactation services may reduce some of these barriers to access.

RESEARCH AIMS

To identify facilitators and barriers of two modes of tele-health service utilization and to compare the differences between two modes of providing tele-lactation services on breastfeeding knowledge, breastfeeding intention, perceived social support, and 3-month breastfeeding continuation behavior.

METHODS

We conducted a mixed method, longitudinal pilot study utilizing prospective convenience sampling and random assignment of postpartum women recruited from two medical centers in Little Rock, Arkansas. Participants (N = 43) were randomized into telephone-only (n = 23) or audio-visual (n = 20) intervention groups. Participants completed a self-administered pre- and post-intervention survey, as well as a semi-structured qualitative phone interview at 4-6 weeks post-discharge.

RESULTS

No significant difference in demographic characteristics across groups was found. At 3 months after discharge, both groups reported continued breastfeeding (telephone-only: n = 17, 81%; audio-visual: n = 18, 90%) with no significant difference between the two groups (p = .663). Additionally, no group differences were found for breastfeeding knowledge or perceived social support. Overall, participants reported positive experiences with tele-lactation, emphasizing the convenience, accessibility, education, and support provided.

CONCLUSION

We found that both telephone-only and audio-visual delivery of tele-lactation services were equally effective. Both methods of tele-lactation services should be considered by health care providers to encourage and sustain breastfeeding behavior in mothers.

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies

In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2  = 0.00%, PQ  < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.

Repetitive negative thinking during pregnancy and postpartum: Associations with mental health, inflammation, and breastfeeding

INTRODUCTION

Repetitive negative thinking (RNT) is a transdiagnostic feature that predicts increased mental health risks, inflammation, and reduced engagement in health promoting behaviors. Depression, anxiety, stress, inflammation, higher body mass index (BMI), and low engagement in health behaviors are associated with adverse outcomes during pregnancy as well as postpartum. However, there is limited literature on the associations between RNT and these contributing factors in the perinatal period, an at-risk time during which women may benefit from clinical interventions directed at RNT.

METHODS

This study examined the contribution of RNT to inflammation [interleukin (IL)-6] and breastfeeding duration through mediating indicators of mental health and BMI. Behavioral and biological assessments occurred during late pregnancy as well as at 4-6 weeks, 4 months, 8 months, and 12 months postpartum.

RESULTS

RNT was positively associated with depressive symptoms, anxiety, and perceived stress (ps ≤ .001) at each assessment timepoint, with the strongest associations observed at the pregnancy assessment and significant, but attenuated, associations during postpartum (ps < .01). In modeling of the association between RNT and IL-6, the indirect effect of BMI was significant at each timepoint (95%CIs 0.0013, 0.0052). Women with lower RNT exhibited longer breastfeeding duration (p = .02). These effects were not significantly mediated by mental health indicators.

CONCLUSIONS

Clinically meaningful relationships, in which RNT predicts mental health, inflammation, and health behavior engagement during pregnancy and postpartum were observed. Clinical interventions to reduce RNT may have unique benefits this time.

LIMITATIONS

Further research is warranted to determine if therapies to reduce RNT confer unique benefits for maternal and child health.

Cortisol, Maternal Stress, and Breastfeeding Rate at Hospital Discharge: A Systematic Review

Introduction: Breastfeeding is considered the best way to provide essential and necessary nutrients to the newborn, intervening in its growth and development. However, early abandonment of this method is quite common, due to various factors such as stress. Objectives: To determine whether the level of postpartum cortisol can serve as an indicator of maternal stress and whether there is a relationship between the level of cortisol and the rate of exclusive breastfeeding (EBF) at hospital discharge. Methodology: Systematic review of the literature under the PRISMA guidelines. PubMed, Web of Science, CINAHL, and Scopus databases were used. Original articles published from 2017 to 2022 in English, French, Portuguese, and Spanish were included. All study designs were eligible. Of the 3,712 records initially identified, 15 studies were included in this review. Results: Elevated cortisol levels, due to immediate postpartum stressors, have direct effects on the performance of the essential hormones in breast milk production. The EBF rates are negatively influenced by perceived maternal stress. Conclusion: Cortisol levels may be a good indicator of the level of stress to which the mother is subjected during the immediate postpartum period.

The Associations of Breastfeeding and Postnatal Experiences With Postpartum Depression Among Mothers of Hospitalized Infants in Tertiary Hospitals

Background

Postpartum depression has been linked to undesirable outcomes for mother-infant dyads, interfering with childcare and breastfeeding practices. This study aimed to determine the prevalence of depressive symptoms among mothers during the postpartum period and its association with breastfeeding and postpartum experiences.

