Knowledge of healthcare providers regarding breastfeeding preterm infants in mainland China

Breastfeeding experience of postnatal mothers separated from preterm infants after discharge: a phenomenology qualitative approach

BACKGROUND

Breastfeeding practices are influenced by the maternal-infant bond relationship. Mothers of preterm infants in the puerperium face many challenges and support is needed to maintain breastfeeding after hospital discharge. This study explored the breastfeeding experiences among mothers of preterm infants and challenges that influenced their breastfeeding practices.

METHODS

A qualitative phenomenological approach was used involving the mothers of preterm infants during the puerperium in Shanghai who fulfilled the inclusion criteria and consented to participate in the study. The mothers were recruited using purposive sampling. Eighteen participants were interviewed using semi-structured in-depth interviews. All interviews were recorded in digital audio, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

The breastfeeding experience among mothers of preterm infants included four themes: breastfeeding motivation, breastfeeding challenges, breastfeeding support and education, and response to parental stress. Breastfeeding challenges included perceived insufficient milk, bottle preference, and maternal-infant separation. Two sub-themes of breastfeeding support included breastfeeding knowledge and approach.

CONCLUSION

To overcome breastfeeding challenges and improve the breastfeeding rate of preterm infants after discharge, medical professionals must develop individualized breastfeeding plans based on a comprehensive assessment of the needs of mothers who delivered a preterm infant.

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.

The Current Status of Breastfeeding Knowledge and Its Influencing Factors in Nursing Undergraduates: A Cross-Sectional Study in China

The aim of this study was to explore the breastfeeding knowledge of nursing undergraduates and the influencing factors. Human milk (HM) is one of the most effective nutritional supplies to improve early development and physical health, but the current status of breastfeeding in China is still not optimal. The breastfeeding knowledge of perinatal women influences their feeding beliefs and behavior. Nursing undergraduates, as core professionals who will care for perinatal women and provide feeding guidance in the future, can significantly affect feeding behavior of mothers and their babies, so their knowledge of breastfeeding may have a potential impact on breastfeeding in China. However, studies on breastfeeding knowledge among nursing undergraduates in China are limited. A convenience sampling method was conducted in four medical universities in China, and eligible nursing undergraduates were selected. An online survey was collected from 5 July 2022 to 5 August 2022. Categorical data were reported as number and percentage, while continuous data were reported as mean ± SD. Multivariate linear regression was used to evaluate the association between influencing factors and breastfeeding knowledge. The overall mean score of the 460 returned questionnaires was 43.991 out of 100. The pass rate of the questionnaire was only 23.04%. Nursing undergraduates had a relatively better grasp of the benefits of breastfeeding and related advice (correct rates: 67.83%). Birthplace, only child or not, the course in obstetrics and gynecological nursing, the course in pediatrics nursing, and placements in maternity or neonatology units were relevant factors for breastfeeding knowledge (p < 0.05). Nursing undergraduates showed unsatisfactory breastfeeding knowledge. It is urgent to raise the knowledge level of breastfeeding among nursing undergraduates. Medical colleges should optimally structure a curriculum of breastfeeding knowledge. Furthermore, it is also necessary to improve the public’s understanding of breastfeeding and the whole society’s attention to breastfeeding in China.

Stepwise Interactive Situated Training Program for Young Nurses’ Safety Behavior and Interrupted Coping Behavior

Young nurses’ safety behavior and interrupted coping behavior affect patient safety. A stepped, interactive and situated training program should be evaluated to assist young nurses in improving themselves. This study aimed to evaluate the effect of the stepwise interactive situated training program on safety behavior and practice ability with respect to nursing interruptions for young nurses and its influencing factors. This was a quasi-experimental, one-group, self-control and pretest–post-test design study. Six hundred young nurses in two provinces were included. The participants underwent a stepwise interactive situated training program from March to August 2019. The program was delivered by designated head nurses and consisted of five themes: mobilization, theoretical training, operational training, specialized training and self-improvement. Five hundred and sixty-two young nurses completed this study. The safety behavior and the practice of nursing interruption were significantly higher after intervention than before. Professional titles, age and occupational time were the influence factors. The stepwise interactive situated training program was effective at improving young nurses’ safety behavior and interrupted coping behavior. Nurses with higher professional titles performed better with regard to the safety behavior and the practice of nursing interruption.

Factors associated with exclusive breastfeeding practice among mothers in nine community health centres in Nanning city, China: a cross-sectional study

BACKGROUND

The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China.

METHODS

The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0-5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices.

RESULTS

In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice.

CONCLUSIONS

Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.

Breastfeeding in hospitalised preterm infants: A survey from 18 tertiary neonatal intensive care units across mainland China

AIM

To understand the use of breast milk and breastfeeding in preterm infants in neonatal intensive care units (NICUs) in mainland China.

METHODS

An online questionnaire survey of reported practices was conducted among 18 tertiary NICUs distributed across all seven districts in mainland China. The items of the questionnaire consisted of the following areas: breastfeeding rate of preterm infants (<37 weeks' gestation) at discharge, the standards used for guiding the clinical practice and the use of breast milk and breastfeeding.

RESULTS

On average, across all hospitals, breastfeeding rate for preterm infants at discharge was 65%, with 41% preterm infants being exclusively breastfed during the hospitalisation prior to discharge. Sixteen (89%) NICUs had policies designating breast milk as the preferred first feed for preterm infants. Donor milk was available in 3 of 18 (17%) NICUs. Kangaroo care was provided in 11 of 18 (61%) NICUs, and 14 of 18 (78%) allowed parental access to the hospitalised preterm infants. A large variation was found in clinical practices around the breast milk testing, breast milk storage and transportation and breast milk fortification methods among different NICUs.

CONCLUSIONS

The use of breast milk in hospitalised preterm infants has increased greatly but still needs to be further improved. A recommendation is made to conduct high-quality original trials to find evidence of the controversial problems, develop evidence-based guidelines, promote the best implementation of the guidelines and provide updated breastfeeding education to health-care providers in order to standardise the use of breast milk and breastfeeding in hospitalised preterm infants.

Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China

BACKGROUND

China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China.

METHODS

Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates.

RESULTS

Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)).

CONCLUSIONS

Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Breastfeeding experiences and perspectives on support among Chinese mothers separated from their hospitalized preterm infants: a qualitative study

Background

Chinese mothers of preterm infants often face obstacles to breastfeeding and commonly experience prolonged maternal-infant separation when their high-risk infants are hospitalized in a Neonatal Intensive Care Unit (NICU). This separation hinders mother-infant attachment and the establishment of breastfeeding. Currently, little is known about Chinese mothers’ experiences breastfeeding their preterm infants, or their support needs. The aim of this study was to develop an understanding of mothers’ experiences breastfeeding a hospitalized preterm infant and the support needed to establish a milk supply during the period separation from their infants.

Methods

A qualitative descriptive study was conducted in Beijing in 2017. A total of 11 Chinese mothers were individually interviewed while separated from their infants. The interviews were audio-recorded and transcribed verbatim. A thematic analysis involving a seven-step protocol identified key themes.

Results

Mothers of preterm infants reported physically and mentally challenging breastfeeding experiences during the period they were separated from their babies. They viewed expressing breast milk as integral to their maternal role, even though some found expressing breastmilk exhausting. With little professional support available, the mothers depended upon nonprofessionals to establish breastfeeding.

Conclusions

The study identified the difficulties mothers experienced establishing a milk supply while separated from their preterm infants, and the importance of access to health professional support.