The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum

Association between Flexibility, Measured with the Back-Scratch Test, and the Odds of Oxytocin Administration during Labour and Caesarean Section

Objective: This study explored whether assessing flexibility levels in clinical settings might predict the odds of oxytocin administration and caesarean section to stimulate labour. Methods: Pregnant women from the GESTAFIT Project (n = 157), participated in this longitudinal study. Maternal upper-body flexibility was assessed at 16 gestational weeks (g.w.) through the Back-scratch test. Clinical data, including oxytocin administration and type of birth, were registered from obstetric medical records. Results: Pregnant women who required oxytocin administration or had caesarean sections showed lower flexibility scores (p < 0.05 and p < 0.01, respectively). The receiver operating characteristic curve analysis showed that the Back-scratch test was able to detect the need for oxytocin administration ((area under the curve [AUC] = 0.672 (95% confidence interval [CI]: 0.682 (95% CI: 0.59-0.78, p = 0.001)). The AUC to establish the ability of flexibility to discriminate between vaginal and caesarean section births was 0.672 (95% CI: 0.60-0.77, p = 0.002). A Back-scratch test worse than 4 centimetres was associated with a ~5 times greater increased odds ratio of requiring exogenous oxytocin administration (95% CI: 2.0-11.6, p = 0.001) and a ~4 times greater increased odds ratio of having a caesarean section (95% CI: 1.7-10.2, p = 0.002). Conclusions: These findings suggest that lower flexibility levels at the 16th g.w. discriminates between pregnant women who will require oxytocin and those who will not, and those with a greater risk of a caesarean section than those with a vaginal birth. Pregnant women below the proposed Back-scratch test cut-offs at 16th g.w. might specifically benefit from physical therapies that include flexibility training.

Having Enough Milk to Sustain a Lactation Journey: A Call to Action

The rates of human milk feeding are suboptimal worldwide. Recommendations for healthy, term mother-infant dyads include early breastfeeding initiation, frequent skin-to-skin contact, and frequent breastfeeding. The normal physiology of lactation can be affected by prenatal factors such as diabetes, obesity, and excessive gestational weight gain. Furthermore, birth-related factors such as early-term gestation, stressful labor, unscheduled cesarean birth, and postpartum hemorrhage can additionally disrupt recommended practices such as early initiation of breastfeeding and skin-to-skin contact. Given that the first 2 to 3 days postpartum are critical to achieving timely secretory activation and establishing an adequate volume of milk, a proactive approach to care can include building awareness of risk factors and development of protocols for the effective early initiation of lactation.

Inequalities in large-scale breastfeeding programmes in Bangladesh, Burkina Faso and Vietnam

Inequalities in breastfeeding programmes and practices have slowed global progress in providing the life-saving protection of breastfeeding for millions of infants despite well-known life-long impacts. As breastfeeding interventions are scaled up, inequalities in coverage and breastfeeding practices should be tracked, particularly in disadvantaged groups, who are likely to suffer the most serious health and developmental impacts of poor childhood nutrition. The literature provides evidence of inequalities in breastfeeding practices, but research is limited on socioeconomic disparities in the coverage of breastfeeding interventions. This paper (1) compares inequalities in breastfeeding practices in intervention and nonintervention areas and (2) documents inequalities in programme coverage by type of intervention. We disaggregated endline evaluation surveys in Bangladesh, Burkina Faso and Vietnam, where rigorous evaluations had documented significant overall improvements, and analysed whether inequalities in breastfeeding practices and programme coverage differed by treatment areas. We used Erreygers index to quantify inequalities and found that breastfeeding practices were largely pro-poor; intervention coverage was not consistently pro-poor. While counselling coverage often favoured women from the poorest quintile, public education/media coverage consistently favoured better-off women. Inequalities favoured more educated mothers in the coverage of combined interventions. None of the programmes had explicit equality objectives. The results indicate the need for introducing specific actions to reduce inequalities in breastfeeding policies and programmes. This is a priority unfinished agenda for nutrition programming.

Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life

OBJECTIVE

The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery.

METHODS

Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC).

RESULTS

81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92).

CONCLUSIONS

This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.

Comparison of Breastfeeding Success by Mode of Delivery

OBJECTIVE

This article identifies how mode of delivery and the presence of labor affect the initiation and effectiveness of breastfeeding.

STUDY DESIGN

This is a retrospective cohort study of breastfeeding success after vaginal delivery, cesarean section after labor, and scheduled cesarean section in term, singleton deliveries in nulliparous patients at a large academic institution from 2017 to 2018. Exclusion criteria included major postpartum complications requiring admission to the surgical intensive care unit or neonatal intensive care unit, general anesthesia, and major fetal anomalies. Breastfeeding success in the immediate postpartum period, defined as the first 2 to 3 days postpartum prior to hospital discharge, was measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. Multivariable linear and logistic regression were used to assess the association between mode of delivery and markers of breastfeeding success after adjusting for potential confounders. A Tukey's post hoc analysis with pairwise comparisons was performed to assess differences in breastfeeding outcomes between vaginal delivery, scheduled cesarean section, and cesarean section after labor.

RESULTS

A total of 2,966 women met inclusion criteria during the study period, 1,936 (65.3%) of whom underwent spontaneous vaginal delivery, 415 (14.0%) of whom delivered by scheduled cesarean section, and 615 (20.7%) of whom underwent cesarean section after labor. There were significant differences in maternal age, obesity, race/ethnicity, insurance status, gestational age at delivery, birth weight, and 1-minute Apgar's score less than 7 between vaginal delivery, scheduled cesarean section, and cesarean section after labor. There were also significant differences between indication for oxytocin, type of anesthesia, and postpartum hemorrhage between the three groups. After controlling for these factors, women who underwent vaginal delivery were more likely to have infants with decreased need for formula supplementation (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.52-1.93) and were less likely to switch from breast to formula feeding (aOR = 1.71, 95% CI: 1.04-1.31) in comparison to women who delivered via cesarean section in labor or scheduled cesarean section. The infants of these women also had an increased number of breastfeeding sessions on average (β = 0.06, p = 0.002), required fewer number of daily formula feedings (β = 0.14, p < 0.001), and experienced a smaller percentage in neonatal weight loss over the first 2 to 3 days of life (β = 0.18, p < 0.001) compared to those born after cesarean section and cesarean section after labor. These women comparatively required less time at each breastfeeding session (β = 0.06, p = 0.005), and produced fewer wet diapers and stools on average (β = 0.12, p < 0.001 and β = 0.12, p < 0.001, respectively). On post hoc analysis with pairwise comparisons, and on separate sensitivity analysis of only women who underwent cesarean delivery, there was no difference in breastfeeding outcome measures between scheduled cesarean section and cesarean section in labor.

CONCLUSION

Women who deliver by cesarean section, despite the presence or absence of labor, are less likely to maintain exclusive breastfeeding postpartum and are more likely to require formula supplementation. These women may need more support with breastfeeding after surgery in order to experience similar benefits for neonatal growth and weight gain.

KEY POINTS

· Women who deliver by cesarean section are less likely to maintain exclusive breastfeeding.. · Women who deliver by cesarean section are more likely to require formula supplementation.. · Women may need more support with breastfeeding after cesarean delivery..

Factors Associated with Exclusive Breastfeeding during Admission to a Baby-Friendly Hospital Initiative Hospital: A Cross-Sectional Study in Spain

BACKGROUND

Breastfeeding is the optimal nourishment for infants and it is recommended that children commence breastfeeding within the first hour of birth and be exclusively breastfed for the initial 6 months of life. Our objective was to determine which factors related to mothers could influence the degree of exclusive breastfeeding during hospitalization, as well as to assess breastfeeding mothers' attitudes towards breastfeeding.

METHODS

A multicenter cross-sectional study was undertaken in the healthcare area of Santiago de Compostela, Spain. The necessary variables were collected using a specially designed ad hoc questionnaire. The researcher responsible for recruitment conducted the interviews with the participants. The reduced Iowa Infant Feeding Attitude Scale (IIFAS-s) was employed to gauge maternal attitudes toward feeding their baby.

RESULTS

In total, 64 women were studied. The overall score of IIFAS-s (mean ± standard deviation) was 36.95 ± 5.17. A positive attitude towards breastfeeding was therefore observed in our sample. No use of a pacifier by the newborn was associated with a positive attitude for breastfeeding. Having previous children (Ora = 6.40; IC95% 1.26-32.51) and previous experience with breastfeeding (Ora = 6.70; IC95% 1.31-34.27) increased the likelihood of exclusive breastfeeding during admission.

CONCLUSIONS

In our study, exclusive breastfeeding during hospitalization is associated with having previous children and prior breastfeeding experience.

Motherhood after Spinal Cord Injury: Breastfeeding, Autonomic Dysreflexia, and Psychosocial Health: Clinical Practice Guidelines

The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women with spinal cord injury (SCI) who face unique challenges and barriers to breastfeeding due to the impact of SCI on mobility and physiology. Tailored provision of care from health care professionals (HCPs) is important in helping women navigate these potential barriers. Yet, HCPs often lack the confidence and SCI-specific knowledge to meet the needs of mothers with SCI. An international panel of clinicians, researchers, consultants, and women with lived experience was formed to create an accessible resource that can address this gap. A comprehensive survey on breastfeeding complications, challenges, resources, and quality of life of mothers with SCI was conducted, along with an environmental scan to evaluate existing postpartum guidelines and assess their relevance and usability as recommendations for breastfeeding after SCI. Building on this work, this article provides evidence-based recommendations for HCPs, including but not limited to general practitioners, obstetricians, pediatricians, physiatrists, lactation consultants, nurses, midwives, occupational therapists, and physiotherapists who work with prospective and current mothers with SCI.