Methodology

This cross-sectional study involved mothers of hospitalized infants (n = 219) at two tertiary hospitals in Klang Valley, Malaysia. Mothers were screened for postpartum depression using the Edinburgh Postnatal Depression Scale with a cut-off of ≥12 for positive screening for depression. Mothers were asked to complete questionnaires on breastfeeding experience, which included breastfeeding self-efficacy and challenges. The questionnaires also collected information on postnatal experiences, including birth outcomes, anxiety and stress levels, and social support. Multiple linear regression was used to ascertain the association of postpartum depression levels with breastfeeding and postnatal experiences.

Results

Overall, 30% of mothers in this study screened positive for depression. Based on multiple linear regression, a higher score of postpartum depression was significantly associated with unpleasant breastfeeding and postnatal experiences reflected by increased scores of anxiety and stress, lower infant birth weight, increased breastfeeding problems, and lower level of social support (p < 0.005).

Conclusions

Maternal emotions, birth outcomes, breastfeeding issues, and social support were associated with postpartum depression. Efforts should be made to increase maternal support, and screening for maternal depression during infant hospital stays should be encouraged.

Welcoming, supportive care in US birthing facilities and realization of breastfeeding goals

BACKGROUND

Emotional and physical support for birthing parents is positively associated with realization of their breastfeeding goals. However, few studies have investigated maternal descriptions of their postnatal unit experience of these domains.

RESEARCH AIM

The objective was to investigate maternal report of their birthing facility experiences and quantify the extent to which accounts of postpartum support were associated with meeting their breastfeeding goals.

METHODS

After IRB review, data were obtained through an online survey distributed from November 2016-May 2017. This analysis utilizes data from 2,771 birthing parents who were at least 18 years of age, experienced maternity care in the United States within five years, and reported that they had intended to breastfeed. Bivariate analysis was followed by logistic regression controlling for significant covariates.

RESULTS

In this sample of primarily non-Hispanic white birthing parents with intent to exclusively breastfeed, the following postnatal unit variables were associated with higher odds of meeting their breastfeeding goals, birthing parents feeling: welcomed (adjusted OR=1.36), that health care promoted their physical health (adjusted OR=1.41), that care promoted their emotional health (adjusted OR=1.38), that they were supported (adjusted OR=1.56), and that they were recognized by their health care team (adjusted OR=1.30). All the measured postnatal unit support variables were significantly correlated with each other, with correlation coefficients ranging from 0.15 to 0.81.

CONCLUSIONS

Before the COVID-19 pandemic, birthing parents' experiences on the postnatal unit were interrelated and associated with meeting their breastfeeding goals. As health care services are reviewed and prioritized during the COVID-19 pandemic and as part of ongoing strengthening of systems, qualitative and observational research can address the mechanisms underlying breastfeeding outcomes to inform the provision of more holistic and effective support.

Antenatal Classes in the Context of Prenatal Anxiety and Depression during the COVID-19 Pandemic

Perinatal maternal anxiety and depression negatively affect intrauterine fetal development, birth outcome, breastfeeding initiation, duration, and milk composition. Antenatal classes potentially reduce the anxiety of pregnant women and may thus contribute to healthy infant development. The study investigates the relationship between participation in online or in-person antenatal classes and levels of anxiety and depression in Polish women during the COVID-19 pandemic. The study group included 1774 adult, non-smoking pregnant women. We compared the state anxiety (STAI-State) and depression levels (EPDS) in women who (i) attended antenatal classes in-person, (ii) attended online classes, and (iii) did not attend any of them. The statistical analyses included a GLM model and trend analysis, while controlling for maternal trait anxiety, age, pregnancy complications, trimester of pregnancy, previous pregnancies, and COVID-19 infections. We observed statistically significant differences in the level of anxiety (and depression). Women who did attend antenatal classes in person had the lowest levels of anxiety and depression. Considering the importance of maternal mental well-being on fetal development, birth outcome, and breastfeeding, in-person participation in antenatal classes should be recommended to pregnant women.

Realigning Expectations With Reality: A Case Study on Maternal Mental Health During a Difficult Breastfeeding Journey

INTRODUCTION

Many mothers have the goal to breastfeed. However, more than 50% will have breastfeeding difficulty by the 3rd day of life. Mothers who are unable to meet their breastfeeding goals are at higher risk for anxiety, depression, embarrassment, and guilt. Those who stop breastfeeding need support and help resolving these feelings. This case study aims to describe one woman's difficulty with mental health surrounding breastfeeding, her decision to bottle feed, and her successful transition back to direct breastfeeding.

