Breastfeeding and health professional encouragement

The Influence of Participation in Pregnancy Courses and Breastfeeding Support Groups on Attitudes and Knowledge of Health Professionals about Breastfeeding

Numerous factors affect the behavior, attitudes, and knowledge of health professionals about breastfeeding. The aim of this paper is to determine the impact of participation in pregnancy courses and breastfeeding support groups on the attitudes and knowledge of health professionals about breastfeeding. The study compares two groups of health professionals according to the results they achieved on a validated questionnaire of behavior, attitudes, and knowledge about breastfeeding. The authors did not make personal contact with the respondents, as the questionnaires were filled out online. The two groups of respondents differed according to the frequency of participation in pregnancy courses, that is, groups for breastfeeding support. The results are presented tabularly and graphically (frequencies and percentages), while differences in the results between the infrequent and regular participants are shown with the Mann–Whitney U test (asymmetric distribution). Better results on the questionnaire were achieved by those who regularly attended breastfeeding support groups (Mdn = 149, IQR = 11) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The same is found for regular visitors of pregnancy courses (Mdn = 149, IQR = 15.75) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The differences are statistically significant (p < 0.00). Partial correlation confirms a more significant influence of breastfeeding support groups (<0.00) than pregnancy courses (p = 0.34). Working in breastfeeding support groups had a statistically significant positive effect on the attitudes and knowledge of health professionals about breastfeeding. The topic of breastfeeding should be given more space and importance during pregnancy courses as well. Personal experience working in breastfeeding support groups and pregnancy courses should be incorporated into the training of medical students.

Effect of Lactation on Maternal Hypertension: A Systematic Review

INTRODUCTION

Hypertension is relatively common in pregnancy, and pregnancy may unmask hypertension among women who are predisposed to it. Lactation may be a means through which to mitigate pregnancy-related vascular risk. The impact of lactation on maternal blood pressure, and the duration of any effect, remains unclear. This study aimed at systematically reviewing the literature evaluating the impact of lactation on the development of hypertension.

MATERIALS AND METHODS

We searched PubMed, including EMBASE and MEDLINE, for studies that reported on the association between breastfeeding and maternal risk of hypertension that were published in a peer-reviewed source. The quality of the studies included was assessed by using the Newcastle-Ottawa Scale.

RESULTS

Nineteen studies met all inclusion criteria for this review. Of the four studies with short-term follow-up, 50% showed a protective association. The fifteen studies with longer-term follow-up were stratified by outcome assessed. Sixty-seven percent of the studies that evaluated for elevated blood pressure and 100% of the studies evaluating for an outcome of hypertension showed a protective association. The minimum duration of lactation associated with a benefit was 1 month. This association was demonstrated in follow-up periods as long as two to three decades. Studies that showed a protective association had overall higher quality ratings.

DISCUSSION

Lactation is associated with a beneficial effect on maternal blood pressure that persists for decades. These results add to the growing body of literature demonstrating the protective association of lactation on maternal cardiovascular risk. Providers may incorporate the decreased risk of hypertension into their counseling on the maternal benefits of lactation.

"Why Even Bother; They Are Not Going to Do It?" The Structural Roots of Racism and Discrimination in Lactation Care

Through semi-structured interviews with 36 International Board Certified Lactation Consultants (IBCLCs) who assist mothers with breastfeeding, this study takes a systematic look at breastfeeding disparities. Specifically, this study documents race-based discrimination against patients in the course of lactation care and links the implicit bias literature to breastfeeding disparities. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient's backs. This study connects patient discrimination in lactation to institutional inequality and offers suggestions to address these inequities.

Hospital Staff's Perceptions with Regards to the Baby-Friendly Initiative

BACKGROUND

Adherence to Baby Friendly Initiative (BFI) practices is low in Canadian hospitals, despite evidence showing a positive impact of BFI practices on breastfeeding rates and duration. In 2012, the provincial Ontario Ministry of Health and Long Term Care added BFI status to its progress indicators for Public Health Units, which are now required to begin BFI implementation.

OBJECTIVE

This study aims to explore health care workers' self-reported knowledge of the BFI and their perceptions of the importance of its components.

METHODS

A questionnaire was electronically sent to 2237 employees working at our institution.

RESULTS

Questionnaires were completed by 651 participants, of which 110 (16.9%) and 87 (13.5%) participants reported having good knowledge of the BFI and the Ten Steps to Successful Breastfeeding, respectively. Multiple logistic regression showed that having children and having received formal breastfeeding education were associated with higher self-reported knowledge. Additionally, 481 (75%) participants reported that it was important or very important to them that the institution adopt the BFI. Having children and being an allied health professional were associated with perceiving the implementation of the BFI as important.

CONCLUSION

The results of our study have allowed us to identify potential barriers to implementation of the BFI, which can be targeted through system changes and staff education. Through this approach, we hope to facilitate acceptance of the BFI at our institution and increase support for optimal breastfeeding practices among our patients.

Availability of Lactation Counseling Services Influences Breastfeeding among Infants Admitted to Neonatal Intensive Care Units

Purpose.

To assess the association between the presence of international board-certified lactation consultant (IBCLC) services at a delivery hospital and the breastfeeding practices of women whose infants required neonatal intensive care unit (NICU) admission.

Design.