Perinatal Risk Factors for Asthma and Allergic Rhinitis in Children and Adolescents

OBJECTIVES

In this study, we evaluated the associations between birth-related exposures, postnatal factors, and the risk of allergic rhinitis and asthma in children and adolescents.

METHODS

We performed a comprehensive search of five literature databases up to May 2023. To quantify the associations of birth-related exposures (birth weight, delivery mode, prematurity, sex, maternal age, and parental allergy history) and postnatal factors (birth order, number of siblings, breastfeeding exclusivity, and breastfeeding duration) with allergic disease, we calculated pooled odds ratios and 95% confidence intervals. We conducted subgroup analyses for allergic disease type, birth order, number of siblings, and parental allergy history. The methodological quality of the identified studies was evaluated using the Newcastle-Ottawa Scale.

RESULTS

This meta-analysis included 31 studies, encompassing 218,899 patients in total. The birth-related exposures of low birth weight, maternal age, and prematurity (less than 37 weeks gestation) were not significantly associated with the risk of asthma or allergic rhinitis during childhood or adolescence. Male sex, family history of allergy, and cesarean delivery were linked to an elevated risk of asthma or allergic rhinitis. Among postnatal factors, exclusive breastfeeding, breastfeeding for longer than 6 months, second or later birth order, and having siblings exhibited protective effects against allergic diseases in offspring.

CONCLUSION

The risks of allergic rhinitis and asthma were elevated in male patients, those delivered by cesarean section, and those with a family history of allergy. Conversely, exclusive breastfeeding, breastfeeding for longer than 6 months, and having siblings corresponded to a reduced risk of respiratory allergic diseases.

Variation in Breastfeeding Initiation and Duration by Mode of Childbirth: A Prospective, Population-Based Study

Introduction: Despite known benefits of breastfeeding, including prevention against infections for infants, in the presence of numerous barriers, less than half of infants in high-income countries breastfeed for 6 months. One potential barrier to breastfeeding is birth by cesarean section (C-Section), which can invoke long-term difficulties. However, our structured literature review found that existing empirical research does not fully elucidate this relationship due to differences in operationalization of C-section and breastfeeding, omission of important confounders, and failure to exclude those who did not initiate breastfeeding (or use time-to-event analyses). In this article, we attempt to overcome these limitations. Methods: We analyzed data from 14,414 mother-infant dyads enrolled in the United Kingdom-based prospective Millennium Cohort Study, beginning in 2001. Using multivariable logistic regression, we examined the association between mode of birth (vaginal, emergency C-section, and elective C-section) and likelihood of breastfeeding initiation. We then applied adjusted Accelerated Failure Time survival models to examine the associations between mode of birth and duration of any and exclusive breastfeeding. Results: Those with planned (but not emergency) C-section were less likely to initiate breastfeeding (odds ratio: 0.84, 95% confidence interval [CI]: 0.71-0.99) relative to vaginal births. However, those with either planned or unplanned C-section discontinued both any and exclusive breastfeeding sooner than vaginal births. This effect was more pronounced for those with planned C-section (time ratio [TR]: 0.75, 95% CI: 0.64-0.89) than unplanned C-section (TR: 0.85, 95% CI: 0.74, 0.97) compared with vaginal births. Conclusions: Through application of rigorous methods, this study provides compelling evidence that breastfeeding duration may be impeded by C-section birth. The findings suggest that additional support for mothers who intend to breastfeed and have a C-section birth may be warranted.

Effect of Lactation Management Model on Breastfeeding Process After Cesarean: A Prospective Randomized Controlled Study

It is important to implement supportive programs to ensure mothers breast feed for the desired period, and infants are fed by only mother's milk. In the research, it was aimed at evaluating the effects of lactation management model on mothers' breastfeeding process following a caesarean section. Women who gave birth by planned cesarean delivery were divided into two groups, randomized control and experimental. Data collection was performed during gestation, first day after postpartum, pre-discharge, on the 9th day in a face to face interview, and in the form of monthly phone interviews up to 6 months. While the experimental group exercised the lactation management model, the control group received routine lactation practices in clinic. In the scores of Breastfeeding Charting System and Documentation Tool, a significant difference was found between the groups (p<0.001). 87.9% of the experimental group and 48.5% of the control group were determined to apply successful breast-feeding techniques. In addition, it was found that all of the experimental group breast fed 1 month longer than the control group, and for the first month, 90.9% of the experimental group and 78.8% of the control group breast fed with mother's milk only and a higher breastfeeding. Among in the experimental group, it was found that breastfeeding self-efficacy was higher, and breastfeeding techniques were accurate and successful and breastfeeding only and continuity rates were higher while breastfeeding related breast problems developed less frequently. Clinical Trials.gov Protocol Registration Number: NCT04593719.

Inflammatory Bowel Disease and Breastfeeding: A Narrative Review

Inflammatory bowel disease (IBD) frequently affects women of childbearing age who may consider breastfeeding. Although breastfeeding has numerous benefits, there remain concerns regarding the safety of breastfeeding among women with IBD. Breastfeeding is important in developing the immune system of infants and has been shown to protect against the development of IBD. The risk of developing an increase in disease activity postpartum is the same regardless of breastfeeding status. Most IBD medications are also considered safe in breastfeeding and have no major risks to infants. Despite this, breastfeeding rates remain low among women with IBD, mostly due to concerns about the safety of IBD therapy with breastfeeding. Many women self-discontinue their IBD medications to breastfeed, and there is often uncertainty among health professionals to make recommendations about therapy. Dedicated IBD clinics can greatly support mothers during pregnancy and breastfeeding periods to enhance their knowledge, optimize their medication adherence, and improve their postpartum outcomes. This review aims to provide the most recent evidence-based literature regarding the safety of breastfeeding in women with IBD and the current recommendations about medical therapies with breastfeeding.

Clinical significance and main parameters promoting the breast‑feeding strategy (Review)

Breastfeeding provides numerous nutritional and immunological benefits, promotes neurological and cognitive development, and protects against chronic and infectious diseases, rendering it beneficial to the survival and well-being of infants. According to international recommendations, infants should be exclusively breastfed for the first 6 months. However, despite global health recommendations and funding initiatives, exclusive breastfeeding rates remain low worldwide. A number of studies attribute the low rates to factors that can be grouped into demographic, psychosocial, economic and midwifery factors, and outline the profile of each mother who opts to exclusively breastfeed her infant. In addition, the number of previous pregnancies, induced labor, the use of epidurals at birth or the possibility of the newborn being delivered prematurely, and the need for admission to an intensive care unit are the factors that reduce the likelihood of exclusive breastfeeding. Further research is required to understand the factors influencing the initiation and maintenance of exclusive breastfeeding, as international interventions have been ineffective. The aim of the present review was to provide an up-to-date summary of these various factors in an aim to assist health care professionals and policy makers in developing effective interventions with which to promote and support exclusive breastfeeding.

The Interaction between Stress and Inflammatory Bowel Disease in Pediatric and Adult Patients

Background: Inflammatory bowel diseases (IBDs) have seen an exponential increase in incidence, particularly among pediatric patients. Psychological stress is a significant risk factor influencing the disease course. This review assesses the interaction between stress and disease progression, focusing on articles that quantified inflammatory markers in IBD patients exposed to varying degrees of psychological stress. Methods: A systematic narrative literature review was conducted, focusing on the interaction between IBD and stress among adult and pediatric patients, as well as animal subjects. The research involved searching PubMed, Scopus, Medline, and Cochrane Library databases from 2000 to December 2023. Results: The interplay between the intestinal immunity response, the nervous system, and psychological disorders, known as the gut-brain axis, plays a major role in IBD pathophysiology. Various types of stressors alter gut mucosal integrity through different pathways, increasing gut mucosa permeability and promoting bacterial translocation. A denser microbial load in the gut wall emphasizes cytokine production, worsening the disease course. The risk of developing depression and anxiety is higher in IBD patients compared with the general population, and stress is a significant trigger for inducing acute flares of the disease. Conclusions: Further large studies should be conducted to assess the relationship between stressors, psychological disorders, and their impact on the course of IBD. Clinicians involved in the medical care of IBD patients should aim to implement stress reduction practices in addition to pharmacological therapies.

Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis

OBJECTIVE

To investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents.

STUDY DESIGN

This study included 634 offsprings aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates.

RESULTS

Median breastfeeding duration was 7 months (minimum = 0, maximum = 36). Boys in the second quartile (median breastfeeding = 5 months) had lower total fat mass % (β (SE) -3.2 (1.5) P = .037), and higher lean mass % (3.1 (1.6) P = .049) and skeletal muscle mass % (1.8 (0.8) P = .031) compared with the reference group (median breastfeeding = 2 months). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) P = .035) was found among girls. No association was found with other cardiometabolic indicators.