MAIN ISSUE

Barriers to the participant's success with breastfeeding were pre-existing history of depression/anxiety, forceps delivery, uncontrolled perineal pain, infant physical trauma, and nipple/flow confusion. The decision to discontinue direct breastfeeding and start bottle feeding came after 2 months of anxiety, frustration, and persistence.

MANAGEMENT

The participant followed her healthcare team's recommendations of triple feeding, lactation support groups, pediatric chiropractic adjustments, and prescribed galactagogues. After 2 months of exhaustion and deliberation, she made the difficult decision to stop breastfeeding for nutritional benefits and switched to breastfeeding only for her infant's pleasure and comfort. Lowered expectations allowed the dyad to heal and her son to transition to nearly exclusive breastfeeding at 4 months of life.

CONCLUSION

Clinicians must be aware of the delicate balance between promoting breastfeeding for its nutritional value and health benefits and supporting a struggling mother with mental health needs.

The Influence of Breastfeeding Educational Interventions on Breast Engorgement and Exclusive Breastfeeding: A Systematic Review and Meta-Analysis

BACKGROUND

Breast engorgement and breast pain are the most common reasons for the early cessation of exclusive breastfeeding by mothers.

RESEARCH AIMS

(1) To examine the influence of breastfeeding educational interventions on breast engorgement, breast pain, and exclusive breastfeeding; and (2) to identify effective components for implementing breastfeeding programs.

METHODS

Randomized controlled trials of breastfeeding educational interventions were searched using five English and five Chinese databases. Eligible studies were independently evaluated for methodological quality, and data were extracted by two investigators. In total, 22 trials were identified, and 3,681 participants were included. A random-effects model was used to pool the results, and a subgroup analysis and meta-regression analysis were conducted.

RESULTS

Breastfeeding education had a significant influence on reducing breast engorgement at postpartum 3 days (odds ratio [OR]: 0.27, 95% CI [0.15, 0.48] p < .001), 4 days (OR: 0.16, 95% CI [0.11, 0.22], p < .001), and 5-7 days (OR: 0.24, 95% CI [0.08, 0.74], p = .013) and breast pain (standardized mean difference: -1.33, 95% CI [-2.26, -0.40]) at postpartum 4-14 days. Participants who received interventions had higher odds of exclusive breastfeeding. Breastfeeding educational interventions provided through lecture combined with skills practical effectively reduced breast engorgement (OR: 0.21; 95% CI [0.15, 0.28]; p = .001) and improved exclusive breastfeeding at postpartum 1-6 weeks (OR: 2.16; 95% CI [1.65, 2.83]; p = .001).

CONCLUSIONS

Breastfeeding educational interventions have been effective in reducing breast engorgement, breast pain, and improved exclusive breastfeeding. A combination of knowledge and skill-based education has been beneficial for sustaining exclusive breastfeeding by mothers.

Personality Characteristics and Emotional Distress Among Chinese Pregnant Women: A Moderated Mediation Model

Previous studies have suggested that certain personality characteristics are associated with emotional distress during pregnancy. However, the underlying mechanism of this association is rarely understood. The current study investigated the links between personality and pregnant women's emotional distress (depressive and anxiety symptoms), tested the chain mediating effects of two resilience factors-social support and positive coping, and explored whether socioeconomic status (SES) could moderate the effects (including direct and/or indirect effects) of personality on their emotional distress. Results of a relatively large sample of pregnant women in China (N = 1157) showed positive associations for psychoticism and neuroticism with depressive and anxiety symptoms as well as negative associations for extraversion with depression and anxiety. After controlling for four important variables (the first pregnancy or not, having adverse pregnancy experience or not, being pregnant as planned or not, and number of weeks of pregnancy), social support and positive coping acted as chain mediators on the associations of personality with depressive symptoms as well as of personality with anxiety. Overall, the association of personality and depressive symptoms demonstrated invariance across socioeconomic status (SES). However, SES moderated the relationship between personality and anxiety. Specifically, the negative association of positive coping with anxiety symptoms was weaker for low SES women than for high SES ones. Results highlight the importance of social support and positive coping to decrease personality-related depressive and anxiety symptom among pregnant women. Furthermore, identifying other resilience factors that alleviate anxiety in women with low SES is urgently called for.

Human Milk for the Term Newborn

Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.