Cross-sectional study using population-level data.

Setting.

Philadelphia, Pennsylvania.

Subjects.

2132 infants admitted to the NICU.

Measures.

Breastfeeding at hospital discharge was measured with the question, “Is the infant being breastfed?” Delivery hospitals were dichotomized as to the presence or absence of an IBCLC on staff.

Analysis.

Logistic regression was used to assess the relationship between breastfeeding at discharge and the presence of an IBCLC at the delivery facility while adjusting for maternal characteristics and birth outcomes.

Results.

Among mothers of infants admitted to the NICU, breastfeeding rates among mothers who delivered at hospitals with an IBCLC were nearly 50% compared with 36.9% among mothers who delivered at hospitals without an IBCLC. The adjusted odds of breastfeeding initiation prior to hospital discharge were 1.34 (95% confidence interval = 1.03, 1.76) times higher for women who delivered at a facility with an IBCLC.

Conclusions.

To increase breastfeeding rates among the NICU population, these findings support the need for universal availability of IBCLCs at delivery facilities that have NICUs.

ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

The planning of a national breastfeeding educational intervention for medical residents

BACKGROUND

Breastfeeding is the ideal form of nutrition for newborns, yet our recent pan-Canadian study showed that the knowledge, attitudes, and beliefs of primary care pediatricians and family physicians are suboptimal with regard to breastfeeding.

OBJECTIVE

We aim to develop, implement, and evaluate a national breastfeeding educational intervention at the postgraduate residency level.

METHODS

Our initial development process is informed by Kern's approach to curriculum development. To date, we have completed breastfeeding education needs assessment surveys of both practicing physicians and medical residents. We have also developed learning outcomes as well as possible strategies for implementing and evaluating this future educational intervention.

RESULTS

The results of our needs assessment surveys provided a rationale to develop a breastfeeding educational intervention for medical residents. Through stakeholder consultations, we have developed five initial learning outcomes for a national breastfeeding educational intervention. We have also identified promising strategies for implementing and evaluating the intervention.

CONCLUSIONS

This systematic process has provided an opportunity to create a national breastfeeding educational intervention for medical residents. It has fostered collaboration between experts and knowledge users, with the goal of impacting breastfeeding rates and duration of women, which will lead to improved maternal and child outcomes.

Survey on breastfeeding among Chinese female physicians and nurses

The present study investigated knowledge of and beliefs about breastfeeding among Chinese female physicians and nurses and their breastfeeding practices. This study documented knowledge, attitudes and practices of breastfeeding among Chinese medical staff. A total of 367 female physicians and nurses completed a self-administered, anonymous questionnaire; 96.2% indicated that breastfeeding was natural, but 29.2% thought it difficult. Only 18.5% of the participants questioned breastfeeding women on feeding status, and 12.8% gave breastfeeding advice when asked. After graduation from school, 79.3% of the participants stated that they did not receive training in breastfeeding. In personal practice, 69.2% initiated breastfeeding; 19.1% were still breastfeeding at 4 months, and only three nurses continued breastfeeding for more than 1 year. In conclusion, breastfeeding-related knowledge is surprisingly poor, and attitudes are less positive. The exclusive breastfeeding rate was found to be low among Chinese female physicians and nurses. The findings highlight the need to re-educate medical staff on breastfeeding, and imply the need for Baby-Friendly Hospital Initiative implementation/training.

Breastfeeding information in midwifery textbooks in Japan: content analysis with evaluation standards based on Delphi method

The purpose of this study was to evaluate breastfeeding information in midwifery textbooks. Evaluation standards were developed in order to perform content analysis. A 3-round Delphi method using a panel of 32 midwives resulted in 36 evaluation items from the original 38 draft items based on 4 major international guidelines and statements on breastfeeding. Subsequently, breastfeeding descriptions in 4 midwifery textbooks most frequently used in Japan were examined using a 4-point scale (A, accurate and sufficient description; B, accurate but insufficient description; C, no description; and D, inaccurate or inconsistent description). Among the evaluation items, 40% were rated as A, 25% as C, 21% as B, and 15% as D across the 4 textbooks. In conclusion, a substantial proportion of breastfeeding information in these textbooks was found to be inaccurate, inconsistent, or insufficient in content.

A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger

BACKGROUND

The practice of exclusive breastfeeding depends on various factors related to both mothers and their environment, including the services delivered by health professionals. It is known that support and counseling by health professionals can improve rates, early initiation and total duration of breastfeeding, particularly exclusive breastfeeding. Mothers' decisions are influenced by health professionals' advice. However, in Niger the practice of exclusive breastfeeding is almost non-existent.The purpose of this exploratory study, of which some results are presented here, was to document health professionals' attitudes and practices with regard to exclusive breastfeeding promotion in hospital settings in the urban community of Niamey, Niger.

METHODS

Fieldwork was conducted in Niamey, Niger. A qualitative approach was employed. Health professionals' practices were observed in a sample of frontline public healthcare facilities.

RESULTS

The field observation results presented here indicate that exclusive breastfeeding is not promoted in healthcare facilities because the health professionals do not encourage it and their practices are inappropriate. Some still have limited knowledge or are misinformed about this practice or do not believe in it. They do not systematically discuss exclusive breastfeeding with mothers, or they mention it only briefly and without giving any explanation. Worse still, some encourage the use of breast milk substitutes, which are frequently promoted in healthcare facilities. Thus mothers often receive contradictory messages.