CONCLUSION

Despite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.

Outcomes and perspectives of woman-newborn dyads following discharge from a quaternary maternity service in Australia: A cross-sectional survey

BACKGROUND

The average postnatal stay for most Australian mothers is two days. Postnatal length of stay is dependent on various factors, such as maternal preferences, mode of birth or complications following birth. However, little is known about the relationship between these elements.

AIM

To prospectively explore maternal and neonatal postnatal outcomes within the context of length of stay, model of care and personal expectations and experiences within the first 3-5 weeks following birth.

METHODS

A cross-sectional study within an urban quaternary Australian hospital was conducted between January 2021 to April 2021. A mixed methods convergent approach was taken.

FINDINGS

Of the 1066 questionnaires distributed, 216(20.2%) responses were usable for analysis. Most mothers (82%) were satisfied with their postnatal stay length (range 6-78 h). Models of care (such as GP shared care, midwifery group practice) were not associated with mothers' satisfaction with their postnatal stay length. Mothers following cesarean section felt less supported, had lower breastfeeding rates and more difficulty accessing postnatal services. Neonatal readmissions (n = 11, 5%) in the first week of life were most often for jaundice, poor feeding or both (n = 7, 64%). Three key themes were generated from the qualitative data and categorised into themes labeled 'Environmental and healthcare delivery constraints', 'Ready or not for discharge' and 'Home now, but support missing'.

CONCLUSION

Participants identified that improvements in postnatal care require more than extending in-hospital length of stay. Rather a more individualised woman-centred focus, in-home supported options, with flexibility in timing needed, especially for those following a complicated birth.

Preference of cesarean delivery and its associated factors among pregnant women attending ante natal care at public health facilities of Debrebrehan City, Ethiopia: Cross-sectional study

BACKGROUND

A Caesarean section is a surgical procedure used to prevent or treat life-threatening maternal or fetal complications. Women's delivery preferences have become a global issue of interest to many researchers and clinicians, especially given the ever-increasing rate of cesarean sections. There is limited data on the preference for cesarean delivery and its associated factors for Ethiopian women, particularly in the study area. The aim of the study is to assess the preference for cesarean delivery and its associated factors among pregnant women attending antenatal care at public health facilities in Debre Berhan, Ethiopia, in 2023.

METHODS

An institution-based cross-sectional study design was done from May 5-20, 2023, among 512 participants, and a multi-stage sampling technique was used. The data were collected by using interviewer-administered semi-structured questionnaires. The data were entered by Epi Data version 4.6 and then transferred to SPSS version 25 for analysis. With logistic regression, those variables with a p-value <0.25 in the bivariate analysis were candidates for multivariate logistic regression, and variables with a p-value <0.05 were considered statistically significant.

RESULT

The preference for a cesarean section was 26%, with a CI of 22.3% to 29.9%. Pregnant mothers who were not satisfied with their previous intrapartum care (AOR; 6.3 CI = (3.5-11), P = 0.01), had no knowledge about cesarean delivery (AOR; 2.9; 95% CI = 1.6-5.3), P = 0.01), had a previous history of spontaneous abortion (AOR; 3.1; 95% CI = (1.5-6.3), P = 0.001), lived in an urban area (AOR; 1.9; 95% CI = (1.0-3.5), P = 0.038), and had a current pregnancy-related problem (AOR; 4.8; 95% CI = 1.9-10), P = 0.001) were significantly associated with the preference for cesarean delivery.

CONCLUSION

In this study, the preference for cesarean delivery was high as compared to the World Health Organization recommendation. Pregnant mothers who were not satisfied with their previous intrapartum care, had no knowledge about cesarean delivery, had a previous history of spontaneous abortion, had an urban residence, and had a current pregnancy-related problem were significantly associated with a preference for caesarean delivery. Clinicians who are working in the delivery room should improve their service provision by using patient-centered care to increase patient satisfaction.

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.

Common maternal health problems and their correlates in early post-partum mothers

BACKGROUND

Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status.

OBJECTIVE

This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore.

DESIGN

This was a cross-sectional study, based on a self-administered questionnaire.

METHODS

A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale.

RESULTS

The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001).

CONCLUSION

Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.

Individuals' Experiences of Having an Unplanned Cesarean Birth: A Qualitative Analysis

OBJECTIVE

The experience of an unplanned cesarean birth may be a risk factor for mood disorders and other challenges in the postpartum period, yet qualitative data on the patient experience are limited. We sought to understand individuals' experiences of having an unplanned cesarean birth.

STUDY DESIGN

This was a secondary analysis of a prospective qualitative investigation among low-income postpartum individuals at a single-, tertiary-care center in which the primary aim was to evaluate patients' postpartum pain experience after a cesarean birth. Participants completed a 60-minute face-to-face interview on postpartum days 2 to 3. Only participants who labored prior to their cesarean birth were included in this analysis. Transcripts were analyzed by two separate authors using the constant comparative method. Themes are illustrated using direct quotes.

RESULTS

A total of 22 individuals were included in this analysis; the majority (n=16, 72.7%) experienced a primary cesarean birth. Over half (n=12, 54.5%) identified as Hispanic and one-third (n=7, 31.8%) identified as non-Hispanic Black race and ethnicity. Four themes regarding the experience of a cesarean birth after labor were identified, including feelings of anguish, belief that vaginal birth is "normal," poor experiences with care teams, and feelings of self-efficacy. Subthemes were identified and outlined.

CONCLUSION

In this cohort, individuals who experienced an unplanned cesarean birth after labor expressed feelings of self-blame, failure, and mistrust. Given the association of unplanned cesarean birth with mood disorders in the postpartum period, efforts to enhance communication and support may offer a means of improving individual experiences.

KEY POINTS

· In this cohort, many individuals expressed negative feelings after an unplanned cesarean birth.. · Conversely, positive themes related to feelings of self-efficacy were identified.. · Efforts to enhance communication and support after an unplanned cesarean birth are warranted..

Factors associated with early initiation of breastfeeding in central Saudi Arabia: a hospital-based survey

BACKGROUND

Early initiation of breastfeeding is central to the success of infant feeding. The World Health Organization (WHO) therefore recommends breastfeeding within the first hour of birth and has set a target to increase the rate to 70% globally by 2030. This suggests the necessity of systematic investigations to capture trends in early initiation of breastfeeding to avail health systems of up-to-date information in the interest of appropriate policy making. Hence, this study was designed to investigate the factors associated with early initiation among mothers who delivered babies in public healthcare facilities in the Al-Qassim Region, Saudi Arabia.

METHODS

The research was a hospital-based, cross-sectional study which featured the recruitment of 546 mothers from March 2021 to June 2021 in five public hospitals. A questionnaire was the tool used for data collection and this was administered via face-to-face, structured interviews. Data were analyzed using binary logistic regression including unadjusted (UOR) and adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULTS

The prevalence of early initiation of breastfeeding was 23.1% (120 of 519 respondents). Maternal and paternal socio-demographic variables, household characteristics, parity, age of the previous child, breastfeeding the previous child or otherwise and the sex of the newborn were not associated with the early initiation of breastfeeding. Mode of delivery and antenatal education about breastfeeding were significant factors. Postnatal care practices were also significant: the provision of help in positioning babies for breastfeeding (AOR 3.5; 95% CI 1.62, 7.57), 24-hour rooming-in (AOR 6.26; 95% CI 1.31, 29.8) and encouragement to practice early initiation of breastfeeding (AOR 3.05; 95% CI 1.71, 5.43) were good, better and the best factors associated with early initiation of breastfeeding respectively.

CONCLUSION

The prevalence of early initiation of breastfeeding is poor and represents a threat to child survival in the study area. Postnatal care practices are crucial factors strongly predisposing mothers to early initiation of breastfeeding and should therefore be institutionalized in health policy frameworks to promote the same in Saudi Arabia.

Breast feeding practices after normal vaginal and caesarean delivery in Gujarat, India

Breast feeding is the mainspring of child survival, nutrition, development and maternal health. Early initiation of breastfeeding is an extremely important factor associated with the maintenance of long-term breastfeeding practice. Breastfeeding practices can be influenced by a variety of variables such as parity, mode of delivery; body mass index (BMI), breast or nipple abnormalities and behavioural factors are equally as important. The present study was conducted to analyze Breast Feeding Practices after Normal Delivery and Caesarean Delivery at a Tertiary Care Hospital. This cross sectional study was conducted at tertiary care hospital, by Convenient non-random sampling method, which included two groups; Group A: 100 mothers who delivered vaginally Group B: 100 mothers who gave birth through caesarean section (n=100 each). Participants were asked to complete standardized questionnaire consists of information on socio demographic and breast feeding practice. All anthropometric measurements were taken. A semi-structured questionnaire was used to collect data on maternal socio demographic characteristics, breastfeeding knowledge, practices along with source of information regarding breastfeeding and maternal experience. The study results shows that initiation of breastfeeding is most common in normal vaginal delivery (70%) among total 100 subjects of vaginal delivery category and also common in subjects with planned C-section (49%) of 100 subject"s caesarean delivery category. Association between the modes of delivery and initiation of breastfeeding within an hour was statistically significant (p<0.01). The present study indicates that C-sections are linked to higher breastfeeding challenges, greater resource usage, and shorter nursing duration.