A systematic integrative review examining the impact of Australian rural and remote maternity unit closures

BACKGROUND

Rural and remote Australian women are less able to access locally situated maternity care and birthing facilities, largely due to the gradual closures of rural and remote birthing services. Closures have occurred due to workforce issues, safety and quality issues and economic rationalisation of services to offset rising health system costs. An examination of the published literature to gain a deeper understanding of this phenomenon is warranted.

QUESTION

What are the impacts of rural and remote maternity unit closures in Australia?

METHODS

A systematic integrative review of published literature on Australian maternity unit closures was undertaken using Whittemore and Knafl's (2005) framework. A database search was conducted with date limiters of 2010 to 2020 on papers within the search parameters "maternity unit*" AND closure* AND women AND (midwife OR midwives) AND Australia, also with "birth unit", "labour ward" and "rural" in varying combinations. This search resulted in 348 papers. After applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process and the Crowe Critical Appraisal Tool (CCAT) and discarding those non-relevant, seven papers remained.

FINDINGS

A methodological analysis of seven papers occurred, three qualitative studies, three quantitative studies and one mixed methods study. Two main stakeholders were identified, the woman, and the health service. Women identified risks associated with travel, lack of access to services, costs or financial issues, safety, and emotional burdens. Women explicitly stated that access to local maternity services would negate many of their concerns. Health services indicated closures were due to safety and quality considerations and workforce issues.

CONCLUSION

Conflict exists in trying to meet the perceived needs of both stakeholder groups. Published evidence supports midwifery models for low-risk women. National policy also supports woman-centred care; however, local service uptake is minimal due to organisational barriers.

A multi-center survey on the postpartum mental health of mothers and attachment to their neonates during COVID-19 in Hubei Province of China

Background

There is an emerging literature on the mental health of both pre- and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

As of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days).

Results

The period of mother-child separation among the confirmed group (33.9±20.9 days) was significantly longer than that of suspected group (16.7±12.2 days) and control group (10.7±8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5±4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5±4.7) and control (48.8±4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman's ρ =-0.33, 95% CI: -0.095 to -0.538, P=0.005; Subscale score of attachment: Spearman's ρ =-0.40, 95% CI: -0.163 to -0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups.

Conclusions

Decreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.

Maternal Depressive Symptoms and Infant Feeding Practices at Hospital Discharge: Findings from the Born in Queensland Study

INTRODUCTION

This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge.

METHODS

Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July-December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding.

RESULTS

About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009).

CONCLUSIONS FOR PRACTICE

Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge.

Made to Feel Like Less of a Woman: The Experience of Stigma for Mothers Who Do Not Breastfeed

Background: Breastfeeding has become the recognized standard for good parenting, with social costs for not breastfeeding, but not every mother wants to or is able to breastfeed. Objectives: This study investigated social and personal costs with no breastfeeding. Materials and Methods: An in-depth survey was conducted with 250 mothers with infants who were not breastfeeding. Situated in the Framework Integrating Normative Influences on Stigma model for stigma, the study analyzed internalized stigma and perception of stigma from others, maternal feelings of warmth for the infant, and hiding formula use. Results: Mothers who chose not to breastfeed reported little personal or public stigma. In comparison, mothers who were unable to breastfeed experienced relatively more internalized stigma and perceived that other people saw them as failures. Mothers who experienced more internalized and perceived social network stigma were likely to hide use of infant formula from others and had lower feelings of warmth for their infants. Knowledge about formula use and availability of support resulted in less stigma and more warmth for the infant. Conclusions: These results suggest that public responses causing a mother to feel guilty for using infant formula result in negative feelings of self-worth and dysfunctional maternal behaviors.

Women's Choice Regarding Breastfeeding and Its Effect on Well-Being

Because of the many known maternal and neonatal health benefits of breastfeeding, there have been significant efforts to encourage exclusive breastfeeding, and many hospitals follow the guidelines of the Baby-Friendly Hospital Initiative. However, even with the right support, many women are unable to exclusively breastfeed, which may make them feel anxious and/or depressed. Psychological pressure to exclusively breastfeed has the potential to contribute to postpartum depression symptoms in new mothers who are unable to achieve their breastfeeding intentions. In this commentary, we focus on the well-being of the mother-infant dyad and argue for further research on maternal stress related to breastfeeding difficulties or pressure and the need to physically and psychologically assess and support women who are unable to breastfeed successfully or exclusively.

Food Insecurity During Pregnancy and Breastfeeding by Low-Income Hispanic Mothers

BACKGROUND AND OBJECTIVES

Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines.

METHODS

We performed purposive sampling of low-income Hispanic mothers (n = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached.

RESULTS

Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies.

CONCLUSIONS

Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.