CONCLUSION

The results suggest the need to train or retrain health professionals with regard to exclusive breastfeeding, and regularly supervise their activities.

[Increasing the rate of exclusive maternal breast feeding in the urban community of Niamey, in Niger: proposals of health professionals]

Les professionnels de la santé (PS) constituent la source la plus fiable d’informations en allaitement particulièrement pour une population majoritairement analphabète comme celle du Niger. Pour jouer efficacement ce rôle, ils ont besoin de disposer des connaissances et des compétences nécessaires en plus de bénéficier de conditions de travail leur permettant de développer des attitudes et d’adopter des pratiques conformes aux normes internationales. Dans le but de documenter les éventuelles améliorations à apporter en vue de contrer les obstacles à la promotion de l’allaitement maternel exclusif (AME) et rehausser le taux de pratique de l’AME, cette étude s’est intéressée, entre autres, à recueillir l’opinion des PS de la communauté urbaine de Niamey à travers des discussions de groupe organisées avec des infirmiers, des sages-femmes, des assistants sociaux et des médecins/pédiatres. Les participantes et participants ont suggéré différentes pistes de solutions susceptibles de favoriser les activités de promotion de l’AME au sein des formations sanitaires. Il s’agit d’interventions se situant au niveau structurel/organisationnel, programmatique et sur un plan plus individuel au niveau des pratiques et comportements des PS. Ces propositions pourraient être considérées par les responsables des établissements de santé en collaboration avec les décideurs, dans la planification, l’implantation et l’évaluation d’actions favorisant une promotion plus efficace de l’AME, notamment en ce qui concerne les attitudes et pratiques appropriées des intervenants centraux que sont les PS. (Global Health Promotion, 2010; 17 (2): pp. 62—71)

Clinical protocol number #19: breastfeeding promotion in the prenatal setting

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Assessing midwives' breastfeeding knowledge: properties of the Newborn Feeding Ability questionnaire and Breastfeeding Initiation Practices scale

BACKGROUND

There are few reliable and valid tools to assess lactation and infant feeding knowledge and practices. This study tested the psychometric properties of two new scales, the Newborn Feeding Ability (NFA) questionnaire and Breastfeeding Initiation Practices (BIP) scale to assess midwives' breastfeeding knowledge and practices specific to breastfeeding initiation.

METHODS

A national postal survey of Australian midwives (n = 3500) was conducted in October 2001. Reliability was determined through Cronbach's alpha coefficient and stability determined by a test-retest. Content validity was established through a critical review of literature and review by an expert panel. Construct validity was informed by an exploratory factor analysis and principle component analysis with varimax rotation. Correlations between NFA and BKQ knowledge subscale scores and BIP and BKQ practice subscale scores assessed criterion validity. A multiple hierarchical regression analysis determined predictive validity of the NFA and BIP.

RESULTS

A response rate of 31.6% (n = 1107) was achieved. Adequate internal consistency was established for both instruments. Five factors on the NFA questionnaire were congruent with knowledge about effects of skin-to-skin contact, physiological stability, newborn innate abilities, work practices and effective breastfeeding. The BIP revealed three factors related to observing pre-feeding behavior, mother/baby care and attachment and positioning practices. Predictive validity of knowledge was moderate (r = 0.481, p < 0.01) and contributed to 31.5% of variance in reported practice. Midwives with high knowledge scores were more likely to report best practice when assisting mothers to initiate breastfeeding. Midwives with more personal breastfeeding experience scored higher on all scales.

CONCLUSION

The Newborn Feeding Ability questionnaire and the Breastfeeding Initiation Practices scale can contribute to practice development by assessing lactation and infant feeding knowledge and practice deficits. Individual learning needs can be identified, and effectiveness of education interventions evaluated using these tools. Further testing is required with other samples of midwives and health professionals involved in the promotion of breastfeeding.

Maternal-newborn nurses? experiences of inconsistent professional breastfeeding support

AIM

This paper is a report of a study to describe the meaning and significance of common, essential elements of inconsistent professional breastfeeding support as revealed through the experiences of maternal-newborn nurses in a hospital.

BACKGROUND

Professional breastfeeding support has been found to have a beneficial effect on breastfeeding, although mothers also report that inconsistent professional breastfeeding support has a negative influence on their breastfeeding efforts.

METHOD

An existential-phenomenological approach was used, and interviews were conducted with 12 maternal-newborn nurses between October 2005 and January 2006. Interview transcripts were subjected to thematic analysis.

FINDINGS

Inconsistency in professional breastfeeding support was directly related to the fact that 'supporting' breastfeeding is a dynamic, multidimensional process with relational, contextual and situational components. Eight themes were identified: Inconsistencies still exist but things are changing; A need for 'buy in'; There is no escaping personal experience; What works for one does not work for all; Time impacts recommendations; We have a privileged vantage point; 'My job': what it is and what it is not and After all, breastfeeding is a maternal 'choice'.

CONCLUSION

Addressing inconsistent professional breastfeeding support involves understanding the multiple institutional and personal factors that influence this phenomenon. Because multiple practitioners assist each mother-infant dyad in learning to breastfeed, fostering strong collaborative relationships within this support team is essential. Regular opportunities for all team members to dialogue and actively participate in the updating of breastfeeding policies may increase 'buy in', promote greater collaboration and decrease both conflict and inconsistencies.