Perinatal complications of the maternal-Fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section: A retrospective study of clinical results associated with bioethical precepts

The obstetrics field is undergoing transformation and committing to ensuring the autonomy of pregnant women in decisions related to birth based on scientific information. The physiological process of birth typically results in vaginal delivery, but medicine has evolved to include obstetric surgeries that are safe and result in few perioperative complications, especially when cesarean section is performed from 39 weeks of gestational age. Thus, the question is whether clinicians should interfere with pregnant women's freedom to choose their mode of delivery by trying to persuade them to choose vaginal delivery. The objective was to analyze the perinatal complications of the maternal-fetal dyad in primiparous women subjected to vaginal delivery versus elective cesarean section with respect to the bioethical precepts of autonomy, beneficence and nonmaleficence. In total, 2,507 women, including 1,807 (72.1%) with vaginal deliveries and 700 (27.9%) with cesarean deliveries, were analyzed between 2017 and 2020. There was no difference between the types of delivery in maternal readmission, death, admission to the intensive care unit, an Apgar score <7 in the 5th minute of life, maternal blood transfusion or comorbidities of the mothers or newborns. The elective cesarean section group showed less need for therapeutic uterotonics. In primigravidae, it was observed that elective cesarean section did not present a higher risk of complications than vaginal delivery. Therefore, this guarantees the autonomy and right of the individual to choose the mode of delivery.

Effect of caesarian section delivery on breastfeeding initiation in Nigeria: logit-based decomposition and subnational analysis of cross-sectional survey

OBJECTIVES

This study investigates caesarian section (CS) and vaginal delivery disparity, impact and contributions to timely initiation of breastfeeding (TIBF) to guide evidence-based strategy for improved breastfeeding practice.

DESIGN AND SETTINGS

A cross-sectional (population-based) analysis of 19 101 non-missing breastfeeding data from the 2018 Nigerian Demographic Health Survey collected via a two-stage stratified-random sampling across the 37 states in the 6 geopolitical-zones of Nigeria.

PARTICIPANTS

Complete responses from reproductive-age women (15-49 years) who had at least a childbirth in the last 5 years prior to the 2018 survey.

MAIN OUTCOME MEASURES

TIBF, that is, breastfeeding initiation within the first hour of newborn life is the outcome, CS is the exposure variable and explanatory factors were classified as; socio-demographic and obstetrics.

METHODS

Descriptive statistics were reported and graphically presented. Bivariate χ2 analysis initially assessed the relationship. Crude and adjusted logistic regression evaluated the likelihood and significance of multivariable association. Multivariate decomposition further quantified predictors' contribution and importance. Statistical analysis was performed at a 95% confidence level in Stata V.17.

RESULTS

44.1% and 20.2% of women with vaginal and CS delivery observed TIBF, respectively. Odds of TIBF were five times lower in women with CS delivery (adjusted OR 'AOR'=0.21: 95% CI=0.16 to 0.26). TIBF odds increase among women who used skilled prenatal provider (AOR=1.29: 95% CI=1.15 to 1.45), had hospital delivery (AOR=1.34: 95% CI=1.18 to 1.52) and in rich wealth class (AOR=1.44: 95% CI=1.29 to 1.60), respectively. Rural residency, unwanted pregnancy and large child size at birth however reduces the odds. Partial skin-to-skin contacts contributed to about 54% (p<0.05) of the negative effect. TIBF is highest in Kano (3.4%) and lowest in Taraba (0.02%) with topmost impact in Bayelsa state (crude OR 'COR'=63.9: 95% CI=28.2 to 144.9).

CONCLUSIONS

CS exposure reduced the odds of TIBF by fivefolds. Hence, the adverse effect of CS exposure on TIBF. Skin-to-skin contact can reduce the negative effect of CS on TIBF. Early mother-child contact peculiar to CS women is critical for improved breastfeeding practice.

Characteristics and factors influencing the volume of breastmilk donated by women to the first human milk bank in Vietnam

Background

Donor human milk (DHM) is essential to the operation of human milk banks (HMB). This study examined characteristics and factors associated with higher volumes of DHM donation at the first HMB in Vietnam.

Method

Data from an online HMB monitoring system collected between February 2017 and July 2022 included demographic characteristics, child information, the timing of donation, and the volume of DHM. Higher volume is defined as equal to or greater than the median DHM volume per donor of 14.4 liters (L). Potential contributors to higher DHM volume were examined using the chi-square test in univariate and multivariable logistic regression analysis.

Results

During the 5.5-year operation, this HMB recruited 517 donors with an average age of 28.6 years. Approximately 60.9% of donors had a college or higher degree and 97.3% gave birth in Da Nang city. Of these donors, the prevalence of cesarean birth was 48.2%, preterm births was 40.2%, and 27.9% had babies with a birth weight of less than 1,500 g. There was a similar proportion of donors between the hospital (48.2%) and community (51.8%). On average, hospital donors started their donations 15 days after birth when their newborns were 33.9 weeks corrected age compared to 63 days and 47.7 weeks among community-based donors. The overall median volume of DHM per donor was 14.4 L over a period of 46 days. The amount and duration were higher in community-based donors (17.5 L in 72 days, 300 ml/day) than those in the hospital (8.4 L in 30 days, 258 ml/day). More than 37% of donors contacted the HMB themselves; the remainder were introduced by health professionals. Factors associated with higher volumes of DHM included higher education (OR: 1.77; 95% CI: 1.09, 2.87), having a full-term newborn (OR: 2.46; 95% CI: 1.46, 4.13), and community-based donors (OR: 2.15; 95% CI: 1.22, 3.78).

Conclusions

Mothers with higher education and from the community donate more breastmilk over a longer duration than those with lower education and from the hospital. Breastfeeding protection, promotion, and support should be offered to all mothers with specialized breastfeeding support for mothers of preterm and sick infants. This will ensure mothers have sufficient breastmilk for their newborns and potentially surplus breastmilk for donation.

Birth outcomes following pelvic ring injury: A retrospective study

OBJECTIVE

To report obstetric outcomes in pregnant women with previous pelvic ring injury (PRI) and investigate the correlation between residual pelvic deformity and the mode of delivery.

DESIGN

Retrospective cohort study.

SETTING

Single medical centre in Taiwan.

POPULATION

Forty-one women with PRI histories from 2000 to 2021 who subsequently underwent pregnancy and delivery.

METHODS

All patients had complete PRI treatment and radiological follow up for at least 1 year. The demographic data, radiological outcomes after PRI and obstetric outcomes were collected to investigate the potential factors of delivery modes using non-parametric approaches and logistic regression. Caesarean section (CS) rates among different subgroups were reported.

MAIN OUTCOME MEASURES

Comparisons of demographic data and radiological outcomes (Matta/Tornetta criteria and Lefaivre criteria) after PRI among patients who had subsequent pregnancy and underwent vaginal deliveries (VD) or CS.

RESULTS

There were 14 VD and 27 CS in 41 patients. Nine patients underwent CS because of their PRI history, 12 patients underwent CS for other obstetric indications and 20 underwent trial of labour. Based on the logistic regression model, retained trans-iliosacral implants did not significantly increase the risk of CS (odds ratio [OR] 1.20; 95% CI 0.17-8.38). Higher pelvic asymmetry value by Lefaivre criteria was a potential risk factor for CS after previous PRI (OR 1.52; 95% CI 1.043-2.213).

CONCLUSIONS

VD is possible after PRI. Retained trans-iliosacral implants do not affect the delivery outcome. Residual pelvic asymmetry after PRI by Lefaivre criteria is a potential risk factor for CS.

Evaluation of Postpartum Midwifery Care in Greece Based on Patient-Reported Outcomes Using the MMAYpostpartum Questionnaire: A Cross-Sectional Study

Background The midwife's role throughout pregnancy and delivery management is essential, with multiple healthcare systems even following a midwife-led model of care. Of particular interest is the improvement and optimisation of midwifery postpartum care, which in Greece is empirically known to have decreased in quality, both due to the economic crisis and the recent pandemic. Aims To collect patient-reported outcomes with regard to the quality of midwifery services in Greece, ascertain baseline patient characteristics that may affect quality assessment, identify key areas for improvement, and propose patient subgroups who would most benefit from more specialized care. Setting and design A prospective, cross-sectional, questionnaire-based survey using the Measurement of Midwifery quality postpartum (MMAYpostpartum) questionnaire was conducted in public and private postpartum care centers in Greece. Methods The MMAYpostpartum questionnaire was distributed to 316 eligible women who received postpartum midwifery care in a healthcare center in Greece during the past three years. Multivariate linear regression was performed to examine significant correlations between baseline parameters and questionnaire scores. Results Ultimately, 204 answers were collected and analyzed. The patient's mean age was 35.5 years, and the mean body mass index (BMI) was 23.5. Overall, submitted scores were lower than those observed in the literature. A statistically significant correlation between older age, delivery at a public hospital, a history of hospitalization during pregnancy, and a lower midwifery service score was demonstrated. No other factors had a statistically significant effect on the quality score. Conclusions Delivery at public healthcare centers, older maternal age, and a history of hospitalization during pregnancy are significant predictors of a lower perceived quality of midwifery care. Thus, such patient subgroups may constitute potential targets for more meticulous midwifery care when resource setting prohibits the overall improvement of quality. Further research is required to collect additional data on patient insight and to test the present observations in a clinical setting.

