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Aderibigbe T, Srisopa P, Henderson WA, Lucas R. Meta-ethnography on the Experiences of Women From Around the World Who Exclusively Breastfed Their Full-Term Infants. J Obstet Gynecol Neonatal Nurs 2024; 53:120-131. [PMID: 38104632 DOI: 10.1016/j.jogn.2023.11.008] [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: 05/26/2023] [Revised: 11/08/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE To synthesize evidence from qualitative studies on the experiences of women from around the world who exclusively breastfed their full-term infants. DATA SOURCES CINAHL Plus, PubMed, APA PsycInfo, Scopus, and ProQuest Dissertation & Theses Global. STUDY SELECTION We selected reports of qualitative studies that were conducted in high-, middle-, and low-income countries; published between January 2001 and February 2022 in English; and focused on the experiences of women who exclusively breastfed their full-term infants. DATA EXTRACTION We extracted the following data from included studies: methodological characteristics (i.e., country of origin, authors' disciplines, research design, sample size, sampling, data collection, and data analysis method), participants' demographics (i.e., age, parity, marital status, education, and exclusive breastfeeding duration) and direct participant quotes, and key concepts and themes about women's experiences of exclusive breastfeeding. We managed and stored extracted data using a Microsoft Excel spreadsheet. DATA SYNTHESIS We synthesized reciprocal translations using Noblit and Hare's approach to meta-ethnography. Five overarching themes emerged from the meta-synthesis: Favorable Conditions, Not a Smooth Journey,Support, Determination and Perseverance, and Reflections on Benefits. CONCLUSION In the included studies, participants experienced challenges with exclusive breastfeeding; however, they also recounted benefits. We recommend 6-month maternity leave and support from family and health care professionals to improve rates of exclusive breastfeeding.
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Kam RL, Amir LH, Cullinane M, Ingram J, Li X, Nommsen-Rivers LA. Breast hypoplasia markers among women who report insufficient milk production: A retrospective online survey. PLoS One 2024; 19:e0299642. [PMID: 38421972 PMCID: PMC10903845 DOI: 10.1371/journal.pone.0299642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES To estimate the proportions of anatomical breast characteristics suggestive of breast hypoplasia among breastfeeding women self-reporting low milk supply. We also explored breast hypoplasia risk factors. DESIGN Online survey conducted between October 2021 and January 2022. SETTING Five low milk supply Facebook groups. PARTICIPANTS 487 women reporting low milk supply with their first child born ≥ 37 weeks gestation within 5 years of participation in this study, and residing in the USA, Australia or the UK. We present data on the primary outcome ('breast type') for 399 women. Women were excluded if the dyad was separated for more than 24 hours during the hospital stay, or if the mother reported removing milk less than 6 times per day from each breast on most days before being aware of having insufficient milk production. PRIMARY AND SECONDARY OUTCOME MEASURES The proportions of proposed breast hypoplasia markers including atypical breast type, widely spaced breasts, breast asymmetry, stretch marks on the breast and lack of pregnancy breast growth. We also estimated the odds of having breast hypoplasia markers in at-risk groups compared to reference groups, adjusting for covariates. RESULTS Approximately 68% reported at least one atypical breast (270/399; 95% CI: 62.9%, 72.1%). Around 47% reported widely spaced breasts (212/449; 95% CI: 42.7%, 52.7%), 72% a lack of pregnancy breast growth (322/449; 95% CI: 68.3%, 77.4%), and 76% stretch marks on the breast (191/250; 95% CI: 70.7%, 81.3%). Multiple logistic regression analyses identified being overweight during pubertal years as a risk factor for atypical breast type and lack of pregnancy breast growth. CONCLUSIONS Participants in low milk supply Facebook groups reported high rates of breast hypoplasia markers. Being overweight during adolescence was a risk factor for breast hypoplasia markers. These findings should be confirmed in well-conducted large cohort studies to determine the strongest combination of hypoplasia markers in predicting low supply.