Prediction of initiation and duration of breast-feeding for neonates admitted to the neonatal intensive care unit

Women who desire to breast-feed their sick newborns often encounter obstacles, including insufficient support and education as well as unsupportive hospital practices. The purpose of this study was to describe maternal, neonatal, and outside influences associated with the intention, initiation, and duration of breast-feeding for women whose newborns were admitted to the neonatal intensive care unit. One hundred mothers were interviewed. Most mothers (67%) intended to breast-feed exclusively and this was significantly related to maternal characteristics such as age, education, parity, smoking and marital status, pre-breast-feeding experience, and the influences of the neonate's father and prenatal education. Seventy-eight mothers initiated pumping. Initiation was significantly related to maternal education, smoking, parity, previous breast-feeding experience, the neonate's physician, the neonate's father, and postpartum breast-feeding education. Fifty-four mothers were followed up by telephone after discharge until weaning. Thirty percent were exclusively breast-feeding at 2 weeks after discharge, and 15% were breast-feeding at 1 year. Duration of breast-feeding was significantly associated with education, marital status, ethnicity, income, assistance from nurses and lactation consultants, and feeding method along with milk type and milk volume at discharge. Increased family support, timely breast-feeding information, and a supportive neonatal intensive care unit environment are needed for women to succeed in breast-feeding their hospitalized newborns.

Breastfeeding support for adolescent mothers: similarities and differences in the approach of midwives and qualified breastfeeding supporters

BACKGROUND

The protection, promotion and support of breastfeeding are now major public health priorities. It is well established that skilled support, voluntary or professional, proactively offered to women who want to breastfeed, can increase the initiation and/or duration of breastfeeding. Low levels of breastfeeding uptake and continuation amongst adolescent mothers in industrialised countries suggest that this is a group that is in particular need of breastfeeding support. Using qualitative methods, the present study aimed to investigate the similarities and differences in the approaches of midwives and qualified breastfeeding supporters (the Breastfeeding Network (BfN)) in supporting breastfeeding adolescent mothers.

METHODS

The study was conducted in the North West of England between September 2001 and October 2002. The supportive approaches of 12 midwives and 12 BfN supporters were evaluated using vignettes, short descriptions of an event designed to obtain specific information from participants about their knowledge, perceptions and attitudes to a particular situation. Responses to vignettes were analysed using thematic networks analysis, involving the extraction of basic themes by analysing each script line by line. The basic themes were then grouped to form organising themes and finally central global themes. Discussion and consensus was reached related to the systematic development of the three levels of theme.

RESULTS

Five components of support were identified: emotional, esteem, instrumental, informational and network support. Whilst the supportive approaches of both groups incorporated elements of each of the five components of support, BfN supporters placed greater emphasis upon providing emotional and esteem support and highlighted the need to elicit the mothers' existing knowledge, checking understanding through use of open questions and utilising more tentative language. Midwives were more directive and gave more examples of closed questions. These differences could reflect the considerable emphasis upon person-centred approaches within the BfN curriculum and, in the case of midwives, the bureaucratic and institutional constraints upon them making it difficult, if not impossible, to take time and touch base with women.

CONCLUSION

Follow up ethnographic work is required to assess the differences in the supportive approaches of BfN supporters and midwives in the practice areas. Such research, which specifically focuses upon how the different approaches are received and experienced by parents, is required before meaningful policy and practice recommendations can be made.

Assessment of breastfeeding practices and reasons for success in a military community hospital

The authors' objectives were (1) to assess factors associated with breastfeeding rates in the early postpartum period and (2) to assess factors contributing to successful breastfeeding among an active-duty and military-dependent population. In September 2002, a baseline breastfeeding survey was administered to women presenting for infant or postpartum care in a military health care facility. A lactation service was then established, and between May and September 2004, a cross-sectional survey was subsequently conducted. Surveys assessed demographics, breastfeeding history and practices, and perceived reasons for success and discontinuation. A total of 934 surveys were collected. Ninety-two percent of women initiated breastfeeding. Eighty-five percent were breastfeeding at 1 week. The rate was 67.0% at 6 weeks and 61.7% at 6 months. Prior breastfeeding experience predicted continued breast-feeding at 6 weeks (OR 2.04); higher education level predicted breastfeeding at 6 months (OR 2.55). Breastfeeding rates increased after the establishment of a lactation service.

A Comparison of Breastfeeding Rates in an Urban Birth Cohort Among Women Delivering Infants at Hospitals That Employ and Do Not Employ Lactation Consultants

OBJECTIVE

To compare rates of breastfeeding at hospital discharge between facilities that employ and do not employ International Board Certified Lactation Consultants (IBCLCs).

METHODS

This study used a cross-sectional design. Data from 11,525 birth certificates of Philadelphia residents who delivered in 2003 were used. Breastfeeding was assessed using a question included on the Pennsylvania birth record, "Is the infant being breastfed at discharge?" The Philadelphia Department of Public Health's lactation consultants collected information on number of hours worked annually by IBCLCs by facility.