Prevalence of exclusive breastfeeding for the first six months of an infant's life and associated factors in a low-middle income country

BACKGROUND

Although breastfeeding is practiced by 98% of mothers in Vietnam, infant breastfeeding behaviors remain far from World Health Organization recommendations and continues to decline. This study aims to explore the prevalence and factors associated with exclusive breastfeeding in the first six months of an infant's life.

METHODS

A cross-sectional study utilized a self-administered maternal questionnaire to collect data on 1072 Vietnamese mothers who brought infants aged between 6 and 30 months to a community health centre (CHC) for routine vaccination. Data collection was conducted from March to May 2021 in two cities in Central and North Vietnam. In order to measure exclusive breastfeeding, we asked mothers to recall (yes / no), if the child had received breast milk, formula, colostrum milk powder, water, vitamin / medicine, fruit juice / honey, and complementary foods aged under six months.

RESULTS

In the first six months, 14.2% of mothers exclusively breastfed their infants. Multivariable logistic regression analysis demonstrated a significant association between exclusive infant breastfeeding and the highest maternal education level (university or postgraduate) (adjusted odds ratio (aOR) 2.55; 95% confidence interval (CI) 1.10, 5.91); male infants (aOR 1.72; 95% CI 1.11, 2.68); duration of skin-to-skin contact greater than 90 min (aOR 7.69; 95% CI 1.95, 30.38); receiving first breastfeeding during skin-to-skin contact (aOR 2.31; 95% CI 1.30, 4.10); completely feeding infant directly at the breast (aOR 1.65; 95% CI 1.00, 2.71) and exclusive breastfeeding intention during pregnancy (aOR 2.48; 95% CI 1.53, 4.00). When compared with mothers who were prenatally exposed to infant formula advertising classified as "often", the prevalence of exclusive infant breastfeeding was higher in mothers who classified their prenatal exposure to infant formula advertising as "sometimes" (aOR 2.15; 95% CI 1.13, 4.10), and "seldom" (aOR 2.58; 95% CI 1.25, 5.36).

CONCLUSION

The prevalence of mothers who practiced exclusive infant breastfeeding during the first six months in Vietnam was low. Infants should receive early maternal-infant skin-to-skin contact greater than 90 min and complete first breastfeeding during skin-to-skin contact. Further, mothers should be protected against infant formula advertisements to maximise the likelihood of exclusive breastfeeding during the child's infancy.

Nursing model of midwifery and postural and psychological interventions: Impact on maternal and fetal outcomes and negative emotions of primiparas

BACKGROUND

Primiparas are usually at high risk of experiencing perinatal depression, which may cause prolonged labor, increased blood loss, and intensified pain, affecting maternal and fetal outcomes. Therefore, interventions are necessary to improve maternal and fetal outcomes and alleviate primiparas' negative emotions (NEs).

AIM

To discusses the impact of nursing responsibility in midwifery and postural and psychological interventions on maternal and fetal outcomes as well as primiparas' NEs.

METHODS

As participants, 115 primiparas admitted to Quanzhou Maternity and Child Healthcare Hospital between May 2020 and May 2022 were selected. Among them, 56 primiparas (control group, Con) were subjected to conventional midwifery and routine nursing. The remaining 59 (research group, Res) were subjected to the nursing model of midwifery and postural and psychological interventions. Both groups were comparatively analyzed from the perspectives of delivery mode (cesarean, natural, or forceps-assisted), maternal and fetal outcomes (uterine inertia, postpartum hemorrhage, placental abruption, neonatal pulmonary injury, and neonatal asphyxia), NEs (Hamilton Anxiety/Depression-rating Scale, HAMA/HAMD), labor duration, and nursing satisfaction.

RESULTS

The Res exhibited a markedly higher natural delivery rate and nursing satisfaction than the Con. Additionally, the Res indicated a lower incidence of adverse events (e.g., uterine inertia, postpartum hemorrhage, placental abruption, neonatal lung injury, and neonatal asphyxia) and shortened duration of various stages of labor. It also showed statistically lower post-interventional HAMA and HAMD scores than the Con and pre-interventional values.

CONCLUSION

The nursing model of midwifery and postural and psychological interventions increase the natural delivery rate and reduce the duration of each labor stage. These are also conducive to improving maternal and fetal outcomes and mitigating primiparas' NEs and thus deserve popularity in clinical practice.

Current prevalence, changes, and determinants of breastfeeding practice in China: data from cross-sectional national household health services surveys in 2013 and 2018

BACKGROUND

The World Health Organization and the government of China have made many efforts to improve breastfeeding practices. The evidence of breastfeeding practices over the past decade in China is limited. The current study aimed to describe the current prevalence, variation trends, and determinants of breastfeeding practices in China using data from the National Household Health Service Surveys (NHHSS) in 2013 and 2018.

METHODS

Women who had at least one live birth in the five years from the 2013 NHHSS numbered 10,544, and 12,766 women from the 2018 NHHSS were included in the current study. The rates of breastfeeding, early initiation of breastfeeding within the first hour after birth, exclusive breastfeeding for at least six months since birth, and continued breastfeeding accompanied by adequate complementary feeding for over two years were measured. Logistic regressions were performed to study the associations between breastfeeding practices and maternal-based, healthcare-based, and infant-based characteristics.

RESULTS

In the 2018 survey, the rates of practiced any breastfeeding, early initiation of breastfeeding within the first hour after birth, exclusive breastfeeding for at least six months, and continued breastfeeding for over two years were 91.50%, 28.16%, 47.90%, and 4.78%, respectively, showing significant improvements compared to the 2013 survey period. Women who received high education, were from a household with high incomes, had more than one child, and had more antenatal and postnatal visits, were more likely to practice breastfeeding and initiate it within the first hour, but they were less likely to breastfeed the infants for two years. Births by caesarean section and low birthweight were associated with worse breastfeeding practices.

CONCLUSIONS

The rates of practicing breastfeeding and exclusive breastfeeding for six months or more in China improved over the past decades, suggesting improved awareness and knowledge of breastfeeding among women. However, individual and social factors may impact practices of early initiation and continued breastfeeding. Strengthening breastfeeding support from family, community, and health professionals (e.g., family member engagement, friendly work environment, and professional consultation, etc.) during the postpartum and infant period may improve women's confidence in breastfeeding practices.

Association of duration of skin-to-skin contact after cesarean delivery in China: a superiority, multicentric randomized controlled trial

BACKGROUND

In China, the rates of early initiation and exclusive breastfeeding are low. The high cesarean delivery rates further contribute to low breastfeeding outcomes. Skin-to-skin contact, a key component of early essential newborn care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to a randomized control trial.

OBJECTIVE

This study aimed to determine the association of the duration of skin-to-skin contact after cesarean delivery with breastfeeding outcomes and maternal and neonatal health outcomes in China.

STUDY DESIGN

This was a multicentric randomized controlled trial that was conducted at 4 hospitals in China. A total of 720 participants at ≥37 gestational weeks with a singleton pregnancy and who received an elective cesarean delivery with epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at a ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2), and 3 (G3) received 30, 60, and 90 minutes of skin-to-skin contact immediately after the cesarean delivery, respectively.

RESULTS

Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in the control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2, and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71%, and 72%, respectively, compared with 22% in the control group (P<.001). The exclusive breastfeeding rate at discharge was 69%, 62%, and 71%, respectively, compared with 57% in the control group (P=.003). Early essential newborn care practices were associated with a reduction in postpartum blood loss and neonatal intensive care unit or neonatal ward admission (P<.001; P=.022) .

CONCLUSION

Our findings highlight that prolonged skin-to-skin contact after a cesarean delivery was associated with higher initiation and exclusive breastfeeding at discharge rates. It also found associations with reduced postpartum blood loss and neonatal intensive care unit or neonatal ward admission.

The effect of Kinesio Taping on acute pain, breastfeeding behavior and comfort level in women with cesarean section: A randomized controlled trial

Background

Kinesio taping is used to provide rehabilitation after surgical operations.

Aim

The aim of this study is to determine the effect of kinesio taping (KT) on acute pain, breastfeeding behavior, and comfort level in women with cesarean section.

Subjects and Methods

This was a randomized, single-blinded study. Women (n = 48) were randomly assigned to KT (n = 24) and control (n = 24) groups. KT was applied to both breasts and rectus abdominis muscles of those in the intervention group at the 8-hour postpartum. VAS (Visual Analogue Scale), LATCH (Breastfeeding Charting System and Documentation Tool), PBSES (Postpartum Breastfeeding Self-Efficacy Scale), and PCS (Postpartum Comfort Scale) were performed on the women in both the intervention and control groups on the 0th, 1st and 2nd postoperative days. Data were analyzed using descriptive statistics, the independent samples t-test, the Chi-square test, and the Friedman test.

Results

Compared to the control group, the pain level was significantly reduced in the KT group (χ2 = 67,225; P = 0.001), breastfeeding self-efficacy increased (F = 221.940; P = 0.001) and the postpartum comfort level (χ2 = 36.432; P = 0.001) improved.