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Affiliation(s)
- Renee L. Kam
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Breastfeeding Service, Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Jenny Ingram
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Laurie A. Nommsen-Rivers
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
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Camargo BTS, Sañudo A, Kusahara DM, Coca KP. Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations. Rev Bras Enferm 2023; 77:e20220773. [PMID: 38088688 PMCID: PMC10704699 DOI: 10.1590/0034-7167-2022-0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. METHODS a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. RESULTS 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. CONCLUSIONS assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
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Affiliation(s)
| | - Adriana Sañudo
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Wang S, Li M, Xiang X, Guo X, Peng C, Wang D, Chen Y. Analysis on the current situation of twin breastfeeding and its influencing factors. Medicine (Baltimore) 2023; 102:e35161. [PMID: 37746974 PMCID: PMC10519451 DOI: 10.1097/md.0000000000035161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Studies have found that exclusive breastfeeding can not only promote the growth and development of infants, but also increase the emotional communication between mothers and infants, and reduce the incidence of maternal breast diseases. To analysis the current situation and influencing factors of breastfeeding twins. A total of 420 twin mothers delivered in our hospital from January 2019 to December 2022 were selected to investigate the situation of breastfeeding within 6 months after delivery. An electronic questionnaire was conducted, and clinical information were collected. Univariate analysis and multivariate logistic regression analysis were applied to analyze the factors influencing exclusive breastfeeding. The rate of exclusive breastfeeding was 21.90%; in the exclusive breastfeeding group, the age <35 years old, bachelor degree or above, rural areas, no nipple depression or flat, no breast distension, no postpartum depression, adequate breast milk, participation in health education during pregnancy, husband support for breastfeeding, no infant feeding difficulties, infant diarrhea, lactose intolerance and return to milk were 96.74%, 53.26%, 65.22%, 80.43%, 76.09%, 80.43%, 73.91%, 63.04%, 69.57%, 71.74%, 65.22%, 70.65%, and 66.30%, respectively. It was significantly higher than that in the non-exclusive breastfeeding group (P < .05). The score of Edinburgh Postpartum Depression Scale (EPDS) was (8.08 ± 1.03) in the exclusive breastfeeding group, which was significantly lower than that in the non-exclusive breastfeeding group (P < .001), while the score of Perceived Social Support Scale (PSSS) was (67.32 ± 9.92), which was significantly higher than that in the non-exclusive breastfeeding one(P < .001). Logistic regression analysis showed that age, education level, nipple depression or flat, breast tenderness, postpartum depression, breast milk volume, health education training during pregnancy, husband support for breastfeeding, PSSS score, infant diarrhea, lactose intolerance, and delectation were the influencing factors of exclusive breastfeeding (P < .001). Our findings suggest that various factors were associated with a low rate of exclusive breastfeeding in twin births, such as age, educational level, and social support. Corresponding measures should be formulated for intervention to promote exclusive breastfeeding.
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Affiliation(s)
- Shoucui Wang
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Li
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Xiang
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xujin Guo
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chaoli Peng
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Daping Wang
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Chen
- Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
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Hill RR, Richard MA, Pados BF. Breastfeeding Symptoms with Tongue- and Lip-Tie. MCN Am J Matern Child Nurs 2023; 48:17-23. [PMID: 36103597 DOI: 10.1097/nmc.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to describe maternal and infant symptoms relative to tongue- and lip-tie severity and describe changes in symptoms and feeding efficiency from pre- to post-frenotomy. STUDY DESIGN AND METHODS A one-group pre- and post-intervention study design was used. Data from a dental practice were collected from medical records of infants less than 1 year old who underwent a frenotomy procedure for tongue- and/or lip-tie. Infant and maternal symptoms were compared with severity of tongue- and lip-tie using binary logistic regression. Wilcoxon Signed Rank test compared pain scores and feeding duration pre- and post-frenotomy. Linear regression compared total number of symptoms reported pre-frenotomy with tongue- and lip-tie severity. RESULTS N = 121 dyads were included. More severe classifications of tongue- and lip-tie were significantly associated with certain infant and maternal symptoms pre-frenotomy. Improvements were noted in all reported infant symptoms post-frenotomy. Feeding duration times significantly decreased post-frenotomy. CLINICAL IMPLICATIONS Infants and mothers experience problematic symptoms with feeding associated with tongue- and lip-tie. Nurses are the primary care providers during postpartum and should be alert to signs and symptoms that may suggest oral restrictions. Early evaluation and involvement of feeding experts may improve the breastfeeding experience of the dyad.