RESULTS

After adjusting for race/ethnicity, education, insurance status, age, marital status, route of delivery, birth weight, and gestational age, delivering in a hospital that employed an IBCLC was associated with a 2.28 (95% confidence interval [CI] =1.98,2.62) times increase in the odds of breastfeeding at hospital discharge. Among women receiving Medicaid, delivering at a hospital that employed IBCLCs was associated with a 4.13 (95% CI =3.22,4.80) times increase in the odds of breastfeeding at hospital discharge.

CONCLUSIONS

The findings presented here identify an association between delivering at a facility that employs IBCLCs and breastfeeding at hospital discharge. As the strength of this association is not negligible, particularly for women on Medicaid, these findings may be used to encourage widespread use of IBCLCs.

A systematic review of the nature of support for breast-feeding adolescent mothers

OBJECTIVE

to review the evidence on the nature of support for breast-feeding adolescent mothers.

METHODS

a systematic review of relevant English-language papers was conducted using an a-priori search strategy. Agreement on final inclusion was reached by consensus across the team. The findings were tabulated and described narratively and thematically.

FINDINGS

of 209 studies identified, seven fitted the inclusion criteria. The papers included in this review varied in design, quality and focus. Five types of support were identified: emotional, esteem, instrumental, informational and network. The participants in the included studies seemed to find the emotional, esteem and network components of support most helpful. Support from the participants' mothers seemed to be particularly powerful. The provision of continuity of support from an expert individual who is skilled in both lactation support and working with adolescents was also highly valued by breast-feeding adolescents. There was also evidence to suggest that targeted breast-feeding educational programmes, specifically designed for the adolescent learner, may be successful in improving breast-feeding initiation and continuation rates in this population. However, a question still arises about which elements of the complex package on offer were most effective.

CONCLUSION

the studies included in the review are diverse. Although the support provided by known and trusted individuals emerges as important to the adolescents, further research is required on the specific nature of that support and the person best placed to provide it. The acceptability and feasibility of other aspects of support and modes of provision also requires additional exploration. Further qualitative and feasibility studies are therefore warranted in order to inform future randomised-controlled interventions trials.

The education of health practitioners supporting breastfeeding women: time for critical reflection

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

Motivational Interviewing to Promote Sustained Breastfeeding

OBJECTIVE

To explore the feasibility of using motivational interviewing to promote sustained breastfeeding by increasing a mother's intent to breastfeed for 6 months and increasing her breastfeeding self-efficacy.

DESIGN

A longitudinal experimental two-group design with repeated measures was selected to explore the feasibility of using motivational interviewing to promote sustained breastfeeding in primiparous mothers.

SETTING

Three Western rural community hospital sites.

PARTICIPANTS

Convenience sample of 73 primiparous breastfeeding mothers ranging between the ages of 19 and 38, M = 25 (SD = 4.5).

MAIN OUTCOME MEASURE

Mothers reported the date of their last day of breastfeeding, defined as any breastfeeding during the previous 24-hour period. Breastfeeding behavior was confirmed at each visit by infant test weights.

RESULTS

The motivational interviewing group (M = 98.1 days, SD = 75.2) breastfed longer than the comparison group (M= 80.7 days, SD = 71.9); however, this difference was not significant, t(69) = 0.991, p = .325, Cohen's d = 0.24, related to the variability in the sample.

CONCLUSIONS

Although not a statistically significant difference, the mean number of days that mothers in the intervention group breastfed was 98 days compared to the mean of 81 days by the comparison group; therefore, motivational interviewing may be useful as a strategy to test in a comprehensive intervention plan.

Infant feeding and the media: the relationship between Parents' Magazine content and breastfeeding, 1972-2000

Mass media content likely influences the decision of women to breastfeed their newborn children. Relatively few studies have empirically assessed such a hypothesis to date, however. Most work has tended to focus either on specific interventions or on broad general commentary about the role of media. In this study, we examined infant feeding advertisements in 87 issues of Parents' Magazine, a popular parenting magazine, from the years 1971 through 1999. We then used content analysis results to predict subsequent changes in levels of breastfeeding among U.S. women. When the frequency of hand feeding advertisements increased, the percentage change in breastfeeding rates reported the next year generally tended to decrease. These results underscore the need to acknowledge the potential role of popular media content in understanding breastfeeding patterns and public health trends.

Toward a Situation-Specific Theory of Breastfeeding

This article reports a preliminary situation-specific theory of breastfeeding developed using an integrative, inductive approach (Im & Meleis, 1999). The theory purports varying levels of conflict versus congruity existing between the mother/infant dyad, a mother and her support networks, and both between and within the networks, all of which either block or facilitate breastfeeding. The theory proposes that to decrease conflict, professionals need to carefully consider their approach to promoting and supporting breastfeeding so as to respect the right of maternal decision-making and to avoid semblances of coercion or paternalism. “Salutary breastfeeding” is proposed as a new, ideal breastfeeding experience that is positive, healthy, and fulfilling, yet encompasses acknowledgement of diversity in maternal/infant dyads and situational context.