Conclusion

In the study, it has been shown that KT has important effects on pain management, breastfeeding success, and increasing comfort level in women with cesarean section compared to the control group and the initial period, and can be used safely.

Predictors of Breastfeeding Duration in the New Hampshire Birth Cohort Study

INTRODUCTION

Breastfeeding has significant health benefits for infants and birthing persons, including reduced risk of chronic disease. The American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months and recently extended its recommendation for continuing to breastfeed with supplementation of solid foods from one to two years. Studies consistently identify lower breastfeeding rates among US infants, with regional and demographic variability. We examined breastfeeding in birthing person-infant pairs among healthy, term pregnancies enrolled in the New Hampshire Birth Cohort Study between 2010 and 2017 (n = 1176).

METHODS

Birthing persons 18-45 years old were enrolled during prenatal care visits at ~ 24-28 weeks gestation and have been followed since enrollment. Breastfeeding status was obtained from postpartum questionnaires. Birthing person and infant health and sociodemographic information was abstracted from medical records and prenatal and postpartum questionnaires. We evaluated the effects of birthing person age, education, relationship status, pre-pregnancy body mass index, gestational weight gain (GWG), smoking and parity, and infant sex, ponderal index, gestational age and delivery mode on breastfeeding initiation and duration using modified Poisson and multivariable linear regression.

RESULTS

Among healthy, term pregnancies, 96% of infants were breastfed at least once. Only 29% and 28% were exclusively breastfed at 6-months or received any breastmilk at 12-months, respectively. Higher birthing person age, education, and parity, being married, excessive GWG, and older gestational age at delivery were associated with better breastfeeding outcomes. Smoking, obesity, and cesarean delivery were negatively associated with breastfeeding outcomes.

CONCLUSIONS

Given the public health importance of breastfeeding for infants and birthing persons, interventions are needed to support birthing persons to extend their breastfeeding duration.

Assessing the impact of pregnancy and birth factors on the maternal and infant microbiota

Background: The microbiota acquired at birth is known to play an intimate role in later life health and disease and has been shown to be affected by the mode of birth. There has been recent interest in microbiota correction by maternal vaginal seeding in Cesarean section-born infants; however, the safety of this practice has been debated. The aim of this study was to assess how other factors, such as timing of sampling, maternal obesity, vaginal Group B Streptococcus colonization (GBS), and antibiotic exposure, affect the maternal and infant microbiota. Methods: Maternal vaginal and saliva samples were collected at three time periods: 35-37 weeks gestation (prenatal), within 24-36 hours after birth (birth), and at ~6 weeks postpartum. Infant saliva and stool samples were collected at ~6 weeks postpartum. 16S rRNA amplicon sequencing was utilized to assess the taxonomic and inferred functional compositions of the bacterial communities from both mothers and infants. Results: Samples from 36 mothers and 32 infants were obtained. Gestational age, breastfeeding, mode of birth, and gravidity were associated with taxonomic alterations in the infant samples, while obesity, antibiotic use, and GBS status were not. Maternal samples were predominantly affected by time, whereby significant alterations including increased microbial diversity were seen at birth and persisted to 6 weeks postpartum. Conclusion: This study provides information on the relationship between health and delivery factors and changes in vaginal and infant microbiota. These results may better direct clinicians and mothers in optimizing the infant microbiota towards health during infancy and later life.

Predictors and trends of Caesarean section and breastfeeding in the Eastern Mediterranean region: Data from the cross-sectional Cyprus Women's Health Research (COHERE) Initiative

INTRODUCTION

Caesarean section (C-section) is a life-saving procedure when medically indicated but unmet need and overuse can add to avoidable morbidity and mortality. It is not clear whether C-section has a negative impact on breastfeeding and there is limited data available on rates of C-section or breastfeeding from Northern Cyprus, an emerging region in Europe. This study aimed to investigate prevalence, trends and associations of C-section and breastfeeding in this population.

METHODS

Using self-reported data from the representative Cyprus Women's Health Research (COHERE) Initiative, we used 2,836 first pregnancies to describe trends in C-section and breastfeeding between 1981 and 2017. Using modified Poisson regression, we examined the relationship between year of pregnancy and C-section and breastfeeding, as well as the association between C-section and breastfeeding prevalence and duration.

RESULTS

C-section prevalence in first pregnancies increased from 11.1% in 1981 to 72.5% in 2017 with a relative risk of 2.60 (95%CI; 2.14-2.15) of babies being delivered by C-section after 2005 compared to before 1995, after full adjustment for demographic and maternal medical and pregnancy related factors. Prevalence of ever breastfeeding remained steady throughout the years at 88.7% and there was no significant association between breastfeeding initiation and the year of pregnancy, or demographic and maternal medical and pregnancy related variables. After full adjustment, women who gave birth after 2005 were 1.24 (95%CI; 1.06-1.45) times more likely to breastfeed for >12 weeks compared to women who gave birth before 1995. There was no association between C-section and breastfeeding prevalence or length.

CONCLUSION

Prevalence of C-section in this population is much higher than WHO recommendations. Public awareness campaigns surrounding choice during pregnancy and change in legal framework to allow for midwife-led continuity models of birthing care should be implemented. Further research is required to understand the reasons and drivers behind this high rate.

Effect of Foot Reflexology and Benson Relaxation on Pain, Breastfeeding and Weight of Neonates of Women Undergoing a Cesarean Section

BACKGROUND

Given the negative effect of postoperative pharmacological pain control on breastfeeding, the present study aimed to compare the effects of reflexology and Benson relaxation methods on pain, breastfeeding, and infant weight gain in women undergoing a cesarean section (C/S).

METHODS

This randomized clinical trial was conducted on 135 women undergoing a C/S in the Gynecology Ward of Bushehr Persian Gulf Martyrs Hospital in Bushehr, Iran, in 2020. The participants were selected using convenience sampling, and randomly divided into three groups of foot reflexology, Benson relaxation, and control. The interventions were performed two hours post-operation and six hours after the first intervention. The pain score was measured and recorded immediately, and 30 and 60 minutes after each intervention. Breastfeeding frequency and duration were also assessed in the first 18 hours of birth. The infants' weight was assessed at birth and 10 days later. Data analysis was performed using inferential statistics, chi-square or Fisher's exact test, Kruskal-Wallis test, Mann-Whitney U or one-way ANOVA, Wilcoxon test and logistic regression analysis.

RESULTS

There was a larger decrease in the pain score of the reflexology and Benson relaxation (P<0.01) groups after the first and second interventions, compared to the control group. The breastfeeding frequency was higher in the two intervention groups, compared to the control group (P<0.001). Furthermore, the rate of return to the birth weight in ten days of birth was higher in the reflexology (P<0.01) and Benson groups (P<0.05) than the control group.

CONCLUSION

Both the reflexology and the Benson relaxation methods effectively decreased pain and increased breastfeeding frequency and the infant's weight gain.

Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts

BACKGROUND

Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned.

OBJECTIVES

We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts.

METHODS

We analyzed 5120 singleton pregnancies from mother-child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator.

RESULTS

Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = -0.79 mo, 95% CI: -1.17, -0.40; obese β = -1.75 mo 95% CI: -2.25, -1.25; exclusive: overweight β = -0.30 mo, 95% CI: -0.42, -0.16; obese β = -0.73 mo, 95% CI: -0.90, -0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding.

CONCLUSIONS

Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.

Handedness and 23 Early Life Characteristics in 37,495 Dutch Twins

In studies of singletons, a range of early-life characteristics have been reported to be associated with handedness, but some of these associations have failed to replicate. We examined associations between 23 early life characteristics with handedness in a large sample of 37,495 5-year-old twins. We considered three definitions of handedness: left-handedness (LH), mixed-handedness (MH), and non-right-handedness (NRH). Our main aim was to test whether the associations with sex, birth weight, gestational age, and season of birth - as reported in singletons - replicate in twins, and to examine twin-specific variables, including zygosity, chorionicity, birth order, and intertwin delivery time. Compared to previously published data from adults born as singletons (7.23%), the prevalence of NRH was higher in both twins (16.19%) and their parents (15.09%). In the twins, LH and NRH were associated with parents' LH. Male sex and lower gestational age were associated with NRH, and LH was associated with not being breastfed. MH was related to neurodevelopmental delays and higher externalizing problems later in childhood. Other previously reported associations were not replicated, and no twin-specific characteristics were related to handedness. These results emphasize the importance of considering multiple definitions of handedness and indicate a small number of replicated associations across studies.

Early initiation of breastfeeding up to six months among mothers after cesarean section or vaginal birth: A scoping review

Background

Early initiation of breastfeeding is important for establishing continued breastfeeding. However, previous research report that cesarean section (C-section) may hinder early initiation of breastfeeding. Despite this, there is currently a lack of literature that examines the rates of breastfeeding after both cesarean section and vaginal birth globally.

Research aims

The objective of this scoping review was to systematically assess the available literature on the rate of early initiation of breastfeeding within the first hour and exclusive breastfeeding up to 6 months after C-section and vaginal birth, as well as any other factors associated with initiation and exclusive breastfeeding.

Methods

We adhered to the PRISMA extension guidelines for scoping reviews in conducting our review. In August 2022, we carried out an electronic database search on CINALH, PubMed, EMBASE, and Cochrane Library, and also manually searched the reference list.