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Adjerid K, Johnson M, Edmonds C, Steer K, Gould F, German R, Mayerl C. The effect of stiffness and hole size on nipple compression in infant suckling. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2023; 339:92-100. [PMID: 36121049 PMCID: PMC9771940 DOI: 10.1002/jez.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
During infant feeding, the nipple is an important source of sensory information that affects motor outputs, including ones dealing with compression of the nipple, suction, milk bolus movement, and swallowing. Despite known differences in behavior across commercially available nipples, little is known about the in vivo effects of nipple property variation. Here we quantify the effect of differences in nipple stiffness and hole size on an easily measured metric representing infant feeding behavior: nipple compression. We bottle-fed 7-day old infant pigs (n = 6) on four custom fabricated silicone nipples. We recorded live X-ray fluoroscopic imaging data of feeding on nipples of two levels of hardness/stiffness and two hole sizes. We tested for differences in nipple compression at the nipple's maximum compression across different nipple types using a mixed model analysis of variance. Stiffer nipples and those with smaller holes were compressed less than compliant nipples and nipples with larger holes (p < 0.001). We also estimated the force applied on the nipple during feeding and found that more force was applied to the compliant nipple with disproportionately larger strains. Our results suggest that infant pigs' nipple compression depends on material type and hole size, which is likely detected by the infant pigs' initial assessment of compressibility and flow. By isolating nipple properties, we demonstrated a relationship between properties and suckling behavior. Our results suggest that sensory information affects feeding behaviors and may also inform clinical treatment of poor feeding performance.
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Affiliation(s)
- K. Adjerid
- Northeast Ohio Medical University, Rootstown, OH
| | - M.L. Johnson
- Northeast Ohio Medical University, Rootstown, OH
| | - C.E. Edmonds
- Northeast Ohio Medical University, Rootstown, OH
| | - K.E. Steer
- Northeast Ohio Medical University, Rootstown, OH
| | - F.D.H. Gould
- Rowan University School of Osteopathic Medicine, Glassboro, NJ
| | - R.Z. German
- Northeast Ohio Medical University, Rootstown, OH
| | - C.J. Mayerl
- Northeast Ohio Medical University, Rootstown, OH
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Mimouni G, Merlob P, Mimouni FB, Bin Nun A, Kasirer Y. Nipple/Areola Dimensions in Early Breastfeeding. Breastfeed Med 2022; 17:506-510. [PMID: 35687116 DOI: 10.1089/bfm.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Nipple dimensions may be an important factor in breastfeeding (BF) initiation success. Objective: To establish standards of nipple/areola dimensions in early BF and to determine whether maternal age, gestational age (GA), parity, cup size, previous BF experience, and early (<2 hours) BF affect nipple dimensions (assessed on the second day of BF). Design/Methods: A total of 205 consecutive BF women were enrolled. They were all Caucasians, and had uncomplicated pregnancies, labors, and vertex vaginal deliveries. Measurements (immediately before and after BF) of nipple length and diameter and of prefeeding areolas were by sliding calipers. Results: In average, there were no significant differences between right (R) and left (L) side dimensions, except for post-BF nipple length, and post-BF horizontal nipple diameter (significantly higher on the L side). Both R and L nipple length correlated positively with maternal age, gravidity, parity, number of previously breastfed infants, and cumulative number of BF months. Early (<2 hours) first BF did not correlate with increased nipple length. Pre-BF nipple length correlated significantly with post-BF nipple length on both sides. There were significant differences between pre- and post- BF values in terms of nipple length (longer length post-BF), but not in terms of nipple diameter. In stepwise regression analysis, where pre-BF nipple length was the dependent variable, and parity (or maternal age, or previous BF), early first BF, and GA were independent variables, parity, maternal age, gravidity, or previous BF experience were positively and significantly associated with nipple length (p < 0.001). The correlation maternal age-nipple length remained significant in primigravida mothers. Conclusions: This study provided a set of standards for nipple and areola dimensions on day 2 of BF in Caucasian women. The only areola/nipple dimension significantly affected by BF is the nipple length. Increasing parity, maternal age, or previous BF experience is significantly associated with increased nipple length.
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Affiliation(s)
- Galit Mimouni
- Department of Obstetrics and Gynecology, The Rabin Medical Center (Beilinson Campus), Petach Tiqvah, Israel
| | - Paul Merlob
- Department of Obstetrics and Gynecology, The Rabin Medical Center (Beilinson Campus), Petach Tiqvah, Israel.,Department of Neonatology, The Sackler School of Medicine, Tel Aviv, Israel
| | - Francis B Mimouni
- Department of Neonatology, The Sackler School of Medicine, Tel Aviv, Israel.,Department of Neonatology, The Shaare Zedek Medical Center, Jerusalem, Israel
| | - Alona Bin Nun
- Department of Neonatology, The Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Kasirer
- Department of Neonatology, The Shaare Zedek Medical Center, Jerusalem, Israel.,Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Douglas P. Re-thinking lactation-related nipple pain and damage. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221087865. [PMID: 35343816 PMCID: PMC8966064 DOI: 10.1177/17455057221087865] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple-areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple-areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.
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Affiliation(s)
- Pamela Douglas
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Possums & Co., Brisbane, QLD, Australia
- Pamela Douglas, c/o Possums & Co., PO Box 5139, Brisbane, West End QLD 4101, Australia.
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