Designing a university-based lactation course

A university-based lactation course was developed to provide lactation education to health care providers, with the goal of improving their knowledge, attitude, and skills in assisting American women to breastfeed. This is a key strategy for achieving the Healthy People 2010 objectives, and it addresses the identified need for education among health care professionals. The university as well as an enthusiastic lactation community provided multidisciplinary clinical experiences and classroom lectures to prepare public health students, nurses, midwives, and nurse practitioners to encourage and assist women in breastfeeding. It is hoped that the success of this class and the experiences of the instructors will motivate other lactation consultants to develop similar educational strategies.

An evaluation of the breastfeeding support skills of midwives and voluntary breastfeeding supporters using the Breastfeeding Support Skills Tool (BeSST)

The promotion of breastfeeding has been established as a global public health issue. Despite this global agenda, breastfeeding initiation and duration rates remain low in many countries. The lack of provision of adequate support to the breastfeeding mother is an important contributory factor to shorter duration of breastfeeding. Health professionals and voluntary breastfeeding supporters are in a prime position to work collaboratively to provide comprehensive support to the breastfeeding mother. However, a comparative evaluation of the breastfeeding support skills of voluntary breastfeeding supporters and health professionals has never been conducted. This study aimed to assess the breastfeeding support skills of midwives and Breastfeeding Network (BfN) supporters. Breastfeeding support skills were assessed using a between-subjects design conducted with 15 midwives and 15 BfN supporters in the north-west of England. Support skills were measured using the prevalidated Breastfeeding Support Skills Tool (BeSST), a questionnaire and video tool. Total scores on the BeSST were significantly higher in the BfN group (mean = 42.5 +/- 6.4 SD) than in the midwife group (mean = 30.7 +/- 8.2 SD) [t (26.5) = 4.4, P < 0.0001]. The BfN group has the breastfeeding support skills necessary to provide adequate assistance for breastfeeding mothers. An interagency and interdisciplinary collaborative model is crucial to developing a coherent and cohesive approach to the support infrastructure for breastfeeding women.

A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England

OBJECTIVE

To explore the nature of interactions between midwives and breast-feeding women within postnatal wards.

DESIGN

A critical ethnographic study using participant observation and focused interviews.

SETTING

Two maternity units in Northern England, UK.

PARTICIPANTS

61 postnatal women and 39 midwives.

FINDINGS

The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'.

KEY CONCLUSIONS

The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet.

IMPLICATIONS FOR PRACTICE

Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.

Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.

How midwives learn about breastfeeding

Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n = 3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n = 1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n = 34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach in-depth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

Are pediatric offices "supportive" of breastfeeding? Discrepancies between mothers' and healthcare professionals' reports

According to previous research, pediatricians describe themselves as being "supportive" of breastfeeding, yet demonstrate suboptimal knowledge and skills when evaluated. Mothers also report dissatisfaction with receiving poor information and support from healthcare professionals (HCPs). To understand the depth of breastfeeding support problems within pediatric clinics, focus groups with mothers and individual interviews with HCPs were completed in 2000 to 2001 at a pediatric practice in a Midwest state. Results from interviews suggest that HCPs and mothers have different perceptions of "support." Existing literature hypothesizes that improvements in support provision could increase breastfeeding durations; this will ultimately involve reconciling mothers' and HCPs' definitions of breastfeeding "support."

Nurses' attitudes, knowledge, and beliefs related to the promotion of breastfeeding among women who bear children during adolescence

This descriptive study examined the attitudes, knowledge, and beliefs of maternal child nurses related to the promotion of breastfeeding among adolescent mothers. Nurses (N = 151) employed by three nonprofit hospitals and city and county public health departments located in the southeastern part of the United States were surveyed. Overall, the findings revealed that participants were generally knowledgeable about and supportive of breastfeeding by adolescent mothers. However, some of the nurses did not know that there are nutritional differences between breast milk and infant formula, continued the practice of imposing time limits for feedings at the breast, and indicated that they were skeptical about young mothers' potential for success with breastfeeding because of immaturity and lack of commitment. Statistically significant differences were noted in mean attitude and knowledge scores based on the participant's specialty; knowledge and attitude were positively correlated with the nurse's level of education. Implications for nursing practice and future research are discussed.

Breastfeeding duration in an Australian population: the influence of modifiable antenatal factors

Despite well-documented health benefits of breastfeeding for mothers and babies, most women discontinue breastfeeding before the recommended 12 months to 2 years. The purpose of this study was to assess the effect of modifiable antenatal variables on breastfeeding outcomes. A prospective, longitudinal study was conducted with 300 pregnant, Australian women. Questionnaires containing variables of interest were administered to women during their last trimester; infant feeding method was assessed at 1 week and 4 months postpartum. Intended breastfeeding duration and breastfeeding self-efficacy were identified as the most significant modifiable variables predictive of breastfeeding outcomes. Mothers who intended to breastfeed for < 6 months were 2.4 times as likely to have discontinued breastfeeding at 4 months compared to those who intended to breastfeed for > 12 months (35.7% vs 87.5%). Similarly, mothers with high breastfeeding self-efficacy were more likely to be breastfeeding compared to mothers with low self-efficacy (79.3% vs 50.0%).

An Australian study of midwives' breast-feeding knowledge

OBJECTIVE

To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context.

DESIGN

Postal questionnaire.

SETTING

National Australia.

PARTICIPANTS

Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI).

FINDINGS

A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.