Results

A total of 55 articles were included in the scoping review. The majority of these studies found that mothers who delivered vaginally had higher rates of breastfeeding compared to those who underwent a C-section, at various time points such as breastfeeding initiation, hospital discharge, one month, three months, and six months postpartum. Notably, there was a significant difference in the rate of early initiation of breastfeeding between the two groups. However, at 3 and 6 months after delivery the gap of exclusive breastfeeding rate between C-section and vaginal delivery is narrow. Breastfeeding education, health care providers support, and mother and baby bonding are other factors associate with initiation and exclusive breastfeeding.

Conclusions

The rate of breastfeeding initiation after C-section has remained low to date. This is due in part to insufficient knowledge about and support for breastfeeding from healthcare providers.

Effectiveness of an Early Skin-to-Skin Contact Program for Pregnant Women with Cesarean Section: A Quasi-Experimental Trial

OBJECTIVE

This study aimed to clarify the effectiveness of early skin-to-skin contact (SSC) after a cesarean section (CS) program.

METHODS

An "early SSC after CS" program was implemented at a tertiary care hospital in Tanzania. A non-equivalent group design was used. A questionnaire was used to collect data on exclusive breastfeeding, breastfeeding intention, Birth Satisfaction Scale-Revised Indicator (BSS-RI) score, perioperative pain with a visual analogue scale, and infant hospitalization for infectious diseases and diarrhea at 2-3 days postpartum. Follow-up surveys were conducted until 4 months postpartum regarding exclusive breastfeeding, breastfeeding intention, and hospitalization of the infants.

RESULTS

This study involved 172 parturient women who underwent CS, with 86 in the intervention group and 86 in the control group. The exclusive breastfeeding rates at 4 months postpartum were 57 (76.0%) in the intervention group and 58 (76.3%) in the control group, with no significant difference. The BSS-RI score was higher in the intervention group (7.91, range 4-12, SD 2.42) than in the control group (7.18, range 3-12, SD 2.02) (p = 0.007) for women who underwent emergency CS. The survival probability for infants hospitalized owing to infectious diseases, and diarrhea was significantly higher in the intervention group (98.5%) than in the control group (88.3%) (χ² = 5.231, p = 0.022) for multiparas.

CONCLUSION

The early SSC after CS program showed a positive effect on the birth satisfaction of women undergoing emergency CS. It also reduced the incidence of infants hospitalized owing to infectious diseases and diarrhea for multiparas.

Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring's tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04-1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.

Impact of a quality improvement program: Early initiation of breastfeeding after cesarean section in a tertiary care hospital, in Eastern India

Background

Early initiation of breastfeeding (EIBF) within 1 h of birth is crucial in preventing newborn deaths and plays a vital role in early infant nutrition. Promoting and supporting breastfeeding is an integral part of midwifery. The objective of the study was to improve the EIBF rate in neonates born through a Cesarean Section (CS) from 0% to 50% within six months through a quality improvement (QI) process and to assess the maternal experience of EIBF in operation theatre (OT).

Methods

Six Plan-Do-Study-Act (PDSA) cycles were conducted to test the change ideas proposed by the team members for a month to improve EIBF. Participants of the study were the stable term newborns delivered by CS under spinal anesthesia.

Results

The EIBF rate improved from 0% to 88% after the sixth PDSA cycle. The effect was sustained for six months. Mothers of 51 neonates (98%) who received EIBF reported that their newborns were breastfed successfully, and it was not physically tiring to feed immediately in the OT.

Conclusions

A quality improvement (QI) initiative was able to improve and sustain the improved EIBF rate after CS. Early skin-to-skin contact to be initiated with EIBF for better neonatal outcomes.

Global increased cesarean section rates and public health implications: A call to action

Over the years; global caesarian section (CS) rates have significantly increased from around 7% in 1990 to 21% today surpassing the ideal acceptable CS rate which is around 10%-15% according to the WHO. However, currently, not all CS are done for medical reasons with rapidly increasing rate of nonmedically indicated CS and the so-called "caesarian on maternal request." These trends are projected to continue increasing over this current decade where both unmet needs and overuse are expected to coexist with the projected global rate of 29% by 2030. CS reduces both maternal and neonatal morbidity and mortality significantly when it is done under proper indications while at the same time, it can be of harm to the mother and the child when performed contrary. The later exposes both the mother and the baby to a number of unnecessary short and long-term complications and increase the chances of developing different noncommunicable diseases and immune-related conditions among babies later in life. The implications of lowering SC rate will ultimately lower healthcare expenditures. This challenge can be addressed by several ways including provision of intensive public health education regarding public health implications of increased CS rate. Assisted vaginal delivery approaches like the use of vacuum and forceps and other methods should be considered and encouraged during delivery as long as their indications for implementation are met. Conducting frequent external review and audits to the health facilities and providing feedback regarding the rates of CS deliveries can help to keep in check the rising CS trends as well as identifying the settings with unmet surgical needs. Moreover, the public especially expectant mothers during clinic visits and clinicians should be educated and be informed on the WHO recommendations on nonclinical interventions towards reduction of unnecessary CS procedures.

Effects on neonatal immunoglobulin concentrations by infant mode of delivery in the upstate KIDS study (2008-2010)

PROBLEM

Previous studies document an association between mode of delivery (MOD) and allergic conditions in children. Immunoglobulin (Ig) concentrations at birth may play a role. The goal of this study is to assess the impact of MOD on Ig concentrations at delivery from newborn dried blood spots (DBS).

METHOD OF STUDY

The Upstate KIDS Study (2008-2010) is a prospective cohort of mother-child pairs recruited from New York State, excluding New York City. Ig subtypes IgA, IgE, IgG1 , IgG2 , IgG3 , IgG4 , and IgM were measured in residual NDBS from the Newborn Screening Program (N = 3274 infants). MOD was categorized as vaginal delivery (VD), emergency cesarean delivery (ECD) or planned cesarean delivery (PCD). Associations between MOD and Ig levels were assessed using ANOVA and multiple regression, with models adjusted for gestational age, birth weight, maternal race, plurality, and smoking status.

RESULTS

IgA, and the IgG subtypes IgG3 and IgG4 were found to be significantly lower in PCD neonates relative to VD neonates in adjusted regression models: 3.57 mg/ml, (95% CI: 3.51, 3.63) compared to 3.64 mg/ml (95% CI: 3.59, 3.69); 8.95 ng/ml (95% CI: 8.88,9.03) compared to 9.03 ng/ml (95% CI: 8.98, 9.08) and 8.05 ng/ml (95% CI: 7.91, 8.20) compared to 8.22 ng/ml (95% CI: 7.91,8.20), respectively.

CONCLUSIONS

MOD may thus be related to neonatal immune profile. Results were found to be robust to sensitivity testing based on maternal complications and indication for CD. Clinical implications are unclear given the small levels of association found in newborns, but the result suggests greater susceptibility to infection, and further study is warranted.

Comparative Study of Breastfeeding in Caesarean Delivery and Vaginal Delivery Using LATCH Score and Maternal Serum Prolactin Level in Early Postpartum Period

Introduction

Practice of starting and sustaining breastfeeding is affected by many conditions, mode of delivery is one of the major factor influencing it. Purpose of the study was to see if the mode of delivery affects the subsequent lactation in early postpartum period and to raise awareness among the community about the importance of mode of delivery in early initiation of breast feeding.

Materials and Methods

Present study was a hospital based observational, comparative prospective study. A sample size of 120 subjects in each group (caesarean delivery CD Group and vaginal delivery VD group) was required. Serum prolactin and LATCH score both at 1st hour and 24th hour were compared in both groups.

Results

Mean LATCH score at 1st hour and 24th hour of CD Group was 5.44 ± 0.68 and 7.12 ± 0.95, respectively. The mean LATCH score at 1st hour and 24th hour of VD Group was 7.12 ± 0.94 and 8.1 ± 1, respectively. Mean serum prolactin level at 1st hour and 24th hour of CD Group was 259.68 ± 33.99 and 309.99 ± 42.27, respectively. Mean serum prolactin level at 1st hour and 24th hour of VD Group was 304.91 ± 42.07 and 333.34 ± 42.65, respectively. The mothers delivered by caesarean had main problem with latch (L) and hold (H) of the baby as compared to mothers delivered vaginally.

Conclusion

Mode of delivery has a direct impact on early initiation of breast feeding. Caesarean delivery is a cause for delay in initiation of breastfeeding.

Oxytocin changes in women with emergency cesarean section: Association with maternal blues by delivery mode

Introduction

Women with emergency cesarean section (CS) have presumed effects of an unscheduled surgery on their salivary oxytocin (OXT) level and psychological state. This study aimed to measure changes in the salivary OXT levels of women with emergency CS and change in the OXT levels by delivery mode, and to investigate the association between changes in OXT levels and maternity blues.

Methods

We used a longitudinal observational study. The eligibility criteria were primipara pregnant women who were planning to have vaginal delivery. The salivary OXT levels of women were measured at 36 weeks gestation, 38 weeks gestation, 1 day postpartum, and 5 days after childbirth. Maternity blues was diagnosed using the Maternity Blues Scale (13 items), 'Fatigue after Childbirth' was diagnosed using the Visual Analogue Scale (0-100), and the subjective symptoms of fatigue was diagnosed using the Jikaku-sho shirabe. The three groups ("Without EA", "With EA", and "Emergency CS") were analyzed separately. The changes in the oxytocin levels of women with emergency CS at four time points were analyzed by using a repeated measure analysis of variance.

Results

The mean OXT levels of women with emergency CS (n = 6) were significantly lower at 5 days after childbirth than at 36 weeks gestation, 38 weeks gestation, and 1 day postpartum. There was a significant middle correlation between changes in the mean maternity blues scores between 1 day and 5 days, and the mean changes in OXT levels from 38 weeks gestation to 5 days after childbirth.

Conclusion

It could be assumed that women with emergency cesarean section may be affected psychologically by the unplanned method of delivery. In the present study, it was not possible to analyze this association because of the small sample size; however, it is possible to clarify predictors as the sample size accumulates in the future.

Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study

INTRODUCTION

Use of medications is a common concern for breastfeeding women, particularly when they are strongly needed or unavoidable to manage maternal chronic conditions. Yet the influence of medication usage patterns on breastfeeding duration in mothers with chronic conditions is unclear. The objective of this study was to examine whether postpartum medication practices were associated with shorter breastfeeding duration or earlier than planned breastfeeding cessation among mothers with chronic conditions.

MATERIAL AND METHODS

We analyzed 346 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study (Alberta, Canada) who initiated breastfeeding after birth. Data were collected through self-report questionnaires spanning late pregnancy to 6 months postpartum. Based on reported use of preexisting medications while breastfeeding, women were classified as continuing medications (reference group), discontinuing one or more medications, or those who did not use preexisting medications. Cox proportional hazards regression was used to analyze the association of medication practices and overall breastfeeding duration in weeks. Logistic regression was used to analyze the association of medication practices and earlier than planned breastfeeding cessation. Multivariable models adjusted for demographic and health-related factors.

RESULTS

Overall, 30.6% of women with chronic conditions stopped breastfeeding in the first 6 months, almost all of whom did so earlier than planned. In multivariable models, medication discontinuation was significantly associated with shorter breastfeeding duration (adjusted hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03-2.70) and earlier than planned breastfeeding cessation (adjusted odds ratio [OR] 1.85, 95% CI 1.01-3.42), whereas medication non-use was not associated with differences in breastfeeding outcomes.

CONCLUSIONS

Women with chronic conditions who discontinued preexisting medications while breastfeeding had significantly shorter breastfeeding duration and were less likely to meet their breastfeeding goals in the first 6 months postpartum compared to women who continued preexisting medications.

The multiple factors of suboptimal early feeding practices among infants aged 0–5 months in Indonesia

Background

Optimal early infant feeding practices are critical to ensure adequate nutrition for infants’ growth and development. This study aimed to examine the determinants of suboptimal early feeding practices (i.e., delayed initiation of breastfeeding, prelacteal feeding, and non-exclusive breastfeeding) among infants aged 0–5 months in Indonesia.

Methods

We used data collected in the 2012 and 2017 Indonesia Demographic and Health Surveys. Analyses were conducted using information from 3,198 live-born singleton infants aged 0–5 months. The primary outcomes used were: (1) delayed initiation of breastfeeding in the first hour after birth, (2) prelacteal feeding in the first 3 days, and (3) non-exclusive breastfeeding in the last 24 h preceding the survey. Potential predictors analyzed were categorized into the environmental, household, maternal, pregnancy, delivery, and child characteristics. Logistic regression analyses were performed to identify factors significantly associated with each outcome.

Results

Approximately 78,6% of infants aged 0–5 months in Indonesia had at least one of the three suboptimal early infant feeding practices. We found a strong association between the three outcome indicators analyzed. The determinants of delayed initiation of breastfeeding included infants from Sumatera region (adjusted odds ratios (aOR) = 2.02, p &lt; 0.001), infants delivered by Cesarean section (aOR = 2.78, p &lt; 0.001), and in non-health facilities (aOR = 1.53, p = 0.003). The determinants of prelacteal feeding in the first 3 days included infants living in urban areas (aOR = 1.32, p = 0.035), the first birth-ranked infants (aOR = 1.32, p = 0.019), and infants who had delayed initiation of breastfeeding in the first hour of life (aOR = 3.90, p &lt; 0.001). The determinants of non-exclusive breastfeeding in the last 24 h included infants whose mothers worked in non-agricultural fields (aOR = 1.52, p &lt; 0.001), infants delivered by Cesarean section (aOR = 1.33, p = 0.044), and the first birth-ranked infants (aOR = 1.28, p = 0.039).

Conclusion

There was a high percentage of infants aged 0–5 months who had suboptimal feeding practices in Indonesia. As we found multiple factors associated with suboptimal early feeding practices among infants, integrated approaches, including health promotion and supportive public policy, are required to ensure infants receive adequate nutrition in the early stages of life.

How is parental education associated with infant and young child feeding in Bangladesh? a systematic literature review

BACKGROUND

Education is expected to bring about positive behavioral changes which could lead to improved health behaviors. Parental education is a primary determinant of child health and development. However, some evidence showed inverse associations between high parental education and recommended infant and young child feeding (IYCF) in Bangladesh. How the association of parental education differs with specific IYCF components has not been reviewed. Therefore, the role of parental education on optimal IYCF practices in Bangladesh appears to be inconclusive. The objective of this review is to summarize how parental education is associated with IYCF practices in Bangladesh.

METHOD

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Google Scholar. Record searching, study selection, and data extraction was performed using Endnote online and Covidence tool, respectively. The Newcastle-Ottawa scale was used for quality assessment of the included studies.

RESULTS

Out of 414 initial hits, 34 studies were included for this review. Of the included studies, 32 were cross-sectional, one was a randomized controlled trial, and one was a retrospective cohort. Most of the studies (n = 24) were nationally representative whereas 10 studies had populations from district and sub-district level. Included studies considered different IYCF-related indicators, including breastfeeding (n = 22), complementary feeding (n = 8), both breastfeeding and complementary feeding (n = 2), both breastfeeding and bottle feeding (n = 1), and pre-lacteal feeding (n = 1). Parental education was found to be positively associated with complementary feeding practices. However, the role of parental education on breastfeeding, in general, was ambiguous. High parental education was associated with bottle-feeding practices and no initiation of colostrum.

CONCLUSION

Public health interventions need to focus not only on non- and/or low-educated parents regarding complementary feeding but also on educated mothers for initiation of colostrum and proper breastfeeding practices.

TRIAL REGISTRATION

This systematic review is registered to PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) with registration ID: CRD42022355465.

Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis

BACKGROUND

Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) women breastfeed at lower rates than non-Aboriginal women. Little is known about factors associated with breastfeeding specific to Aboriginal women and infants.

AIM

Determine the protective and risk factors associated with breastfeeding for Aboriginal women in Australia.

METHODS

CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English reporting protective and risk factors associated with breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Ten percent of papers were co-screened, and two reviewers completed data extraction. Narrative data synthesis was used.

FINDINGS

The initial search identified 12,091 records, with 31 full text studies retrieved, and 17 reports from 14 studies met inclusion criteria. Protective factors included living in a remote area, attending an Aboriginal-specific service, attending a regional service, higher levels of education attainment, increased maternal age, living in larger households, being partnered, and having a higher reported number of stressful events and social health issues. The identified risk factors were smoking in pregnancy, admission to SCN or NICU, and being multiparous.

CONCLUSION

This review identified factors associated with breastfeeding for Aboriginal women. Government focus, support, and consistent funding are required to plan and implement evidence-based interventions and services for Aboriginal women and infants in urban, rural, remote, and very remote locations. Rigorous research is required to understand the Aboriginal-specific factors associated with breastfeeding to improve rates and health outcomes for Aboriginal women and infants.

Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017-2018 Canadian Community Health Survey

Human milk is the ideal source of nutrition for infants; however, adherence to breastfeeding recommendations is suboptimal and availability of Canadian breastfeeding data are limited. Using the 2017-2018 Canadian Community Health Survey Public Use Microdata File (Maternal Experiences Module, n = 5558, weighted n = 1 669 462) we computed breastfeeding indicators and explored sociodemographic, health, and geographical predictors of breastfeeding with univariate logistic regression models. Nationally, of all participants who gave birth in the preceding 5 years, 91% initiated breastfeeding, 43% exclusively breastfed to ≥5 months and 35% to ≥6 months, 56% reported any breastfeeding at ≥6 months, and 31% reported breastfeeding at ≥12 months. Breastfeeding cessation was most commonly attributed to insufficient milk supply (25%), but reasons differed significantly by breastfeeding duration. Breastfeeding initiation, exclusivity for ≥5 months, and extended breastfeeding ≥12 months all differed by geographic region, and by most sociodemographic and health characteristics. Positive breastfeeding outcomes were highest in British Columbia, and lowest in Quebec and the Atlantic region, and generally higher if caregivers had recently immigrated to Canada, were married, were >30 years of age, were not White, were nonsmoking, had completed postsecondary education, and had an annual household income >$40 000. These disparities indicate the need for tailored, equitable approaches to breastfeeding support, and continued regional monitoring of breastfeeding outcomes.