Breastfeeding knowledge and practice of pediatric nurse practitioners

INTRODUCTION

The purpose of this secondary analysis is to examine and report on pediatric nurse practitioners' (PNPs') attitudes, experience, and knowledge about breastfeeding and to compare the results with those from a sample of pediatricians and other nurse practitioners and nurse-midwives.

METHOD

A breastfeeding study questionnaire was sent to all PNPs (N = 95) in a northwestern state. The response rate was 81%.

RESULTS

Respondents were nearly unanimous in their belief that "breast is best" and that it was their role to recommend breastfeeding to expectant mothers. In general, 74% of respondents believed they were effective or very effective in meeting the needs of breastfeeding patients. Although they were very supportive of breastfeeding, they were less knowledgeable about specific management strategies. Personal experience (nearly three fourths had themselves breastfed) was named by many as the most valuable source of information. Although PNPs appeared to have a more supportive attitude and better information than pediatric physicians, they reported themselves to be less effective in providing breastfeeding assistance than did their pediatric physician colleagues.

DISCUSSION

PNPs generally agreed about the importance of promoting breastfeeding and their effectiveness in doing so. However, many PNPs did not gain experience in breastfeeding support and management in their educational programs and incorrectly answered questions on basic management strategies.

The loving support breastfeeding campaign: awareness and practices of health care providers in Mississippi

OBJECTIVES

To evaluate the impact of the national breastfeeding promotion campaign, Loving Support Makes Breastfeeding Work, on health care providers in Mississippi.

DESIGN

Cross-sectional study.

SETTING

The Mississippi WIC (Women, Infants, and Children) program implemented the national Loving Support project for the state. Questionnaires were mailed to all hospitals with obstetric services and WIC clinics and to a random sample of one half of the practicing pediatricians and one third of the practicing family physicians in the state.

PARTICIPANTS

Two hundred and two health care providers, including 104 nurses and 98 physicians, responded to the questionnaire.

MAIN OUTCOME MEASURES

Health care providers' (a) awareness of the breastfeeding promotion activities in the state; (b) changes in practice in providing breastfeeding advice and referrals to lactation specialists and for breast pumps; and (c) changes in the management of breastfeeding-related problems.

RESULTS

A significantly higher proportion of nurses than physicians mentioned breastfeeding benefits to mothers, provided breastfeeding management advice, and referred mothers for breast pumps and to lactation specialists after the campaign.

CONCLUSIONS

This study showed the positive impact of the campaign on nurses' breastfeeding awareness and practices. More efforts are needed to continue breastfeeding outreach activities for health care providers.

Adolescent mothers and breastfeeding: experiences and support needs--an exploratory study

The experiences and support needs of adolescent mothers who commenced breastfeeding were elicited using focus groups and in-depth semistructured interviews. The study took place in the North West of England, UK. The qualitative data were analyzed using thematic networks analysis. Five themes related to experiences emerged: feeling watched and judged, lacking confidence, tiredness, discomfort, and sharing accountability. A further 5 themes were developed to describe the adolescents' support needs: emotional support, esteem support, instrumental support, informational support, and network support. These forms of support were most effective when provided together in a synergistic way and within a trusting relationship. Key supporters identified were the mother's mother, the partner, and the midwife employed in a teenage pregnancy coordinator role. Health professionals need to further explore the ways in which relationships may be developed and sustained that provide the range of support required by adolescent mothers to enable them to continue breastfeeding.

Evaluation of an educational intervention on breastfeeding for NICU nurses

The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.

Thai nurses' beliefs about breastfeeding and postpartum practices

Cultural beliefs are important determinants of health care behaviours. Nurses have an important influence on infant feeding decisions and maternal postpartum care, but little is known about the extent to which their practice is influenced by traditional beliefs and/or recent innovations driven by evidence-based research. The aim of this study was to investigate Thai nurses' traditional beliefs about breastfeeding and related postpartum care, and their impact on nursing practice. A survey of 372 nurses working in hospitals and health services in Ubon Ratchathani, Thailand was undertaken. Questionnaire items were developed from a review of the literature and exploratory interviews with Thai women. Descriptive statistics were used to represent the incidence of particular beliefs and behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional beliefs and practices. There were discrepancies between nurses' beliefs and contemporary evidence-based practices. Many nurses supported traditional Thai postpartum practices such as food restrictions and encouraging hot baths. Some traditional beliefs supported by nurses may be detrimental to women and babies such as "lying by fire", discarding of colostrum, and giving boiled water to neonates. Only half the nurses reported that they encouraged mothers to breastfeed immediately following birth. The study was undertaken in the North-East of Thailand, where the population is known to have strong belief systems. Reliability and content validity of the tool would be enhanced through replication studies and qualitative investigations of other breastfeeding issues. There is a need for professional development strategies such as peer review and mentoring to address inadequate knowledge and outdated practices of some health professionals, as well as continuity of care models to assess quality care outcomes that are culturally appropriate.

Update on pediatric nutrition: breastfeeding, infant nutrition, and growth

Recent studies continue to point out the critical nature of a patient's nutritional status in helping to determine important health outcomes in pediatrics. We review recent data concerning the composition of breast milk and its adequacy to support infant growth in the first six months of life, as well as trials that support breastfeeding as an important method to delay or reduce the incidence of atopic diseases such as eczema, allergies, and asthma. Studies have also been published that show how physician education and training about breastfeeding can be optimized. Studies showing how nutritional status is measured (using standard anthropometric techniques as well as more modern measures of basal metabolic rate) are highlighted, as well as the role of micronutrient supplementation of patients with the human immunodeficiency virus infection and diarrheal diseases.

Improving breastfeeding knowledge, attitudes, and practices of WIC clinic staff

OBJECTIVE

This study was conducted to assess the impact of a breastfeeding promotion clinic environment project implemented by the state of Mississippi on breastfeeding knowledge, attitudes, and practices of WIC clinic staff.

METHODS

Thirteen pairs of matched intervention and comparison WIC clinics participated in the study. Clinical and administrative staff completed pre-test and post-test self-administered questionnaires in 1998 and 1999.

RESULTS

A total of 397 staff members provided pre-test data, and 277 staff members provided post-test data. Before project implementation, the intervention and comparison groups were similar overall. The majority of staff had positive attitudes/beliefs about breastfeeding, but gaps in knowledge and practices were noted. Post-test data showed that the project improved knowledge, attitudes/beliefs, and confidence/practice of intervention clinic staff.

CONCLUSIONS

Clinic environment projects, which combine physical improvements and staff training, are effective in promoting support for breastfeeding among public health clinic staff. Similar interventions may contribute to the overall effectiveness of breastfeeding promotion programs.

First time mothers' views of breastfeeding support from nurses

PURPOSE

To gain insights into the perceptions of first-time mothers regarding nurses' support of breastfeeding.

STUDY DESIGN

Phenomenology.

METHOD

Audiotaped interviews were conducted with 20 primiparous breastfeeding mothers within the first month after giving birth vaginally to healthy term infants. Data analysis was concurrent with data collection, and trustworthiness of the data was established.

RESULTS

Nurses provided emotional, informational, and tangible support. Nonsupportive behaviors were also identified, including a sense that the nurse was in a hurry, failed to offer breastfeeding assistance, and was inflexible while working with the mother and infant.

CLINICAL IMPLICATIONS

Nurses can contribute significantly to the successful initiation of and continuation of breastfeeding, and provide new mothers with the confidence and reassurance critical for breastfeeding success.

Liminality and breastfeeding: women negotiating space and two bodies

It is almost universally accepted that breastfeeding infants is nutritionally superior to bottle-feeding. However, despite this medical advice, in many countries breastfeeding rates remain low and in the UK, rates are relatively static. The literature on breastfeeding has discussed international rates and the broad socio-economic factors influencing these rates. Through an observational study of a group of breastfeeding and non-breastfeeding women in the United Kingdom, this research utilises contemporary theoretical perspectives on the body, space and rites of passage, and investigates the reasons why some breastfeeding mothers may be in a liminal period, and the breastfeeding event itself, at times, a liminal and marginalised act. The paper argues that, for the group studied, breastfeeding is sometimes discouraged by its medicalisation, and that breastmilk and breastfeeding are often considered by mothers to be embarrassing. Many of the women studied regarded certain public and private places to be unacceptable places to breastfeed and claimed to modify their behaviour accordingly. The paper demonstrates the value of conducting locally based qualitative research into breastfeeding experiences, and of using theoretical perspectives from post-medical geography to interpret women's experiences.

Breastfeeding initiation and duration: a 1990-2000 literature review

OBJECTIVE

To review the literature on breastfeeding initiation and duration and to delineate effective strategies for promoting positive breastfeeding behaviors.

DATA SOURCES

Computerized searches on MEDLINE, CINAHL, and the Cochrane Library.

STUDY SELECTION

Articles from indexed journals relevant to the objective and published after 1990 (except for classic findings) were reviewed. Although a myriad of pertinent articles was located, referenced citations were limited to three per point. When article selection was required for a specific point, preferences were given to (a) randomized controlled trials; (b) meta-analyses; (c) studies with the largest, most representative samples; and (d) investigations conducted in North America.

DATA EXTRACTION

Data were extracted and organized under the following headings: benefits of breastfeeding, breastfeeding initiation and duration, personal characteristics, attitudinal and intrapersonal characteristics, hospital policies and intrapartum experience, sources of support, breastfeeding interventions, and review implications.

DATA SYNTHESIS

Although the health benefits of breastfeeding are well documented and initiation rates have increased over the past 20 years, most mothers wean before the recommended 6-months postpartum because of perceived difficulties with breastfeeding rather than due to maternal choice. Women least likely to breastfeed are those who are young, have a low income, belong to an ethnic minority, are unsupported, are employed full-time, decided to breastfeed during or late in pregnancy, have negative attitudes toward breastfeeding, and have low confidence in their ability to breastfeed. Support from the mother's partner or a nonprofessional greatly increases the likelihood of positive breastfeeding behaviors. Health care professionals can be a negative source of support if their lack of knowledge results in inaccurate or inconsistent advice. Furthermore, a number of hospital routines are potentially detrimental to breastfeeding. Although professional interventions that enhance the usual care mothers receive increase breastfeeding duration to 2 months, these supportive strategies have limited long-term effects. Peer support interventions also promote positive breastfeeding behaviors and should be considered.

CONCLUSIONS

A promising intervention is the complementation of professional services with peer support from a mother experienced in breastfeeding. This lay support appears to be an effective intervention with socially disadvantaged women.